Physicians, Patients, and Others: Autonomy, Truth Telling, and Confidentiality

1. Physicians, Patients, and Others: Autonomy, Truth Telling, and Confidentiality

2. Privacy & Confidentiality Privacy: the right to control access to one's body, one's self, and information about one's self Confidentiality: the right to have information about one's self revealed to others restricted unless there is an agreement to the contrary on both sides

3. Privacy & Confidentiality • Why privacy? • Protects autonomy • Protects right to control access to the self • Protects right to relations with varying degrees of intimacy • Protects from the harm of mis-use of information • Protection of privacy & honoring confidences enhances trust

4. Privacy & Confidentiality • Generally accepted principles: • Privacy is an essential part of the doctor/patient relationship • Information revealed or shared in the doctor/patient relationship ought generally to be held in confidence • Physicians should, in general, tell their patients the truth

5. Privacy & Confidentiality • Are there exceptions to these generally accepted principles? • Some possible exceptions: • harm to self • harm to others • greater good/social benefits • "need to know"

6. Privacy & Confidentiality • Tarasoff: Do psychiatrists have a duty to warn potential victims of their patients? • Balance/weigh: • privacy of the doctor/patient relation • harm to victims • the threat: serious, focused

7. Privacy & Confidentiality • Other legal duties to warn: • STD's • other infectious diseases, e.g. hepatitis, AIDS • Child abuse, elder abuse • Faculty abuse • Other protected professional/client relations: • priest/penitent • lawyer/client • journalist/source

8. Privacy & Confidentiality • Medical records/patient information: • "need to know" • Siegler: list of those who have access and need to know is too large to manage, therefore confidentiality is a decrepit concept ?? • Will electronic record-keeping make it easier to access information?

9. Privacy & Confidentiality • Medical records/patient information (cont.): • How is "need to know" to be defined? • For the benefit of the patient? • For use of those involved in care and treatment? • For research use of data? • Does everyone with a need to know need to know everything?