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?

Answer 1

The fundamental element which keeps the trust between patient and health care worker is the confidentiality. The safeguarding of confidentiality protects the health of the community. But in modern medicine it is not sheer to have confidentiality. General Medical Council (GMC) professional conduct explains the exceptions, when a breach of confidentiality is supported. The disclosure with the consent of the patient, disclosure required by law and disclosure in the public interest can be there.

The members of the health care team , have access to the confidential data, and they must handle it professionally, shouldn't keep the information visible to other clients or unauthorized people, shouldn't publish it on social media, and should not be transferred to unauthorized people. Also the records of the data must be handled safely.

The NHS trust has nominated a Caldicott Guardian for protecting the patient confidentiality and developed Caldicott principles to be followed when confidentiality has to be breached. These principles are:

• Justify the purpose of disclosure
• Use patient identifiable information when absolutely necessary only
• Use minimum patient identifiable information
• Restrict access to personal information
• Handles of patient identifiable data should be aware of their responsibilities.

The Human Rights Act 1998 provides some rectification to the breach of confidentiality and Article 8 affirm the fundamental right to privacy. But the breach of this right includes Public safety, national security, economic well being of the country, prevention of disorder or crime, protection of health or morals, or for the protection of rights and freedom of others.

Communicable diseases like HIV , share a controversial space when the disclosure issue arises, mostly because of the social stigma associated with the condition. Disclosure of this information to at risk partners (sexual) is a legal and ethical challenge to the health care worker. Usually the local HIV team take up the task and the breach of confidentiality is justified in certain circumstances, Eg: the sexual partner of the patient is pregnant or unprotected sexual contact had occurred with the patient, which may risk the partner too. Even though, if possible the patient must be given a chance to disclose by him/ herself.

Access of information to third parties may be justified when requested by:

• Employers of the patient
• Insurance companies
• Lawyers or police through court order
• Complaint procedures

While giving report, the doctors must give evidence based and honest statements. They can not hinder the criminal proceedings, and the breach of confidentiality is defended.

As per Public Health (Control of Disease) Act 1982, doctors are required to report epidemiological information by providing data on communicable diseases.

Public curiosity need not be considered a reason for the breach of confidentiality. But when some situations arise like, there is criminal activity, a failure to satisfy legal obligation, undone justice, or risk of health or safety to an individual, and then the act of breach is justified. The major cause of breach is injustice to the public or hazard to the public.