Confidentiality in Healthcare Ethics & Law

Confidentiality in Healthcare Ethics & Law 

Session Objectives •  What is confidentiality? confidentiality? /Why respect confidentiality? • The law  • Is confidentiality absolute/Exceptions to confidentiality/Breeching confidentiality/Breeching confidentiality  • onfidentiality !"eath# incapacity and $inors • onfidentiality % alliati'e care case study 

Confidentiality • Generally, if institution/person ‘A’ holds information about person ‘’ then person ‘C’ cannot obtain that information in the normal course of events without the consent of person ‘’ 

• ‘Most people consider health information to be highly  personal and, therefore, need to be confident that their  privacy will be protected whenever they use a health service ... Clear and open communication between the health service provider and health consumer is integral to good privacy’ (adwanshi )*++,-

What information is confidential?  .ll identifiable patient infor$ation# whether written# co$puterised# 'isual or audio recorded or si$ply held in the $e$ory of health professionals# is subect to the duty of confidentiality0 It covers: •  .ny clinical infor$ation about an indi'idual1s diagnosis or treat$ent •  . picture# photograph# 'ideo# audiotape or other i$ages of the patient •  Who the patient1s doctor is and what clinics patients attend and when •  .nything else that $ay be used to identify patients directly or indirectly0 )B2. *++3-

When does a matter become confidential? Broadly spea4ing the courts ha'e recognised three ele$ents to deciding whether a $atter is confidential5 • The nature of the infor$ation • 6ature of the encounter • 6ature of any disclosure

Why respect confidentiality? • Trust is an i$portant aspect between patients and healthcare professionals0 atients without fear of a  breech of confidentiality should be able to co$$unicate sy$pto$s that often they $ay feel are e$barrassing# stig$atising# or indeed tri'ial •  Without this trusting relationship patients $ay not di'ulge infor$ation which $ay $a4e treating the$ i$possible • atients $ay not see4 $edical attention at all • 7as i$portant role in a professional patient relationship establishing a sense of security# freedo$ of action and self respect for patients

http://www.dataprotection.ie/viewdoc.asp?DocD!""#  $"%%&'

Why respect confidentiality?

Why respect confidentiality? • 7ospital policy  8 ontained within each $e$ber of staff contract of e$ploy$ent 8 an result in disciplinary action

Why respect confidentiality? • Professional Code of Conduct – An Bord Altranais ‘!nformation regarding a patient’s history, treatment and state of health is privileged and confidential...’  ‘"rofessional #udgement and responsibility should be e$ercised in the sharing of such information with  professional colleagues. %he confidentiality of patient’s records must be safeguarded.’ )

http5//www0nursingboard0ie/en/publications9current0as px?page:;  -

(he rish )edical Co*ncil + ,*ide to -rofessional Cond*ct and thics • ‘Confidentiality is a fundamental principle of medical ethics and is central to the trust between patients and doctors’ • ‘"atient information remains confidential even after death’ • ‘&ou should ensure as far as possible that the patient’s  privacy is maintained at all times and that accidental disclosure of confidential information does not occur’  • ‘&ou should ensure as far as possible that confidential information in relation to patients is maintained securely and in compliance with data protection legislation’.

Why respect confidentiality? The Data Protection Commissioner Criminal sanctions • nly you and the people you authorise to share  your pri'ate infor$ation with ha'e a right to  'iew your infor$ation )relatives of a com!etent adult do not*#

,ro*ps • Incapacity  • "eath • 2inor

ncapacity •  Where an indi'idual cannotM co$prehend or retain treat$ent infor$ation# belie'e it and  weigh it in the balance to arri'e at a choice then they are considered unable to consent to that treat$ent

• If a doctor decides to breach confidentiality on the ‘best interest’  argu$ent# first they $ust weigh the possible har$s against the benefits# second# they $ust be prepared to ustify their decision and third if unsure they should consult experienced colleges

(e  )adult refusal of $edical treat$ent- F,@@;G , .ll E( 3,@

eneral 2edical ouncil0 onfidentiality5 protecting and pro'iding infor$ation0 http5//www0g$c%u40org/guidance /current/library/confidentiali ty0asp

Death • "eclaration of ene'a ! ‘respect for the secrets confided... even after the  patient has died’  • eneral 2edical ouncil ! ‘e$tends after death’ • 2orally an indi'idual1s confidentiality is still considered to reHuire respect

• Legally %confidence is pri$a facie a personal $atter thus the legal duty ends with the death of a patient • "eath certificate is a public docu$ent • 2edical records can be accessed if certain criteria are $et under the Creedo$ of Infor$ation .ct by their spouses or next of 4in

)inors • ffences .gainst the erson .ct ),@@-# allows consent to surgical# $edical or dental treat$ents )this act does not allow the$ to decline treat$ent• The hild are .ct ),@@, Q!nsofar as practicable, give due consideration, having regard to his age and understanding, to the wishes of the child’. )hild are .ct ,@@,Law (efor$ o$$ission in Ireland ha'e suggested that it is the pre'ailing belief in Irish legal opinion that under ,O1s ha'e no personal power to consent to $edical treat$ent

Case ‘Against all the odds, and despite being referred to a hospice, Collette showed signs of recovering from bowel cancer. After several months, the consultant decided that Collette was no longer terminally ill, although he could not be certain that she would not become ill again in the future.  Accordingly, he felt she no longer re+uired the e$tensive support supplied by the hospice and discharged her. Collette was very upset by this, partly because she did not want to loose her terminally ill status, which had generated her more attention from her family than she had become accustomed to in the past. %he hospice staff were not unsympathetic. %hey had promised that they would not abandon her and would care for her until she died. %he staff also widely believed that her family had rather neglected her previously.  ecause they did not wish to let Collette down, she was given radically reduced honorary status as an outpatient. -or instance she still attended social events and had her hair set by the hair dresser who donated some of her spare time to the hospice. !t +uicly became obvious that Collette’s  family did not realise that she was no longer thought to be terminally ill. %he nurse manager attempted to tal to Collette about this, but she was  politely and firmly told to mind her own business.’ 0ebb 12234

How can healthcare providers ins*re confidentiality is maintained •

Discretion in general conversations 8

"#ew technology$% &aceboo' Twitter

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(nline posting of unprofessional content )*atherine C+ Chretien et al+ JAMA. 2009;302(12):1309-1315 Oct, 2009)

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Examining how we talk to patients 8

(ut,side wor'

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-ith #on,clinical personnel%)con.dentiality agreement/

How do we ‘carry’ data? 8

0nsecured laptops

8

012 'eys

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Is data anonymised where possible

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When information is shared 3 every party must be aware of his4her obligation of con.dentiality

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1ee' patient consent as early as is reasonably possible

S*mmary • onfidentiality is +ITA in healthcare ! But is not always an absolute right • There are ; exceptions defined by the Irish $edical council •  . healthcare professional '%(T be able to stand o'er any breech of confidentiality and it should be a last resort • Duties to inform authorities in certain cases (Child abuse, elderly abuse, public interest ) – where danger exists, should only be done after careful consideration •  .ll co$petent persons o'er ,3 ha'e the right to confidentiality% for all other persons healthcare pro'iders $ust act in the patients best interests