This document discusses medical ethics and legal medicine related to confidentiality and privacy. It begins by defining privacy and confidentiality, noting that privacy respects a patient's body while confidentiality respects their personal medical information. It then outlines various measures to protect patient privacy during medical examinations and treatments. The document also discusses the concept of medical secrets and the duty of confidentiality, the importance of which is enshrined in ethics codes and laws. Exceptions to maintaining confidentiality are noted, as well as measures to protect confidential information and ensure it is kept private.

1. MEDICAL ETHICS
AND
LEGAL MEDICINE
Dr. Rami Abo Ali
Medical
Ethics
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Dr.
Rami
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2. CONFIDENTIALITY
Medical
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3.  Privacy :
 A right or expectation to not be interfered with
 - Be free from surveillance
 - A moral right to be left alone.
 RESPECTS PATIENT’S BODY
 Confidentiality :
 Is the right of an individual to have personal, identifiable
medical information kept out of reach of others.
 RESPECTS PATIENT’S INFORMATION
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4. MEASURES TO PROTECT PRIVACY
1) Make sure examination takes place in isolation from other
patients, unauthorized family members, and/or staff
2) Provide gender-sensitive waiting and examination rooms
3) Provide proper clothing for the admitted patients
4) Make sure patients are well covered when transferred
from one place to another in the hospital
5) Make sure your patient’ s body is exposed ONLY as much
as needed by the examination or investigation
6) Patients should have separate lifts and be given priority
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5. MEASURES TO PROTECT PRIVACY
7) Always take permission from the patient before
examination
8) Insure privacy when taking information from patients
9) Avoid keeping patients for periods more than required by
the procedure.
10) It ’s prohibited to examine the patient in the corridors or
in the waiting area.
11) During examination, no foreign person unrelated to the
patient allowed
12) Give patients enough time to expose the part with pain
13) Only relevant personnel are allowed to enter the
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6. 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”
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7. MEDICAL SECRET
 It includes any information that the doctor (or
treatment team) 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 the patient ’ s identity,
condition, diagnosis, investigations’ results, treatment,
and/or prognosis (whether chances of cure, disability, or
death)
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8. PRIVACY IS VALUED IN ETHICS AND LAW
 Protecting someone’s privacy involves protecting them
from unwanted access or control by others.
 In this way it is linked with personal autonomy and it is
also viewed as a key element of personal identity.
 Privacy can be thought of in terms of five dimensions:
1. Physical privacy
2. Informational privacy
3. Decisional privacy,
4. Personal property
5. Expressive privacy.
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9. 1. Physical privacy
Protecting patients’ physical privacy will alert staff to:
• Introduce physical touch with request and explanation.
• Minimize the duration and the extent of exposure.
• Minimize or get permission for the bedside presence of
medical/nursing students, spectators, or cameras
producing photographs for study purposes
• Provide explanations to patients of what happens during
times when they are unconscious
• The importance of expanding the number of single over
shared hospital rooms
• The sensitivity of many patients to rooms of mixed sexes
• The possible preference of some patients for doctors or
nurses of their own sex .
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10. 2. Informational Privacy
Secrecy, confidentiality, anonymity and protection of patient
data
3. Decisional Privacy
Patients can expect to be allowed, if not encouraged, to
make their own decisions and act on their decisions if they
so choose free from state, governmental or health
professionals interference
Concerns responsibility for very important choices about
treatment, termination of treatment, and involvement in
clinical trials
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11. 4. Personal Property
 Includes all of a patient’s personal belongings and,
especially, those items that are considered by them to be
most important, e.g., personal diaries, letters, handbags
and wallets.
5. Expressive Privacy
 Protects a region for expressing one’s self-identity or
personhood through activity or speech.
 Self expression is critical for lifestyle choices that
contribute greatly to defining oneself and one’s values.
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12. WHAT IS 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 disclosure”
 “The nondisclosure of information except to another
authorized person”.
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13. WHY IS THERE A DUTY FOR CONFIDENTIALITY?
 Trust between patients and health professionals.
 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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14.  Because it has long been held as an honored bond between
health professionals and patients, the keeping of
confidentiality has been enshrined in both professional and
legal codes.
 It was first articulated in the Hippocratic Oath (c.5Th
Century BC):
 ‘What I may see or hear in the course of the treatment or
even outside of the treatment in regard to the life of
men, which on no account one must spread abroad, I will
keep to myself, holding such things shameful to be
spoken about.’
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15. CONFIDENTIALITY IS PROTECTED BY PROFESSIONAL CODES
AND LAWS
 Ancient and modern medical and nursing codes stress
the duty of confidentiality as a ‘time honored principle’
that extends beyond death.
 Health professionals are also legally obliged to protect
patient confidentiality under the common law: legal
sanctions are in place for breaches of patient
confidence.
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16. CONFIDENTIALITY IN THE HEALTHCARE SETTING
 All information about one’s patient is confidential.
 This means not only their health situation but also,
living situation, family, and finances.
 As part of the Health Insurance Portability and
Accountability Act (HIPAA): healthcare organizations
must make sure that patient’s medical information
remain safe and confidential .
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17. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY
ACT (HIPAA)
 The Health Insurance Portability and Accountability Act of
1996 (HIPAA) is a federal law that required the creation of
national standards to protect sensitive patient health
information from being disclosed without the patient's consent
or knowledge
 Assures that individuals’ health information is properly
protected while allowing the flow of health information needed
to provide and promote high quality health care and to protect
the public's health and well being.
 Applies to health plans, health care clearinghouses, and to any
health care provider who transmits health information.
 Protects all individually identifiable health information held or
transmitted by a covered entity or its business associate, in any
form or media, whether electronic, paper, or oral .
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18. THING THAT SHOULD BE KEPT CONFIDENTIAL
 Name
 Address
 Birth date
 Social Security Number
 Phone number
 Medical record number
 Diagnosis
 Treatment
 Prognosis
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19. CONFIDENTIALITY MEASURES
1) Limit the accessibility to the medical records
2) Do not discuss the patient’ s medical information with
unauthorized family members
3) Do not disclose patient’ s information without his/her
consent, or in established exceptions
4) Do NOT collect information not related to the
provision of care
5) Set policies that regulate access to medical
information and how any breach to confidentiality is
managed
6) Limit sharing of information with other staff, unless in
cases of consultations and second opinion
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20. CONFIDENTIALITY MEASURES
 In all records
 Never inappropriately access records;
 Shut/lock doors, offices and filing cabinets;
 Query the status of visitors/strangers;
 In manual records
 Hold in secure storage;
 Tracked if transferred, with a note of their current location
within the filing system;
 Returned to the filing system as soon as possible after use;
 Stored closed when not in use so that the contents are not
seen by others;
 Kept on site unless removal is essential.
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21. CONFIDENTIALITY MEASURES
 In electronic records
 Always log out of any computer system or application
when work is finished;
 Do not leave a terminal unattended and logged in;
 Do not share Smartcards or passwords with others;
 Change passwords at regular intervals;
 Always clear the screen of a previous patient’ s
information before seeing another.
 Email and fax
 Whenever possible, clinical details should be separated
from demographic data;
 All data transmitted by email should be encrypted 21
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22. TIPS FOR MAINTAINING CONFIDENTIALITY
 Only view information on patients that you are directly
providing care to.
 After viewing confidential information on the computer,
log off so others cannot view the information.
 Avoid discussing a patient’s care in non-private areas
,examples: elevator, hallway or cafeteria. You never
knows who is listening.
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23. TIPS FOR MAINTAINING CONFIDENTIALITY
 Be careful of what you throw away.
 Personal health information should never be disposed of
in the trash can.
 Any document thrown in the trash is open to the public
and therefore a breach of information.
 Think before you speak.
 Is what you are about to say confidential?
 If so is the person you are speaking to part of the
patient’s healthcare team?
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24. IF PATIENTS LACK THE CAPACITY TO CONSENT TO SHARING
INFORMATION
 Health professionals may need to share information with
relatives, friends in order to enable them to be involved in
decisions about the patient’s best interests.
 The sensitivity of the information and any known wishes of
the patient in regard to it must be taken into account.
 While hospitals may routinely seek the consent of the ‘next of
kin’ in relation to a decisions, this consent has no legal basis.
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25. WHAT IF A FAMILY MEMBER ASKS HOW THE PATIENT IS
DOING?
 While there may be cases where the physician feels naturally
inclined to share information, such as responding to an
inquiring spouse, the requirements for making an exception
to confidentiality may not be met.
 If there is not explicit permission from the patient to share
information with family member, it is generally not ethically
justifiable to do so.
 Except in cases where the spouse is at specific risk of harm
directly related to the diagnosis, it remains the patient's (and
sometimes local public health officers’), rather than the
physician's, obligation to inform the spouse.
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26. DISCIPLINARY ACTIONS FOR BREACHING PATIENT
CONFIDENTIALITY
 Disciplinary actions for breaching patient confidentiality can
range from fines to termination of employment, depending
on the extent of the breach.
 Be aware that you can be held liable even if you give out your
patients’ personal information by mistake.
 In June 2010 five California hospitals were issued
administrative fines and penalties totaling $675,000 after it
was determined they'd failed to prevent unauthorized access
to confidential patient medical information.
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27. CONSIDERING THE DISCLOSURE
 You may disclose personal information if it is of overall
benefit to a patient who lacks the capacity to consent.
 When making the decision about whether to disclose
information about a patient who lacks capacity to consent,
you must :
a) make the care of the patient your first concern
b) respect the patient’s dignity and privacy
c) support and encourage the patient to be involved, as far as
they want and are able, in decisions about disclosure of
their personal information
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28. THE FIVE C'S OF CONFIDENTIALITY AND HOW TO DEAL
WITH THEM
 Consent—A clinician may release confidential information with the
consent of the patient or a legally authorized surrogate decision
maker, such as a parent, guardian, or other surrogate designated by
an advance medical directive.
 Court Order —A clinician may release confidential information
upon the receipt of an order by a court of competent jurisdiction.
 Continued Treatment —A clinician may release confidential
information necessary for the continued treatment of a patient.
 Comply with the Law —A clinician may reveal confidential
information in order to comply with mandatory reporting statutes
(e.g., child abuse), and other such lawful purposes.
 Communicate a Threat —This is the well known Tarasoff exception
to confidentiality that involves the clinician's duty to protect others
from violence by a patient. 28
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29. CONDITIONS TO DISCLOSE MEDICAL SECRET
1) Approval from the patients within the limit given in the
approval
2) If the information are required by judiciary
3) Consultation or second opinion.
4) Notification of events of public health interest/threats
(birth, death, notifiable diseases, etc.)
5) Prevent individual/personal threats (e.g. prevent crimes)
6) If needed by the doctor to defend him/herself before
judges, or discipline committee
7) If the patient consciously and truly admits committing a
crime on which another person was accused/punished
 Remember: Disclosure should be only to the concerned party & not
beyond the needed limits 29
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30. THE DUTY OF CONFIDENTIALITY EXTENDS BEYOND DEATH
 Guidelines that protect living patients equally apply after
patients have died.
 Exceptions to confidentiality also equally apply.
 International guidelines governing the release of medical
records of deceased patients generally consider:
 the known wishes of deceased patients in relation to their
information.
 the impact of non-disclosure on the wellbeing and welfare
of third parties – avoiding harming them or benefitting
them.
 the impact of disclosure on the reputation of the
deceased; the possibility of anonymising the information. 30
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31. DECEASED PATIENTS
 Your duty of confidentiality continues after a patient has died .
 Whether and what personal information may be disclosed after a
patient’s death will depend on the circumstances.
 If the patient had asked for information to remain confidential, you
should usually respect their wishes.
 If you are unaware of any instructions from the patient, when you
are considering requests for information you should take into
account:
 Whether the disclosure of information is likely to cause distress
to, or be of benefit to, the patient’s partner or family
 Whether the disclosure will also disclose information about the
patient’s family or anyone else
 Whether the information is already public knowledge or can be
anonymised or coded, and
 The purpose of the disclosure’
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32. CASE
 Your 36-year-old patient has just tested positive for HIV.
He asks that you not inform his wife of the results and
claims he is not ready to tell her yet.
 What is your role legally? What would you say to your
patient?
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33. CASE 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 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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