CONFIDENTIALITY AND ACCESS TO MEDICAL INFORMATION

PREPARED BY:PN FARAH SALWANI MUDA@ISMAILFSU

INTRODUCTION:THE DILEMMA… Patient does not want the information to be

known to others. Patient feels under pressure or embarrassed

with their illness as it may be detrimental on their current employment or insurance cover

Faced with suspected cases of rape, abuse or even HIV/AIDS

Are these covered by the principle of confidentiality?

DEFINITION OF CONFIDENTIALITY The legal or ethical duty to keep private

information secure and secret from others. Purpose: respects a patient’s autonomy,

acknowledges patient’s privacy, protects doctor’s integrity.

Therefore, communication between the doctor-patient will be honest & straightforward.

Patients feel free to disclose important information

HIPPOCRATIC OATH

“whatever things I see or hear concerning the life of men, in my attendance on the sick or even apart there from, which ought not be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets”

DECLARATION OF GENEVA

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

Therefore, confidentiality in a doctor-patient relationship is an ethical obligation and part of ones human rights.

Everyone has the right to respect as a human being, to self determination, to physical and mental integrity and to privacy

WORLD HEALTH ORGANISATION (WHO)

a)all information must be kept confidential, even after death

b) information can only be disclosed if the patient gives explicit consent or the law specifically provides for it.

c)all identifiable patient data must be protected

d)patients have the right of access to their medical files which includes diagnosis, treatment and care

CONT… e)patients have the right to require clarification,

updating of personal and medical data concerning them which are not relevant to the diagnosis, treatment and care.

f) there can be no intrusion into a patient’s private and family life

g)medical interventions may only be carried out when there is proper respect shown for the individual’s privacy

h) patients have the right to expect physical facilities which ensure privacy, esp when care providers are offering personal care, carrying out examinations or treatment

MALAYSIAN MEDICAL CODE OF PROFESSIONAL CONDUCT

Paragraph 2.22-Abuse of confidence “a) practitioner may not improperly

disclose information which he obtains in confidence from or about a patient

JUSTIFICATIONS FOR BREACHING CONFIDENTIALITY

Got patient’s consent-patient competent, no duress or undue influence

Statutes permits eg:the Prevention and Control of Infectious Diseases Act 1988

For public interest-X v Y[1988]-practicing doctors having AIDS. Held:preserving confidentiality of hospital records identifying AIDS sufferers were more important than publishing such information for public interest

To prevent harm to 3rd party-Tarasoff case

DISCLOSURE OF HIV/AIDS STATUS Even when public interest requires disclosure,

it must be confined to what is strictly a necessity

It does not justify disclosing all details In Malaysia, counseling is conducted to ensure

that there is consent for blood or other testing Charter for doctors-HIV patients are

encouraged to inform the attending doctors of their status. But this information shall be restricted to medical professionals only.

UNDER COMMON LAW Disclosure of a HIV status is allowed provided that

these 2 conditions are satisfied. 1) there is real risk to the people to be informed 2) disclosure is the only practical way to protect them Doctors are advised to explain the nature and

implication of such disease If patient refuse to allow others to be informed,

disclosure is allowed as long as there is a foreseeable risk of death or serious harm. The patient must also be told about such disclosure of information

IS THERE ANY PRIVILEGED COMMUNICATION BETWEEN DOCTORS & PATIENTS?

No! not yet… Law recognises the ethical duty of

confidentiality between doctors/patients but compels disclosure if public interest demands it.

PP v Dato’ Seri Anwar Ibrahim & AnorHeld: there is no privilege under law for a

doctor to refrain from disclosing what transpired between him and his patient.

ACCESS TO MEDICAL RECORDS-MALAYSIA No particular legislations are available

which allows such access. Nevertheless it is the right of the

patient to see his medical record. This is to verify accuracy of the

information kept in it. Also needed to bring claims in medical

negligence