PRINCIPLES AND CODES OF MEDICAL ETHICS; CONFIDENTIALITY IN THE MEDICAL PROFESSION

„What I see or hear in the course of the treatment…., which on no account must be spread abroad, I will keep to myself“

Hippocratic oath, 400-300 BC

“I will respect the secrets which are confided in me, even after the patient has died.”

Declaration of Geneva, as amended Sydney 1968

PATIENT´S EXPECTATIONS QUALITY CARE. CONFIDENTIALITY.

Question:What do you think? Nowadays, is there any problem which can disturb any of these expectations?

Answers: Internet, e-mail, fax machines; Computerized medical records (e.g. for insurance

company); More physicians sharing patient´s information;

Personal and confidential information about patients should be limited to conveying it to the absolute minimum number of healthcare employees.

WHAT IS CONFIDENTIALITY? The basic confidentiality in a doctor-

patient relationship is that patients have right to expect a doctor do not to disclose any personal information about the patient during the course of medical activity.

This principle protects right to patient and helps doctor treat them properly.

PRINCIPLES OF CONFIDENTIALITY Doctor should respect the patient´s

wish if he or she doesn´t want information to disclose.

If the patient does agree to the disclosure of confidential information, only as much as necessary should be released.

The doctor must be prepared to justify and explain his or her reasons in the case of a decision to disclose this information.

THE PRINCIPLES OF CONFIDENTIALITY 1(GENERAL MEDICINE COUNCIL)

28. Confidentiality is central to the trust between doctors and patients and an essential part of good care. Without assurances about confidentiality, children and young people, as well as adults, may be reluctant to get medical attention or to give doctors the information they need to provide good care.

29. Teenagers may be particularly concerned about keeping confidential information from their parents, schools, children’s services, the police and other statutory agencies. Young people, parents and other adults receiving psychiatric care, and other vulnerable people might have similarly increased concerns about sharing confidential information.

THE PRINCIPLES OF CONFIDENTIALITY 2(GENERAL MEDICINE COUNCIL)30. But sharing information appropriately is essential to providing

safe, effective care, both for the individual and for the wider community. It is also at the heart of effective child protection. It is vital that all doctors have the confidence to act on their concerns about the possible abuse or neglect of a child or young person.

31. Confidentiality is not an absolute duty. You can share confidential information about a person if any of the following apply. a. You must do so by law or in response to a court order. b. The person the information relates to has given you their consent

to share the information (or a person with parental responsibility has given consent if the information is about a child who does not have the capacity to give consent).

c. It is justified in the public interest – for example, if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential.

CONFIDENTIAL INFORMATION CAN BE

DISCLOSED ONLY WITH THE CONSENT OF THE PATIENT, OR OF SOMEONE PROPERLY

AUTHORIZED TO ACT ON THE PATIENT´S BEHALF!

THE EXAMPLES FROM PRACTICE In Humphers v Interstate (1985) a physician was sued after he disclosed his

patient´s identity to the adult daughter, she had placed for adoption in infancy.

In Bagent v. Blessing Care Corp. (2007) an Illinois hospital and hospital phlebotomist were sued by a patient whose sister was told of the patient´s positive pregnancy test. The phlebotomist falsely assumed the patient had discussed the pregnancy with her sister. Even a spouse cannot be presumed a confident.

In Gracey v. Eaker (2002) a married couple sued their marriage counselor for breach of confidentiality. The therapist sometimes met with the spouse separately. The couple alleged that the therapist revealed sensitive and personal information that neither spouse had disclosed to the other.

In Morris v. Consolidation Coal Co. (1994) an employer videotape an employee engaging in physical labour at this home despite claiming a serious disability for which he was receiving workers compensation benefits. The employer showed this videotape to the employee´s doctor. The physician then wrote a report stating that he could no longer certify a back injury. The employee sued the physician alleging breach of physician patient confidentiality relationship. He also sued the employer for interference with his confidential relationship with his patient.

A PATIENT´S BILL OF RIGHTS1. The patient has the right to considerate and respectful care.2. The patient has the right to and is encourages to obtain from physicians and other direct caregivers

relevant, current, understandable information concerning diagnosis, treatment and prognosis.3. The patient has the right to make decisions about the plan of care prior to and during the

course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the consequences of the action.

4. The patient has the right to have an advance directive (such as living will, healthcare proxy, or durable power of attorney for healthcare) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honour the intent of that directive to the extent permitted by law and hospital policy.

5. The patient has right to every consideration of privacy.6. The patient has the right to expect that all communications and records pertaining to

his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law.

7. The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.

8. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate medically indicated care and service.

9. The patient has the right to ask and be informed of the existence of business relationship among the hospital, educational institution, other healthcare providers, or payers that may influence the patient´s treatment or care.

10. The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent.

11. The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.

12. The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities.

FIVE FORMS REQUIRED TO PROTECT PATIENT´S PRIVACY

1. The privacy notice;2. Acknowledgement that the notice was

received;3. Authorization, or consent, from the

patient to provide information to others;

4. An agreement reached with a healthcare professional´s business associates;

5. A trading partner agreement.

PHYSICIAN´S RIGHTS Physicians have the right to select the patients they wish

to treat. They also have the right to refuse service to patients. They may state the type of service they will provide. They have the right to expect payment for all treatment

provided. They withdraw from a relationship of the patient is

noncooperative. They have the right to take vacations and time off from

their practice. They should notify their patients when they will be

unavailable.

EXAMPLES OF PHYSICIAN´S DUTIES Conflict of interest – physicians should not place their own

financial interests above the patient´s welfare. Professional courtesy – historically, there is an unwritten

practice among many physicians that they would not charge each other for professional services. However, this practice has lost favor because many physicians are concerned about the lack of documentation when seeing a fellow physician free of charge.

Reporting unethical conduct of other physicians – A physician should report any unethical conduct by other physicians.

Second opinions – Physicians should recommend that patients seek a second opinion whenever necessary.

Sexual conduct – It is unethical for the physician to engage in sexual conduct with a patient during the physician-patient relationship.

Treating family members – Physicians should not treat members of their family except in an emergency.

EXAMPLE FROM PRACTICE„Medical Interview Preparation - Duties of a Doctor“

http://www.youtube.com/watch?v=gqxk1YzkuYs

BASIC PRINCIPLES OF MEDICAL PROFESSION

Beneficence, Non-malefinence, Justice, Autonomy.

CASE STUDY / CULTURAL CONFLICT AND PROFESSIONAL O

A doctor who encounters patients from a different cultural background may find that ethical questions are raised by treating them - questions which are not normally problematic inn western culture.An example of a case involving these issues will indicate the dedicatees which can be encountered.A mother who grew up in Laos before moving to the west brings her four-month-old baby to have regular immunizations, as is normal in the west. However, the mother - who is a intelligent and articulate person- is one of group immigrants from Laos who still practise some of the customs of that country. One of these customs is a way of “healing” a baby who seems nervous and irritable; a flower from a particular plant is dipped in oil and burnt over the baby’s skin, causing some small burns on the skin {and obviously causing pain to the baby}. When the physician at the woman’s local health centre discovers what has happened, she is in a dilemma; should she tell the woman not to practice any more of these “remedies” on her baby or not?

1] What type of healing did the mother from Laos use?2] Why should we tolerant traditional medical practices?3] When and how should we react against traditional medical practices?

REVISION What is confidentiality and why it is so

important in relationship between a patient and a doctor?

Why or how can be confidentiality disturbe?

Can you say some rights of a patient? Can you say some right of a doctor?