130507L - PRIVACY AND CONFIDENTIALITY

Lecture for 4^th year medical students Salman bin Abdulaziz University Kharj on May 7, 2013 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)

1.0 PRIVACY

Privacy and confidentiality are two different concepts that are sometimes confused with one another. An individual has a right to privacy that implies the right to make decisions about personal or private matters and blocking access to private information. Privacy and autonomy are closely related. Privacy rights define and protect an area in the life of the citizen from which the state is excluded. The physician can enter into this privacy only if there is an autonomous decision of informed consent. There are situations in which the Law permits invasion of a citizen’s privacy such as compulsory screening and treating of some diseases.

2.0 DEFINITION OF MEDICAL CONFIDENTIALITY

The patient voluntarily allows the physician access to private information in the trust that it will not be disclosed to others. This confidentiality must be maintained within the confines of the Law even after death of the patient. In routine hospital practice many persons have access to confidential information but all are enjoined to keep such information confidential.

3.0 THE BASIS FOR MEDICAL CONFIDENTIALITY:

3.1 Clinical care: If the patient is not assured that information revealed to physicians will be kept in confidence, he or she will not provide sufficient information to the physician for proper diagnosis and management. Such violation destroys future co-operation because the patient will hold back some information from the caregiver thus impairing correct diagnosis and appropriate management.

3.2 Autonomy and privacy: The patient has a right to keep personal information private and inaccessible to unauthorized persons.

3.3 Fidelity: It is part of the trust between the patient and physician that their professional relationship remains private. The psychological basis of fidelity is the private and privileged relationship of trust between the patient and the caregiver. Revealing secrets that occurred to a third party is a violation of the trust. If a person seeks advice and divulges secret information, that information is protected because the advisor is supposed to be trusted

3.4 The social basis lies in the prohibition of spreading rumors, and backbiting.

3.5 The legal basis is based on the law of contract, three Principles of the Law, and the Law of Property. Keeping medical secrets is part of the physician-patient contract; fulfilling a contract is an obligation in Islam. Revealing secrets injures the reputation of the patient and violates the Principle of Injury which states that an individual should not harm others or be harmed by others.  Under the Principle of Hardship confidential information can be revealed in cases of necessity. The Principle of Hardship states that hardship mitigates easing of the rules and obligations. Necessity legalizes the otherwise prohibited. Therefore for purposes of treatment, information can be revealed to other healthcare workers. Information can also be revealed in pursuit of justice.