Confidentiality.
How is she getting on?
A long stay patient is concerned for her neighbour in the same ward. She asks you to
tell her how the neighbour is doing. You know her neighbour is recovering well. To
tell a person about a patient’s condition without the patient’s consent is a breach of
confidentiality. In this scenario however, where the patients know each other and,
what you are asked involves a positive response, is it ethical to let them know that
their neighbour is doing fine?
TUTOR NOTES
Duty of confidentiality
Dilemma: Whether or not to breach confidentiality concerning a patient
Some possible areas for discussion include:
Duties
Patient welfare/best interests
Confidentiality
Special problems concern:
children
psychiatric/mentally ill patients
HIV/Aids patients
celebrity patients
professional colleagues
Ethical aspects
o
o
o
o
o
o
Protect rights and interests of patients
Relationship between healthcare professional and patient
Right of confidentiality
o Ethical basis
 Respect for autonomy – self-determination
 Implied promise/faithfulness
 Trust and candour
Consent to disclosure – even to family members/friends
o consent to family implied in absence of specific direction otherwise?
What constitutes confidential information?
Problems in public hospitals regarding control of personal information
Principles
o
o
o
o
Respect for autonomy
 Veracity - truthfulness
 Faithfulness – faithful to patient’s best interests
Non-maleficience duty to patient to ensure no harm is done
Beneficience - act to benefit patient
o paternalism
Justice
Deontology: assumes a duty of care to patients to protect from harm
Consequentialism: considers consequences of actions for all parties involved
Virtues: integrity, honesty, trustworthiness, veracity, courage, fortitude, respect for others,
respects patient’s confidences, compassion, fairness, self-control, prudence, etc.
Professional aspects
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Professional duties
Professional guidance – professions self-imposed standards
o GMC; BMA; RPSGB: NHS/DoH
Professional misconduct
Professional judgement in information disclosure
Legal aspects
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duty of confidentiality
tort of breach of confidence
o in public interest for people to trust healthcare professionals
identifying a patient
o if patient is named – breach of confidentiality
o if patient can be identified from information given – breach of
confidentiality
breach of contract of employment
Data Protection Act
Summary points
A duty of confidentiality is owed to all patients, including immature and mature
minors and incompetent adults which endures beyond the individual’s death
Careful consideration must be given before divulging any information about a
Patient; a matter of professional judgement
Patients may disclose information to healthcare professionals that they would not
tell anyone else
In general, confidential information should not be shared unless it is authorised
by the patient or by the law
ETHICAL DECISION-MAKING
Is the question an ethical one?
Legal and professional issues but also ethical issues: Avoiding harm, Doing good,
Confidentiality, Faithfulness
Step 1 – Gather relevant information
Step 2 – Identify type of ethical problem
 rights and best interests of patient
 maintaining confidentiality
Step 3 – Analyse problem
 principles of autonomy, non-maleficence; beneficence; faithfulness
Step 4 – explore options/solutions
 deontological approach – weighing of conflicting principles/conflict of duties –
which course of action best respects duties and rights?
 utilitarian approach – consider all potential consequences (to all parties involved)
– what benefits and harms will each course of action produce and which will lead
to best overall consequences?
 virtues approach – which course of action develops moral virtues?

alternative courses of action, e.g.
breach confidence ↪ loss of trust ↪ anger/upset ↪ loss of faith in healthcare
professionals
maintain confidence ↪ professionals duties of beneficience/non-maleficience/fidelity
seek patient’s consent ↪ maintain trust/confidence ↪ respect for autonomy/selfdetermination ↪ find out how much information they wish to disclose, etc?

N.B. frequently, there are no definitive right answers, only answers that are more
or less reasonable, more or less defensible: two people may come to an opposite
decision using the same information - it depends on how important each
consideration is to each person and also the degree to which an individual takes a
“deontologist“ or a “consequentialist” approach.
Step 5 – make decision
Step 6 – assess and reflect
Discussion review/links
Pharmacist duties, responsibilities and accountability
Privacy and confidentiality