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10 - Confidentiality

Published online by Cambridge University Press:  05 August 2012

D. Micah Hester
Affiliation:
Division of Medical Humanities, University of Arkansas
Toby Schonfeld
Affiliation:
Emory University, Atlanta
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Summary

Objectives

  1. Deine confidentiality and privacy in healthcare, and identify applicable laws, regulations, and institutional policies.

  2. Explain why privacy and conidentiality are important in the clinical setting and the harms that may result from breaches of them.

  3. Describe behaviors or actions that respect, promote, diminish, or violate patient rights to privacy and conidentiality in healthcare settings.

  4. Identify challenges that arise in protecting conidentiality and privacy, particularly between the desire to honor patient conidentiality and the duty to warn at-risk third parties.

  5. Identify how to respect conidentiality and privacy in the ethics consultation process.

Case

Al lies unconscious following an automobile accident and is on a ventilator in the ICU. He is 35 years old and teaches economics at a local university. Al learned he was HIV+ 5 years ago. Since that time, Al has taken anti-HIV medications regularly and has received treatment from a local HIV clinic. According to medical records and the patient’s report, the medication has been effective in reducing his viral count to undetectable levels. Prior to this accident, Al had been experiencing no serious symptoms of the HIV infection, although on a few occasions he reported some physical fatigue. Al has a history of substance abuse, but has been drug free for over 5 years.

Al’s critical care team is considering a tracheostomy. However, Al’s family does not know about his HIV status. In fact, Al has discussed at length his refusal to disclose his status to his family members with his primary physician. He cited the way they treated him after they found out he had been using drugs, as well as how they treated his friends. He is certain that, if his family members knew he was HIV+, they would cut off all contact with him and he would lose their support.

How should the healthcare team proceed? Should a physician disclose Al’s HIV status to his family?

Type
Chapter
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Publisher: Cambridge University Press
Print publication year: 2012

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References

Edwards, RB 1988
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research 1983 http://bioethics.georgetown.edu/pcbe/reports/past_commissions/summing_up.pdf
Sankar, PMora, SMerz, JFJones, NL 2003 Patient perspectives on medical confidentiality: a review of the literatureJ Gen Inte Med 18 659CrossRefGoogle ScholarPubMed
Siegler, M 1982 Confidentiality in medicine – a decrepit conceptN Engl J Med 307 1518CrossRefGoogle ScholarPubMed
Tarasoff v. the Regents of the University of California 1976
US Department of Health and Human Serviceshttp://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

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