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 institutional policies.

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 confidential information.
• 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 that,
• 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.

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