In this essay, attention will focus on the need to maintain confidentiality as a legal and professional aspect of health care delivery and how which affects trust within the Associate Physician (PA). - Patient relationship. In particular, emphasis will be placed on areas where confidentiality is violated, both in situations where there is a legal mandate in situ and especially where there is no legal status per se but a precedence has been recognized in Common Law. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get the original essay Confidentiality has been at the heart of medicine since its inception, and a core tenet of the Hippocratic Oath states: Whatever whatever, in connection with my practical professional work, or unrelated to it, which I see or hear in the lives of men, of whom I should not speak abroad, I will not divulge it, believing that everything must be kept secret. Hippocrates reflects the importance and value of privacy. in the AP-Patient relationship, the heart of which is to respect the ethical principle of autonomy: allowing an individual to have control over decisions affecting their medical treatment and to choose what happens to the information they communicates (Nixson 2017). All staff working within the NHS are bound by a legal duty of confidentiality to protect any personal information they may come into contact with. This is not only a requirement of an employee's employment contract, but also a requirement of the common law duty of trust and the Data Protection Act 1998. (Hywel Dda University Health Board 2015). For there to be an effective AP-Patient relationship, the patient and society as a whole must have trust in the system: Trust is an essential part of the doctor-patient relationship and confidentiality is at the heart of this. Patients may avoid seeing a doctor, or underreport their symptoms, if they believe their personal information will be disclosed by doctors without their consent, or without the ability to have some control over the timing or amount of information shared. PA To be able to provide safe and effective care, the patient must feel comfortable telling her secrets, her innermost thoughts and being honest. The patient must be able to expect that any information communicated will result in complete confidentiality. In cases where confidentiality must be violated, this should be an exception to the rule and for the "general public good", and the patient must be even more aware of any violation and to whom (Brazier & Cave 2011). There are many situations in which confidentiality is acceptably breached in medicine, including where a patient has given consent, where there is actual harm or threat of serious harm, for example in order to protect children or adults vulnerable, or disclosure in the “public interest” for example. Besides the general public believing that these are ethically acceptable violations (Jones 2003), there are laws that mandate certain violations of the law. For example, there is a legal duty under the Public Health (Control of Disease) Act 1984, combined with the Health Protection (Notification) Regulations 2010 which requires PAs to not only treat patients with of named diseases according to a strict set of criteria, but that they are also obliged to treat patients with named diseases. to inform the relevant local body, such as PublicHealth Wales. The public at large recognizes the importance of such breaches of confidentiality, as it is a generally accepted assumption that disclosure is in the public interest; takes priority over personal privacy in order to minimize the spread of such infections. When the breach of confidentiality becomes controversial, there is no legal mandate for disclosure. It has been recognized that the law surrounding this area is haphazard (Pattison 2014) and less than satisfactory (Herring 2017) due to few established precedents in the Common Law and yet there is a large number of governing statutes which can often contradict each other. with levels of importance (Stanton 2018). The main laws are the Data Protection Act (2018) and the Human Rights Act (1998). Herring points out that professional bodies such as the GMC have clear guidelines on how their members (including PAs) should act in cases of breach and that the courts, in turn, have somewhat mirrored the professional guidelines of the Common Law. It should be noted that this lack of legal clarity may also prevent some individuals from pursuing future proceedings questioning the ethics of such regulations. (Herring 2017). The landmark common law case that specifically addresses the breach of confidentiality in a health care setting as such, setting a current precedent, is W v Egdell (1990). In Egdell, W had been convicted of manslaughter and detained under the Mental Health Act (Herring 2017). MHA) (1983). W had requested an independent report from a psychiatrist (Egdell) for an upcoming mental health tribunal. Egdell wrote in his report that W continued to be extremely dangerous, stating that those currently responsible for his care did not seem to realize how dangerous W was, as highlighted by his continued obsession with explosives. W's attorney exercised his legal right and chose not to include this report at the hearing. Egdell then breached patient confidentiality by sending his report to both the Home Office and the director of the establishment where W was detained. Egdell believed he was acting in good faith and believed it was morally and professionally legitimate to violate W's confidentiality in order to protect the public from the clear risks W posed to cause significant harm to others. Egdell won his case in the appeals court, but with the important provision that W is entitled to a certain degree of confidentiality, namely that Egdell could not write about the case in a newspaper article, sell to a newspaper, “gossip” with colleagues or write a book. In each of these situations, appropriate measures would be necessary to protect W's identity, which, given the importance of this case to date, would be exceptionally difficult to implement. An in-depth discussion around this case highlights important areas, namely: the threat of a real and serious incident. danger to the public: there must be convincing evidence of the likelihood of serious harm and the risk must be permanent. For example, past risk is not enough. This could be seen in a woman suffering from postpartum depression (PPD) expressing a desire to harm her newborn. Having these feelings during one pregnancy does not necessarily mean that she would have these thoughts in future pregnancies or even that she would suffer from PPD. should be limited to the minimum information necessary to protect the public and appropriate persons who have a legitimate interest in the matter. (Brazier 2011) in the example above, reveal to social services thatthe mother expressed a desire to cause harm to her baby, is legitimate, what would not be relevant to the discussion with social services is the fact that the mother had breast augmentation surgery thirteen years previously or, at default, of having informed the breast surgeon of the expressed intention to harm by the mother. In the recent case of ABC v St George's Healthcare NHS Trust, South West London and St George's Mental Health Trust, Sussex Partnership NHS Foundation Trust (2017), the issue of duty of care in relation to breach of confidentiality was explored. ABC's father was found guilty of manslaughter. He was sentenced to a hospital order under the MHA (1983). A few years after the conviction, he was diagnosed with Huntington's disease, a chronic, progressive and fatal neurological disorder. The special case is that Huntington's disease is a hereditary disease in which the child of a parent with the disease also has a fifty percent chance of developing the disease. Concerns and discussions with the father of his medical team, he expressly prohibited from disclosing his condition to ABC. Later, ABC was accidentally informed of her father's diagnosis after giving birth to a child. ABC was tested following this revelation and was also confirmed to have the disease. ABC has filed a 'wrongful birth' claim against the NHS organizations involved in his father's care in the High Court. The basis of her complaint was that her father's confidentiality should have been breached and as a result she terminated the pregnancy on the grounds that she would eventually become seriously ill and also that the child would potentially have a fifty percent chance to inherit the disease. The case was not heard by the High Court as a “strike out” order was accepted. This decision was subsequently overturned by the Court of Appeal, the decision being set aside on the basis that there was at least room for discussion as to whether the existing law relating to persons who owe a duty of care should be extended to third party. The judge specifically cited professional genetic counseling (Royal College of Physicians, The Royal College of Pathologists, The British Society for Human Genetics 2011) which makes clear that there are professional obligations towards those who, although not having existing relationship with a clinician, have a vital interest in the information that the clinician had obtained www.ukhumanrightsblog.com. As such, these obligations provide a good basis for an extension of the statutory duty of care to potentially affected persons. As the medical, legal, and ethical communities await ABC's trial, much discussion surrounds possible alternatives regarding the choice between preserving confidentiality. of one patient and prevent harm to another, particularly in the area of ​​genetics as testing becomes more widespread. Nixon (2017) questions whether a duty of care should also be extended to a "duty to warn", as it has been suggested that the greatest harm caused by maintaining confidentiality falls on the relative and, therefore, the rights of the loved one should predominate (Dove, Chico, Fay, Laurie, Lucassen, Postan 2019). Some countries have already adopted this principle. For example, in Australia, it is permitted to disclose genetic information without a patient's consent in circumstances where the physician reasonably believes that reliance on the disclosure is necessary to lessen or prevent a serious threat to life, health or health. the safety of another person who is a genetic relative (Nixson 2017). This, 26 (2), 328-345.