CONFIDENTIALITY
Definition
• To hold in confidence a secret
or private matter, privacy.
• Not to be divulged or
communicated to others.
Development of, and
Basis for,
Confidentiality
• Grounded in the moral rules of:
– do not deprive of freedom or
opportunity, and
– do not break your promises.
• Integral to the principle of
respect for autonomy.
• Individuals ordinarily have the
right to determine to what
extent their thoughts, feelings,
and sentiment shall be
communicated to others.
• It is legitimate to share personal
secrets with others and expect
them to maintain the secret.
• Without such respecting the
privacy of others, human life as
we know it would not be
possible.
• Fundamental to the marital
privilege upheld in American
law is that one spouse cannot be
forced to testify against the
other.
• A promise of confidentiality and
silence creates an obligation
beyond just respect for another,
it creates a special bond.
• Professional confidentiality
imposes additional
responsibility. Professionals
grant clients / patients secrecy
even when they might otherwise
have a reason to speak out.
Professional
Confidentiality
• Patients believe that what they
tell a health professional is
confidential.
• Patients take for granted that
health professionals owe them
secrecy even in the absence of
an explicit verbal request; such
is a component of the implied
professional covenant / contract.
Benefits
• Confidentiality in the
professional / patient
relationship protects the
autonomy of the patient.
• Confidentiality encourages full
disclosure by patients of
information that may be
sensitive but essential to
treatment.
• Confidentiality allows patients
to seek help they might not
otherwise seek if they thought
their disclosures would be
shared with others.
Examples
• An attorney concealing past
crimes of a client.
• A psychotherapist concealing
patient’s thoughts about hurting
someone.
Codification of
Confidentiality
Expectation
• Professional confidentiality
expectations have been
formalized in professional
codes.
• ADA Principles of Ethics and
Code of Professional Conduct:
“Dentists are obliged to
safeguard the confidentiality of
patient records.”
Advisory Opinion
Interpretations of the Code
Adopted by the ADA
Council of Ethics, Bylaws,
and Judicial Affairs
Ethics Becoming Law
Laws and Administrative
Regulations Relating to the
Practice of Dentistry, Dental
Hygiene, and Dental
Specialities
Commonwealth of Kentucky
1997
313.140 Unprofessional Conduct
Unprofessional conduct includes,
but in not limited to:
“…willfully betraying any
professional secrets.”
Unprofessional conduct is
grounds for revocation or
suspension of license.
Is Confidentiality A
Moral Absolute?
In the Affirmative...
• Confidentiality is absolute and
should never be violated.
Otherwise, critical information
may not be revealed or patients
may not seek help.
• The law that retains
confidentiality for HIV infected
individuals is based on this
argument.
For the Negative...
• Confidentiality is not absolute.
Infringements on personal
privacy are morally justified
when others or society may be
harmed by maintaining the
confidence.
• Most general theories and
professional conduct codes hold
that the rule of confidentiality is
not absolute.
• Recall that the “moral rules” are
universal, not absolute. That is,
deviations from such rules must
be justified in such a manner
that reasonable people could
agree that the deviation from a
given rule should be permitted.
• Respecting an individual’s
autonomy should not trump
potential suffering of significant
harm by others; the tension
between the principle of nonmaleficience and
confidentiality.
• But, compelling rights of others
must be at stake, that is, a
significant risk of harm to
others who are outside the
clinical relationship
• In some instances, society has
delineated such compelling
rights in laws that require the
breaching of the rule of
confidentiality.
Examples of
Required Breaches of
Confidentiality
•
•
•
•
Sexually transmitted disease
Child abuse
Gunshot wounds
Threat of imminent harm to
another by a psychiatric patient
under the care of a
psychotherapist.
Supported by AMA Principles
of Ethics which states:
“a physician shall safeguard
patient confidences within the
constraints of law.”
Tarnoff vs Regents
of the
University of
California
California Supreme Court
1 July, 1976
Plaintiff - Parents of woman
killed by male patient under the
care of psychotherapist.
Defendant - Psychotherapist,
University Hospital, University
and Board of Regents
Situation
• Patient divulged during therapy
that he was going to kill the
woman. Therapist informed the
campus police that patient may
harm an individual. Police
apprehended the patient but
determined that he would not
harm anyone and released him.
• Psychotherapist continued to
treat patient but did not inform
the victim in danger under the
principle of confidentiality.
Ruling
• A majority of the Supreme
Court held that “the protective
privilege of confidentiality ends
where the public peril begins.”
• Found in favor of plaintiff’s
complaint for breach of duty to
exercise care to protect the
woman.
• Dissenting view emphasized
that breaching confidentiality
may prevent patients from
seeking care, if they cannot
fully confide in health
professional
Issues in Dentistry
• Problems typically not as severe or
dramatic as in some other arenas of
health care.
• Usually inadvertent breaches due to
open operatories.
• Staff and other patients may hear
dentist - patient discussions; staff
may have access to records.
• Uncontrolled access to computer
data.
• Issues in College of Dentistry:
conducting case histories, or case
presentations in reception area,
hallways, or in operatories loud
enough for others to hear.