<ul><li>LEGAL ASPECTS  </li></ul><ul><li>OF CARE:  Next Time it Could be You </li></ul><ul><li>Jacqui Hitchen </li></ul>
LEGAL  ASPECTS OF CARE <ul><li>AIM: </li></ul><ul><li>To develop and enhance the individual’s knowledge, awareness and und...
LEGAL  ASPECTS OF CARE <ul><li>Learning  Outcomes: </li></ul><ul><li>Develop an understanding of the legal and professiona...
<ul><li>What do you understand by the following </li></ul><ul><li>terms? </li></ul><ul><li>Accountability </li></ul><ul><l...
<ul><li>Define the following: </li></ul><ul><li>Negligence </li></ul><ul><li>Identify 2 ways in which you may be ‘negligen...
Define the term: <ul><li>Consent </li></ul><ul><li>What is the age of majority – what is  </li></ul><ul><li>it’s significa...
Define the following: <ul><li>Confidentiality </li></ul><ul><li>Breach of Confidentiality </li></ul><ul><li>Disclosure of ...
LEGAL ASPECTS OF CARE <ul><li>NEGLIGENCE </li></ul><ul><li>3 ESSENTIAL ELEMENTS: </li></ul><ul><ul><li>A Duty of Care must...
NEGLIGENCE <ul><li>Damage flows from the event </li></ul><ul><li>Would harm or loss have occurred even if there had been n...
NEGLIGENCE <ul><li>Contributing Negligence </li></ul><ul><li>Did the individual contribute to the extent/happening of the ...
VICARIOUS LIABILITY <ul><li>A Health Authority or employer has 2  </li></ul><ul><li>forms of liability in negligence </li>...
VICARIOUS LIABILITY   Cont…   <ul><li>DIRECT LIABILITY </li></ul><ul><li>The Authority itself is at fault </li></ul>
VICARIOUS LIABILITY   Cont…   <ul><li>VICARIOUS   – ‘serving instead of an other’  </li></ul><ul><li>‘ delegated’ (authori...
VICARIOUS LIABILITY   Cont… <ul><li>To be successful against an employee requires: </li></ul><ul><li>Proof of negligence <...
THE LAW AND THE PRACTITIONER SPECIALIST PRACTITIONERS AND VICARIOUS LIABILITY <ul><li>Specialist practitioners who develop...
THE LAW AND THE PRACTITIONER <ul><li>Negligence: </li></ul><ul><li>To Whom Does a Practitioner Owe a Duty of Care? </li></...
THE LAW AND THE PRACTITIONER <ul><li>The Duty of Care </li></ul><ul><li>“ You must take  reasonable  care to avoid  acts  ...
LEGAL ASPECTS OF CARE <ul><li>The Bolam Test (Bolam v Friern Barnet HMC 1957) </li></ul><ul><li>Asks one simple question: ...
LEGAL ASPECTS OF CARE Negligence Causation: A patient must prove, on a  balance of probabilities  that the breach of duty ...
LEGAL ASPECTS OF CARE Negligence Causation: Correspondingly, if a patient  cannot  prove that the chances of the breach of...
LEGAL ASPECTS OF CARE The Bolam Test (Bolam v Friern Barnet HMC (1957) 2 All ER 118, The plaintiff contended that the defe...
LEGAL ASPECTS OF CARE Bolitho v City and Hackney HA (1997) 4 All ER 771 (HL) 16 th  January 1984 P, a 2yr old boy, who had...
Bolitho v City and Hackney HA (1997) 4 All ER 771 (HL)(cont) <ul><li>Dr H was called in the first instance and she delegat...
Bolitho v City and Hackney HA (1997) 4 All ER 771 (HL)(cont) <ul><li>The Health Authority accepted that Dr H had acted in ...
THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>A legally valid consent consists of the following elements: </l...
THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>CONSENT </li></ul><ul><li>Dimond (2005 pp): </li></ul><ul><li>“...
THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>CONSENT </li></ul><ul><li>“ In the absence of consent all, or a...
THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>CONSENT </li></ul><ul><li>However, when there is  ‘informed’  c...
THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>BATTERY </li></ul><ul><li>Defined as: </li></ul><ul><li>“  an i...
FAMILY LAW REFORM ACT (1969) <ul><li>‘ The consent of a minor who has obtained the age  </li></ul><ul><li>of 16 years to a...
FAMILY LAW REFORM ACT (1969)   Cont… <ul><li>Section 8 of the Family Law Reform Act (1969) can also be  </li></ul><ul><li>...
FAMILY LAW REFORM ACT (1969) PARENTAL CONSENT <ul><li>Not an absolute  – can be overruled by the  </li></ul><ul><li>Courts...
The Human Rights Act and NHS Law <ul><li>Disputes between Patients and Doctors: </li></ul><ul><li>Information Issues </li>...
The Human Rights Act and NHS Law <ul><li>Information Issues; </li></ul><ul><li>May be considered under 2 headings: </li></...
The Human Rights Act and NHS Law <ul><li>Information Issues: </li></ul><ul><li>Patient’s right to information: disclosure ...
The Human Rights Act and NHS Law <ul><li>Consent to Treatment </li></ul><ul><li>The patient’s right to accept or refuse/re...
The Human Rights Act and NHS Law <ul><li>Presently, the foundation of most legal arguments is based upon the Bolam test (B...
The Human Rights Act and NHS Law <ul><li>Article 14: The right not to be discriminated against     says: </li></ul><ul><li...
CONFIDENTIALITY <ul><li>From the Latin: </li></ul><ul><li>Con  – completeness </li></ul><ul><li>Fidere  – to trust </li></...
CONFIDENTIALITY <ul><li>The principle of confidentiality is the cornerstone of medical ethics.  It can be traced back to t...
CONFIDENTIALITY <ul><li>It is not always appreciated that there is no right or privilege for a nurse or doctor to respect ...
Confidentiality A patient/client has a   RIGHT   to expect that   INFORMATION  given in   CONFIDENCE  will be used   ONLY ...
CONFIDENTIALITY <ul><li>Until now, confidentiality has been a professional duty enforced in limited circumstances by Commo...
CONFIDENTIALITY BREACH  of confidentiality occurs : If anyone   deliberately  or by  accident  gives information, which  h...
CONFIDENTIALITY <ul><li>DISCLOSURE  of information occurs in the following ways: </li></ul><ul><li>With the consent  of th...
CONFIDENTIALITY <ul><li>Disclosure  in the  PUBLIC’S BEST INTEREST </li></ul><ul><li>English case law:  </li></ul><ul><li>...
CONFIDENTIALITY <ul><li>Public interest v private rights </li></ul><ul><li>The Human Rights Act (1998) </li></ul><ul><li>A...
CONFIDENTIALITY <ul><li>Public interest v private rights </li></ul><ul><li>The Human Rights Act (1998 ) </li></ul><ul><li>...
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Jacqui Hitchin - Law Presentation at Edge Hill University

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Jacqui Hitchen presentatio non Law for students studying Anaesthesia and Recovery care modules at Edge Hil University

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Jacqui Hitchin - Law Presentation at Edge Hill University

  1. 1. <ul><li>LEGAL ASPECTS </li></ul><ul><li>OF CARE: Next Time it Could be You </li></ul><ul><li>Jacqui Hitchen </li></ul>
  2. 2. LEGAL ASPECTS OF CARE <ul><li>AIM: </li></ul><ul><li>To develop and enhance the individual’s knowledge, awareness and understand of professional and legal issues within everyday practice </li></ul>
  3. 3. LEGAL ASPECTS OF CARE <ul><li>Learning Outcomes: </li></ul><ul><li>Develop an understanding of the legal and professional issues within everyday practice </li></ul><ul><li>Examine the concepts of accountability and responsibility giving consideration to their implications for practice and the practitioner </li></ul><ul><li>Examine, through discussion, the issues within a legally valid consent. </li></ul>
  4. 4. <ul><li>What do you understand by the following </li></ul><ul><li>terms? </li></ul><ul><li>Accountability </li></ul><ul><li>Responsibility </li></ul><ul><li>Give an alternative word for ‘accountability’ </li></ul><ul><li>– but you are not to use responsibility! </li></ul><ul><li>I don’t need another word for responsibility </li></ul><ul><li>Consider, are these two concepts one and </li></ul><ul><li>the same or are they different? </li></ul>
  5. 5. <ul><li>Define the following: </li></ul><ul><li>Negligence </li></ul><ul><li>Identify 2 ways in which you may be ‘negligent’ </li></ul>
  6. 6. Define the term: <ul><li>Consent </li></ul><ul><li>What is the age of majority – what is </li></ul><ul><li>it’s significance? </li></ul><ul><li>What is/are the consequences of not </li></ul><ul><li>gaining consent? </li></ul>
  7. 7. Define the following: <ul><li>Confidentiality </li></ul><ul><li>Breach of Confidentiality </li></ul><ul><li>Disclosure of Confidentiality </li></ul><ul><li>Differentiate between breach and disclosure </li></ul>
  8. 8. LEGAL ASPECTS OF CARE <ul><li>NEGLIGENCE </li></ul><ul><li>3 ESSENTIAL ELEMENTS: </li></ul><ul><ul><li>A Duty of Care must be owed </li></ul></ul><ul><ul><li>Duty of Care must be broken </li></ul></ul><ul><ul><li>Breach of duty must have caused the event </li></ul></ul>
  9. 9. NEGLIGENCE <ul><li>Damage flows from the event </li></ul><ul><li>Would harm or loss have occurred even if there had been no negligent conduct? </li></ul><ul><li>Loss compensatable in law </li></ul><ul><li>Physical, harm, pain, suffering, loss of future earnings, loss of function, shock, psychiatric disorders </li></ul><ul><li>Remoteness </li></ul><ul><li>e.g.Thalidomide; Pituitary Gland-Growth Hormone </li></ul><ul><li>DOH Drug company liable not the administering nurse </li></ul>
  10. 10. NEGLIGENCE <ul><li>Contributing Negligence </li></ul><ul><li>Did the individual contribute to the extent/happening of the incident? </li></ul><ul><li>This will be taken into account </li></ul><ul><li>NB: Practitioner is bound by their Code of Professional Conduct </li></ul>
  11. 11. VICARIOUS LIABILITY <ul><li>A Health Authority or employer has 2 </li></ul><ul><li>forms of liability in negligence </li></ul>
  12. 12. VICARIOUS LIABILITY Cont… <ul><li>DIRECT LIABILITY </li></ul><ul><li>The Authority itself is at fault </li></ul>
  13. 13. VICARIOUS LIABILITY Cont… <ul><li>VICARIOUS – ‘serving instead of an other’ </li></ul><ul><li>‘ delegated’ (authority). The Authority is </li></ul><ul><li>responsible for the faults of others – mainly </li></ul><ul><li>its employees </li></ul>
  14. 14. VICARIOUS LIABILITY Cont… <ul><li>To be successful against an employee requires: </li></ul><ul><li>Proof of negligence </li></ul><ul><li>Person was an employee </li></ul><ul><li>Person was acting in the course of his/her employment </li></ul>
  15. 15. THE LAW AND THE PRACTITIONER SPECIALIST PRACTITIONERS AND VICARIOUS LIABILITY <ul><li>Specialist practitioners who develop unusual or pioneering roles, it is important that the employer knows and sanctions exactly what the practitioner undertakes a part of his/her role. </li></ul><ul><li>IF THIS IS NOT THE CASE </li></ul><ul><li>The practitioner may be regarded as not working ‘within the course of his/her employment ’ or be outside hospital policy. </li></ul>
  16. 16. THE LAW AND THE PRACTITIONER <ul><li>Negligence: </li></ul><ul><li>To Whom Does a Practitioner Owe a Duty of Care? </li></ul><ul><li>Those whom he/she can REASONABLY foresee might be harmed by actions or omissions </li></ul>
  17. 17. THE LAW AND THE PRACTITIONER <ul><li>The Duty of Care </li></ul><ul><li>“ You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour. Who then in law is my neighbour? The answer seems to be persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions which are called in question” </li></ul><ul><li>Lord Atkin (1932) Test case: Donoghue v Stevenson </li></ul>
  18. 18. LEGAL ASPECTS OF CARE <ul><li>The Bolam Test (Bolam v Friern Barnet HMC 1957) </li></ul><ul><li>Asks one simple question: </li></ul><ul><li>Is this the REASONABLE act of the REASONABLE PRACTITIONER ? </li></ul><ul><li>This promotes 2 further questions: </li></ul><ul><li>What is REASONABLE </li></ul><ul><li>And </li></ul><ul><li>Who is this REASONABLE PRACTITIONER ? </li></ul>
  19. 19. LEGAL ASPECTS OF CARE Negligence Causation: A patient must prove, on a balance of probabilities that the breach of duty of care caused his injuries. If he can prove this to a probability of 51% or more , then full compensation is recoverable with no deduction for the percentages by which he cannot prove causation.
  20. 20. LEGAL ASPECTS OF CARE Negligence Causation: Correspondingly, if a patient cannot prove that the chances of the breach of duty having caused his injuries are as high as 51%, then the action will fail totally.
  21. 21. LEGAL ASPECTS OF CARE The Bolam Test (Bolam v Friern Barnet HMC (1957) 2 All ER 118, The plaintiff contended that the defendants were vicariously liable for the carelessness of a doctor who administered ECT to the plaintiff without administering a relaxant drug or without restraining the convulsive movements of the plaintiff by manual control. The plaintiff suffered a # hip as a consequence.
  22. 22. LEGAL ASPECTS OF CARE Bolitho v City and Hackney HA (1997) 4 All ER 771 (HL) 16 th January 1984 P, a 2yr old boy, who had a history of hospital treatment for croup, was readmitted under the care of Dr.H & Dr.R. On the following day, he suffered 2 short episodes during which he turned white and clearly had difficulty in breathing.
  23. 23. Bolitho v City and Hackney HA (1997) 4 All ER 771 (HL)(cont) <ul><li>Dr H was called in the first instance and she delegated DR R to attend in the 2 nd instance, but neither attended P, who appeared to quickly return to a stable state. At 2.30pm P suffered total respiratory failure and a cardiac arrest, resulting in severe brain damage. He subsequently died and his mother continued his proceedings for medical negligence as adminstratrix of his estate. </li></ul>
  24. 24. Bolitho v City and Hackney HA (1997) 4 All ER 771 (HL)(cont) <ul><li>The Health Authority accepted that Dr H had acted in a breach of her duty of care to P but contended that the cardiac arrest would not have been avoided if Dr H or some other suitable deputy had attended earlier. </li></ul><ul><li>She lost her case and subsequent appeal to the House of Lords </li></ul>
  25. 25. THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>A legally valid consent consists of the following elements: </li></ul><ul><li>The patient has capacity in law </li></ul><ul><li>The patient being properly informed before hand </li></ul><ul><li>The consent being given voluntarily </li></ul><ul><li>These elements serve an important clinical purpose, but also serve to protect the practitioner from legal claims. </li></ul><ul><li>CAPACITY </li></ul><ul><li>A patient’s capacity to give consent centres upon his/her status and understanding, but </li></ul><ul><li>every adult is presumed to have capacity , as is every child between the ages of 16 and 18 </li></ul><ul><li>years. (Family Law Reform Act 1969 Section 8) </li></ul><ul><li>This presumption can be rebutted, so it is important, if the need arises, to consider </li></ul><ul><li>whether the patient is ‘capable of understanding’ the information given in respect of the </li></ul><ul><li>proposed treatment (Gillick v West Norfolk and Wisbech A.H.A. 1986) </li></ul>
  26. 26. THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>CONSENT </li></ul><ul><li>Dimond (2005 pp): </li></ul><ul><li>“ Any adult, mentally competent person has the right in law to consent to any touching of his/her person”. </li></ul>
  27. 27. THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>CONSENT </li></ul><ul><li>“ In the absence of consent all, or almost all, medical treatment and all surgical treatment of an adult is unlawful however beneficial treatment may be. This is incontestable”. </li></ul><ul><li>Lord Donaldson Master of the Rolls, F v West Berkshire H.A. (1989) </li></ul>
  28. 28. THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>CONSENT </li></ul><ul><li>However, when there is ‘informed’ consent there can be no battery. </li></ul><ul><li>“ Consent can be valid only if it is given after consideration of the patient by the practitioner”. </li></ul>
  29. 29. THE LAW AND THE PRACTITIONER PRINCIPLES OF CONSENT <ul><li>BATTERY </li></ul><ul><li>Defined as: </li></ul><ul><li>“ an intentional or reckless application of force to another person” </li></ul><ul><li>Pinfold (1991 pp25) </li></ul>
  30. 30. FAMILY LAW REFORM ACT (1969) <ul><li>‘ The consent of a minor who has obtained the age </li></ul><ul><li>of 16 years to any surgical, medical or dental </li></ul><ul><li>treatment which, in the absence of consent would </li></ul><ul><li>constitute a trespass to person will be effective as it </li></ul><ul><li>would be if he were of full age: and where a minor </li></ul><ul><li>has by virtue of this section given an effective </li></ul><ul><li>consent to treatment, it shall not be necessary to </li></ul><ul><li>obtain any consent for it from his parent/guardian’ </li></ul>
  31. 31. FAMILY LAW REFORM ACT (1969) Cont… <ul><li>Section 8 of the Family Law Reform Act (1969) can also be </li></ul><ul><li>interpreted as giving power to the parents to give a valid </li></ul><ul><li>consent on behalf of their child of 16/17 </li></ul><ul><li>‘ Nothing in this section shall be construed as making </li></ul><ul><li>ineffective any consent which would have been effective if this </li></ul><ul><li>section had not been enacted’ </li></ul>
  32. 32. FAMILY LAW REFORM ACT (1969) PARENTAL CONSENT <ul><li>Not an absolute – can be overruled by the </li></ul><ul><li>Courts if the consent/refusal of consent is </li></ul><ul><li>deemed to be against the interests of the </li></ul><ul><li>child. </li></ul>
  33. 33. The Human Rights Act and NHS Law <ul><li>Disputes between Patients and Doctors: </li></ul><ul><li>Information Issues </li></ul><ul><li>Treatment Issues </li></ul><ul><li>Life and Death Issues </li></ul>
  34. 34. The Human Rights Act and NHS Law <ul><li>Information Issues; </li></ul><ul><li>May be considered under 2 headings: </li></ul><ul><li>Patient’s right to information and the concept of informed consent </li></ul><ul><li>Patient’s right to confidentiality </li></ul>
  35. 35. The Human Rights Act and NHS Law <ul><li>Information Issues: </li></ul><ul><li>Patient’s right to information: disclosure and informed consent </li></ul><ul><li>Article 8 (1) of the ECHR says: </li></ul><ul><li>Everyone has the right to respect for his private and family life, his home and his correspondence </li></ul>
  36. 36. The Human Rights Act and NHS Law <ul><li>Consent to Treatment </li></ul><ul><li>The patient’s right to accept or refuse/reject treatment is well known. However, taken together, there are 4 aspects of the Human Rights Act that may challenge the status quo: </li></ul><ul><li>Article 2: The right to life </li></ul><ul><li>Article 3: the right not to be subjected to inhuman or degrading treatment </li></ul><ul><li>Article 8: The right to private and family life </li></ul><ul><li>Article 9: The right to freedom of thought and religion </li></ul>
  37. 37. The Human Rights Act and NHS Law <ul><li>Presently, the foundation of most legal arguments is based upon the Bolam test (Bolam v Friern Barnett HMC 1957) </li></ul><ul><li>Question: Will the Act have a serious impact on the Bolam Test? </li></ul><ul><li>Answer: Article 2 deals with the “Right to Life” and may put the Bolam Test into conflict </li></ul><ul><li>Under the Act there is a case to argue that the test should ask: did the reasonable practitioner take appropriate and even adequate measures to ensure a patient’s right to life under Article 2 </li></ul>
  38. 38. The Human Rights Act and NHS Law <ul><li>Article 14: The right not to be discriminated against says: </li></ul><ul><li>“ The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion national or social origin, associated with a national minority, property, birth or “other status” </li></ul><ul><li>This term “other status” is taken to include AGE </li></ul><ul><li>This Article has a potential serious impact upon DNR policies </li></ul>
  39. 39. CONFIDENTIALITY <ul><li>From the Latin: </li></ul><ul><li>Con – completeness </li></ul><ul><li>Fidere – to trust </li></ul><ul><li>To trust wholly (Warwick 1989) </li></ul>
  40. 40. CONFIDENTIALITY <ul><li>The principle of confidentiality is the cornerstone of medical ethics. It can be traced back to the Hippocratic Oath </li></ul><ul><li>“ Whatever, in connection with my professional practice or not in connection with it, I see or hear in the life of men, which ought not to be spoken abroad, I will not divulge as reckoning that all such should be kept secret”. </li></ul><ul><li>(Hippocrates 5 th Century BC) </li></ul>
  41. 41. CONFIDENTIALITY <ul><li>It is not always appreciated that there is no right or privilege for a nurse or doctor to respect the confidentiality of information provided by a patient when required to answer questions by a court. Even a priest has to disclose information acquired in a confessional if required by law. </li></ul><ul><li>(Dimond 2005) </li></ul>
  42. 42. Confidentiality A patient/client has a RIGHT to expect that INFORMATION given in CONFIDENCE will be used ONLY for the purpose for which it was given and WILL NOT be released to others WITHOUT THEIR CONSENT The death of the patient/client DOES NOT absolve the practitioner from this obligation
  43. 43. CONFIDENTIALITY <ul><li>Until now, confidentiality has been a professional duty enforced in limited circumstances by Common Law. </li></ul><ul><li>However , as a consequence of the Human Rights Act Article 8 (1) it becomes a Statutory right subject to the differences in Article 8 (2) </li></ul>
  44. 44. CONFIDENTIALITY BREACH of confidentiality occurs : If anyone deliberately or by accident gives information, which has been obtained in the course of professional practice,to a third party without the consent of the patient/client
  45. 45. CONFIDENTIALITY <ul><li>DISCLOSURE of information occurs in the following ways: </li></ul><ul><li>With the consent of the patient/client </li></ul><ul><li>Without the consent of the patient/client when disclosure is required by LAW or ORDER OF COURT </li></ul><ul><li>By accident </li></ul><ul><li>Without the consent of the patient/client when disclosure is considered necessary in the PUBLIC’S BEST INTEREST </li></ul>
  46. 46. CONFIDENTIALITY <ul><li>Disclosure in the PUBLIC’S BEST INTEREST </li></ul><ul><li>English case law: </li></ul><ul><li>W v Egdel [1990] 1 AC 10 </li></ul><ul><li>American case law: </li></ul><ul><li>Tarasoff v Regents of the University of California (1976) </li></ul>
  47. 47. CONFIDENTIALITY <ul><li>Public interest v private rights </li></ul><ul><li>The Human Rights Act (1998) </li></ul><ul><li>Article 8 Right to respect for private and family life (Children) </li></ul><ul><li>A claimant who gave birth to an “unwanted” disabled child as a result of her doctor’s failure to treat and advise her appropriately, was able to recover her economic loss arising from the additional costs occasioned by the disability </li></ul><ul><li>Sarah Jane Groom v Dr Miranda Ruth Selby CA (2001) </li></ul>
  48. 48. CONFIDENTIALITY <ul><li>Public interest v private rights </li></ul><ul><li>The Human Rights Act (1998 ) </li></ul><ul><li>Article 10: Freedom of expression </li></ul><ul><li>Everyone shall have the right to freedom of expression </li></ul><ul><li>The exercise of these freedoms may be subject to restriction; conditions or penalties which are described in law …. For the protection of the reputation of others, for preventing the disclosure of information received in confidence …. </li></ul>

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