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The Bioethical Issue of Patient Confidentiality in the US

There are various bioethical issues affecting the US and the whole healthcare sector

worldwide, with one of the most common issues being the doctor-patient confidentiality ethical

issue. Considering this issue, it is key to understand that apart from the objective information

collected by medical professionals, sometimes sensitive data regarding the patient's family, their

habits, and the activities they engage in are usually filled in their profiles (Noroozi, Zahedi,

Bathaei & Salari, 2018). In addition, medical services today contain many instances of

interprofessional collaboration, meaning that many parties apart from the medical professionals

alone will require access to the patient's information to provide the best services and care to

them. However, this does not guarantee that patient privacy should not be observed because,

according to research, it is identified that all healthcare professionals worldwide and their

interprofessional collaboration teams are required or expected to take an integrated approach

towards safeguarding patient confidentiality as one of the ways of observing universal ethical

codes and also, they should always demonstrate respect to the rights of patients in their

procedures (Karasneh et al., 2021).

Ideally, three main factors constitute the challenges of confidentiality in healthcare in the

United States and other regions worldwide that is; management issues whereby in some

scenarios, individual healthcare institutions lack sufficient laws, policies, and regulations that

protect the patient’s information fully (Noroozi, Zahedi, Bathaei & Salari, 2018). Another factor

is organizational ethics, whereby through lack of proper regulations, management of human

resources, or technological usage in the facility, data accessibility and publication does not

consider the patient’s privacy. The last factor involves the doctor-patient connection whereby

issues like less attention to the patient's needs and non-considerate service provision provided by
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the professionals might sometimes lead to issues of breach of patient’s concealment (Noroozi,

Zahedi, Bathaei & Salari, 2018). Maintaining confidentiality by healthcare professionals is

important because they must ensure that patient data and sensitive or vital information has

always been protected from unauthorized parties. It helps build trust between the healthcare

professional and the patient and helps demonstrate professionalism by the medical officer. Apart

from these factors, maintaining confidentiality helps develop a proper doctor-patient relation;

hence it is easier for society to build belief in healthcare providers and their services.

The different ways through which patient confidentiality is breached within healthcare

facilities include; overriding the victim’s custody of clinical data and documentation (Beltran-

Aroca et al., 2016). Through exposure of personal data obtained through consultations with other

parties, including medical personnel or other external people not involved in the victim’s clinical

care. Moreover, improper disclosure of the case’s sensitive data resulted from inadequate

groundwork or coordination of the activities in the hospital. In most cases, the severity of the

inpatient’s privacy breach ranges from mild to grave depending on the type or sensitivity of data

used without the victim’s authorization and the impact that the breach might cause on the

victim’s well-being, especially psychologically (Beltran-Aroca et al., 2016). The main areas

notorious for these breaches include; meeting offices, nursing rooms, and other areas like a

passageway, lifts, hospital entry points, or stairs, among other locations within the facility.

To prevent the impacts of this problem, the government of the United States has

developed systems of safeguarding protected patient information (PHI) through the health

insurance portability and accountability act (HIPAA) public law (Tariq Rayhan & Hackert,

2018). This law protects inpatients against breaches on the data found in their admission profiles,

billing records, prescription records, referral documents, discharge, and follow-up appointments,
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among other details. It applies to all workers in the healthcare facility and all locations where the

above data is located. Under this act, the main issues of concern include;

 Conduction of proper risk analysis and data security during healthcare provision,

especially if electronic healthcare technology is involved (Tariq Rayhan &

Hackert, 2018).

 Activation of encryption function, especially where wireless networks are

involved.

 A key consideration of where patient's PHI is stored whereby if stored on things

like flash disks and laptops, they are properly secured or encrypted.

 Unique user identification whereby through HIPAA enhancements under the

health information technology for economic and clinical health (HITECH) act,

case data users can be tracked during and after they access patient data (Tariq

Rayhan & Hackert, 2018).

 Implementation of stronger authentications, such as those involving biometric

features, before accessing victim’s information.

 Promoting selective access where only a few authorized healthcare professionals

or parties can access patient information under certain strict circumstances (Tariq

Rayhan & Hackert, 2018).

 Continuous auditing and risk assessment of the healthcare systems are used to

determine any flaws or weaknesses that might lead to data breaches and prevent

them.

 Informing inpatients regarding their rights and the privacy practices conducted by

their healthcare providers.

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 Employment of dedicated information technology staff.

 Setting clear third-party agreements that protect patients' data and information

from a breach (Tariq Rayhan & Hackert, 2018).

 Legal prevention of inadvertent leaking of personal PHI to any party, including

the victim's close people, unless proven necessary.

Jointly these issues lead to the development of victim concealment rights and different ways

patient information can be safely shared and communicated without leading to breaching

problems.

Several case studies in the United States demonstrate the legislative part of patient

privacy and it is essential for regulations governing the revelation of case data, such as; the case

of Tarasoff v. Regents in the University of California, where a graduate student Poddar after

having an affair with Tarasoff that ended badly, he went and confided with their psychologists in

the institution Dr. Moore about having homicidal thoughts towards her ex-partner before

committing the murder later on (Appel, 2019). In this case, even though the psychologists had

previously informed the police about the scenario before the murder, it was later identified by the

supreme court of California that as medical professionals, they have their duty to warn and

protect their victims and any other party involved in case of such a situation (Appel, 2019).

Finally, to solve the issues of breaching patient privacy and prevent future damages like

the one in the case study above, medical professionals and all workers in healthcare facilities are;

properly train their employees and inform them all about HIPAA laws, encourage reporting of

any HIPAA violations in healthcare facilities, employees to have a signed consent that

confiscates them in case they violate the HIPAA rules, ensuring proper disposal of case’s PHI

once they are done using them through practices like shredding them and incinerating them to
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the extent they cannot be reconstructed, and using the office for civil rights (OCR) under health

and human services (HHS) to monitor patients data and conduct any investigations whenever any

HIPAA violations occur where victims prove guilty will be required by law to pay hefty amounts

and suffer consequences in jail for their actions (Tariq Rayhan & Hackert, 2018). It is also

advised that strategies such as communication privacy management (CPM) in healthcare

institutions can be applied to ensure confidentiality pledges have been developed, which all

healthcare workers follow while protecting victim’s data (Petronio, Dicorcia & Duggan, 2012).
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References

Appel, J. M. (2019). Trends in confidentiality and disclosure. Focus, 17(4), 360-364.

Beltran-Aroca, C. M., Girela-Lopez, E., Collazo-Chao, E., Montero-Pérez-Barquero, M., &

Muñoz-Villanueva, M. C. (2016). Confidentiality breaches in clinical practice: what

happens in hospitals?. BMC medical ethics, 17(1), 1-12.

Karasneh, R., Al-Mistarehi, A. H., Al-Azzam, S., Abuhammad, S., Muflih, S. M., Hawamdeh,

S., & Alzoubi, K. H. (2021). Physicians’ knowledge, perceptions, and attitudes related to

patient confidentiality and data sharing. International Journal of General Medicine, 14,

721.

Noroozi, M., Zahedi, L., Bathaei, F. S., & Salari, P. (2018). Challenges of confidentiality in

clinical settings: compilation of an ethical guideline. Iranian Journal of Public Health,

47(6), 875.

Petronio, S., Dicorcia, M. J., & Duggan, A. (2012). Navigating ethics of physician-patient

confidentiality: A communication privacy management analysis. The Permanente

Journal, 16(4), 41.

Tariq Rayhan, A., & Hackert, P. B. (2018). Patient Confidentiality.