Critical Essay Medical Ethics Re Confidentiality

Critical Essay Medical Ethics Re Confidentiality

Medical diagnosis and treatment produce information useful to direct patient care and a variety of other social circumstances. It has been a traditional precept of medical ethics, however, that confidentiality in health care is the best way to protect the well-being of patients. For this reason, there is a strong presumption that information produced in the course of health care may not ordinarily be disclosed without the patient's permission. This chapter examines the ethical and legal foundations of confidentiality within medical relationships. Both ethics and the law support a strong presumption in favor of medical confidentiality. That confidentiality is not, however, absolute, and there are justifiable exceptions, as described below.

Ethical and Legal Reasons for Confidentiality

There is strong ethical and legal agreement that medical relationships ought to be respected as confidential. This agreement is as old as the Hippocratic Oath which says: “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 of.”

This counsel was designed to protect patients from rumor and social judgment. Many of the purposes of confidentiality remain the same 2500 years later. The Declaration of Geneva oath (formulated following World War II and updated in 1982), which is administered to many medical school graduates, declares: “I will respect the secrets which are confided in me, even after the patient has died.” The American Medical Association asserts “The physician should not reveal confidential communications or information without the express consent of the patient, unless required to do so by law.”

Many ethical theories insist on respecting individuals as the central figures in decisions affecting their life choices. One way to do so is to respect the confidentiality of medical information: regardless of consequences, it is important to respect the way in which patients want information to be kept confidential. This is a way of respecting the individual dignity of a person, and not as a means to some other social end.

There are also consequentialist reasons for maintaining confidentiality. Confidentiality protects people in vulnerable states. It also encourages patients to be entirely candid about their injuries and disorders. If patients fear that information about their illnesses and treatments will be broadcast, they may withhold information, and medical management may be compromised. If physicians routinely breach confidentiality, it is feared patients will not trust them. This effect may be highly prejudicial to the management of somatic disease and may be especially damaging in psychiatric relationships.

The law also respects the need for confidentiality in medical treatment. It approaches the matter as one of privacy. Both statute and court interpretations protect patients from unwanted disclosures of information gathered in the course of health care. Most state laws protect patient communications as a matter of privileged communication, something not to be disclosed without permission or legally recognized ...