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Ethical Issues - Confidentiality

Ethical considerations

Confidentiality can be considered from a number of different ethical perspectives

Respect for patient autonomy

The principle of respect for patient autonomy acknowledges the right of a patient to have control over his or her own life – and this would include the right to decide who should have access to his/her personal information. Can there be a breach of confidentiality if a patient never knows that the healthcare professional has disclosed the information? Where the basis for the duty of confidentiality is the principle of respect for autonomy any breach of confidentiality means that the patient’s autonomy has not been respected, whether or not the patient is aware of the breach.

Implied promise

The health professional-patient relationship could be seen as having elements of an implied contract and this could include an implied promise that health professionals keep information about their patients confidential. It is reasonable for patients to expect that information they divulge to their doctors or other health professionals will be kept confidential. If confidentiality is subsequently breached the patient may feel that a promise has been broken. This view of confidentiality is different from that of patient autonomy because it depends on the concept of the doctor-patient relationship rather than what the patient wants or believes.

Virtue Ethics

Virtue ethics focuses on the position of the doctor rather than that of the patient (as is the case with respect for autonomy). This approach asks what a virtuous doctor would do in the particular circumstances - what issues would a virtuous doctor take into account in deciding whether or not to disclose confidential information?

Consequentialism

From a consequentialist position the question of whether it is wrong to breach confidentiality is determined by the consequences of the breach. One of the consequences of a breach of confidentiality could be that the patient will lose trust in his/her doctor, and perhaps doctors generally, resulting in him/her not accessing healthcare in the future with a detrimental effect on his/her (and others?) health. On the other hand there may be situations where there are bad consequences of not breaching confidentiality, for example third parties may be denied information which would have serious implications for their health and treatment