Utilitarianism as an Ethical Concept - Essay Example

Confidentiality According to the International of medical ethics, doctors are expected to preserve absolute secrecy of the information they know about their patients. This is a way of reciprocating trust. Doctors must respect the confidences from the side of patients and must prove to be trustworthy. At the same time, there are consequences of breaching privacy from a legal and social perspective. Patients accept that information should be shared with the medical team in order to get professional care. Personal information may be disclosed without patients’ consent in exceptional cases. This essay seeks to investigate whether confidentiality is an absolute right or whether legitimate breach can be allowed. The patient must be informed that a disclosure will be made in the public interest if that is the case. The patients must have the documents with reasons for disclosing the information. Studies show that medical confidentiality in Belgium and France is absolute and is strictly guarded by the criminal code. In France, confidentiality breach is not allowed by the law even when it is to the best interest of the patient. Doctors are expected to keep information from patients confidential. However, there are instances when doctors are required to breach confidentiality when required by the law. In such cases, the doctor does not fear legal proceedings. However, the breach may be legal but that does not make it ethical. There are instances when court orders have been used to compel doctors to breach confidentiality to satisfy statutory requirements (Burckhardt & Nathaniel 2008). There are instances when patients give doctors explicit consent to disclose their confidentiality. Doctors are allowed to disclose confidential information when they believe it is to the best interest of the patients. This situation is controversial and difficult to justify. In some cases, a doctor may seek the intervention of the third party (Dennis 2000). This happens when the patients lacks the capacity to decide. The law of confidentiality can be breached when doctors are acting in the best interest of the public. This involved confidentiality with the public interest. A compelling example is in the case when the doctor is required to volunteer confidential information to the police to investigate criminal conduct. Patient confidentiality is guarded by the criminal law in few jurisdictions. However, the Hippocratic Oath implies that some extent of exposure is allowed. In the Geneva declaration, the law appears to suggest that confidentiality is not absolute. The declaration of Geneva indicates that doctors should respect the secrets of the patients even after their demise. In 1993, there was a professional conduct code by GMC which was replaced by the confidentiality guidance from GMC in 1995 in London. The same confidentiality law for protecting and providing information by GMC in 2004 came up with redefined clauses for the physicians (Dennis 2000). This law allowed doctors to share confidential information with other doctors and health professionals. This law allowed a close relative to be given information in case the patient is not in a position to receive the information. The law indicated that the confidentiality is not absolute and that eight legal exceptions (Tingle 2002). Caring for the patients in a health facility is a team responsibility. Therefore, it is difficult to maintain the concept of confidentiality among a team of medical concepts. A compelling example is the information on sex of the patient. Disclosure increasingly becomes a matter of clinical judgment (Trinity Healthforce Learning 2005). Confidentiality that deals with patient identification information like sex, primary disease and name are an initial level of information (Diekema et al 2011). The medical information of the patient includes genetics factors, past medical information, treatment investigation and disease. The social information from patients touches on the family matters and social relationships. The provisions of the statute law demands that the authorities be notified with facts about a patient before disclosure. This is contained in the 269 NHS Acts 2006. The Act is boosted by the s.172 (2) Road Traffic Act 1988 which calls on the doctor to reveal information about road accident patients even when they are having criminal offenses. The Abortion Regulations SI/ 1991/499 lay a few conditions for disclosing patient information. The latest law allowing confidentiality breach is the Prevention of Terrorism Act with allows the information of suspects to be passed to the police. Utilitarianism is an ethical concept that suggests that that a proper cause of action leads to overall happiness. There is a belief that proper medical decisions with regard to confidentiality are bound to cause increased satisfaction. Deontology is a medical concept in ethics that call upon doctors to do what is right and appropriate while conducting their medical duties (Trinity Healthforce Learning 2005). Under deontology, doctors are required to discuss truthfully with the patients to empower them make the most informed decisions with regard to confidentiality breach (Diekema et al 2011). The doctor-patient confidentiality is build upon the principle that a person seeking medical assistance should not be inhibited by the fear that their information will be disclosed to others. The knowledge in confidence should be for the exclusive benefit of the patient. Confidentiality covers all the medical records together with the communications between the doctor and the patient (Tingle 2002). The duty to confidentiality continues even after the patient has been discharged. There are situations in which others become hurt if confidentiality is not breached. A practical example is when a patient suffers from uncontrolled epilepsy and fails to inform the driving license authority. A patient may choose to keep HIV positive status a secret to their spouse. The results of these actions put others in outright danger. The desire to preserve the confidentiality of a patient may be overruled by the need to secure others from grave harm (Guido 2010). This position is greatly contested. There are arguments that patients are likely to suffer more harm if they cannot entrust their doctors with confidential information. Statistics show that MRSA affects most of the health workers and doctors working in hospitals. The doctors are vulnerable the TB and HIV infection in case they of minor accidents. The medical practationers are not required to reveal the status of those suffering from such conditions. However, these diseases require special caution. A telling example is the MRSA which is controlled through avoiding sharing personal items. Patients suffering from the MRSA should be excluded from work to avoid skin-to-skin contact (Diekema et al 2011). At the same time, the medical information should be kept confidential (Guido 2010). This has lead to increased spread of these contagious diseases that risk public health in a quest to preserve patient information confidentiality. The principle of autonomy demands that people must control their lives as much as they can. This means that people should control who accesses their private information (Guido 2010). People have the right to control what people know about them. Therefore, patients have the right to have the doctors’ keeps their information confidential. The relationship between the patient and doctors is such that there is an implied promise that the information from the patient shall be kept confidential (Hebert 2009). Patients have expectations concerning medical confidentiality which are based the long standing tradition between doctors and the patients. The principle of implied promise expects fidelity to be applied and that it is important to keep promises. The philosophical basis of confidential information demands respect from the medical fraternity. Confidentiality is a right but not an absolute right. There are exceptional cases that necessitate the legitimate breach of confidentiality (Diekema et al 2011). The patient has the right to autonomy and to the information necessary to autonomous decision-making. The information is acquired in the process of acquiring healthcare. This information is kept confidential by the entire healthcare team. In Canada, it is not clear who owns that information. There are instances when confidentiality is breached without the consent of the patient (Wheeler 2011). This happens mostly in the cases when the information is used for research reasons. A telling example is the case of peptic ulcer. There are instances where the patients are not disadvantaged with the dissemination of private information. The idea of confidentiality does not raise deep concern in conditions like mental illness, sexual related conditions which have few disadvantages arising from the risk of dissemination. The right to confidentiality is limited to many interests in the healthcare deployment. The patient is required to understand the circumstances under which private or confidential information can be disclosed (Tingle 2002). The weight of the decisions varies. They are cases when disclosure of the HIV status leads to stigmatization. There are also cases where revelation of communicable diseases attracts unnecessary rejection. Disclosure to the third parties happens when information passed to people taking care of the patients. These people need to understand the nature of the ailments the patients have (Trinity Healthforce Learning 2005). Therefore, it is considered important to share confidential information with the third parties. This provision can be objected by the patients. The patients have a right to understand the implications of such disclosures before giving consent to it (Guido 2010). Confidentiality is essential in the preservation of trust between health professionals and patients. At the same time the legal and ethical safeguards of confidentiality must be balanced against the need to protect both individual and public interests. The patient information that is classified as confidential includes clinical information about a diagnosis, photograph or video images of a patient, and any other information that can cause the patient to be identified. The keeping of the confidential information offers both ethical and legal dilemma to the medical fraternity in some occasions. There are cases when doctors claim that it is not practical to obtain the consent. Patients are allowed to give explicit or implied consent to the disclosure of their personal information. Consent must be defined. Sometimes the disclosure touches of specific information or parts of the body. Consent can also imply to the future disclosure to achieve particular purposes. Explicit consent happens when the patient actively agrees. This happens with in writing or orally after holding discussions with a patient. In this case, there is no doubt and the consent is considered to be ideal (Guido 2010). The patient agreement can be implied or signaled. In this case, the patient must be informed on how the information shall be used and of their right to refuse. Implied medical consent to confidential information is not a lesser consent. Health professional must bear the responsibility for any disclosure and must demonstrate the consent was based on good faith and information (Hébert 2009, p. 23). The most sensitive the information is, the more likely explicit consent shall be required, e.g. sexual health information. The confidentiality of information in medical cases is relative. There are multiple reasons that necessitate such breaches (Burckhardt & Nathaniel 2008). The legitimized breaches must be justified by ethical and legal bases. There are instances when the information is considered to have an anonymous source. In this case, the patient information is used freely. In this case, the clinical information is separated from details that reveal personal information like name, postal code and date of birth. A patient is able to give valid consent if they are adequately informed without any coercion. Before patients give consent to information disclosure, they must understand the issue in question. Justice demands that they retain the information in their minds long enough to make a credible decision. Patients must be given the chance of weighting the arguments for or against the decision they are about to make. This includes the disclosure of sensitive information (Guido 2010). If the information is not convincing, the patients have a right to reject it. Patients must believe the information and express it in some form. Non-maleficence is the requirement for the patient to consent to treatment or disclosure of confidential information to protect them from harm (Tingle 2002). Non-maleficence is a means of respecting the privacy and dignity of the patients. This protection includes bodily invasion, coercion, invasion or deception (Burckhardt & Nathaniel 2008). Patients must be given the implication of consenting to the breach of private information. Beneficence is the situation that patients must have access to all knowledge that benefits them. This information must respect the autonomy of the patients. Beneficence is the therapeutic benefit that encourages patients to adhere to the care procedures and medical advice (Guido 2010). This enables patients to pass their concerns with complete picture of the implications. Patients must be assured of the benefits of giving the consent to confidential information. Autonomy is believed to be the ability to have information about potential disadvantages and advantages to any proposed treatment or disclosure of confidential medical information. This enables the patients to deliberate on whether or not to accept the mode of treatment or the proposed medical procedures or disclosures (Dennis 2000). In consenting to the disclosure, the patients become part of the plans and the aims of the health professional act. In cases where the patient is not competent to get a personal opinion concerning medical information or procedures, the law demands that the decision be taken to the best interest of the patient. In such cases, the family must be involved in the discussions. The family must use the appropriate legal documentation and possibly give an opinion on what the patient could have preferred (Trinity Healthforce Learning 2005). The principle for the respect of the autonomy includes the right for self-determination and the choices of patients. This principle entails protecting the rights of those with diminished autonomy like the mentally challenged and children. Physicians must give highest loyalty to the needs of the patients. Beneficence on the need for cooperation between medical professionals and the populations involved (Guido 2010). The right to confidential information by the patients must be per sued in light of these aspects. The health professionals must ensure that the patients are fully informed on the medical and social implications that are likely to arise from certain medical disclosures (Trinity Healthforce Learning 2005, p. 13). Patients must be given ample time to decide the path to follow. The laws on ethics seek to ensure fair treatment of patients and giving them what they deserve. Given the right to confidentiality is not absolute; the safeguards must be put in place to ensure the patients interests are not entirely lost. Medical geneticists interact with the life histories of patients (Burckhardt & Nathaniel 2008). The provision of the statute law requires that information shall not be disclosed unless there is a court order for the purpose of the proceedings which have already begun (Dennis 2000). The provisions of the Act also allow disclosure of confidential information for purposes of bona fide scientific research. According to the abortion regulation, the disclosure may be made to the practitioner who terminated the pregnancy or with a written consent of the woman whose pregnancy was terminated. According to the Road Traffic Act 1988, the doctors are allowed to disclose the identity of the patients being treated following a road accident. All laws are based on ethics but not all ethics are captured in law. The breach of confidentiality must be minimal, legal and justifiable. In case of legal proceedings, the breach of confidentiality comes with legal safeguards. Ethics and law overlap in many instances. Partial definition of law is one of the ways in which people express ethics (Guido 2010). Minimal breach of confidentiality must ensure that only negligible damage to the patient compared to the positive contribution to the public. In this case, the law demands a formal pledge that the breach of confidentiality ensures subsequent respect of confidentiality. Recent changes in the law have necessitated alterations in the way medical confidentiality is maintained (Burckhardt & Nathaniel 2008, p. 17). In the United Kingdom, the rules are laid down by GMC. They reflect the tenor of the Hippocratic Oath and development of occupational physicians. Consent must be given before medical information can be given to employers. Ethics and laws that relate to confidentiality evolved long before the information highway was born. Physicians are duty bound to inform patients on the limits of confidentiality and protection. This helps patients in deciding whether treatment outweighs the risk of disclosure of sensitive information. It is recommended that an attorney should review the data in the repository by the healthcare providers, system vendors and consultant. Sensitive information that pertains to patients should be subjected to security regulation e.g. HIV status, pregnancy termination, mental health, and drug abuse. The security experts must regularly assess the data repository to ensure data security and confidentiality (Guido 2010). When patients are transferred from one health center to another, he may need to give consent to confidential information given to another physician. The authority to release confidential information is given to the patient, the legal guardian to the child with health challenges and the administrators. Any disclosure to a third party is referred to as a breach of confidentiality. This happens when the consent of the patients is not sought directly or through court order. The medium of getting access to the consent is not necessarily important. The patient has a right to healthcare information. According to the perspectives of the patient on confidentiality, the involvement of the doctor threatens the autonomy the autonomy to same extent. If the moral autonomy of a patient is to be respected, then patients must learn to engage in multiple aspects. These include withholding information and divulgence of information (Burckhardt & Nathaniel 2008). The idea of respect is seen by patients as a moral issue. The perspective of patients on the matter of confidentiality is also a moral issue. The value of confidentiality has great value in the field of medicine. According to the Hippocratic Oath states that “whatsoever I see or hear, in the course of my professional social intercourse, I will not diverge”. In the contemporary medical ethics, primacy is accorded to the right of a patient to dispose their own body the way they wish. This right gives to other sets of rights that touch on confidentiality and autonomy (Guido 2010). The right to autonomy includes the right to privacy. A major overriding factor of confidentiality is the legal requirement. The physicians must be absolved incase of legal challenges touching on confidentiality. The doctor-patient relationship must be professional and legal requirements that threaten the effectiveness of the medical arena. A patient may be given specific consent to release information in specific contexts (Tingle 2002). Doctors are vulnerable to litigation for negligence. This is different from general unspecific consent that touches on information dissemination within a hospital. The effect of general consent is the ability to breach confidentiality of the patient any time the health team wishes. The amount of information used by the healthcare team is limited to the need of the specific information. The larger the size of the team, the more vulnerable the information is to dissemination for other purposes other than medical reason. There is a worry that patients lack the capacity to monitor the confidential information they give consent. There are instances where the confidential information is used for commercial reason (Trinity Healthforce Learning 2005). The contemporary society accepts the need for limitation of confidentiality with some exceptions. When a patient has an ethical objection to the kind of treatment being given, they have a right to object. This includes prevention and specifically vaccination or immunization. The objection can be extended to children which makes the situation more complex. This challenges the preservation of confidentiality involving evasion of legal requirement (Burckhardt & Nathaniel 2008). There are instances where the communication of information leads to increased disadvantages for the patients. The law requires that information must be passed to the patients in a language they can understand. According to studies, confidentiality is a major component in the field of medicine. In cases of abortion, the patient has the right to know the major effects of the procedure before the procedure begins. This is meant to prepare the patient to give accurate assessment before consenting to the procedure (Trinity Healthforce Learning 2005). In genetics, the same legal requirements are applied. There have been suggestions that the law of confidentiality has been weakened over the years. The statute and common law that require a patient be informed and all matters that pertain to medical procedures have continued to be redefined. The medical and professional responsibility must be balanced with confidentiality. This situation is made complex by the fact that people rarely participate in the legal processes that touch on patient confidentiality and the right to make full informed decisions (Diekema et al 2011). The altering or the erosion of the laws of confidentiality is taken to mean that the public have no objects. The right to confidentiality must be balanced with the actual situation of the patient. The right cannot be termed as absolute but the law makes provisions for the breach under stern considerations. The awareness of the confidentiality of medical records or its breach has been confined to minority situations. These situations are meant to reduce the negative effect of the breach. In conclusion, confidentiality is a value in the medical world but it is not an absolute value. The health workers appear to be more aware of the confidential concerns than the patients. This stems from the fear of litigation (Diekema et al 2011). The medical teams are said to place less emphasis on the statutory requirements that allow the breach of confidentiality even when there are sections that are not covered by the law. The limitation of confidentiality by the law has not caused the healthcare teams to feel reduced responsibility to uphold it. The physicians are actively required to assess the weight of using confidential information for public good against the damage done to the patient. According to the medical law on confidenciality, the basic principles to confidentiality have been laid down. The common law suggests that confidentiality is likely to be compromised in the cases of negligence. This may extend to passage of confidential information from between parties. Healthcare professionals are expected to keep patient information confidential. References Burkhardt, M. A., & Nathaniel, A. K. 2008. Ethics & issues in contemporary nursing. Clifton Park, NY: Thomson Delmar Learning. Dennis, J. C. 2000. Privacy and confidentiality of health information. San Francisco, Calif: Jossey-Bass. Diekema, D. S., Mercurio, M. R., & Adam, M. B. 2011. Clinical ethics in pediatrics: A case-based textbook. Cambridge: Cambridge University Press. Guido, G. W. 2010. Legal & ethical issues in nursing 1st ed. Boston: Pearson. Hébert, P. C. 2009. Doing right: A practical guide to ethics for medical trainees and physicians. Don Mills, Ont: Oxford University Press. Trinity Healthforce Learning. 2005. Beyond compliance: Confidentiality in healthcare; protecting patient privacy. Carrollton, TX: Trinity Healthforce Learning. Tingle, J. 2002. Patient confidentiality. Welwyn Garden City, Hertfordhshire: EMIS Professional Pub. Wheeler, H. 2011. Law, Ethics and Professional Issues for Nursing: A Reflective and Portfolio-Building Approach. Hoboken: Taylor & Francis. Read More