BIOETHICS:

PATIENT’S PRIVACY & CONFIDENTIALITY

DR. INAYAT ULLAH MEMON

MBBS, MCPS (Path), MMedSc (Australia)
PGD Bioethics (CBEC, SIUT), Masters Bioethics (AKU), PGDip-
Telemedicine/E-Health

2nd Lecture, 2nd Year

INDUS MED. COLLEGE. TMK
24th July 2020
Plan of Today’s Lecture:
■ Definition Privacy and Confidentiality
■ Differences between confidentiality and Privacy
■ Measures to protect Privacy
■ Why to maintain Confidentiality
■ What is considered Confidential
■ Proficiency to keep the medical secret
■ How to secure Confidentiality
■ Situations where right of Privacy and Confidentiality
can be breached
■ Conditions: When to disclose Medical Secrets
■ Case Studies
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 PRIVACY:

Privacy relates to personal (bodily

physical) information, that a person

would not wish other to know,

without prior authorization

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PRIVACY:

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 CONFIDENTIALITY:

■ The ethical principle or legal right that a

physician or other health professional will hold
secret all information relating to a
patient, unless the patient gives consent
permitting the disclosure.

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 Differences:
Privacy Confidentiality
• A right or • Is the right of an
expectation to not individual to have
personal, identifiable
be interfered with.
medical information
• Be free from
kept out of reach of
surveillance
others.
• A moral right to be
left alone.
Respect Patients’
Information
Respect Patients’
Body
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 Measures to protect Privacy

• Always take permission from the patient

before examination
• Make sure that examination takes place in
isolation from other patients, unauthorized
family members, and/or staff
• Make sure there is another person (nurse) of
the same sex as the patient and is present
all the time of the examination
• Provide gender-sensitive waiting and
examination rooms

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 Measures to protect Privacy (cont.):

• Make sure patient’s body is well covered

when shifted from one to other place in hospital
• Make sure your patient’s body is exposed
ONLY as much as needed by the
examination or investigation
• Avoid keeping patients for periods more than
required time
• It’s prohibited to examine patients in
corridors or in the waiting area.
• Give patients enough time to expose the
part who are with pain
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Why to maintain the confidentiality?

• Build Trust between patients and

healthcare professionals
• So as patients give information about their
health in confidence.
• Individuals will be encouraged to seek
appropriate treatment and share
information relevant to it.

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 What is considered Confidential?

• All identifiable patient information,

whether written, computerized, visually
or audio recorded or simply held in the
memory of health professionals, is
subject to the duty of confidentiality.

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 What is considered Confidential
(cont.)?
• It covers:
 The individual’s past, present or future physical or
mental health
 Any clinical information about an individual’s
diagnosis/treatment
 A photograph, video, audiotape or images of the
patient;
 Who the patient’s doctor is, and when/ what clinics
patients attended
 Anything else that may be used to identify patients
directly or indirectly
 The past, present, or future payment for the
provision of health care to the individual
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 Proficiency to keep the medical
secret:
• Medical secret is defined as “Any medical information
that comes to the knowledge of the practitioners
as a result of their work whether directly obtained from
the patient, or otherwise”
• It includes any information that the doctor knows
about the patient (alive or dead), directly or indirectly
that a patient may deem its disclosure undesirable
or harmful to his/her health, reputation, financial,
social or professional status.
• It includes any information about patient’s identity,
diagnosis, investigations’ results, treatment, and/or
prognosis (good or bad)
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How to secure Confidentiality?

1. Do not discuss the patient’s medical

information with unauthorized family
members
2. Do not disclose patient’s information
without his/her consent,
3. Do NOT collect information not related to
the provision of care
4. Hospital should set policies that regulate
access to medical information and how any
breach to confidentiality is managed
5. Limit sharing of information with other
staff, unless in cases of consultations and
second opinion
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 Situations when right of privacy &
confidentiality can be breached:

• Concern for the safety of other

specific persons

• Concern for public welfare

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 Conditions: when to disclose
Medical Secrets:
1. Approval from the patients or their SDM
(Substitute Decision-Maker), within the limit given in
the approval
2. If the information are required by judiciary,
Consultation or second opinion
3. Notification of events of public health interest
/threats (birth, death, notifiable diseases, etc.)
4. Prevent individual/personal threats (e.g.
prevent crimes)
5. If needed by the doctor to defend him/herself
before judges, or discipline committee

Remember: Disclosure should be only

to the concerned party & not beyond
the needed limits 15
 Case study: Case: 01

Your 36-year-old patient has just tested

positive for HIV. He asks that you (Physician)
not to inform his wife of the results and
insists he (Patient) is not ready to tell her yet.

 What is your role legally?

 What would you say to your patient?

(Source:http://depts.washington.edu/bioethx/topics/confidc1.html)

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 Discussion:
 Because the patient's wife is at serious risk
for being infected with HIV, you have a duty to
ensure that she knows of the risk.

 While public health law requires reporting both

your patient and any known sexual
partners (wife) to local health officers.

 It is generally advisable to encourage the

patient to share this information with his wife
on his own, giving him a bit more time if
necessary.
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 Case study: Case: 02

 A 75-year-old woman shows signs of abuse

that appears to be inflicted by her husband.

 As her husband is her primary caregiver, she

feels dependent on him, and pleads with you
not to say anything to him about it.

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 Discussion:

 In this case, the required reporting laws can

be interpreted in a number of justifiable ways.
 The laws supporting reporting elder abuse
(and child abuse) allow you to break
confidentiality and report suspected abuse.
 However, if you think it is possible to give
woman support and access to other services
without reporting the case immediately, those
will help her more in the long run.
 Either way, you have an obligation to
address her abusive situation.
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 Case study: Case: 03

 A 60-year-old man has a heart attack and is

admitted to the medical ward with a very poor
prognosis.
 He asks that you not share any of his
medical information with his wife as he
does not think she will be able to bear it. .
 His wife meets you in the hall and asks about
husband's prognosis.

 What would you tell his wife?

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Thanks for Patient Listening

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