Which law or policy regarding justifiable breaches of confidentiality would best

Question

Which law or policy regarding justifiable breaches of confidentiality would best protect both the public health and the rights of persons with communicable diseases? And, if the law or policy permits, but does not require, a breach of confidentiality by mandating the disclosure of information to third parties such as sexual partners under certain conditions, what is the ethically justifiable course of action for public health officials? Which ethical and other factors are relevant to these decisions? On what ethical grounds can a public health official justify their decisions?

Explanation / Answer

Confidentiality is central to the preservation of trust between doctors and their patients.

Concerns about confidentiality have fueled debates about the proper balance of individual and societal interests. Disease surveillance and reporting have often been controversial, particularly for sexually transmitted disease and tuberculosis in the first half of the 20th century and more recently regarding HIV and diabetes.

Confidentiality concerns are even more sensitive in the digital age. High-profile breaches of individuals’ health information have heightened anxiety about privacy, as have plans to create interconnected electronic health information networks. In the public health arena, several well-publicized breaches have occurred within the past few years, including the accidental attachment of an electronic file containing the names and addresses of 6500 HIV/AIDS patients to an e-mail in a county health department, the theft from an employee’s car of a state health department laptop computer containing information on approximately 1600 families, and a state health department employee’s misuse of a computerized list of AIDS patients to look up acquaintances, among other breaches.

Certain information, including HIV/AIDS surveillance information and mental health or substance abuse data, is particularly sensitive and often receives greater confidentiality protection under the law; some states and localities have enacted “super-confidentiality” laws for these diseases.

Public health agencies should assess all possible threats and address as many as feasible using policies, education, and preventive engineering. Emerging technology may help address threats by enhancing the privacy and security of data in transmission and storage. Although an assurance of perfect privacy of health and personal information is impossible, public health agencies should minimize risk by improving staff skills and the ways data are acquired, used, maintained, stored, and shared. Individuals will be more likely to provide personal health information if they have confidence in the security of their data. Public health agencies must proactively impose data security; they depend on the data they receive to promote and protect the public’s health.

the case, claiming that Dr. Moore had an obligation to protect Podder’s confidentiality. Tarasoff’s parents appealed and the California Supreme Court ruled that, “the discharge of this duty may require the therapist to take one or more of various steps. Thus, it may call for him to warn the intended victim, to notify the police, or to take whatever steps are reasonably necessary under the circumstances.” (Ref. Tarasoff case).

The implication of this ruling is that a duty to warn third parties of imminent threats trumps a duty to protect patient confidentiality, however, it is usually difficult for a therapist or health care provider to accurately ascertain the seriousness and imminence of a threat. Tarasoff has subsequently been interpreted to endorse the provider’s duty to warn when a patient threatens an identifiable victim. Ethically, most would agree that a duty to warn an innocent victim of imminent harm overrides a duty to confidentiality, but these cases are rare and judgment calls of this sort are highly subjective. Hence, the duty to maintain confidentiality is critical, but may be overridden in rare and specific circumstances.

Exception 2: Legal requirements to report certain conditions or circumstances

State law requires the report of certain communicable/infectious diseases to the public health authorities. In these cases, the duty to protect public health outweighs the duty to maintain a patient's confidence. From a legal perspective, the State has an interest in protecting public health that outweighs individual liberties in certain cases. For example, reportable diseases in Washington State include (but are not limited to): measles, rabies, anthrax, botulism, sexually transmitted diseases, and tuberculosis. Suspected cases of child, dependent adult, and elder abuse are reportable, as are gunshot wounds. Local municipal code and institutional policies can vary regarding what is reportable and standards of evidence required. Stay informed about your state and local policies, as well as institutional policies, governing exceptions of patient confidentiality.

When disclosure is appropriate or required, physicians should disclose HIV/AIDS information, which is protected health information, in accordance with its extremely confidential nature as required by city, state, and federal laws and regulations, including the Health Insurance Portability and Accountability Act of 1996.

Ethical issues are associated with any discussion of HIV reporting and contact notification. Ethical principles that come into conflict include the right to know, the right of confidentiality and privacy, protection against discrimination, the duty to warn, and the duty to protect the public health. While public health officials usually perceive being responsive to the greater good of the population as their duty, physicians see maintaining the bond between themselves and their individual patients as their duty. Mandatory reporting requirements may seem to conflict with the physician's ethical obligations, including the Hippocratic Oath, which prohibits inappropriate disclosure of any kind of personal health information.

The tension between reporting and confidentiality in HIV and AIDS cases is difficult for physicians. Although the ends of the spectrum may provide for relatively clear action—such as when an infected patient is known to engage in unsafe sexual practices without disclosure—the discussion of HIV disclosure is a difficult issue. Patients may be debilitated and physically vulnerable and may be subject to significant insurance and social discrimination if HIV status is wrongfully disclosed.

Physicians must be cognizant of their patients' circumstances and the sensitivities surrounding the discussion of HIV disclosure. This means that they should know their patients well and follow the well-worn aphorism to treat the patient as an individual, rather than as simply a disease. Although the discussions may not be any easier or the actions any less difficult to take, the path toward fulfilling the needs of the patient—and the society in which we all live—may become more clear.

Related Questions

Navigate

• Browse (All)
• Browse W
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.