This document discusses several topics relating to medical ethics, including patient confidentiality, autonomy, and beneficence. It notes that patient confidentiality is highly regulated by law in countries like the US, UK, and EU. Violations can result in civil, administrative, or criminal liability. The principle of patient autonomy means respecting a patient's right to make their own medical decisions, and violating that through actions like performing procedures without consent can constitute battery. However, doctors also have a duty of beneficence to act in the patient's best interests. The document examines some of the complex ethical dilemmas that can arise when balancing these duties.

1. Patient
confidentiality
Ethical and legal ramifications
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2. Patient confidentiality
(U.S. Department of Health & Human Services, 2017)
(European Parliament and of the Council, 2017)
(General Medical Council, 2017)
Legal
requirement
Depends on
jurisdiction
Not an absolute
right
Disclosures
limited in extent
and scope
USA: HIPAA
Privacy and
Security Rule
EU: Directive
95/46/EC
UK: GMC Good
practice
National laws in
the EU
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3. Ethics: Patient Autonomy
„the rule of the self that is free from control and interference
from others as well as any personal limitations that prevent the
making of a personal choice” (David Weisstub & Guillermo Pintos, 2013)
Principal issues
Informed consent
Battery
Negligence
Fraud
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4. Breach of Autonomy: Medical battery
Medical battery
 Battery is a criminal offense
 Battery can also be the basis of
a civil lawsuit
 Forcing beneficial care on an
unwilling patient is battery
”Every human being of adult years and sound mind has a right to
determine what shall be done with his own body; and a surgeon who
performs an operation without his patient's consent, commits an
assault, for which he is liable in damages.”
Battery as a legal threat
 the patient has been lied to about
the treatment
 other fraud in the informed
consent (consent is invalid)
 the patient is incompetent and
receives improper care
 intent to cause harm
("Basic right to consent to medical care - Schoendorff v. Society of New York Hosp., 105 N.E. 92, 93
(N.Y. 1914)", n.d.)
(The LSU Medical and Public Health Law Site, n.d.)
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5. Patient confidentiality
“Trust is an essential part of the doctor-patient relationship and
confidentiality is central to this. Patients may avoid seeking medical help, or
may under-report symptoms, if they think their personal information will be
disclosed by doctors without consent, or without the chance to have some
control over the timing or amount of information shared”
GMC Good Practice Guidance
• Principles of confidentiality and patients’ privacy
• Responsibilities for managing and protecting PI
• Disclosures to support direct care
• Disclosures to protect the patient and others
• Other disclosures
(General Medical Council, 2017)
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6. Principle
of Beneficence
„The principle of beneficence is seen as
pertinent to the routine delivery of health
care, the discovery of new therapies, and
the rationale of public policies related to
health care.
• Non-maleficence
• Beneficence
• Confidentiality
(Shelp, 1982)
Hippocratic ethics
(Munyaradzi, 2012)
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7. Truthfulness
• 90% of patients wish to know their condition
• Appropriate sensitivity and tact
• Relevant aspects of the illness
• Expected outcomes
• Available treatments
• Exemptions: risk of suicide
• Deception with placebo
(the University of Washington, n.d.)
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8. Landmark cases
Conscientious Refusal
Contraceptive refill
Pharmacist refused to refill the prescription on religious grounds
Professional responsibility vs. personal belief
Patient autonomy vs. perceived beneficence
Pharmacist’s conduct constituted
The ruling limited the pharmacist’s license
(McLean, 2011)
"a danger to the health, welfare, or safety of a patient and was
practiced in a manner which substantially departs from the
standard of care ordinarily exercised by a pharmacist and
which harmed or could have harmed a patient.“
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9. Medical ethics: practical dilemmas
• Field developing over time
• Research on terminal
cancer patients
• Political and religious
perspectives
• Adolescents and people
with diminished capacity
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(Macklin, 2015)

10. Key takeaways
• Patient confidentiality is highly regulated
• Violations: civil, administrative and criminal liability
Confidentiality
 Defined in law in the USA, UK and EU
 Disclosures limited in extent and scope
Autonomy v. Beneficence
 Ask for Next of Kin, seek Power of Attorney
 Medical negligence
 Medical battery
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11. Recommendations for change
• Potential for liability
• Continuing professional education
• Update on landmark cases
• Takeaways for practice
• Advisory body for complex cases
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12. References
Basic right to consent to medical care - Schoendorff v. Society of New York Hosp., 105 N.E. 92, 93 (N.Y. 1914).
Biotech.law.lsu.edu. Retrieved 19 June 2017, from http://biotech.law.lsu.edu/cases/consent/Schoendorff.htm
David Weisstub & Guillermo Pintos. (2013). Autonomy and Human Rights in Health Care: An International
Perspective. New York : Springer Books.
General Medical Council. (2017). GMC | Confidentiality: good practice in handling patient information (2017).
Gmc-uk.org. Retrieved 19 June 2017, from http://www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp
General Medical Council. (2017). GMC | Contents: Confidentiality: good practice in handling patient information.
Gmc-uk.org. Retrieved 19 June 2017, from http://www.gmc-uk.org/guidance/ethical_guidance/30579.asp
European Parliament and of the Council. (2017). EUR-Lex - 31995L0046 - EN - EUR-Lex. Directive 95/46/EC of
the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the
processing of personal data and on the free movement of such data. Retrieved 19 June 2017, from http://eur-
lex.europa.eu/legal-content/en/TXT/?uri=CELEX:31995L0046
Macklin, R. (2015). The Ethical Dilemma of Forced Chemotherapy on a Teen. The Doctor's Tablet. Retrieved 19
June 2017, from http://blogs.einstein.yu.edu/the-ethical-dilemma-of-forced-chemotherapy-on-a-teen/
McLean, M. (2011). Conscientious Refusal. Scu.edu. Retrieved 19 June 2017, from
https://www.scu.edu/ethics/focus-areas/bioethics/resources/conscientious-refusal/
Munyaradzi, M. (2012). Critical reflections on the principle of beneficence in biomedicine. The Pan-African
Medical Journal, 11(29). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325067/
The LSU Medical and Public Health Law Site. Battery—No Consent. Biotech.law.lsu.edu. Retrieved 19 June 2017,
from https://biotech.law.lsu.edu/map/BatteryNoConsent.html
University of Washington. (2017). Truth-telling and Withholding Information: Ethical Topic in Medicine.
Depts.washington.edu. Retrieved 19 June 2017, from https://depts.washington.edu/bioethx/topics/truth.html
U.S. Department of Health & Human Services. (2017). HIPAA for Professionals. HHS.gov. Retrieved 19 June
2017, from https://www.hhs.gov/hipaa/for-professionals/index.html
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