Confidentiality entails the patient’s right to have the personal information kept in privacy. Thus, the information should only be available to the patient, the physician, and other authorized personnel such as insurance personnel. Confidentiality is protected by the HIPAA 1996, which was ennacted to guarantee the protection and privacy of the patient's records. The disclosure of patient information leads to personal or professional problems. The confidential information refers to patient records such which may include the outcome of the lab tests, and diagnosis, among others. The patients expect the physician to ensure their medical information is securely stored in private. The breach of confidentiality takes place when the medical records are shared during research or case study (Bourgeois, Nigrin, & Harper, 2015). Thus, in case the patient medical records are used during research, personal information, or any information that can reveal the identity of the patient should be deleted. HIPAA empowers patients to sue the medical professionals in case of breaching confidentiality. However, the greatest threat to confidentiality takes place when medical records are being shared with health insurance firms. More so, it is not only the physicians who access the patient medical records but also the employees of insurance firms, researchers, and other healthcare workers, among others. For the patient to have the medical information shared, the individual must provide written consent.
Patient’s Legal Right to Privacy
The right to privacy refers to a situation where the patient has the right to think and behave as they wish while making decisions regarding their medication and health. Thus, the right to autonomy is very important in a healthcare setting. The patient’s legal right to privacy differs from the right to privacy. The patient legal right to privacy entails the management of confidential information relating to the patient. As such, the patient medical information is expected to be maintained in privacy from third parties as defined by the confidentiality of information (Doherty, Purtilo & Elsevier, 2016). Legal privacy is essential in ensuring a respective and effective relationship between the physician and the patient. Through guarantying the privacy, the patient opens up about the health problem with the physician. Breaching of this privacy of the confidential information can result in the suing of the physician.
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Concept of Need to Know as it Relates to Maintaining Confidentiality
Confidentiality and the right to privacy are closely related terms when managing the patent information. This is because the patient well-being can by jeopardized upon realizing that the medical information is being accessed by unauthorized personnel; ultimately, that result in the loss of trust. However, while managing the patient, there are many stakeholders or health care professionals who give input depending on their specialty to restore patient health. Thus, the concept of the need to know arises when the patient healthcare information ought to be shared by the group of health professional team who have the right to the patient information. Thus, the concept of the need to know demands the modification of the duties of confidentiality for protection of the patient, other parties and circumstances under which the medical information may be disclosed for certain healthcare concerns.
Ethical Norms Involved in Keeping and Breaking Professional Confidences.
According to Epstein and Turner (2015), professional ethics refers to the principles that define nursing behavior in regards to what is right or wrong. Thus, nursing ethics are an integral part of the nursing practice. The main classification of nursing ethical norms includes deontology and utilitarianism. The deontological ethical norms require moral and ethical means an end goal. Contrarily, the utilitarianism uses the ideology that the end justifies the means; therefore, the means may not necessarily be moral or ethical. There are diverse ethical norms that are applicable in healthcare.
Justice and fairness
Healthcare should be provided fairly. For instance, when serving a group of patients, they should be distributed equitably, fairly, and justly to all the patients in the group.
Beneficence
This ethical concern requires the professionals doing the right thing to their client.
Accountability
This requires the professional to take responsibility for their actions. Thus, the professional has to accept the outcome of their actions, along with the accompanying consequences.
Fidelity
This demands the professions to honor their promise of being true and faithful to their professional responsibilities and promises that are characterized by the provision of high-quality healthcare in a safe and competent way.
Autonomy
The professionals are required to respect patient opinion, beliefs, values, and perspectives. This is after the professional has accepted the client as a unique individual from others. The professional should allow the patient to make decisions with coercion since the patient has the right to accept or reject the medication.
Veracity
This entails the professional being truthful to the patient by not withholding any information irrespective of whether it can result in the patient being distressed.
General Legal Exceptions to Breaching Confidentiality
According to Peterson (2018), the general legal exceptions to the professional standard of practice that maintains that confidences should not be broken include the following”
When the patient has given consent that the medical information may be disclosed, then professional is released from the duty of confidentiality.
Disclosure of patient's medical information may occur when a multidisciplinary medical team is engaged in managing the patient health to guarantee an optimal outcome.
When carrying out an audit which is normally undertaken with the assumption of implied consent. When carrying out the audit, the data is required to be anonymized optimally.
Children medical information. The professional is required to persuade the children to disclose their medical information to their parents. However, in case they fail, the professional is required to balance, and in case the minor’s health is at risk, then the professional should disclose the information. This is mostly in cases entailing anesthetists.
Disclosure to friends, family, and other third parties: the professional may be exempted from the duty of disclosure in case of a critical care setting where the patient is critically ill, and the disclosure is being done for the interest of the client. The information may be disclosed to third parties who may request it such as the insurance, employer, and lawyers. In so doing, the medical professional is required to provide honest information that must be substantiated using evidence.
When the information is being demanded judicial proceedings or statutory purposes.
When the information is required for the detection or prevention of criminal activities.
When the disclosure is being made for purposes of public interest. Although that may be contentious, the court may be required to make a ruling on the disclosure.
The disclosure is made in the interest of the public. There is a statutory requirement when the medical professional may be required to disclose the patient's medical information when the patient poses a threat to the public.
Public health reasons. This occurs where the benefits of the disclosure outweigh the consequences of the disclosure.
Practical Options for Healthcare Professionals to Break a Confidence
There are several practical options that a health professional or inter-professional care team can take when faced with the possibility of breaking confidence. The first practical option would be to seek the consent of the patient, whereby the client will respond in either way. The second assesses the consequences of the disclosure from a legal and medical perspective.
Aspects of Documentation that Affect Confidentiality
There are several issues of documentation that affect confidentiality, and these include:
Security: while the National Institute of Standards and Technology (NIST) is responsible for setting the security guidelines, the security of the medical records is highly influenced by emergence of the electronic health records (EHR) that can easily be broken into in case of a break of the security (Lemaillet, et al., 2016; Rajkomar, et al., 2018). Thus, the confidentiality of medical documents can be broken when hacked, destroyed, or manipulated by an external or internal user.
Integrity: to guarantee the confidentiality of the health records, the medical professionals should ensure that the data is not manipulated and is accurate.
Availability: the documentation of the documentation should be made in such a way that it is not accessible to third parties.
Comparing Ethical Issues of Confidentiality Traditionally and Electronic Medical Records
The ethical challenge surrounding confidentiality from a traditional and electronic medical records approach mainly entails security. Confidentiality from the traditional approach entails locking the medical records in stores and rooms that could be accessed through doors. Thus, the confidentiality of the information was very complicated. However, presently, the electronic medical records, along with the patient care information systems, involve data being stored in a database in a digital format. Thus, the information is shared with only the required parties. However, there are optimal security features that should be put in place to secure the database and guarantee confidentiality. Therefore, while the confidentiality from a traditional perspective entailed the use of brick and walls, in the error of electronic health records and patient care information systems, confidentiality is guaranteed through software and hardware.
Key Privacy Considerations Related to the Use of Social Media in Healthcare
The social media has become a popular platform in healthcare; however, its use in healthcare raises some ethical issues regarding the privacy of medical information. The social media is popular among the youthful generals who share their information with friends and in their groups. The following are the privacy considerations:
When using the minors to either recruit participants in medical research using social media, get consent from the parents is complicated.
It is essential to ensure that privacy of the medical information collected is stored confidentially.
The old generation needs to be trained on how to use the social made while the privacy of their personal information is guaranteed.
Hippocratic Oath, HIPPA, and its Application in Mental Health Cases
The mentally-challenged patients are a vulnerable group that deserves to be provided quality medical attention, just like other ordinary people. Thus, the principles of HIPAA and Hippocratic Oath need to be embraced when addressing the medical needs patients with medical challenges. The Hippocratic Oath focuses on the importance of non-maleficence and confidentiality (Hulkower, 2016). Thus, while managing the medical challenges faced by mentally challenged individuals, medical professionals should guarantee the privacy of their medical information. The principle of non-maleficence demands that the medical practitioner to instead not go good than to harm the patient. Thus, they should not experiment using mentally ill patients who are susceptible. However, there are no penalties for breaching this oath.
The HIPAA 1996 was enacted to guide the modernization of the medical information. It demands the medical records of all patients to be protected against theft and fraud and addresses the limitation facing the coverage of healthcare insurance. In regards to the HIPAA, it lays a foundation for healthcare coverage for the mentally challenged persons while also guarantying the privacy of their medical information. A breach of HIPAA results in medical malpractices.
References
Bourgeois, F. C., Nigrin, D. J., & Harper, M. B. (2015). Preserving patient privacy and confidentiality in the era of personal health records. Pediatrics , 135 (5), e1125-e1127.
Doherty, R. F., Purtilo, R. B., & Elsevier (Amsterdam). (2016). Ethical Dimensions In the Health Professions . St. Louis, Missouri: Elsevier.
Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing , 20 (2), 1-10.
Hulkower, R. (2016). The history of the Hippocratic Oath: outdated, inauthentic, and yet still relevant. Einstein Journal of Biology and Medicine , 25 (1), 41-44.
Lemaillet, P., Cooksey, C. C., Levine, Z. H., Pintar, A. L., Hwang, J., & Allen, D. W. (2016, March). National Institute of Standards and Technology measurement service of the optical properties of biomedical phantoms: Current status. In Design and Quality for Biomedical Technologies IX (Vol. 9700, p. 970002). International Society for Optics and Photonics.
Peterson, J. L. (2018). Confidentiality in medicine: how far should doctors prioritise the confidentiality of the individual they are treating?. The postgraduate medical journal , 94 (1116), 596-600.
Rajkomar, A., Oren, E., Chen, K., Dai, A. M., Hajaj, N., Hardt, M., & Sundberg, P. (2018). Scalable and accurate deep learning with electronic health records. NPJ Digital Medicine , 1 (1), 18.
