Respecting Patient Rights
Basic Bioethics For Residents, CCF Residency Programs, November 28, 2000
- I. Communicating with Patients and Families
- II. Informed Consent: Empowering Patient Participation in Decision Making
- III. Assessing Patients' Decisional Capacity
- IV. Maintaining Patient Confidentiality
- V. Honoring Patients' Advance Directives
IV. Maintaining Patient Confidentiality
When patients know that private, personal, and sensitive information about
them will be protected and held in confidence, they are more likely to trust
their physicians and to discuss their problems candidly. Physicians and other
professionals will then be better able to treat and care properly for their
patients. Confidentiality of medical information:
- Excludes unauthorized persons from having access to patient information.
- Is not breached when physicians share patient information with other health
professionals involved in the patient's care and when the information has
relevance regarding that care.
Physicians should not release confidential information without a patient's
consent unless required by ethics or law. Ethics or law might require physicians
to breach confidentiality (e.g., warning identified sexual partners that a patient
is HIV+). In such situations, the confidentiality of the patient is overridden
by a physician's duty to protect identified individual persons or to protect
the public at large. In most medical practices, circumstances requiring a breach
of confidentiality will be rare, and should be an act of last resort. Before
breaching confidentiality, physicians should first discuss the issue directly
with the patient and counsel the patient to take appropriate actions to protect
identified individuals. When a physician determines, either ethically or legally,
that confidentiality should be breached, this should be done in ways that minimize
harms to the patient and that follow the requirements of applicable laws and
Special precautions should be taken by physicians to address areas in which
there is an increasing risk of violating patient privacy and confidentiality:
- Electronic communications of patient information (e.g., via computers and
fax machines) whereby unauthorized persons might be able to read or access
- Discussions with health professionals about specific patients in public
areas (e.g., hospital elevators, corridors or cafeterias).
- Discussions with patients (or families) about their medical conditions in
open or public areas.
- Discussions of information about patients who are well-known to the public,
without the explicit consent of these patients.
A final area of consideration and caution relates to adolescent patients. Physicians
caring for adolescent patients must balance respect for an adolescent's confidentiality
and developing autonomy, with parental and family involvement and support. The
American Academy of Pediatrics makes the following recommendations for confidentiality
in adolescent health care:
- Every reasonable effort should be made to encourage adolescents to involve
their parents in the promotion of their health.
- When parents are in a physician-patient relationship with the same physician
who provides care for their adolescent child, the physician should clarify
- adolescent patients will have an opportunity for examination and counseling
apart from their parents.
- the same confidentiality will be preserved between the adolescent patient
and the physician as between the parent and the physician.
- Adolescent patients should be informed under what circumstances (e.g., life
threatening emergency) the physician will breach the adolescent's confidentiality.