quote: Normally, under medical ethics, doctors are obligated to keep a patient's health information confidential — even after the patient dies. This duty is central to the doctor-patient relationship.
quote: Doctors are grappling with whether to tell a patient's relatives when the patient has an inherited disease or mutation that could afflict other members of the family.
quote: In an article in Wednesday's Journal of the American Medical Association, doctors and legal experts argued against imposing a mandatory "duty to warn" nonpatients
quote: "The cornerstone of the patient-physician relationship is the assurance of confidentiality,"
quote: Requiring doctors to disclose such information would undermine the doctor-patient relationship and might violate recent federal privacy laws, the article said.
What do y'all think? I think that if it the doctor thinks it's serious enough, then he should be able to over-rule the confidentiality rules.
Posts: 2756 | Registered: Jul 2002
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posted
It's a really tough call. Confidentality can only be broken (and patients are supposed to be told this up front) in the case of the patient talking about harming himself or others. At least, that's what it is in mental health practice. Not sure about medical practice.
*waits for docs to post*
Posts: 14745 | Registered: Dec 1999
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posted
I think you can WARN someone without revealing actual details.
I think they should be able to say, "You and your spouse need to talk about your mutual health because there are hazards that you need to be aware of."
It puts up a warning flag, but puts the details in the hands of the couple. It also releases the doctor from any liability in the event that Life Threatening Illness.
Example? My wife worked for an opthamologist and had a regular patient with a very sad story.
The guy was married. He stepped out on his wife (what an idiot. And if that offends someone here who thinks that a good idea or constructive, then I apologize). He contracted Aids. He knew it and didn't tell her. He got her pregnant. His wife found out during pregnancy that both She and her Baby had Aids.
Ironically, both his wife and child have died of Aids, but he is still alive.
Posts: 1533 | Registered: Sep 2004
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quote: Doctors are grappling with whether to tell a patient's relatives when the patient has an inherited disease or mutation that could afflict other members of the family.
Doctors can break confidentiality if the patient indicates harming someone else, or themselves, right? The question is, is that if the patient did not notify relatives of the situation, would that be interpreted as harming someone else? Is negligance of the patient to notify them, harming them? The patient did not directly harm them. It's not pushing them into a busy street, but its not notifying them of the oncoming semi.
posted
This is what genetic counseling is for. Patients with diseases or conditions that are genetic should be referred to a genetic counselor, who can take a family history, talk to the patient and his/her spouse/children/others if appropriate about quality of life issues, possible advances in the future, chances of inheritance, and options, especially if the patient is expecting a child or trying to conceive. This is, of course, all done with the patient's consent, but most people will give consent for family to be involved in these decisions once they realize what is at stake.
Posts: 21182 | Registered: Sep 2004
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posted
So ther is no ethic regarding public health that overrides confidentiality? How creepy. I'm not too aware of the boundaries on confidentiality, since learning it's way different for Catholic priests vs. Bishops in the Church of Jesus Christ of Latter Day Saints.
Posts: 11017 | Registered: Apr 2003
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I am a bit disappointed this didn't get more than 4 posts, and no answer that really suited the question- though I doubt we will find a full 100 percent correct one.
Posts: 530 | Registered: Jan 2003
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posted
I think in the case of a genetic problem that led to death, the doctors should tell the family. I don't think there is really a privacy issue...since it was not a behavior that led to the disorder, so it is not like it will harm the 'memory' of the person.
I think the risk to the family far outweighs any privacy issue.
This is a bit of an aside...but pooka mentioned the difference in catholic priests and LDS priests...what is the difference? Do LDS priests not have to keep things confidential?
Posts: 1901 | Registered: May 2004
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posted
I'm not sure of LDS rules, but Catholic priests are allowed NO exceptions to the confessional seal. If they know the person is going to leave the church and go shoot the Pope, they can't tell anyone about it.
quote:1467. Given the delicacy and greatness of this ministry and the respect due to persons, the Church declares that every priest who hears confessions is bound under very severe penalties to keep absolute secrecy regarding the sins that his penitents have confessed to him. He can make no use of knowledge that confession gives him about penitents' lives. This secret, which admits of no exceptions, is called the 'sacramental seal,' because what the penitent has made known to the priest remains 'sealed' by the sacrament."
Canon 983 §1 The sacramental seal is inviolable. Accordingly, it is absolutely wrong for a confessor in any way to betray the penitent, for any reason whatsoever, whether by word or in any other fashion.
Can. 984 §1 The confessor is wholly forbidden to use knowledge acquired in confession to the detriment of the penitent, even when all danger of disclosure is excluded.
So if LDS allows any exceptions (to save a life, for instance), it is significantly different than the Catholic rule.
quote:So ther is no ethic regarding public health that overrides confidentiality
This is the law in Hawaii regarding reportable diseases:
quote:Section 321-311.5, Hawaii Revised Statutes, requires health care providers and medical facilities to provide the Hawaii Department of Health (DOH) with specific patient information needed to conduct an epidemiologic investigation. This information includes patient name, name of minor patient’s parent or guardian, address, telephone number, age, sex, race or ethnicity, clinical signs and symptoms, laboratory test results, diagnostic interview data, treatment provided, and the disposition of the patient. The law also protects anyone supplying this information to the DOH from civil or criminal liability. Failure to comply with this law is a misdemeanor.
We are of course required to maintain the same level of confidentiality that the medical provider is, but we are legally entitled to the information.
There are dozens of reportable diseases, but they fall into the following categories
Vaccine preventable diseases such as measles
Sexually transmitted diseases - the main ones we see are Chlamydia & Gonorrhea
Food and water borne illnesses - Salmonella, Shigella, Giardia, Food poisonings
Blood borne diseases - Hepatitis, AIDS, etc
When doing contact notification, we have to keep the case name and other identifying information confidential as well. We can tell them that they have been named as a sexual contact of a person who has been diagnosed with Gonorrhea, for instance, but cannot tell them who gave us their name. Of course, depending on their own habits, that may tell them who our case is, but we cannot confirm it.
Posts: 2069 | Registered: May 2001
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posted
Thanks, Maui Babe, I was hoping it was something like that. I think we tend to hear "confidentiality" and think "Catholic priest".
LDS Bishop confidentiality is much more like Mental Health professional confidentiality. My understanding is if there was a crime committed or not reporting it could endanger others, the bishop is to report it. The church can be held liable if they don't. But our bishops are lay volunteers and not lifelong dedicants. My info doesn't come from any official handbook.
quote: What the film fails to realize is that this conversation is not protected by the sacramental seal because the sinner makes it absolutely clear he is not asking forgiveness, does not repent and plans to keep right on sinning as long as he can get away with it. At this point, Father Greg should pick up the phone and call the cops.
Does a penitent actually have to express remorse and desire for change in order for it to be a sealed confession?
quote:II. CONFIDENTIALITY OF HIV-RELATED INFORMATION
***
C. Exceptions to the Confidentiality of HIV-Related Information Confidential HIV-related information can only be disclosed or compelled to be disclosed to certain persons. Most importantly, such persons include the individual who has undergone the HIV-related test or who has an HIV-related condition (or the designee of the individual) and persons involved in the care and treatment of the individual. In addition, disclosure can also be made to a peer review organization, an insurer (to a limited extent), the Department of Health and related local departments, a funeral director and persons given access to such information pursuant to a court order. 1. Possible Harm to Third Parties at Significant Risk A physician may, but is not required to, disclose confidential HIV-related information to a known sex-sharing or needle-sharing contact of the patient. A physician can only disclose this information if:
*the physician reasonably believes disclosure is medically appropriate and there is a significant risk of future infection to the contact;
*the physician has counseled the patient regarding the need to notify the sex-sharing or needle-sharing contact and the physician reasonably believes that the patient will not inform the contact or abstain from sexual or needle-sharing behavior which poses a significant risk of infection to the contact; and
*the physician has informed the patient of his or her intent to make the disclosure.
Disclosure should be made in person if possible. When making the disclosure, the physician must not reveal the identity of the individual or any other sex-sharing or needle-sharing contact. A physician does not have an affirmative duty to identify, locate or notify any contact.
posted
In regard to doctor-patient confidentiality, there are very different issues with communicable and genetic diseases. I believe (and I could be wrong) that every state has different laws regarding exposure notification. I think that most states do require health care professionals to contact anyone they believe has been exposed to a communicable disease.
The genetic disease notification issues strikes a cord with me. I've had no contact with my father since I was 3 and he didn't exactly leave a medical history behind. I have a vague idea of some of the things I should look out for (PCOS, heart disease, diabetes), but that's it.
quote:This is what genetic counseling is for.
Absolutely, but there needs to be much more publicity about it.
Jewish people especially need to look into genetic counseling since there are so many Jewish genetic diseases (Cystic Fibrosis, Canavan, Tay-Sachs, to name a few).
Posts: 3037 | Registered: Jan 2002
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I thought I hadn't heard of Canavan, but when I googled it I realized I have, I just didn't know the name. Posts: 11017 | Registered: Apr 2003
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posted
Priests don't necessarily have that protection in all states, although in practice it's seldom pursued. But the priest has no option, no matter what a secular authority says or threatens to do to compel testimony.
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