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Confidentiality In Medical Ethics (What It Is & When To Break It)

Confidentiality In Medical Ethics (What It Is & When To Break It)

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Confidentiality lies at the core of medical ethics, ensuring a strong foundation for the patient-physician relationship.

This ethical obligation requires doctors to protect the privacy of patients’ medical information, fostering trust and enabling open communication.

By respecting patients’ privacy, healthcare professionals can provide appropriate care, support informed decision-making, and maintain their reputation as reliable caregivers.

In this article, I’m going to further explore exactly what the principle of confidentiality means to healthcare providers, why it is so crucial to practising medicine and in what circumstances it can be broken.

LEARN MORE: My comprehensive guide to medical ethics also covers confidentiality

What Is The Principle Of Confidentiality?

Confidentiality is a fundamental principle in medical ethics that emphasises the importance of maintaining trust between the patient and the healthcare professional.

It involves the protection of personal information shared by a patient with their physician, which can include their medical history, test results, and any conversations between the two parties.

Doctors have an ethical obligation to respect and protect the privacy of their patients.

This responsibility stems from the need to establish a secure environment where patients feel comfortable sharing sensitive information, details about their physical and mental health, and any other concerns.

A doctor explains a treatment option to a patient
A doctor explaining treatment options to a patient

The assurance of confidentiality enables patients to be more open with their healthcare professionals, leading to better diagnosis, treatment, and overall healthcare.

The principle of confidentiality not only applies to doctors but also to other healthcare providers and staff members who may have access to patient records or confidential information.

The confidentiality obligation extends to the sharing of information with other professionals, unless certain situations deem it necessary, such as to prevent potential harm or to comply with legal requirements.

Why Is Confidentiality Important In Medicine?

Confidentiality in medical ethics is crucial for several reasons. Firstly, it helps build trust between patients and their healthcare providers.

When patients feel confident that their personal information is protected, they are more likely to seek medical care and share important information about their health.

This open communication allows healthcare providers to make accurate diagnoses and provide appropriate treatment, ultimately improving patients’ overall well-being.

I can’t tell you how difficult it would be to work as a doctor if my patients didn’t want to give me all the facts about what was going on with their health!

Secondly, confidentiality is essential in protecting the privacy rights of patients. People have the right to control who has access to their personal and medical information.

The common law recognises individuals’ rights to autonomy in relation to the disclosure of data, similar to the right to individual autonomy in relation to treatment.

Lastly, confidentiality plays a vital role in preserving the reputation and integrity of healthcare professionals and institutions.

When patients trust their healthcare providers to maintain confidentiality, it enhances the credibility of the entire medical profession.

Upholding confidentiality is thus necessary to maintain public trust and ensure a high standard of medical care nationally.

Legal And Ethical Frameworks

There are a number of publications and even legal frameworks that support the concept of confidentiality.

General Medical Council Guidelines

The General Medical Council (GMC) provides guidelines for healthcare professionals on maintaining confidentiality and managing patient information.

Trust is a crucial element in the doctor-patient relationship, and confidentiality is central to this.

The GMC highlight the ethical and legal duties of confidentiality to protect patients’ personal details from inappropriate disclosure.

Data Protection Act

The Data Protection Act plays a significant role in safeguarding patient information. In the UK, this act regulates the processing of personal data, including health information.

The Act outlines principles for data controllers- the people or organisations responsible for collecting, processing, and storing personal data:

  • Process personal data fairly and lawfully
  • Obtain personal data for specific, lawful purposes
  • Ensure personal data is adequate, relevant, and not excessive
  • Keep personal data accurate and up to date
  • Retain personal data no longer than necessary
  • Implement security measures to protect personal data
  • Control transfers of personal data outside the European Economic Area
  • Ensure individuals can access, object, or rectify their personal data

Confidentiality: NHS Code Of Practice

The Confidentiality: NHS Code of Practice is a guidance document for the NHS in England. It sets out the required practice standards for maintaining patient confidentiality and handling personal information within the NHS.

The code covers a range of issues, such as:

  • Legal and ethical responsibilities to respect confidentiality
  • How and when information may be shared with others
  • Security of information and its storage
  • Consent and circumstances when it can be implied or overridden
  • Providing patients with access to their records
  • Monitoring and compliance with the relevant legislation and guidance

If you’re hoping to work in the NHS in the future, either as a doctor, nurse or any other kind of healthcare professional, I’d recommend having a quick flick through it to see what sort of standards you’d be expected to uphold.

Maintaining Confidentiality

As a doctor, you do always have to have in the back of your mind how you’re ensuring you don’t breach a patient’s confidentiality by mistake.

Handling Of Patient Records

Poor handling of patient records is one of the easiest ways that confidentiality can be breached without explicitly meaning to.

Doctors should ensure that records are stored securely and access is restricted to authorised personnel only.

Electronic records should be safeguarded with appropriate encryption and password protection measures.

When disposing of physical records, proper shredding or incineration processes should be implemented to prevent unauthorised access to sensitive information.

Communication With Colleagues And Third Parties

Clear communication between healthcare professionals is vital for effective patient care. However, it is crucial to strike a balance between collaboration and confidentiality.

When discussing cases with colleagues or third parties, doctors should avoid sharing identifiable patient information, such as names, addresses, and dates of birth, unless it is necessary for the patient’s care and they have provided consent.

Anonymised or de-identified data should be used wherever possible, and any disclosure of personal health information should follow the principle of the minimum necessary standard.

Use Of Social Media

In the era of social media, clinicians must remain proactive in maintaining patient confidentiality.

Practitioners should exercise caution when posting online, avoiding any discussion of patient information, even in private groups or forums.

Identifiable images of patients should not be shared without explicit consent.

It’s important for healthcare professionals to educate themselves on the privacy settings and policies of various platforms, and to maintain a clear separation between their professional and personal online presence.

Ultimately, the ethical obligation to safeguard patient confidentiality must always be prioritised, regardless of the communication medium used.

When Can Confidentiality Be Broken?

While confidentiality is a key tenet of modern medical ethics, there are situations in which it can be legally and ethically broken.

When Can Confidentiality Be Broken Pixel Infographic

The Patient Consents To A Disclosure

In certain situations, a patient may choose to give explicit consent for their confidential medical information to be disclosed.

This consent should ideally be in writing and must be explicit and specific about the information and the intended recipient.

It is essential for the healthcare professional to ensure the patient is well-informed about the nature of the disclosure and the potential consequences before obtaining their consent.

Public Interest

There are instances where the disclosure of confidential information may be ethically justified in the interest of protecting public health or safety.

This can include cases where there is a risk of harm to others, such as a patient with potentially violent behaviour.

Public interest can override medical confidentiality when the threat of harm is significant, and disclosure could prevent or minimise this harm.

However, the decision to disclose should be proportional to the level of risk and only involve sharing the necessary information.

Required By A Court Order

A court order can require healthcare professionals to disclose confidential medical information.

When faced with such an order, it is crucial to comply, as failure to do so may result in legal consequences.

However, medical professionals should consult with legal counsel to ensure the order is valid and seek guidance on how best to comply with its requirements while maintaining their ethical obligations to their patients.

Required By Statute

Laws may mandate the reporting of specific information to regulatory bodies or health authorities.

This includes disclosures related to infectious diseases, child abuse, or other public health concerns.

In such cases, medical professionals have a legal obligation to report this information and must follow the appropriate procedures and guidelines.

It is essential for healthcare providers to stay updated on the relevant statutes and regulations to ensure compliance while respecting patient confidentiality.

Example Interview Questions About Confidentiality

Medical school interviewers love to test applicants on their knowledge of confidentiality and how it can apply to different healthcare scenarios.

  1. How would you handle a situation where a patient discloses sensitive information to you, but asks you not to share this information with their family or other healthcare providers? This question assesses the interviewee’s ability to balance the patient’s right to privacy with the need for effective communication among the healthcare team.
  2. If you suspect a colleague of breaching patient confidentiality, how would you address this issue? This question evaluates the candidate’s approach to upholding ethical standards and confronting potential misconduct in a professional manner.
  3. What would you do if you were asked to disclose confidential patient information to a third party, such as a law enforcement officer or a court order? This question examines the interviewee’s awareness of the legal obligations in such situations and their ability to protect patient confidentiality while complying with the law.
  4. How would you handle a situation where a patient refuses life-saving treatment but requests that their decision be kept confidential? This question highlights the ethical challenges in balancing a patient’s autonomy with the principle of confidentiality.

Final Thoughts

As technology advances and electronic health records become the norm, preserving confidentiality and navigating the ethical landscape is likely to become increasingly significant.

Doctors need to be vigilant about protecting patient information while fulfilling their duties and upholding the principles of medical ethics.

Maintaining confidentiality is a continuous process that includes secure storage of medical records, appropriate sharing of patient information with other healthcare professionals, and ensuring patient privacy during medical consultations.

By adhering to the principles of confidentiality, healthcare providers fulfil their ethical and legal obligations to protect patient privacy and uphold the integrity of the medical profession.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.