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Editorial Reviews. Review. "The first volume of this series deserves 5 STARS for its interesting Doctor-Patient Confidentiality: Volume One (Confidential #1) Kindle Edition. by .. I wish I knew I was delving into a 10 part series when I started this book. Even though I also received Part 2 at the author's website I had to go.
Table of contents

Anonymity has value in a variety of public health and medical research contexts. Although a number of prominent scientists and lay people have made their genomes public, genetics research and scholarly publication standards call for protection of the identities of research subjects and their families. Concerns can arise about whether particular methods of anonymization adequately shield research subjects from invasion of privacy and breaches of confidentiality. The use of the anonymously deployed personal diary for learning about and assessing health-related behavior has become commonplace Minichiello et al.

Research subjects are asked to record contraception use, condom use and other sexual practices in diaries which become research tools. Researchers must take care to warn research subjects about the dangers of disclosing information which could expose them to social or legal sanctions. Yet the case for individual privacy, confidentiality and anonymity in the context of a stigmatizing illness may be exceptionally strong, counterbalanced by a case for aggressive public health surveillance of severe illnesses without true cures Burr It has been suggested that anonymous testing allows persons with AIDS to engage in dangerous, morally irresponsible behavior without accountability.

Proponents of anonymous testing reply that policy-makers and ethicists should not assume that men and women who learn they are HIV positive on the basis of anonymous tests will egoistically conceal their status from sexual partners. Some individuals have knowingly imposed serious risks on others. But newly informed positive test-takers may responsibly notify past and future partners, refrain from risky behaviors, and seek medical care.

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Confidentiality thrives as a legal duty and institutional practice, despite the emergent trend towards voluntary openness about personal medical information. The specifics of health and medical care have become acceptable topics of ordinary conversation outside the family circle. In the U. Disclosures that would have been considered indelicate or stigmatizing thirty years ago are made freely today, whether to make conversation, share a concern, educate the public, or endorse a non-profit or pharmaceutical product.

To a noteworthy degree, openness is also compelled by morals and law. Medical accountability is a feature of modern life. World-wide, people are coming to think of minor and major contagious illnesses as conditions giving rise to public accountability. In Japan, it is now expected that people with cold and flu will wear surgical face masks to protect others from the spread of cold and flu viruses. International travelers entering Tokyo are politely invited to report symptoms of illness to officials.

International visitors to Taipei have their body temperatures scanned for fever automatically as they proceed to customs. Many people speak openly about health matters with strangers as a condition of receiving and paying for health care. The same is true of a family which needs to apply for government benefits for aging or disabled kin. The more disclosures a family must make, the wider the circle of confidentiality and the lesser the medical privacy.

Questions of distributive justice are raised by mandatory disclosures to government made as a condition of access to care. The risks and burdens of state knowledge of the individual are disproportionately borne by the least well off segments of society. The duty of confidentiality is a core consensus norm within health care Currie One important manifestation of this consensus in the U.

Ethical and legal duties of confidentiality

The technological age has given rise to the call for health care providers, even those who work alone or in small groups, to be aggressive in the adoption of responsible information practices. All would agree that office practices can and should be designed to protect the identity of clients and the privacy of conversations.

Common understandings are that practitioners should be judicious in the collection of information; they should store treatment notes and records in a secure manner; they should share information only with consent or as required by law; and they should protect sensitive information in its online and off-line forms using locks, passwords, encryption and other appropriate devices. Sensitive information that is no longer needed should not be retained indefinitely. Health Care providers are ascribed ethical obligations to avoid casually discussing confidential patient matters in social media or in e-mail that may not be entirely private or secure Chretien et al.

They must avoid discussing patient matters on mobile phones in public places, such as in office corridors, hospital lobbies and on trains. Confidentiality can be violated by unauthorized recordings and disclosure of medical photographs. At a minimum informed consent would appear to be required for making and disclosing photographs on whose basis a person could be identified.

Ethically imperative consent was not obtained in a notorious U. Allen Videotaping has come to play a routine role in family therapy and is not considered unethical by typical practitioners AAMFT Many clinicians believe the therapeutic and training benefits of videotaping outweigh the risks of unauthorized use or disclosure. Even if unauthorized use or disclosure were not a concern, an ethical question would remain.

Should behavioral health clients be called upon to create recordings which inherently sacrifice the privacy of their homes, communications and expressions of emotions? Physicians are debating whether to increase the use of video and audio-taping in routine clinical practice, surgery and research, and bioethicists are weighing in Blaauw et al. Should office visits be recorded as part of the standard medical record?

How Patient Confidentiality is Protected 6 of 8

On the one hand, recordings would address the problem of faulty memory and incomplete encounter notes. Recordings could document informed consent procedures and provide evidence to avert or support malpractice suits. On the other hand, recordings could inhibit patients and increase their discomfort. There has been relatively little attention paid by philosophers to physical privacy concerns in medicine compared to informational concerns.

These expectations that they will not be needlessly touched, crowded, gawked at or imaged relate to the need for psychological comfort, dignity and security. In the future, the use of internet communications may make some routine primary health care possible without patients having to venture from home and be touched by providers Chepesiuk In the meantime, health care typically involves physical contact with others. Solitude is a form of physical privacy of special interest to medical ethics Storr ; Barbour The sick do not want to be lonely and abandoned, but they may want personal space and time alone.

Solitude has value as a context for quiet reflection about the significance of illness and injury. The sickest patients may both crave and fear solitude.

Introduction

When alone they come face-to-face with the potentially cruel reality of impending death. Yet in company they may feel patronized or guilty about the burdens they impose on family and friends. Whether the suffering is the agony of injury, childbirth, recovering from major surgery or dying, persons may feel that they should not have to deal with others while in such a state or at such a time. Implicit social norms validate deferring to wishes of the sick or dying for seclusion and solitude Post ; Nissenbaum These wishes may arise and be violated not only in hospital, hospice or nursing home settings, but also in mental hospitals and prisons, where panoptic policies of monitoring and surveillance prevail Bozovic ; Holmes and Federman 16—17; Foucault Philosophers in the virtue ethics and Christian ethics traditions have identified modesty as a moral virtue Schueler Modesty is a form of physical privacy of special interest to medical ethics.

If patients are to receive the best care, they must be willing to expose their bodies to medical personnel and technicians. Busy emergency rooms and neighborhood clinics may be unable to cloak or seclude patients at all. In-patients in teaching hospitals are expected to adapt to diminished physical privacy, since medical students and researchers accompany attending physicians on rounds and participate in care.

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Yet feelings of modesty and felt obligations of bodily modesty are commonplace. Many individuals understand bodily modesty as a moral virtue, and act accordingly. Under some religious traditions, such as those of Muslims, Orthodox Jews and the Amish, bodily modesty is a requirement of faith.

Being asked to disrobe, even for a good reason, may impose the cost of going against principle or desire Kato and Mann Health care providers respond to the modesty values of their patients in a number of ways. They provide special modesty garments and sheeting to minimize nudity. They ask patients to uncover only those portions of the body which must be exposed, and then only for the period of time necessary. While hospitals cannot offer every in-patient a private room, shared rooms are generally dividable by curtains that grant patients some degree of physical seclusion and associational intimacy with visiting family and friends.

Male gynecologists and obstetricians help patients cope with sex-specific modesty norms and sexual abuse concerns by working with female assistants. Some health care providers maintain medical procedures staffing policies sensitive to modesty and harassment concerns. Indeed, mammograms on women are generally performed by female technicians.

On the other hand, the radiologists and radiology technicians who deliver prolonged, intimate radiation services to breast cancer patients are likely to be male. Patients may encounter health institutions and providers who are unwilling to honor what they may regard as impractical or discriminatory preferences for same-sex or same race caregivers, preferences sometimes motivated rightly or wrongly by modesty concerns.

Another aspect of physical privacy is bodily integrity.

Mandatory testing and health evaluation offend bodily integrity by forcing persons to submit their bodies to unwanted touching and visual inspection Allen Policy makers and the courts have generally permitted a great deal of nonconsensual urine testing of school children and people in jobs tied to public safety, public service and crime control. Drivers can be subjected to alcohol intoxication screening at road blocks or in hospital emergency rooms after accidents to promote highway safety.

The concerns about neuroimaging and lie detection raised earlier in this article under the rubric of secrecy could as easily be raised here in connection with bodily integrity. Nonconsensual uses of imaging and lie-detection to assess honesty or character arguably demeans and disrespects autonomous moral agents and assaults bodily integrity. These issues arise in peace and war, and with respect to the living and the dead.

Certainly, law-based constraints exist, but so too do principle-based and other moral constraints Faden et al. Organ harvesting with or without consent may be defended on utilitarian moral grounds.

Why doctor-patient confidentiality is so important - Gerling Law Offices, P.C.

A related philosophical question is whether a legal regime of opting into organ donations or opting out of organ donation better serves the demands of justice and morality. Post-mortem sperm donation raises important ethical questions about bodily integrity. Harvesting the sperm of a deceased man raises concerns about respect for corpses; using sperm to create embryos and ultimately to parent the children of dead men raises concerns about parental autonomy and beneficence toward children. Respect for the intimacy of the experiences of suffering, childbirth, recovery and dying is required by sound ethics.

People who are in pain or grieving have an interest in including some people and excluding others. People commonly want to reserve sharing the joys of medical experience with friends and family, no less than the agonies. They have what can be thought of as an associational privacy interest in selective intimacy.

Injured, suffering, and dying adults may badly desire intimacy, even sexual intimacy. A patient may wish to exclude strangers or inessential medical personnel at times when the presence of loved ones is welcome. Parents of newborns may regard strangers photographing their babies as violations of family intimacy.

If associational privacy is important, a bored visitor strolling the halls of a hospital should not maneuver to watch a randomly selected patient give birth; and if he does, he merits criticism as a morally offensive intruder. Hospitals and hospital patients have clashed over who should be allowed visitation and a role in decision-making or hands-on care.

Some institutions have kept extended family, paramours, gay or lesbian partners and children away from in-patients.