A Research Of Whether Confidentiality Should Be Limited In The Healthcare Setting
Over the years there have been many debates on whether or not confidentiality in the healthcare field should be limited. Many people are in support of confidentiality not being limited due to the fact that it protects patients from mistreatment, supports access of all individuals to healthcare, and also allows for better health results. However, other individuals believe that confidentiality should be limited because in some instances there may come a time where benefiting the individual or other outside individuals are more important than confidentiality. With much research completed, I have decided to take a stance in this debate.
I along with others, believe that there are many benefits that come with the support of confidentiality. The benefits that come with confidentiality include, trust of patients which can result in better health outcomes, as well protecting innocent individuals from any harm. I believe that there are many boundaries that are crossed when confidentiality is limited or broken. When it comes to confidentiality, it is often assumed that professionals within the healthcare have a responsibility to keep medical information confidential, and rightfully so. “Confidentiality, for example, prevents physicians from disclosing information shared with them by a patient in the course of a physician–patient relationship. Unauthorized or inadvertent disclosures of data gained as part of an intimate relationship are breaches of confidentiality”.
I believe that the disclosure of information regarding medical conditions and files can potentially cause harm to the patient as well as others involved in the “case”. For example, HIV is a sexually transmitted disease, when it is disclosed that a woman has HIV, several questions and concerns will be raised regarding the HIV status of her as well as the status of her partner or previous partners. I believe a medical condition like this is something that a patient would want kept confidential, something like this can be embarrassing for the patient. Now that I am 20 years old, when I go to the doctors I have the opportunity to sign whether or not I want my information regarding medical concerns, kept confidential. As a young woman, I think whatever information given to the doctor should always be kept confidential, especially if it is regarding information being told to my parents. I have a very close relationship with my parents, however, if I were to have HIV or something like that I’m not so sure I would want them notified about that as well as my partner. When I visit any of my doctors I typically confine in them, I believe it is their duty to keep my information private. As I continued my research, it had stated, “Some diseases have stigmas attached to them that could make people think less of you. For example, back in the 1980s, many people who had symptoms of HIV and AIDS were afraid of being found out. They didn’t go to their doctors until it was too late. Because you know your health records are private, you’re probably more likely to seek treatment – for whatever you have”. HIV and AIDs are both diseases that can end up being extremely dangerous. A disease like this is embarrassing, and if it were me, I would want it kept private as well. If I knew it was going to be kept private, I would pursue in medical treatment. If it weren’t kept private, it would cause me to shut down not wanting to seek any type of treatment. By not seeking any treatment and shutting down, it can result in much worse results due to the fact that my medical provider broke my confidence.
As mentioned previously, arguments have been raised regarding limits of confidentiality, and whether there are exceptions to breaking confidentiality. Throughout my research process, I have found many codes of ethics that argue both sides, on when or if confidentiality should ever be broken. It is stated, “Some, such as the Declaration of Geneva of the World Medical Association, contain an apparently exceptionless rule regarding confidentiality. The Declaration of Geneva states simply, I will respect the secrets which are confided in me, even after the patient has died”. With this statement, I couldn’t agree more. There are no exceptions. Confidentiality is exceptionless. As I read further, it is also stated that “the clinician should always work for the benefit of the patient according to his or her ability and judgement. This would permit breaking of confidences whenever the clinician believes the patient would benefit”. This is where it gets a little sticky, although it states that the clinician should always work for the benefit of the patient, this statement basically says that confidentiality is kept unless it needs to be broken for the good of the patient. If the patient has not authorized that his or her information can be shared amongst others, then confidentiality should not be broken. In the book of Case Studies in Biomedical Ethics, it mentions The American Medical Association and how it has changed its position. It states, “Prior to 1980, the AMA permitted disclosure when it would benefit the patient, when it would benefit others, or when the law required. Thus, even without patient approval, physicians following the AMA could breach confidence not only for the patient’s welfare but also for the welfare of others. A physician may not reveal the confidence entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of his patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the society”.
Although the last part goes on to mention that confidentiality can be disclosed if it is required by law, I disagree with confidentiality being disclosed at all, however, the law is the law and no one can change it. I believe that it being required by law would be the one and only exception to breaking confidentiality. Nowadays, there are so many mentally ill people as well as people who just have crazy thoughts. When a threat is made that could potentially effect society, it is required by law to break confidence. Because it has happened too often, this would be the one exception. Many other people argue that confidentiality should be broken when it is used to benefit others. Out of all the exceptions that people argue, I disagree with this one the most. When a patient is visiting a doctor, he or she expects that the doctor does whatever they can in order to benefit the patient and no one else. The doctor’s patient is his or her full responsibility, and the only person that should matter to the doctor is the patient he is taking care of. In the code of ethics, it is stated that “they would permit confidence to be broken when doing so would benefit third parties”.
I believe that if there is any exception to breaking confidence, it should definitely not be this one. I believe that all actions done in the hands of the doctor should only be done if it is solely benefiting the patient of his or hers. As I continued reading, the code of ethics had mentioned, “The issues of confidentiality can arise in situations in which a physician is committed to maintain the promise to keep information confidential until he or she discovers that he also made a commitment that will require breaking confidence. The problem can be especially acute if the promise has been made to another patient as in the classic case that first appeared in the Hastings Center Report”. Problems like this can arise often causing the doctor confusion on not knowing what to do and how to handle a situation like this. When the doctor has two choices, benefit the other patient by breaking confidence, or to keep his word and not break confidence, he should always pick that. Breaking confidence can cause so much harm to the patient and can result in her trust being lost.
Stepping aside from the fact that many people argue that breaking confidence can benefit others and the patients, there are many benefits to not disclosing any type of confidentiality. Within my research I have found that, “It can help the whole country! When people are confident that what they say to healthcare professionals is private, they’re more likely to participate in studies and healthcare initiatives. That helps fight disease and lessen the spread of epidemics. Patient confidentiality isn’t just a good idea; it’s the law. Under the Health Insurance Portability and Accountability Act (HIPAA), your medical records and other health information you provide to healthcare professionals and facilities, and insurers is privileged information”. I chose to include this because it is basically the whole heart of this argument. Although there are people that argue that breaking confidence can have benefits I stand by that that breaking confidence should never be allowed. I truly believe that the end all be all to this argument is that confidentiality is simply a right of privacy to the patient. It is a value of respect to the patient, and a value the patient can gain from the provider.
Privacy is important, some research states that “Breaches of privacy and confidentiality not only may affect a person’s dignity, but can cause harm. When personally identifiable health information, for example, is disclosed to an employer, insurer, or family member, it can result in stigma, embarrassment, and discrimination. Thus, without some assurance of privacy, people may be reluctant to provide candid and complete disclosures of sensitive information even to their physicians”. When confidentiality is ensured, it can result in a much better relationship between the provider and the patient. A much better relationship can have a greater effect on the communication between the two, resulting in a better health outcome.
