The obvious harm to the patient in this case was his loss of life, but failing to provide needed care can cause substantial harm short of death. For instance, Sandroff, R (5) and Alistair Kent (6) 3 insist the health professional should ignore the concerned person's right to privacy whenever breach of confidentiality can prevent harm. Balancing the competing duties of maintaining privacy in the doctor-patient relationship with minimising potential harm caused by non-disclosure of HIV status is not always easy, says Tak Kwong Chan The theoretical reasons for breaching patient confidentiality to protect a third party from risk of HIV infection are straightforward. INTRODUCTION. Protecting the patient’s physical and mental health is considered the physician’s primary responsibility. On one hand, the physician has a legal and ethical duty to Mrs. B to maintain confidentiality. A conflict of duties. Two problems attend the question of civil liability for the unprivileged disclosure of medical secrets: First, there is the very basic question of what remedies the law affords to the disgruntled patient. The Duty to Preserve Confidentiality . In particular, should a physician be able to breach confidentiality when public health or safety is threatened? Health Insurance Portability and Accountability Act. A conflict of duties Mrs. B’s refusal to share her test results with her daughter places Dr. T in a dilemma. Several factors ethically support both a breach of confidentiality and the physician’s duty to warn and protect the third party: the emerging professional consensus that confidentiality is not absolute; the known identity of a third party who stands in harm’s way; the risk to unknown and unidentified sexual partners of the third party; and the deadliness of AIDS. Physician's Duties: Patient's Expectations . When providing care, consider the risks and benefits and, where significant, discuss these with the patient and record the discussion in the notes. Therapeutic nihilism is as unethical as negligent practice. While the American Society for Reproductive Medicine guidelines may support disclosure over the objections of the surrogate, the authors argue that such disclosure is a violation of the surrogate’s rights and the physician’s ethical and professional duties. The Supreme Court recognized that physicians may disclose confidential patient information in the limited and exceptional circumstances in which they have reason to believe there is an imminent risk of serious bodily harm or death to an identifiable person or group. Note. The most obvious examples of public health concerns outweighing individual rights are from contagious disease cases. The ethical category of Non-Malfeasance represents the doctor’s attempt to avoid any act or treatment plan that would harm the patient or violate the patient’s trust, and has been popularized in the phrase “first, do no harm.” Non-Malfeasance is supported through Confidentiality and Prevention. On one hand, the physician has a legal and ethical duty to Mrs. B to maintain confidentiality. The physician-patient relationship conveys many duties; one is to prevent harm. Google Scholar 7 ThePresident’sCommissionfortheStudy of Ethical Problems in Medicine and Biomedical and Be- The state's interest in preventing harm is weighty. Patient-physician confidentiality is a fundamental tenet of medical ethics. You may only disclose confidential information in the public interest without the patient's consent, or if consent has been withheld, where the benefits to an individual or society of disclosing outweigh the public and patient's interest in keeping the information confidential. confidentiality) Each of these principles is a duty that is binding unless it is in conflict with equal or stronger duties. Confidentiality and serious harm in genetics—preserving the confidentiality of one patient and preventing harm to relatives. For instance, an impaired parent should not be allowed to drive. CONFLICTS AND RESOLUTIONS The Physician’s Legal and Ethical Duties. case 6.3 | Breaching patient confidentiality to prevent possible harm Andy Cox is a nurse in a physician’s office some 30 miles from his hometown. 19. Mrs. B's refusal to share her test results with her daughter places Dr. T in a dilemma. Current legal and ethical debates highlight duties of the physician that are relevant to the issue of driving. Similarly, the duty of care towards a patien … Confidentiality and fitness to drive: Professional, ethical, and legal duties in the case of the diabetic bus driver S Afr Med J. I. In the course of duty and relationship with patients the physician must adhere to certain principles of medical ethics (autonomy, non-maleficence, beneficence and justice), rules (fidelity, confidentiality, privacy and veracity) and virtues (compassion, kindness, respect, etc). A study indicated that 72% of Americans believed “the doctor's obligation to treat all sick people” in 1991. Principle IV of the American Medical Association's Code of Medical Ethicsstates, “[a] physician shall safeguard patient confidences and privacy within the constraints of the law” [1]. Public Health. The physician’s He is also a member of his town’s school board. Similarly, paragraph (b)(3) recognizes the overriding value of life and physical integrity and permits disclosure reasonably necessary to prevent reasonably certain death or substantial bodily harm. Such an obligation had been first established more than 140 years earlier than 1991. Thus, although doing no harm should be one's first consideration, it must not prevent the clinician from avoiding all treatments which have some risk attached. opiates given to relieve a terminally ill patient’s pain may suppress respirations and hasten death. and legal duties of confidentiality in medicine, the physician’s obligation should be to maintain confidentiality . The Nigerian National Health Act (passed by both legislative Houses and awaiting the President’s signature) forbids disclosure of medical information save in the following circumstances, namely, the patient consents in writing, the disclosure was made pursuant to a court order or legal requirement, or to prevent a serious threat to public health. Some—privacy, confidentiality, continuity of care, and reasonable prudence—are well known and much discussed. Confidentiality. Geo L J. interest in disclosure outweighs both the individual’s right to confidentiality, and the public interest in a confidential health service, information can be disclosed without consent, and even in the face of a competent refusal. European Journal of Human Genetics, 12, 93–97. Concerning the first argument, as noted earlier, most confidentiality laws allow reporting of abuse or neglect. 112 Common Ethics Issues in Rural Communities a check-up. 5 A physician's duty of care includes the duty to identify reasonably foreseeable harm resulting from treatment and, if possible, to prevent it. duties, as is the case with the physician-patient relationship. In Wenden v Trikha, a duty to protect a third party or parties was indicated if a requisite proximity of relationship existed12. prevent a highly likely and foreseeable harm to an identi- fiedindividual. victim may be insufficient action to prevent harm in certain circumstances. In Canada, several cases have provided some guidance since Tarasoff and before Smith v Jones. Medicine has an obligation to protect the well-being of the community. If there is reason to believe that the parent's impaired judgment substantially risks harming the patient or others, the pediatrician should attempt to decrease that risk by the least restrictive means. There may, however, be cases where public interest overrides doctor/patient confidentiality. Jessica De Bord, DDS MSD MA, Wylie Burke, MD PhD, & Denise M. Dudzinski, PhD MTS (2013) Confidentiality is one of the core duties of medical practice. Mandatory reporting laws raise important ethical questions, because they prioritize public and patient welfare and set aside both patient autonomy and the physician's duty to protect confidentiality; that is, to not disclose what a patient reveals during their encounter with their physician. CrossRef Google Scholar It is less clear how to deal with the physician’s responsibility to prevent harm to the public. The physician's decision to reveal confidential information in order to prevent harm to the patient or others should be based on the probability of harm, the magnitude of the expected harm, and the possibility of alternative methods for avoiding harm that do not require infringement of confidentiality. While reports to CPS do violate ethical duties of confidentiality, one might argue that it is acceptable to breach confidentiality to prevent serious, imminent harm to identifiable individuals.21 A famous US court case, Tarasoff Lucassen, A., & Parker, M. (2004). Because the seriousness of the threatened injury outweighs the damage done to the patient by breaching confidentiality, the obligation of confidentiality must give way to the duty to prevent harm to others. One day Mr. Richards, a teacher from the school, visits the physician for . A surrogate’s confidentiality must be maintained as it is an essential element of the physician–patient relationship. Other duties, such as reporting and warning obligations, may give physicians pause, especially if they require a breach of confidentiality or disregard for the patient’s express wishes. The duty to maintain confidentiality is an ancient and weighty obligation and has many beneficial consequences for patients and society generally. Between a rock and a hard place: AIDS and the conflicting physician’s duties of preventing disease transmission and safeguarding confidentiality. Confidentiality is a central aspect of the physician–patient relationship.1 Codes of professional ethics and the laws of most countries affirm its importance.2, 3 According to Swiss criminal law, violations of medical confidentiality are punished by a fine or a prison sentence. I engage on the concept of “harm” to discuss the moral scope of the duty to warn an involved third party and when it is justified to breach confidentiality of the patient. 1988; 76:169–202, fn 63. Likewise, potential harm also is thought to override confidentiality duties on the basis of the familial nature of genetic information. The failure of a physician to warn the patient or a third party of a foreseeable risk is a separate and distinct negligent act. This leaves open, however , the question of a journalist’s obligations in When employees of the physician’s office gain an understanding of the compliance HIPAA requires, they can feel secure in their dealings with patients and other individuals. These include: Protecting the patient . This will usually be where disclosure is required to prevent or mitigate a risk of serious harm to others. It requires health care providers to keep a patient’s personal health information private unless consent to release the information is … Chapter 11 -- The Physician’s Other Duties: Good Faith, Loyalty and Confidentiality. 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