Running head: PATIENT INFORMATION 1

Patient Information: When Is it okay to Disclose?

Student's Name

Institutional Affiliation

Author Note
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Patient Information

Introduction

Every individual has a right to have personal information kept private, especially, on

their medical conditions. Therefore, access to such crucial data should only be allowed to the

authorized doctor in charge of caring for that patient or with an informed consent. According

to the reports by the General Medical Council (GMC), patient confidentiality issues are

among the most frequent queries. While the ethical principles still remain unchanged the

matters arising and the changing circumstances have necessitated the development of

guidelines for handling patient information by the GMC (Stanton, 2018).

Besides confidentiality, four other basic principles usually at play include autonomy

which gives the patient a right of a say in their health choices; justice that provides for the

benefits and risks of care to be equally shared in the society; beneficence that involves

decisions that benefits the patient; and nonmaleficence that means no harm to the patient. An

ethical dilemma may present with two om more of these principles at the same time and

decision taken must therefore be one that directly benefits the patient. This paper therefore

seeks to answer the question on when it’s okay to disclose patient information.

Analysis of Privacy Breach

While Dr Johnson clearly breached patient confidentiality, it could also be viewed as

a case of assumptions based on moral values. The physician assumed that the couple were in

a normal loving relationship and the only right thing to do was to let the husband know of his

wife’s diagnosis. This is important especially in preparing patients and their families for the

course of treatment; it enhances the provision of the kind of support needed by the patient.

Therefore, one can argue that Dr Johnson was just right to disclose such information to

Megan’s husband being the only family member present at the time and legally they were

still married. However, this was not the case as the couple were already in a strained
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relationship such that were it not for their younger daughter they would have separated. The

reason Megan did not disclose such sensitive information to her husband despite him

agreeing to drive her to the hospital. The question of relationships, love and friendships with

respect to information access comes then into play.

Privacy is, thus, key to respect, love, friendship as well as building trust. This,

therefore, touches on the principle of autonomy; the duty to value and respect individual’s

decisions in their healthcare choices. Since personal information is just an extension of the

individual, accessing this private data without their consent is a direct invasion to their

privacy. Normally disclosure of personal information against their will especially medical

records may result in debilitating psychological consequences.

When faced with such ethical dilemmas, there are various factors that should be

considered before taking the decision. Some of these issues are legal matters however there

are also crucial questions related to your duty to the patient. The principle of utility argues

that the most attractive option when faced such issues, doing good is of great importance. As

a result of the effects scheduled procedure the doctor had advised Megan to look for an

alternative driver since she would be drowsy after the treatment. She didn’t want to trouble

her mother or other friends so she only had Ken as the last option who agreed to drive her to

the hospital even though she did not reveal her illness to him.

In order to ensure that his patient got the needed support after the procedure, Dr

Johnson discussed the confidential information with Ken. This can be viewed as an act of

beneficence to Megan given her condition (cancer) that require a special kind of care and

which will require financial as well as family support. Morally, every course of action taken

by the physician is intended to improve Megan’s life by promoting happiness and this has to

start with family and friends. However this doesn’t seem to be the case since the breach of

confidentiality only angers the patient contrary to the intended happiness. One may tend to
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adopt alternative argument that good deed in this instance would be keeping her condition

confidential even though it’s morally wrong. Despite utilitarian concept being appealing, it

may have certain effects that many people would consider unpalatable. The bottom line here

is the most and only important thing in this case should have been Megan’s happiness which

both the doctor and Megan gave different perspectives.

Ideally, privacy is a crucial foundation for the development of relationships; it’s

essential in conducting ordinary human affairs that promotes social interchange. How much

of personal information revealed to a friend or family determines the degree of intimacy in

that relationship (Rachels, 2017). Individuals may tend to open up to their therapists or doctor

on matters that would otherwise remain secret and that requires a great level of trust as well

as the assurance of confidentiality. Rachel argues that a couple may behave differently in the

presence of a third party as opposed when they are alone. This could be the reason Megan’s

physician thought that the couple had a normal loving relationship even though their marriage

was already broken.

Justification for Breach in Confidentiality

In a healthcare environment, patients' confidentiality is provided for by some

statutory exceptions that can either be permissive or mandatory and are intended to protect

the public. Such guidelines and policies offer the basis for interpretation on the correct time

when public safety interest should take effect over the right to confidentiality. Morse and

Casemore (1999) proceed further to note that medical records must be availed upon summons

or other orders issued by a tribunal in line with the Statutory Powers Procedure Act as

provided for under the Health Disciplines Act. The Coroners Act further also provides that

medical records must be surrendered to the authorized officer (police, a coroner or a

physician) in the execution of their powers in accordance with this act. The constitutionality

of such laws has always been upheld in the courts.

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Further studies indicate that in an event where a patient file a suit against a healthcare

provider regarding care given, the medical records will form crucial evidence in that case

(Mair, 2008). Since these hearings always happen in an open court and in the presence of the

public, it then follows that the confidential information must be discussed publicly. A

reference is made to a case of Kadian v Richards [2004] SWSC 382, where the determination

preserved the patients’ right to confidentiality regarding health records unless it’s a case of

negligence filed by a patient against their doctor; in such events loss of the right to

confidentiality is limited to the information needed for adequate preparation for the defense

team.

The obligation of a doctor to caution a third party may at times be greater than that

owed to patient confidentiality. This may occur in situations where a patient poses an even

greater health and safety risk to a third party who may not be a patient or the public. Usually,

the liability of any harm to a third party will be owed to the doctor if the individual was not

warned of the potential safety risks thus the it would be advisable for the physician to

sufficiently warn the third party. Currently, there are no provisions in Ontario to this effect

and in fact the existing policies prohibit disclosure of patient’s information. For instance, a

case Tarasoff 36 of a student at the California University, the student had earlier reported to

Dr. Moore who alongside his supervisor didn’t warns Tarasoff who was eventually murdered.

Therefore, should the doctor face such an ethical dilemma, it would be advisable to caution

the third party and face disciplinary action (Villas-Bôas, 2015; Morse & Casemore, 1999).

There can also be an implied or expressed consent to warrant the use of confidential

information. Implied consent according to the GMC guidelines can be applied as long as the

information is directly benefiting the patient otherwise an informed consent must be sort

before sharing confidential patient information (Stanton, 2018; CDC, 2003). Since Megan

cannot drive herself following the procedure, the doctor might have deemed it fit to apply an
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implied consent in disclosing her diagnosis to Ken in a bid to ensure proper care is given to

her even while at home.

How Unethical Habits Are Established and Change Strategy

Physicians and doctors usually act as managers in their corresponding fields and thus

have the obligation of making ethical decision with the patient’s interest at the core. This has

not been easy due to the existence of overlapping ethical principles which often conflict at

critical decision-making processes. Actually, what promotes the bad habits as seen in the case

of Megan is the constant conflict in deciding which principle should be applied in critical

decision processes. This is because ethical values are not just about the five principles

highlighted, there are other important factors usually considered like truth-telling, cultural

perspectives, transparency as well as showing respect for patients and their families while

also being cognizant of patient own beliefs.

Despite being professions who are always expected to act in line with the standards

and ethical provisions, physicians are also human and part of the society thus personal belief,

emotions as well as societal values may often cloud their judgment processes. In most cases

the desire to act in the best interest of the subject may force a doctor to take unethical

decision just as Dr. Johnson thought informing Megan’s husband of her diagnosis was best

for her judging from the seriousness of the illness and the kind of care required forthwith.

It's not usually easy to avoid such habits since it is an issue of dilemma and no

particular option or principle really seem right at the time. But should one be faced with such,

then reference should be given to the ethical guidelines provided by the professional bodies

such as the GMC to take the right decision or at least the one that poses a lesser disciplinary

implication. When litigations occur the medical records of that particular patient will always

be used as evidence in that case and reference will also be given to the provisions on ethical

standards to come up with the determination (Hartry, 2007). Thus, the only way to avoid the
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bad habits from being established is through strict adherence to the professional code of

ethics irrespective of conflicting personal beliefs. In worst case proper disciplinary action can

be initiated which may range from filing for damages, job loss, imprisonment and loss of

practice license.

Ethical right of confidentiality can therefore be guarded by implementation policies

that promote ethical practice at all levels. Strengthening of the hospital’s ethics and legal

committee to deal with ethical cases as well as review guidelines will also be a good way of

fostering an ethical practice (Stanton, 2018). The department of health and human services

also issued a Privacy Rule to enact the provisions of the Health Insurance Portability and

Accountability Act (HIPAA) of 1996 which defines how the access and use of private health

information. The privacy rule that ensures that individual medical records have the proper

protection (CDC, 2003).

It is because the issue of privacy and confidentiality are becoming a greater risk today

especially in this era of technology. Most people are enlightened on their rights and even a

slight breach of these rights may lead to legal action. As seen from some of the cases

presented earlier, more cases are expected due to this trend thus healthcare professionals must

strive to act within the ethical standards (Mair, 2008; Villas-Bôas, 2015).

Conclusion

Based on the presentation, I can conclude that respect to the patient, the assurance of

confidentiality does not only facilitate their participation in the course of therapy as a result

of increased trust but also enhances autonomy. This is because of the confidence that patient

have on the fact that their medical data is safe with their care giver. However, there are

circumstances that warrant disclosure of these crucial information; these include when the use

of this information will benefit the patient, patient poses a greater threat a third party and in

court proceedings.
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Therefore, it can be assumed that Dr. Johnson’s act of revealing Megan’s diagnosis to

her husband was an act to benefit the patient though he violated the privacy rule. First, they

were still legally married even if their relationship was strained and so the husband deserved

to know. Secondly, given that the procedure would make her drowsy thus posing a threat to

her own life, the doctor had the obligation of explaining Megan’s carer (Ken) the details on

her condition so as to ensure proper care is accorded even at home (beneficence). Finally,

based on the cancer diagnosis specialized care was going to be needed and this required both

financial and family support hence it was just in order to bring her only family at that time on

board.
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References

CDC. (2003). HIPAA privacy rule and public health. Guidance from CDC and the US

Department of Health and Human Services. MMWR: Morbidity and Mortality Weekly

Report, 52(Suppl. 1), 1-17.

Goold, S. D., & Lipkin Jr, M. (1999). The doctor–patient relationship: challenges,

opportunities, and strategies. Journal of General Internal Medicine, 14(Suppl 1), S26.

Hartry, N. (2007). Visually impaired drivers and public protection vs confidentiality. British

Journal of Nursing, 16(4), 226-230.

Mair, J. (2008). Litigation and doctor-patient confidentiality. Health Information

Management Journal, 37(2), 56-59.

Morse, J. R., & Casemore, A. L. (1999). Doctor-patient confidentiality: To disclose or not to

disclose. Advoc. Q., 22, 312.

Rachels, J. (2017). Why privacy is important. In Privacy (pp. 11-21). New York, Routledge.

Stanton, C. (2018). Patient information: To share or not to share?. Medical law review, 26(2),

328-345.

Villas-Bôas, M. E. (2015). The right and duty of secrecy, as a patient protection. Revista

Bioética, 23(3), 513-523.