Medical Ethics - Confidentiality
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Patients have a right to expect that identifiable information about themselves provided or discovered in the course of their health care will not be shared with other people without their knowledge, and the disclosure of identifiable information without subject consent to someone who did not previously know it breaches confidentiality.
Nevertheless, recognition of the importance of confidentiality should not impose unnecessary restrictions on what most patients rightly perceive as the essential purpose of providing it: the delivery of appropriate and effective care to themselves.
Furthermore, while patients' rights to privacy and control of their data are important they are not absolute.
Occasions arise where confidentiality not only can be breached but there may be an ethical or legal requirement to do so. Such occasions are the focus of this document.
The duty of confidentiality is owed to all patients, including mature and immature minors, and adults who lack the capacity to take decisions for themselves. The duty endures beyond the individual's death.
Confidentiality and the bioethical principles
Confidentiality is linked in to several bioethical principles.
- Confidentiality shows a respect for an individual's autonomy and their right to control the information relating to their own health.
- In keeping information about the patient secret the doctor is acting beneficently.
- Disclosing information without the patient's consent can damage the patient, malificent. Maintaining confidentiality can therefore also be seen as non-maleficent.
Breaching confidentiality
Logically, confidentiality can only be breached when the recipient of the information learns something that was previously unknown to him or her. It is not a breach of confidentiality to discuss the medical implications of general information which is already known by the recipient.
Where relatives, for example, are already aware of an individual's condition
or diagnosis, an explanation of the possible options for that patient does not
breach confidentiality but revealing the person's views of those choices would
do so.
(Source: BMA)
Confidentiality may be broken in certain circumstances. For instance, if there is a risk to a third party this may overrule the necessity to maintain confidentiality.
A patient may, for instance, disclose to his doctor that he believes his sister is an evil witch. His delusion is also linked to a plan to kill her. The doctor must weigh up his duty to his patient to maintain confidentiality against a duty to protect the unknown sister. This dilemma involves a conflict between the principles of autonomy and non-maleficence outlined above.
So, in some cases the doctor may, at their own discretion, decide to disclose information. Examples could include:
- where serious harm may occur to a third party, e.g. threat of serious harm to a named person;
- where a doctor believes a patient to be the victim of abuse and the patient is unable to give or withhold consent to disclose;
- where, without disclosure, a doctor would not be acting in the overall best interests of a child or young person who is his/her patient and incapable of consenting to disclosure;
- when, without disclosure, the task of preventing or detecting a serious crime by the police would be prejudiced or delayed;
- when, without disclosure, the task of prosecuting a serious crime would be prejudiced or delayed (e.g. a patient tells you that he killed someone several years ago);
- where a doctor has a patient who is a health professional and has concerns over that person’s fitness to practice and posing a serious danger to patients in his or her care;
- where a doctor has concerns over a patient’s fitness to drive.
Adapted from: Dr Ben Green, http://www.priory.com/ethics.htm; Good Psychiatric Practice: Confidentiality [2000] Royal College of Psychiatrists.
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Back to: Ethics study guide index page
Written by: Michael Harris
Last updated: 16 September 2006