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Confidentiality & Privacy

Ethics Champions ProgramFebruary 4, 2009

John F. Wallenhorst, Ph.D.Vice President, Mission & Ethics

Bon Secours Health System

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Purpose

Understand origins of the right to privacy, and the obligation, and limits, of confidentiality

Explore practical applications for health care through case study review and discussion

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Case Study – Mr. Jones 60 year-old man admitted with a heart attach; very

poor prognosis He asks that you not share his medical

information with his wife; he does not think “she will be able to take it”

His wife sees you in the hallway and asks you about her husband’s prognosis What would you tell her? What are your required to do legally?

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Privacy

Right to be left alone

and free from unwanted publicity.

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Right to Privacy Foundational as it relates to the obligation of

confidentiality Flows from fundamental rights to life, liberty

and property In health care, most often the right to control

access to and distribution of information Violations of the right to privacy often involve

obtaining information without permission

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Privacy in Health Care Persons have a right to decide who has

access to their bodies or information related to delivery of care

Unless patient gives explicit permission there is a proscription against sharing information Takes into account a special concern for those

who are not capable of protecting themselves

Keeping information to themselves.

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Confidentiality

Obligation not to pass along information about another person without their

permission.

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Obligation of Confidentiality Different than right to privacy But grounded in it Rooted in fiduciary relationships;

relationships of trust Two-fold focus:

Respect for privacy by restricting access to information

Respecting and reinforcing bonds of trust Supporting the care process

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Catholic Health Care

Dignity of the Person Community Justice Prudence Benefit - Burden

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Catholic Health Care

Ethical & Religious DirectivesPart Three: The Professional-Patient Relationship=RelationshipMutual respect, trust, honesty, appropriate

confidentialityDirective 34: respect for privacy and confidentiality

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Codification Hippocratic Oath

“Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot."

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Codification American Medical Association

“That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret."

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Codification American Medical Association

“That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret."

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Codification Professional codes of ethics; state laws; acts of

ethical decision making Federal Privacy Act (1974)

Medical information and records Health Insurance Portability & Accountability Act

(1996) Both:

Improve health care services and research by ensuring flow of medical information

Limiting access to and use of information Carries both civil and criminal penalties

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Joint Commission Administrative procedures and physical

safeguards Authorized use of medical records for

Treatment Quality assurance Utilization review Education Research

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Problem Moral problem: no completely clear lines Impossible to delineate all imaginable scenarios Professional judgment and ethical reflection are

almost always required Rule of thumb

Offer only as much information as is required to provide optimal care

Provide only information that is relevant to the situation

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General Agreement Confidences are to be kept “Need to know” Supporting delivery of care Not for personal gain Not to malign Not as gossip

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Not an absolute obligation.

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Tarasoff Case

Psychiatrist has access to information regarding potential homicide; homicide occurs

1976 judgment“Duty to warn”“Right of confidentiality ends where public

peril beginsBreaching confidentiality is warranted under certain

circumstances

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Exceptions Minors Abuse Safety Public welfare

Duty to report harm.

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Practical Points

Understand and support organization’s HIPPA structures

Understand relevant state laws Promote organizational conversation,

education and leadership around the issuesNot just about complianceAbout dignity, respect, justice

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Practical Points

Don’t assume family members and friends have permission

Don’t provide information over the phone to those whose identity is not verified

Don’t use information that you have from outside health care setting

Special issue in long term care and behavioral health Intimate knowledge, relationship, often key to promoting

good care

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Case 1 – Mr. Jones

What do you say to Mrs. Jones? What support mechanisms are there? Is there an obligation only to Mr. Jones?

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Case 2 – Allison

16 year old girl; seeks medical attention:Birth controlPregnancy testSexually transmitted diseaseSubstance abuse

Her father asks physician for a conferenceWhat can you disclose?

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Case 3 – Mrs. Johnson

75 year old woman Signs of abuse that may have been

inflicted by her husband Husband is primary caregiver Mrs. Johnson is dependent on him, and

pleads with you not “to cause a stir”What do you do?Is this different from case one

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About Relationships

Supporting strong, trust-filled relationships In service to health, well-being and comfort A dimension of holistic care

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Questions & Conversation