Privacy & Confidentiality

Overview of Ethical Issues in Privacy and Confidentiality

  • Ethical issues surrounding privacy and confidentiality have historical roots.

Historical Perspectives

  • Hippocratic Oath: Hippocrates stated the importance of not divulging information shared during professional practice, emphasizing confidentiality as a "holy secret."

  • Florence Nightingale: Advocated for nurses' obligation to be trustworthy and refrain from gossiping about patients, ensuring only authorized individuals access patient information.

Contemporary Issues in Privacy and Confidentiality

  • Ethical breaches in privacy and confidentiality are common, subtle, and varied.

    • Patient Rounds: Patients can overhear discussions due to open units, leading to potential confidentiality breaches.

    • Patient Exposure: Patients may be left undraped longer than necessary during care delivery.

    • Inappropriate Discussions: Conversations in medication rooms or elevators can breach patient confidentiality.

    • Gossip: Sharing patient information irrelevant to care decisions raises ethical concerns.

    • Visitor Interaction: Sharing patient information with visitors without consent can violate privacy rights.

Impact of Global Events on Privacy

  • Post-9/11 Context: The September 11 attacks shifted perceptions of privacy; individuals faced choices between privacy and security.

    • Surveillance Exposure: Whistleblowers like Edward Snowden revealed extensive surveillance, raising ethical dilemmas regarding privacy.

    • Public Discourse: A notion emerged that privacy signifies guilt; political narratives reinforced this view.

The Role of Health Care Professionals

  • Health care workers navigate complex privacy issues daily while receiving sensitive information from patients.

    • Patient Trust: Patients often disclose private information in a therapeutic relationship due to trust in health care professionals.

    • Intimate Knowledge: Physical exams and care take place in personal spaces, requiring careful consideration of what information is essential versus unnecessary.

Definitions of Privacy and Confidentiality

  • Privacy:

    • Refers to individuals' right to limit exposure of their bodies and personal lives.

    • Often considered less important than efficiency in care delivery.

  • Confidentiality:

    • Concerns the protection of health information by professionals, detailing how private data is managed and protected.

    • Overlaps with privacy rights, as patients expect discretion in disclosing personal details.

Ethical Framework and Legal Codes

  • Ethical guidelines emphasize individual agency in controlling personal information access.

  • Civil Codes: Enshrine personality rights, including life, dignity, and privacy, as inalienable rights.

  • Quebec Charter of Human Rights:

    • Articles emphasize rights to personal inviolability and privacy, mandating respect for confidentiality.

  • OIIQ Code of Ethics: Contains provisions related to maintaining the secrecy of confidential information, especially around documentation and third-party disclosures.

Exceptions to Confidentiality

  • Clear exceptions allow breaches of confidentiality:

    1. Patient Consent: Patients can authorize information disclosure (e.g., to insurance companies).

    2. Court Orders: Required disclosures for legal proceedings (e.g., abuse cases).

    3. Statutory Duty: In life-threatening situations (e.g., intent to harm).

    4. Public Interest: Mandated reporting of communicable diseases.

Elements of Disclosure

  • Disclosure must demonstrate:

    • Clear risk to persons.

    • Serious risk of harm or death.

    • Limited extent of information shared, proportional to the risk.

Landmark Cases Impacting Duties

  • Historical cases shape understanding of confidentiality duties:

    • Tarasoff Case: Established duty to warn potential victims of threats.

    • HIV Disclosure: Canadian Supreme Court rulings regarding disclosure of HIV-positive status.

Reflection Questions for Nurses

  • Expectation of Privacy: Do nurses maintain privacy in their professional conduct?

  • Name Tag Policies: Ethical dilemmas around concealing identities for safety versus institutional policies on visibility.

  • Social Media Impact: How do platforms alter perceptions of privacy, with reminders of potential consequences, such as in the case of Caroline Strom?