Physicians, Patients, and Others: Autonomy, Truth Telling, and Confidentiality

Privacy & Confidentiality Privacy: the right to control access to one's body, one's self, and information about one's self Confidentiality: the right to have information about one's self revealed to others restricted unless there is an agreement to the contrary on both sides

Privacy & Confidentiality Why privacy? Protects autonomy Protects right to control access to the self Protects right to relations with varying degrees of intimacy Protects from the harm of mis-use of information Protection of privacy & honoring confidences enhances trust

Generally accepted principles: 1)Privacy is an essential part of the doctor/patient relationship 2)Information revealed or shared in the doctor/patient relationship ought generally to be held in confidence 3)Physicians should, in general, tell their patients the truth Privacy & Confidentiality

Are there exceptions to these generally accepted principles? Some possible exceptions: 1)harm to self 2)harm to others 3)greater good/social benefits 4)"need to know" Privacy & Confidentiality

Tarasoff: Do psychiatrists have a duty to warn potential victims of their patients? Balance/weigh: a)privacy of the doctor/patient relation b)harm to victims the threat:serious, focused Privacy & Confidentiality

Other legal duties to warn: STD's other infectious diseases, e.g. hepatitis, AIDS Child abuse, elder abuse Faculty abuse Other protected professional/client relations: priest/penitent lawyer/client journalist/source Privacy & Confidentiality

Medical records/patient information: "need to know" Siegler: list of those who have access and need to know is too large to manage, therefore confidentiality is a decrepit concept ?? Will electronic record-keeping make it easier to access information? Privacy & Confidentiality

Medical records/patient information (cont.): How is "need to know" to be defined? 1)For the benefit of the patient? 2)For use of those involved in care and treatment? 3)For research use of data? Does everyone with a need to know need to know everything? Privacy & Confidentiality