Patient confidentiality is one of the pillars of modern medical profession. It implies that the medical practitioner is under the obligation to keep his patient’s medical profile confidential. The main reason is to help the patient maintain his privacy. However, there have been numerous cases of breach of such confidentiality, which has raised varying ethical implications. Further, there have been instances where the medical practitioner has felt that he needs to divulge such private information to a 3rd party.
Often, this results in a dilemma, and the medical professional has to balance between maintaining the patient’s confidentiality and promoting the public good (McHale, 1993). Further, governments worldwide have passed laws that have enhanced the protection of a patient’s confidentiality. All these issues have complicated the understanding of patient morality and the morality behind it. Indeed, various stakeholders have questioned the need for such confidentiality and whether there are instances where it can be denied.
However, understanding patient confidentiality requires scrutiny of a society’s moral considerations. This is because such confidentiality is more a moral issue than a professional one. Indeed, the degree to which patient confidentiality is guaranteed depends on a society’s moral code. Therefore, it is imperative that patient confidentiality reflect the moral code of the society. Values behind Patient Confidentiality Patient confidentiality is reflective of four main values that the society holds dear (Banatar, 2003). The first of these values is with regard to the autonomy of a person.
Society agrees that adult persons are autonomous. This means that they have the capacity to determine their destiny. As a result, they need to reserves the right to make decisions with regard to their lives independently. This is because they have the power to control their lives. Confidentiality, therefore, only acts to further this autonomy in the sense that it is only the adult patient who can determine how to use any medical information about himself. Often, this is in appreciation of the sensitive nature of most medical information and the damaging effect it could have on a person.
Another value pertinent to the issue of patient morality is privacy. Most people prefer to keep sensitive information about themselves private. This is because of shame or vulnerability that could arise out of the transfer of such information to the public. As a result, they consider medical information private and privileged. Promise-keeping is another value at the core of patient confidentiality. In this regard, patients presume that doctors have the obligation to keep their oath concerning patient confidentiality (Banatar, 2003).
As a result, most patients often assume this confidentiality implicitly with only a few seeking explicit confirmations of the same. Lastly, utility is another value that guides the principle of patient confidentiality. This value implies that medical attention is beneficial and desirable in society. Therefore, there is a need to enhance its accessibility and value in society. In this regard, upholding patient confidentiality promotes the use of medical care among individuals. This is because people prefer keeping their medical profile secret and patient confidentiality offers them such a chance.
Patient confidentiality, therefore, motivates patients to undergo rigorous diagnosis since they believe that information regarding such diagnosis remains private. Patient Confidentiality and the Law Besides the above underlying values, there has been a need for legislation to enhance the observance of patient confidentiality by medical professionals. However, laws regarding patient confidentiality have their basis in ethics rather than law (Krauss, 1996). Indeed, they borrow from the ancient Hippocratic Oaths of the Romans that all physicians had to take.
The law also defines the conditions under which such confidentiality applies. Firstly, for Hippocratic laws to take place, there has to be an established doctor-patient relationship. This implies that the patient must have at one point sought professional help from the doctor. Indeed, the doctor can always invoke the doctor-patient privilege where any agency asks him to divulge information concerning his patient. Secondly, the confidential information only applies to the information the doctor gained by virtue of his examination of or communication with the patient (Bourke & Wessely, 1996).
According to the law, such confidentiality remains even after the termination of the doctor-patient relationship. However, the patient retains the power to waive such a privilege when and if he wants. This is possible by writing consent to the concerned doctor. Additionally, in cases where the patient files for medical injury, he waives the doctor-patient privilege allowing the doctor to divulge the information necessary to determine the case. There are other implicit ways in which the patient can waive such privilege. For instance, a patient who takes another person in his consultation with a doctor is deemed to have waived his privilege.
In the US, these laws lack harmonization and vary across the various states. In such cases, divulging the patient’s information does not lead to breach of such confidentiality. Limits to Patient Confidentiality While the law safeguards patient confidentiality, it also recognizes moral limits under which such confidentiality can be forfeited. Often, these are circumstances that perpetuate the public good. This puts the medical practitioner in a dilemma as he has to evaluate the circumstance to determine whether it warrants the breach of patient confidentiality.
Indeed, such a breach involves the evaluation of the moral obligations the doctor has both towards his patient and society. Where the latter carries more weight than the former, the medical professional may breach the patient confidentiality. One instance where such breach is allowable is where the maintaining patient confidentiality can harm others (Banatar, 2003). The In this regard, the values defining patient confidentiality lose weight and their relevance diminishes. This is because of the principle that the enjoyment of privileges by one person must not curtail the enjoyment of the privileges by another.
An excellent example is where a husband is suffering from HIV/AIDs and is keeping his status from his wife. This puts his wife at risk of contracting the ailment unless the doctor informs her so that she can protect herself. In such a scenario, the patient loses his privileges while those of the wife are upheld. However, this is not always straightforward, and medical practitioners may find themselves in complex moral dilemmas pitting the public good against individual privileges. Another instance that may call for breach of patient confidentiality is where the patient is at harm (Banatar, 2003).
The There are instances where the patient whom the confidentiality principle protects is at danger if that confidentiality is not breached. There are several instances this can happen. For instance, a patient may prevent the doctor from divulging information regarding his diagnosis. However, that information could be helpful to the patient if his parents or spouse becomes aware of it. In this regard, the doctor may feel the obligation to divulge the patient’s medical information. However, the patient’s right to autonomy still remains.
This means that the doctor cannot breach the patient’s confidentiality; he can only persuade the customer to forgo his privileges. However, the privilege of the patient disappears where he is not capable to make a credible decision. In such a scenario, the guardian, next of kin or even a proxy may decide on the patient’s privileges. When breaching confidentiality, there is a need for care to cause the patient the minimum possible damage (Banatar, 2003). The Firstly, the medical professional should attempt to convince the patient or his guardian of the moral value of making the disclosure.
Often, this is enough to persuade them that the breach is necessary, and the patient may do himself. However, there are instances where the patient or his guardians are not willing to bulge. This leaves the doctor with no option, but to breach such confidentiality himself. However, morality demands that the doctor informs the patient of his intention before undertaking it. Further, the doctor should divulge the minimum possible information to the least number of persons. Conclusion Morality is the most concrete pillar holding up the society. Without it, society would most obviously crumble.
As a result, it is imperative that all social sectors uphold morality to enhance social order. This applies to the medical profession, as well. Indeed, owing to its close interaction with humanity, the medical profession should be at the forefront in championing morality. Therefore, patient confidentiality needs to be guarded jealously since it is at the core of morality. However, morality calls for the pursuance of the greatest public good. Consequently, doctors need to weigh the moral weight of any decision they make in regard to patient confidentiality.
Banatar, D. 2003). Confidentiality. Retrieved on 29 November 2012 from http://www. ajol. info/index. php/cme/article/viewFile/43846/27365. Bourke, J. , & Wessely, S. (1996). Confidentiality. Retrieved on 29 November 2012 from http://www. ncbi. nlm. nih. gov/pmc/articles/PMC2323098/http://www. ncbi. nlm. nih. gov/pmc/articles/PMC2323098/. Krauss, J. B. (Dec 1996). Ethics in community mental health care: Confidentiality and common Sense. Community Mental Health Journal, 32, 513-8. McHale, J. (1993). Medical Confidentiality and Legal Privilege in Social Ethics and Policy Series. Routledge.