Confidentiality is one of the biggest arguments that tend to happen between people’s concious, employers and employees, doctors and patients, lawyers and clients and the bold question remains; where exactly is the line drawn and the niggling voice inside one’s head may wonder just how far you can step over the line and how much trouble would ensue based upon how far you went. Confidentiality runs the gamut of enduring principles as well as on the consequences of choices made. In principle, it is common knowledge that one is unable to reveal medical history or conversations with a client.
This is simply stated and is expected to always be held in check thus endurance of the policies and rules that govern this. In principle this task seems easy but what if a chance encounter of a specific conversation happens and reveals to you information that you know needs to be passed on? What if your patient tests positive for HIV and has a spouse? What if the positive patient is also pregnant. What if the spouse of the positive patient happens to be closely related to you?
There are many arguments on how to approach this and with the end result of all the arguments, it still remains the patients responsibility to inform whom they choose. A doctor in this position is still unable to divulge this information. What of the attorney whose client just let slips out that one of the top 10 wanted criminals is holed up in your clients home. An attorney is bound by confidentiality and must not divulge this. What if the criminal is a drug trafficker and is responsible for the attorney’s family deaths or other mishaps?
In these two circumstances how do you think the doctor and the attorney may feel. This is the beginning of the end of ethics. The ethics of anything I think need to be rewritten, especially those of confidentiality. When bound by ethical rules you have two choices; one is to remain bound by them and hope for the best and try not to let it interfere or to step over those bounds and breach the ethical wave and hope not to lose your license to practice which would be one of the worst consequences. Depending on the magnitude of the breach may also depend upon the consequence.
Ethics has become the co conspirator of values and values originally is much of what made or broke a business. Where once ethics weren’t laws, now they are and those laws need to be revisited. The definitive line of when you can and cannot divulge confidential information needs to have a broader base. Just like mandatory reporters for abuse victims, it should become not the responsibility of the doctor, lawyer or other person to divulge but that these who hold the confidential information be allowed to have the option if the other party is not going to.
There obviously should be guidelines within this. As in the earlier example of the HIV patient, if the diagnosis would harm another, then the option for the doctor to reveal the result within a 30-60 time frame should be there. In the case of the drug trafficker, the attorney should immediately be able to inform law enforcement. The standards should not preclude certain informational aspects. It is in these cases that doctors, attorneys or whomever should act and or be considered as a mandatory reporter.
If someone knows a crime will be committed, they should have this option of divulgence. In not allowing certain confidentialities to be “broken” what kind of actual ethics is it to let criminal continue to run free, a person to cause harm or potentially cause harm to others or to allow a crime to be committed. In allowing certain information, under a broader based ethics divulgence per circumstance be revealed then that crime may not be committed and so forth. What kind of ethics is ethics really when it can actually put someone in harms way?
It is understand that the privacy of others has a strong philosophy, sociological and legal issues but those same issues are inherent with everyone. It isn’t meant to be that those with confidential information just blab but maintain that only certain circumstances can be spoke of and only to a small degree. My belief of just a simple sentence of I am sorry but I need to inform you of…, simply inform and let it go at that. It may sound cold in some cases but it can save lives in the end whereas keeping quiet can actually kill.
The dividing line of when to disclose should be based upon the addage of “beyond a reasonable doubt” and certain hearsay as it is already associated with current legislations. In these situations this “broken” confidentiality may be extended to the person who was informed. Just like now, certain disclosures have certain consequences, this should remain in tact. This new disclosure of confidential information would definitely violate what people know as the accepted confidentiality but in weighing the pros and cons of saving a life or jailing a criminal this should not be outweighed by silence.
There is much logic to this thought and in revisiting legislature, this knew ethics of confidentiality can be used worldwide. In being used worldwide then there may indeed be less deaths, crime and more awareness and these are key factors in a more productive community in the long term.
Kenneth W. Goodman, PhD. Privacy, Confidentiality, Law and Ethics January 30th, 2008 http://209. 85. 173. 132/search? q=cache:fzGpgbL9TK8J:www. dcmsonline. org/jax-medicine/2008journals/ethics/privacy. pdf+why+were+ethics+for+confidentiality+originally+written&hl=en&ct=clnk&cd=7&gl=us&client=firefox-a
Kenneth Goodman writes of privacy issues and their morals, values and the importance of confidentiality to patients. Mr. Goodman is an advocate for complete confidentiality and approaches this with vigor in his own reasoning as to why it needs to stay as it is and how the ethics should not be breached under any circumstances. He does recognize the difficult situations that persons are put in but nevertheless and steadfastly, he holds that under no circumstance should these ethics be violated. This is in direct contrast with my belief of divulgence in certain circumstances.