Medical Ethics And Law

Medical Ethics And Law

Four bioethical principles that are often used in medical ethics analyses are autonomy, beneficence, non-maleficence and justice.

Where these principles are invoked they must be correctly used and defined.

Other methods of analysis can produce a more holistic and three-dimensional approach to problems (Tauber 2005)

Confidentiality

Confidentiality is not a single ethical principle in itself, rather it is linked in to several bioethical principles.

Confidentiality shows a respect for an individual's autonomy and their right to control the information relating to their own health. In keeping information about the patient secret the doctor is acting beneficently. Disclosing information without the patient's consent can damage the patient. For instance if a doctor were to reveal privileged information about a celebrity patient to the newspapers then this would be the very reverse of beneficent i.e. malificent Maintaining confidentiality can therefore also be seen as non-maleficent. (Tauber 1999)

Breaking confidentiality

Confidentiality may be broken in certain circumstances. For instance if there is a risk to a third party this may overrule the necessity to maintain confidentiality. Examples of this conflict of duty may be seen in psychiatry. A patient may, for instance, disclose to his doctor that he believes his sister is an evil witch. His delusion is also linked to a plan to kill her. The doctor must weigh up his duty to his patient to maintain confidentiality against a duty to protect the unknown sister. This dilemma involves a conflict between the principles of autonomy and non-maleficence outlined above. (Walter 2003)

The breaking of the confidence in the example above would be seen as reasonable at the time of writing in the UK and in the USA. However you could envisage a change in the prevailing ethos of the day, where the concept of confidentiality became more or less important or more or less restrictive. The details of the doctor-patient consultation might be seen as absolutely sacrosanct and so no details could ever be revealed to another individual. Conversely the consultation might be seen as transparent, and details might be shared without let or hindrance between healthy professionals and state officials. (Veatch 1988)

In some cases the doctor may, at their own discretion, decide to disclose information. Examples could include:

where serious harm may occur to a third party, whether or not a criminal offence, e.g. threat of serious harm to a named person

where a doctor believes a patient to be the victim of abuse and the patient is unable to give or withhold consent to disclose

where, without disclosure a doctor would not be acting in the overall best interests of a child or young person who is his/her patient and incapable of consenting to disclosure

when, without disclosure the task of preventing or detecting a serious crime by the police would be prejudiced or delayed

when, without disclosure the task of prosecuting a serious crime would be prejudiced or delayed (e.g. a patient tells you that he killed someone several years ago)

where a doctor has a patient who is a health professional and has concerns ...