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Patient Privacy and Confidentiality: Unethical Practices

Introduction

Among the most acute problems that today have to be solved in a medical institution, there is the protection of patients’ confidential information. In addition, the issue of patient privacy is becoming critical. Information about the fact of addressing for medical help, the patient’s state of health, the diagnosis of illness, and other data obtained during examination and treatment should be treated as a medical secret. It is forbidden to disclose such information by persons who became aware of it during training, fulfilling of professional, official, and other duties, except for cases when, by legislation and with the consent of a citizen, it is allowed to transfer such information for certain purposes, as well as cases when it is provided according to the law without the patient’ consent.

Confidential data may include not only information about the patient’s health but also those facts or circumstances that the patient shares with medical professionals during treatment. The right to privacy and confidentiality must be applied in a multicultural, social, and religious context. This requires the appropriate level of medical staff competence, including nurses, in the area of bioethics and medical deontology.

Ethical Dimensions of the Issue

The rule of privacy states that the medical staff should not collect, accumulate, and distribute (transfer or sell) information about a patient’s private life without his/her consent. The elements of private life are the fact of addressing a doctor, information about the state of health, biological, psychological, and other characteristics of the patient, methods of treatment, habits, lifestyle, etc. This rule protects citizens’ privacy from unauthorized intrusions by others – including doctors or scientists (Williams & Taylor, 2016). It is appropriate to use the rule of bioethics – the rule of confidentiality (preservation of medical secrecy). Without the patient’s permission, it is forbidden to transfer information about his health status, lifestyle, and personal characteristics to “third parties.” This rule can be considered the privacy rule integral part (George & Bhila, 2019). While the “rule of truthfulness” speaks about the openness of communication of social interaction partners – doctors and patients – the “rule of confidentiality” is intended to protect from unauthorized external intrusions by direct participants (Ataiyero & Ajiteru, 2015, pp. 15-16). In turn, the rule of privacy is associated with the material rules on medical secrecy, and the rule of confidentiality – with procedural rules about it. Privacy is fundamental to respect for individual dignity. The Lisbon Declaration on the Rights of the Patient, adopted by the 34th World Medical Assembly (September-October 1981) states that “it is necessary to always respect the human dignity and right of patients to privacy, as well as their cultural and moral values in the provision of medical care and through hands-on medical education” (WMA, 2005, p. 2-3). Patient privacy is linked to all principles of bioethics, but especially close to the principles of respect for patient autonomy and the principle of integrity.

The patient must be confirmed the guarantee of confidentiality of the information provided by him/her. It is not allowed to disclose information constituting a medical secret by persons who became aware of it during training, the performance of professional, official, and other duties (George & Bhila, 2019). A doctor or a nurse has no right to divulge medical secrets even to the patient’s family and friends. The legislation defines a rather narrow range of situations in which a medical staff is allowed to transfer information to third parties. It is primarily about those cases when the patient is not capable of independently stating his will due to impaired consciousness, or due to minority.

Relevance of the Ethical Issue to Health Professions/Nursing

For certain vulnerable populations, maintaining confidentiality is an important aspect of receiving health care. For example, privacy and confidentiality are important in realizing the sexual and reproductive rights of women and adolescents (Williams & Taylor, 2016). Privacy and confidentiality are also important elements for patients trying to diagnose and treat stigma-related illnesses, namely HIV/AIDS and mental disorders.

Depending on the type of treatment, in some healthcare settings, only a few healthcare professionals have access to specific medical information about a patient. For example, a nurse who vaccinates a patient does is not empowered for getting access to medical information about the patient’s mental state because this does not have a relation to the case. However, there should be no conflict of the right to health information confidentiality with the “right to access to health information” (Beltran-Aroca et al., 2016, p. 4). The person who owns the health information does not have the right to disseminate this information to those who do not belong to the specialists providing medical services. Security breaches can lead to administrative, civil, disciplinary, or even criminal liability for the clinic. If due to the leakage medical secrets will become public in an unsanctioned manner, the clinic will have to compensate for the damage which was caused to the patient, as well as his/her business reputation, and pay all costs incurred due to the disclosure of information, and the penalty.

Currently, some security doctrines deal with health information security requirements. In particular, these are HITECH and HIPAA forms, two federal laws designed to protect confidential information and patient welfare by enforcing regulatory standards in any organization that provides healthcare services. These federal standards, although written with the specificity of the healthcare industry in mind, cannot modernize quickly enough to keep pace with innovation. At the same time, more advanced security infrastructures, such as those published by NIST (National Institute of Standards and Technology), are very general in scope, not to mention health information security departments. This situation determines the exceptional relevance of medical personnel’s bioethics to patients’ privacy and confidentiality.

Relevant Ethical Analysis

Working with medical personal data has several features. Clinics are required to store data about the health of each patient in the form of a medical record, and disclosure is prohibited under any conditions. Therefore, the problem of possible information leaks arises here, and it is healthcare that leads to the anti-rating of data leaks (Wallace, 2015). Sometimes employees who are responsible for data security in information systems do not have the necessary competencies or demonstrate an irresponsible attitude to the issue. However, more often than not, problems arise through the fault of “ordinary” specialists: according to the empirical studies, employees account for more than half of data losses – and about 80% of them arise without malicious intent, due to errors and negligence (Wallace, 2015). Thus, it is necessary to provide deep knowledge and develop skills in the practical application of the philosophy and principles of bioethics and medical deontology among junior medical personnel, that is, nurses.

The principle of confidentiality is a condition for protecting the patient’s social status. We live in an imperfect world, in which, quite often, a diagnosis or other medical information can become a stigma for a person, which significantly limits his/her ability to self-assertion. Having become public, such information often causes an unconscious reaction, which is expressed in social isolation of a person – stigmatization, as a result of which a social vacuum is formed around him/her. Each person lives among people and occupies a certain status, and violation of confidentiality poses an immediate threat to this human value. It should be noted that this value has an independent meaning, and is not dependent on the financial damage fact. It is unlikely that financial benefits (for example, compensation for damage) can serve as compensation for the damage caused to self-esteem, self-respect, honor, etc.

Confidentiality of the relationship is necessary to ensure that the doctor or nurse communicates with the patient in an open and frank manner. The patient must be sure that this communication will not lead to undesirable consequences. Only the patient’s confidence in the strict observance of medical confidentiality provides his/her frankness, without which normal professional activity is impossible.

Thus, the issues of bioethics and medical deontology come to the fore. Deontology suggests the principles of the relationship of medical professionals with patients; a nurse should adhere to the ethics and deontology four universal principles – “professionalism, autonomy, justice and mercy” (De Silva et al., 2018). However, the confidentiality of patient data and the inviolability of his private life are correlated in all of the principles mentioned above. From the point of view of compliance with these principles, nurse ethics and deontology implies that when providing medical care, a nurse should obligatorily comply with all applicable legal requirements, as well as moral standards. This obliges the nurse to strictly adhere to the code of professional ethics and job responsibilities, which in turn means competent handling of patients’ personal and medical data. From the point of view of the principle of autonomy, the nurse should respect the personality of each patient. The following provisions are also associated with this principle: respect for the patient’s political and other beliefs, confidentiality, cross-cultural competence of a nurse should be manifested (George & Bhila, 2019). In turn, the cross-cultural competence of the nurse is necessary for making correct decisions about interaction with the patient regarding his confidential information.

The fairness (honesty) principle means that there should not be a distinction between patients by their profession, social status, and also by other characteristics. Moreover, the nurse should not share confidential information about the patient even with his relatives, except in cases of the patient’s insanity, his stay in a prolonged unconscious state, and so on. The principle of compassion includes an attentive and sensitive attitude towards the patient, including the ethics of communication with the patient when it is necessary to discuss with him/her some confidential data regarding health or lifestyle, in the interests of the treatment process.

Personal Professional Response to the Issue

As a nurse, constant observance of medical ethics and deontology principles is crucially important for me personally. To acquire and consolidate the necessary competencies, it seems appropriate for me to constantly familiarize myself with the latest professional and scientific publications in this area. In my opinion, in the area of patients’ privacy and confidentiality, applying the principles of evidence-based medicine is just as important as in other areas of healthcare. In addition, life-long learning is necessary for a nurse to keep abreast of the latest technical and legislative innovations in the field of protecting patients’ rights to privacy and confidentiality.

Conclusion

Patient privacy is linked to all principles of bioethics, but especially close to the principles of respect for patient autonomy and the principle of integrity. The subject of confidentiality observance is the diagnosis, health data, prognosis of the disease, and all the information received by doctor or nurse as a result of examination or when listening to patient complaints. It should be noted also that even non-medical information of the patient or his relatives received in the process of performing official duties by medical staff, should be treated as confidential. The disclosure of confidential patient information potentially leads to harm to him/her, as well as negative consequences for the medical institution in the form of lawsuits and regulatory sanctions. In turn, legislation in the field of protecting patients’ privacy and confidentiality grows based on certain moral qualifications of the actions of medical personnel, indicated in the framework of medical ethics and deontology. Thus, knowledge and strict adherence to the principles of deontology is the basis of compliance with legal norms.

References

Ataiyero, Y. O., & Ajiteru, E. A. (2015). Concept analysis of patient confidentiality: The nursing perspectives. International Journal of Nursing Didactics, 5(12), 14-18.

Beltran-Aroca, C., Girela-Lopez, E., Collazo-Chao1, E., Montero-Pérez-Barquero, M., Muñoz-Villanueva, M. (2016). Confidentiality breaches in clinical practice: What happens in hospitals? MC Medical Ethics, 17(52), 1-12.

De Silva, T., Freire, M., Vasconcelos, M., Da Silva, S. (2018). Deontological aspects of the nursing profession: understanding the code of ethics. Revista brasileira de enfermagem, 71(1), 3-10.

George, J., & Bhila, T. (2019). Security, confidentiality and privacy in health of healthcare data. International Journal of Trend in Scientific Research and Development, 3(4), 373-377.

Wallace, I. (2015). Is patient confidentiality compromised with the electronic health record?: A position paper. Computers, Informatics, Nursing, 33(2), 58-62.

Williams, R. L., & Taylor, J. F. (2016). Four steps to preserving adolescent confidentiality in an electronic health environment. Current Opinion in Obstetrics & Gynecology, 28(5), 393-398.

WMA (2005). WMA Declaration of Lisbon on the rights of the patient. Handbook of WMA Policies.