The most obvious examples of public health concerns outweighing individual rights are from contagious disease cases. case 6.3 | Breaching patient confidentiality to prevent possible harm Andy Cox is a nurse in a physician’s office some 30 miles from his hometown. Some—privacy, confidentiality, continuity of care, and reasonable prudence—are well known and much discussed. In Wenden v Trikha, a duty to protect a third party or parties was indicated if a requisite proximity of relationship existed12. Thus, although doing no harm should be one's first consideration, it must not prevent the clinician from avoiding all treatments which have some risk attached. Physician's Duties: Patient's Expectations . 19. This leaves open, however , the question of a journalist’s obligations in The obvious harm to the patient in this case was his loss of life, but failing to provide needed care can cause substantial harm short of death. Mrs. B's refusal to share her test results with her daughter places Dr. T in a dilemma. Concerning the first argument, as noted earlier, most confidentiality laws allow reporting of abuse or neglect. When providing care, consider the risks and benefits and, where significant, discuss these with the patient and record the discussion in the notes. On one hand, the physician has a legal and ethical duty to Mrs. B to maintain confidentiality. Between a rock and a hard place: AIDS and the conflicting physician’s duties of preventing disease transmission and safeguarding confidentiality. Medicine has an obligation to protect the well-being of the community. The physician-patient relationship conveys many duties; one is to prevent harm. interest in disclosure outweighs both the individual’s right to confidentiality, and the public interest in a confidential health service, information can be disclosed without consent, and even in the face of a competent refusal. If there is reason to believe that the parent's impaired judgment substantially risks harming the patient or others, the pediatrician should attempt to decrease that risk by the least restrictive means. It requires health care providers to keep a patient’s personal health information private unless consent to release the information is … I. The Nigerian National Health Act (passed by both legislative Houses and awaiting the President’s signature) forbids disclosure of medical information save in the following circumstances, namely, the patient consents in writing, the disclosure was made pursuant to a court order or legal requirement, or to prevent a serious threat to public health. The Physician’s Legal and Ethical Duties. There may, however, be cases where public interest overrides doctor/patient confidentiality. Because the seriousness of the threatened injury outweighs the damage done to the patient by breaching confidentiality, the obligation of confidentiality must give way to the duty to prevent harm to others. victim may be insufficient action to prevent harm in certain circumstances. It is less clear how to deal with the physician’s responsibility to prevent harm to the public. In particular, should a physician be able to breach confidentiality when public health or safety is threatened? While the American Society for Reproductive Medicine guidelines may support disclosure over the objections of the surrogate, the authors argue that such disclosure is a violation of the surrogate’s rights and the physician’s ethical and professional duties. Such an obligation had been first established more than 140 years earlier than 1991. This will usually be where disclosure is required to prevent or mitigate a risk of serious harm to others. The ethical category of Non-Malfeasance represents the doctor’s attempt to avoid any act or treatment plan that would harm the patient or violate the patient’s trust, and has been popularized in the phrase “first, do no harm.” Non-Malfeasance is supported through Confidentiality and Prevention. European Journal of Human Genetics, 12, 93–97. Chapter 11 -- The Physician’s Other Duties: Good Faith, Loyalty and Confidentiality. Health Insurance Portability and Accountability Act. Protecting the patient’s physical and mental health is considered the physician’s primary responsibility. Confidentiality is a central aspect of the physician–patient relationship.1 Codes of professional ethics and the laws of most countries affirm its importance.2, 3 According to Swiss criminal law, violations of medical confidentiality are punished by a fine or a prison sentence. 7 ThePresident’sCommissionfortheStudy of Ethical Problems in Medicine and Biomedical and Be- 112 Common Ethics Issues in Rural Communities a check-up. In the course of duty and relationship with patients the physician must adhere to certain principles of medical ethics (autonomy, non-maleficence, beneficence and justice), rules (fidelity, confidentiality, privacy and veracity) and virtues (compassion, kindness, respect, etc). Mandatory reporting laws raise important ethical questions, because they prioritize public and patient welfare and set aside both patient autonomy and the physician's duty to protect confidentiality; that is, to not disclose what a patient reveals during their encounter with their physician. I engage on the concept of “harm” to discuss the moral scope of the duty to warn an involved third party and when it is justified to breach confidentiality of the patient. Note. The failure of a physician to warn the patient or a third party of a foreseeable risk is a separate and distinct negligent act. A conflict of duties Mrs. B’s refusal to share her test results with her daughter places Dr. T in a dilemma. opiates given to relieve a terminally ill patient’s pain may suppress respirations and hasten death. 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