08/01/2014

Privacy and Confidentiality (Privasi dan Kerahasiaan)

Learning Objectives
Mahasiswa mampu menjelaskan definisi serta perbedaan antara privasi (privacy) dan kerahasiaan (confidentiality) Mahasiswa mampu menjelaskan pentingnya menghargai privasi dan kerahasiaan pasien. Mahasiswa mampu menjelaskan beberapa pengecualian yang dapat dibenarkan dalam kaitannya dengan kerahasiaan pasien

Dr. Amalia Muhaimin, MSc. (Bioethics) Department of Bioethics, School of Medicine Faculty of Medicine and Health Sciences Universitas Jenderal Soedirman
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Topics
1. Definitions of privacy and confidentiality. 2. Reasons for respecting privacy and confidentiality. 3. Duty of healthcare providers to protect the privacy of patients. 4. Duty of healthcare providers to maintain confidentiality (aka. professional secrecy). 5. Which information should be confidential? 6. Justified breaches of confidentiality 7. Special circumstances of research

Can you give any example related to privacy in everyday life?

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1. Definitions
Privacy (Privasi):
The right to be left alone (hak untuk tidak diganggu) The right of an individual or a group to be free from intrusion from others, and includes the right to determine which information about them should be disclosed to others The capacity to be physically alone (solitude); to be free from physical interference, threat or unwanted touching (assault, battery); or to avoid being seen or overheard in particular contexts
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CONFIDENTIALITY:

What is confidentiality?

An attribute of personal information requiring that it not be disclosed to others without sufficient reason Confidentiality is closely related to privacy, but not identical.

How is privacy related to confidentiality?

One observes rules of confidentiality out of respect for, and to protect and preserve, the privacy of others It refers to the obligations of individuals and institutions to use information under their control appropriately once it has been disclosed to them.

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2. Reasons for respecting privacy and confidentiality

a. Individuals own their information: it is essential to their personal integrity. b. For many people privacy is an essential aspect of their dignity; invading their privacy against their will is a violation of their dignity. c. Respect for others requires protecting their privacy and the confidentiality of information about them. d. Doctors need patients trust!

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Cases:
A few weeks after an Orlando woman had her doctor perform some routine tests, she received a letter from a drug company promoting a treatment for her high cholesterol. (Orlando Sentinel, November 30, 1997). A 30-year FBI veteran was put on administrative leave when, without his permission, his pharmacy released information about his treatment for depression. (Los Angeles Times, September 1, 1998) The new hidden cameras will allow us o see if anyone is violating our privacy policy by reading someone elses email
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(UC Davis Health System) http://www.ucdmc.ucdavis.edu/compliance/guidance/privacy /example.html

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3. Duty of health care providers to protect the privacy of patients

ask patients permission to examine him/her unclothed should ensure that an unclothed patient cannot be viewed by passers-by etc

4. Duty of health care to maintain confidentiality The duty of maintaining confidentiality (professional secrecy) has been part of Western medical ethics since Hippocrates Preceded the notion that privacy is a right What do you think? Ethics courses in non-Western countries should discuss the source of medical confidentiality in their cultures

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5. Which information should be confidential?

Confidentiality extends to all personal (health) information, including genetic data UNESCO International Declaration on Human Genetic Data: all medical data, including genetic data and proteomic data, regardless of their apparent information content, should be treated with the same high standards of confidentiality

When can information be disclosed?

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6. Justified breaches of confidentiality

a. Sharing information for patient care In hospital setting access to the patients chart Outside hospital family members need patient information to provide care and/or to protect themselves b. Using interpreters An interpreter will need access to information about the patient; interpreters should be bound to observe confidentiality
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Justified breaches c. Teaching medical students Observation & discussion of patients is a necessary part of medical education; students should be informed of their obligation to maintain confidentiality d. Mandatory reporting Health care practitioners should be familiar with the law Infectious diseases, Suspected child abuse, Suspected family abuse Patients should be informed that their information has to be reported to the appropriate authorities
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Justified breaches e. Serious danger to others patient threaten to harm others, by violence /sexual contact patient has a transmissible disease such as HIV f. Genetic information Do other individuals with the same genetic makeup (close family members) have a right to a patients genetic information? Physicians should consult national regulations/ guidelines g. With patient or guardian consent This should generally be obtained for all breaches of confidentiality and renders the breach acceptable ethically.
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7. Special circumstances of research

a. Disclosure of personal health information requires prior consent of the research subject; b. Anonymized information consent for disclosure? refer to national regulations/guidelines, otherwise international guidelines such as the Declaration of Helsinki c. Communities and individuals have a right to privacy information should be kept confidential, especially when disclosure may be harmful to the community. d. Scientific publication should respect confidentiality to the greatest extent possible consent is always required when an research subject can be identified in a publication
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Case studies
Your 36-year-old patient has just tested positive for HIV. He asks that you not inform his wife of the results and claims he is not ready to tell her yet. A 75-year-old woman shows signs of abuse that appears to be inflicted by her husband. As he is her primary caregiver, she feels dependent on him and pleads with you not to say anything to him about it. How is this case different from Case 1? How would you handle this situation?

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Reference UNESCO. Bioethics Core Curriculum. Section 1: Syllabus. UNESCO 2008. Available at: http://unesdoc.unesco.org/images/0016/001 636/163613e.pdf

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