2024 Revised Content: Confidentiality Informed Consent (PDF)

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn INFORMED CONSENT, ADVANCE HEALTH CARE DIRECTIVES & CONFIDENTIALITY Prof David Smith Presented By Dr Eman Al Arayedh IPCP Learni...

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn INFORMED CONSENT, ADVANCE HEALTH CARE DIRECTIVES & CONFIDENTIALITY Prof David Smith Presented By Dr Eman Al Arayedh IPCP Learning outcomes 1. Display high-quality communication with patients and demonstrate competence in conducting a structured history 2. Demonstrate basic competence in physical examination of cardiovascular, respiratory, gastrointestinal and neurological systems 3. Demonstrate professional behaviour towards patients and colleagues and engagement in ‘critical reflection’ to learn from experiences 4. Identify the challenges faced by patients living with a chronic disease and their families 5. Explain the ethical principles underpinning patient care and the doctor-patient relationship including recognition of issues arising for doctors practicing in multicultural environments 6. Demonstrate an understanding of the basic principles of evidence-based medicine (EBM) as applied to the clinical care of individual patients 7. Illustrate how patients access the healthcare system including recognition of the social and cultural influences on health 8. Recognise the basic principles of therapeutics and issues INFORMED CONSENT What is informed consent? “Every human being of adult years and sound mind has a right to determine what shall be done with his body” Schoelendorff v New York Hospital 211 NY 125 Consent justifies what would otherwise be prohibited i.e. trespass to the person’s body True consent to what happens to one’s self is the informed exercise of a choice, and that entails an opportunity to evaluate knowledgeably the options available and the risks attendant upon each – Canterbury v Spence (1972) 464 F 2d 772 The success of informed consent depends on patients being able to understand and sufficiently retain the information they are given so as to enable them to analyse that information and use it to make a decision. It is a process not a once-off event. Irish Medical Council: Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Consent – general principles – When patients give consent, they are making a voluntary choice. You should help patients make decisions that are informed and right for them. You should not give patients the impression that their consent is simply a formality or a signature on a page (see Appendix C). – You must make sure that patients have given their consent before you provide any medical investigation, examination or treatment. Consent is required by law and is an essential part of respect for patients’ autonomy. Patients have the right to decide what happens to their own body. They also have a right to refuse medical treatment or withdraw consent (see paragraph 15). (No. 9) Legal bases of Consent The Supreme Court has stated that: – “The requirement of consent to medical treatment is an aspect of a person’s right to bodily integrity under Article 40, s. 3 of the Constitution” (In re a Ward of Court 2 IR 79 at 156, Denham J.). The Supreme Court in the same case made it clear that: – “If medical treatment is given without consent it may trespass against the person in civil law, a battery in criminal law and a breach of the individual’s constitutional rights” Reality? INFORMED CONSENT -- Valid Consent Five elements are crucial in the concept of informed consent: i. Disclosure of information -- reasonable person standard, forced information ii. Comprehension -- two-way communication, info provided iii.Voluntariness/ choice-- free of controlling influences e.g. social/financial iv. Competence/Capacity -- sufficient rationality and intelligence -- value- Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Information for patients (No. 11) – You must give patients enough information, in a way that they can understand, to enable them to exercise their right to make informed decisions about their care. Consent is not valid if the patient has not been given enough information to make a decision. – The amount of information patients need before making a decision will vary according to a number of factors including: the nature of the condition; the type of investigation; the complexity of the treatment; the risks associated with the treatment or procedure (and the risks of non- treatment); and the patient’s own wishes. Role of Communication [T]he doctor’s advisory role involves dialogue, the aim of which is to ensure that the patient understands the seriousness of her condition, and the anticipated benefits and risks of the proposed treatment and any reasonable alternatives, so that she is then in a position to make an informed decision. This role will only be performed effectively if the information provided is comprehensible. The doctor’s duty is not therefore fulfilled by bombarding the patient with technical information which she cannot reasonably be expected to grasp, let alone by routinely demanding her signature on a Voluntary The real question in each such case is ‘Does the patient really mean what he says or is he merely saying it for a quiet life, to satisfy someone else or because the advice and persuasion to which he has been subjected is such that he can no longer think and decide for himself?’ In other words, ‘Is it a decision expressed in form only, not in reality?’ Re T (Adult: Refusal of Medical Treatment) 3 WR 782, 795 Impact of Capacity: The Traditional View Capacity as bright-line divider: No possibility of movement between the categories  Making Decisions Objective evaluation of best interests by court or experts No role for the person  Challenges to the Traditional View Empirical evidence: range of capacities Scandals/abuses Human Rights  Human Rights European Convention on Human Rights “[E]ven a minor interference with the physical integrity of an individual must be regarded as an interference with the right to respect for private life under Article 8, if it is carried out against the individual’s will” United Nations Convention on Storck v Germany ECHR 406 the Rights of Persons with Disabilities Art 12(3) States Parties shall recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life Assisted Decision-Making (Capacity) Act 2015 Key Elements Complex: 129 sections/3 Schedules Link to ratification of CRPD Removal of “Best interests” Introduction of range of supported decision- making measures Guiding principles 1. Statutory presumption of capacity 2. A person will not be found to lack the capacity to make a decision unless all practicable steps have been taken, without success, to help him or her to do so 3. A person is free to make an unwise decision and this will not in and of itself be seen as an indication of lack of capacity 4. Any intervention made under the Bill must be necessary, in a manner that minimises restriction of the person’s rights and freedom of action, and have due regard to the need to respect the right of the person to his or her dignity, bodily integrity, privacy and autonomy 5. Any intervention must give effect, in so far as is practicable, to the past and present will and preferences of the person, in so far as they are reasonably ascertainable  Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Capacity to consent (No. 10) – Every adult patient is presumed to have the capacity to make decisions about their own health care. As their doctor, you have a duty to help your patients to make decisions for themselves by giving them information in a clear and easy-to- understand way and by making sure that they have suitable help and support. Patients have the right to have an advocate of their choice during discussions about their condition and treatment. – Adults who are considered not to have the capacity to make a decision are entitled to the same respect for their dignity and personal integrity as anyone with full capacity.  Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 You should seek and listen to their views, and involve them in decisions about their healthcare to the extent that they are willing and able to be involved. – A lack of capacity may arise from a long-term or permanent condition or disability, or from short-term illness or infirmity. A person lacks capacity to make a decision if they are ????????????????????????????????  Capacity HSE Guidelines 2022 Best practice favours a “functional” or decision- specific approach to defining decision-making capacity; – it should be issue specific and time specific – depends upon the ability of the individual to comprehend, reason with and express a choice with regard to information about a specific decision. The “functional” approach recognises that there is a hierarchy of complexity in a decision and also that cognitive deficits are only relevant if they actually impact on decision making.  Capacity HSE Guidelines 2022 Best practice and international human rights standards favour “supported decision-making” where possible. It is important to give those who may have difficulty making decision the time and support they need to maximise their ability to make decision for themselves The possibility of incapacity and the need to assess capacity formally should only be considered if having given all appropriate help and support, a patient: – Is unable to communicate a clear and consistent choice or – Is obviously unable to understand and use the information and choices provided. Decision-making Co-decision-maker assistant Decision-making Enduring power of representative attorney Advance healthcare directive Appointees One of the most important innovations in the 2015 Act is that it allows a relevant person to appoint someone to act as their supporter, either as: A Decision-Making Assistant or A Co-Decision-Maker. The Circuit Court may appoint a Decision-Making Representative on behalf of the relevant person. If authorised to do so by the Court, a Decision-Making Representative may consent to and refuse medical treatment on behalf of the relevant person. However, they cannot be authorised to refuse life-sustaining treatment. Decision-Making Assistant Lowest and least formal tier Appointed by a person who considers that his or her capacity is or may shortly be in question Relevant decisions set out in a decision- making assistance agreement Functions of decision-making assistant – assist to obtain relevant information – explain relevant information – ascertain and help appointer to communicate will and preferences – assist appointer to make and express decisions – help to ensure that decisions implemented Decision-Making Assistant The appointer still makes the decision No capacity assessment required Notified to but not formally registered with the Decision Support Service Co-Decision-Making Mid-tier, more formal support Appointed by a person (‘appointer’) who considers that his or her capacity is or may shortly be in question Co-decision-maker is a relative or friend in a pre- existing relationship of trust Functions of co-decision-maker: – advise appointer, helping to obtain and understand information – ascertain and help appointer to communicate will and preferences – make a relevant decision jointly; may not include making gifts – make reasonable efforts to ensure that decision is implemented Co-Decision-Making Co-decision-making agreement is registered within the DSS with supporting documents including formal capacity statement Relevant decisions taken otherwise than jointly are null. DSS conducts periodic reviews -- updated capacity statements are required DSS may apply to court in matters of non- compliance Decision-Making Representation Court makes a declaration that relevant person lacks capacity – Court may make order: Making the decision/s if satisfied matter is urgent or it is expedient to do so – The court may make a declaration about the person’s capacity in specified matters – Declaration is subject to periodic review by the court – The court may make the decision for the person, or – The court may appoint a Decision-Making representative – In making order takes account of any Enduring Power of Attorney EPA/Advanced healthcare Directive AHD and in making order ensure terms are not inconsistent with EPA/AHD Decision-Making Representation – In appointing DM Representative court will have regard to: The known will and preferences of relevant person Desirability of preserving existing relationships within family Any conflict of interest Complexity of financial affairs and expertise available to a proposed DMR Relationship/Compatibility between relevant person + proposed representative Whether proposed representative will be able to perform functions Decision-Making Representative: Scope of Authority Decision-Making Representative: Scope of Authority Cannot prohibit contact with others Authority confined to decisions included in court order Cannot make decisions on life-sustaining treatment (consent or refusal) Shall not restrain relevant person unless exceptional emergency circumstances Shall not administer medication to control or modify behaviour of a relevant person Summary In summary the three levels of support are: a ‘decision-making assistant’ will be someone who helps with information and discussions, but will not actually make a decision for someone else; a ‘co-decision-maker’ will be a joint decision-maker; and a ‘decision-making representative’ will be a substitute decision-maker. Enduring Powers of Attorney Extension of Powers of Attorney Extension of Powers of Attorney legislation (Powers of Attorney Act 1996 and the Enduring Powers of Attorney Regulations 1996 (SI No. 196/1996) as amended by SI No. 287/1996) to cover healthcare Advance Healthcare Directives (AHDs) Ethical Rationale for AHDs Respect for autonomy acknowledges and protects the right to a life structured by one’s own values (integrity view) The 2015 Act includes a legislative framework for Advance Healthcare Directives (AHDs), which sets out clear guidelines to allow a person to make a legally binding refusal of treatment and to make treatment requests. A directive-maker may also appoint someone to act as their Designated Healthcare Representative, and give this person authority to consent to and refuse treatment, including life-sustaining treatment, always with reference to the AHD Advance Healthcare Directives (AHDs) A legally recognised arrangement that lets you plan ahead for healthcare and treatment decisions. It lets you set out your wishes about these types of decisions in case you are unable to make these decisions sometime in the future. A person who has the authority to make certain decisions on your behalf regarding healthcare and treatment decisions. These decisions must be based on your wishes set out in an advance healthcare directive. They can only act on your behalf if you lose the ability to make certain healthcare decisions for yourself. Forms of Advance Healthcare Decision- Making Forms of Advance Healthcare Decision-Making Definition: an adult’s written statement setting out type & extent of treatment to which adult consents to or refuses if adult losses capacity to make treatment decisions AHCD is an expression of autonomy & provides a patient with a mechanism to record refusal of treatment Two types of AHCD – Instructional directive i.e. directions for treatment & – proxy directive i.e. designated person is allowed to communicate patient’s treatment choices Forms of Advance Healthcare Decision- Making – An advance healthcare plan or directive has the same status as a decision by a patient at the actual time of an illness and should be followed provided that: the request or refusal was an informed choice, in line with the principles in paragraph 9; the decision covers the situation that has arisen; and there is nothing to indicate that the patient has changed their mind. – You are not obliged to provide treatment that is not clinically indicated for a particular patient. ‘A refusal of treatment set out in an advance healthcare directive shall be complied with if: at the time in question the directive-maker lacks capacity to give consent to the treatment; the treatment to be refused is clearly identified in the directive; the circumstances in which the refusal of treatment is intended to apply are clearly identified in the directive.’ Forms of Advance Healthcare Decision- Making A request for a treatment = shared meaning? ‘A request for a specific treatment set out in an advance healthcare directive is not legally binding but shall be taken into consideration during any decision-making process which relates to treatment for the directive-maker if that specific treatment is relevant to the medical condition for which the directive-maker may require treatment.’ Forms of Advance Healthcare Decision- Making Who can make an AHD? A relevant person who has attained the age of 18 years and who has capacity is entitled to refuse treatment for any reason (including a reason based on his or her religious beliefs) notwithstanding that the refusal – appears to be an unwise decision, – appears not to be based on sound medical principles, or – may result in his or her death. The Hospice Foundation has excellent examples of AHD in their documents Think Ahead. https://hospicefoundation.ie/i-need-help/i-want-to-think-a head/  Role of the family No other person such as a family member, friend or carer and no organisation can give or refuse consent to healthcare on behalf of an adult (over the age of 18 years of age) who lacks capacity unless they have specific legal authority to do so. Ward of Court or is the subject of an enduring power of attorney which covers the decision in question. However these people should be consulted Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Emergency situations (No. 14) – In an emergency, where consent cannot be obtained, you should provide medical treatment to anyone who needs it, provided the treatment is limited to what is immediately necessary to save a life or to avoid significant deterioration in the patient’s health. Doctrine of necessity Doctrine of necessity in emergency Where impossible to obtain consent for immediately necessary procedure Expansion in AC v Hickey and Ors IESC 73? Applies ‘where there is a need to take action but it is not possible to communicate with the assisted person, and the action to be taken is such that a reasonable person would take in the best interests of the assisted person in all of the circumstances.’ But hospital must ‘seek the assistance of the court within a reasonably short time’. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Responsibility for seeking consent (No. 13) – If you are the doctor providing treatment or undertaking an investigation, it is your duty to make sure that the patient has given consent before providing treatment. As the treating doctor, you should usually give information and seek the patient’s consent yourself, as you will have a full understanding of the procedure or treatment, how it is carried out and the risks attached to it. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Delegation of consent taking – If it is not possible for you to do this, you may delegate all or part of the process to another suitably trained and qualified person. The person to whom you delegate must know enough about the proposed investigation or treatment, understand the risks involved and be able to explain and discuss these issues with the patient. If you delegate all or part of the consent process, you remain responsible for making sure that the patient has given their consent. – You should not delegate any part of the consent process to an intern unless the procedure is a minor one with which the intern is very familiar and the intern’s medical supervisor has clearly explained the relevant information about the procedure to them. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Timing of consent process (No. 12) – Taking consent is not a one-off event. It involves a continuing dialogue with the patient, keeping them up-to- date with any changes in their condition and the treatments or investigation proposed. – Whenever possible, you should discuss treatment options and their risks at a time when the patient is best able to understand and retain the information. You should also give the patient enough time before the treatment to consider their options and reach a decision. You should not usually seek consent from a patient when they are stressed, sedated or in pain, and, therefore, less able to make a calm and reasoned decision. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Refusal of treatment (No. 15) – Every adult with capacity is entitled to refuse medical treatment or withdraw consent. You must respect a patient’s decision to refuse treatment or withdraw consent, even if you disagree with that decision. In these circumstances, you should explain clearly to the patient the possible consequences of refusing treatment and, where possible, offer the patient a second medical opinion. – You should record your discussion with the patient, the information you gave and the patient’s refusal of treatment in the patient’s medical notes. – If you have doubts or concerns about the patient’s capacity to refuse treatment, you should follow the guidance in paragraph 10 and seek legal advice. CHILDREN  Minors: Age of Consent The consent of a minor who has attained the age of 16 years to any surgical, medical or dental treatment which, in the absence of consent, would constitute a trespass to his or her person, shall be as effective as it would be if he or she were of full age; and where a minor has by virtue of this section given an effective consent to any treatment it shall not be necessary to obtain any consent for it from his or her parent or guardian. S. 23 (1) of the Non-Fatal Offences Against the Person Act 1997 Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Children and young people (No. 18) – When treating children and young people, your primary duty is to act in their best interests. You should involve them as much as possible in discussions about their healthcare, give them information suitable for their age, listen to their views and treat them with respect. – By law, patients aged 16 years and over are entitled to give consent to surgical, medical or dental treatment. Patients 6 over 18 years are entitled to give consent to psychiatric treatment , organ or tissue donation, or participation in 7 medical research. The law relating to refusal of treatment by young people aged 16 and 17, against medical advice and parental wishes, is uncertain. If this situation arises, you should consider getting legal advice before acting on the decision. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 – Where the patient is under the age of 16 years, the parent(s) or guardian(s) will usually be asked to give their consent to medical treatment on the patient’s behalf. – When patients under 16 want to make a healthcare decision without the knowledge or consent of their parent(s) or guardian(s), you should encourage them to involve their parent(s) or guardian(s) in the decision. – If a young person refuses to involve a parent/guardian, you 8 should consider the young person’s rights and best interests, taking into account:  Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Mature Minor the young person’s maturity and ability to understand the information relevant to the decision and to appreciate its potential consequences whether the young person’s views are stable and reflect their core values and beliefs whether the young person’s physical or mental health, or any other factors are affecting their ability to exercise independent judgement the nature, purpose and usefulness of the treatment or social care intervention the risks and benefits involved in the treatment or social care intervention Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 any other specific welfare, protection or public health considerations, covered by relevant guidance and protocols such as the 2011 Children First: National Guidelines for the Protection and Welfare of Children (or any equivalent replacement document). Where this is the case, the relevant guidance or protocols must be followed. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Children and young people have a right to confidential medical treatment as set out in paragraph. However, parents and guardians also have a legal right to access medical records of their children until they are 18. You should tell children and young people that you cannot give an absolute guarantee of confidentiality. Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 Consent to genetic testing (No. 17) – Genetic testing can help to diagnose an illness or help to predict the development of an illness in the future. Patients must have counselling about the possible consequences of genetic testing before you seek their consent. 5 Other important areas of consent Blood Transfusions Clinical Photography and other recordings Patient’s who cannot understand English Deaf patients Blind patients Retention of Tissue Post-Mortems / Coroners  References & sources Beauchamp, T. & Childress, J. (2013) Principles of Biomedical Ethics 7th edition Oxford University Press British Medical Association (2012) Medical Ethics Today 3rd edition. Wiley-Blackwell Cave, E “Goodbye Gillick: Identifying and Resolving Problems with the Concept of Child Competence (2014) 34(1) 103 Donnelly, M. “Developing a Legal Framework for Advance Healthcare Planning: Comparing England & Wales and Ireland” (2017) 24(1) European Journal of Health Law 67 Health Service Executive (2022) National Consent Policy. HSE. Parts 1 and 2 http://www.hse.ie/eng/services/list/3/hospitals/ulh/staff/resources/pp pgs/NationalConsentPolicy/ Irish Medical Council (2019) Guide to Professional Conduct and Ethics www.medicalcouncil.ie  References & sources Madden D. Medicine, Ethics and Law (3rd Ed) (Bloomsbury, 2016), Ch 9, 10, 11 Manson, M and O’Neill, O Rethinking Informed Consent in Bioethics (Cambridge University Press, 2007), Mills S and Mulligan A, Medical Law in Ireland (3rd Ed) Bloomsbury, 2017) Ch 5,6,7 World Medical Association (2015) Manual of Medical Ethics 3rd edition www.wma.net References DSSFamilies and the Assisted Decision-Making (Capacity) Act https://www.youtube.com/watch?v=YJ2mT6JpLK4 Decision Support Service FAQ https://decisionsupportservice.ie/faq DSS Information: Overview of the Assisted Decision-Making (Capacity) Act, 2015 and role of the DSS https://www.youtube.com/watch?v=awyiT12gIPE DSS Information: Overview of the Assisted Decision-Making (Capacity) Act, 2015 and role of the DSS Shorter Version https://www.youtube.com/watch?v=TyYNiwv8xjk References HSE Assisted Decision Making Capacity Act 2015 A Short Guide - Explainer video https://www.youtube.com/watch?v=xOd72CVcBCA HSE Respecting the rights of the person and the role of families under the 2015 Act https://www.youtube.com/watch?v=jEuU2RvlPzs https://www.hse.ie/eng/about/who/national-office-human-rights-equality-policy/assisted-dec ision-making-capacity-act/ References Think.ahead_.advance.healthcare.directive https://hospicefoundation.ie/wp-content/uploads/2023/02 /Think-Ahead-My-Advance-Healthcare-Directive.pdf Think.ahead_.planning.pack_ Edited by Mary Donnelly and Caoimhe Gleeson The Assisted Decision-Making (Capacity) Act 2015: Personal and Professional Reflection https://cora.ucc.ie/handle/10468/12231?show=full CONFIDENTIALITY Privacy in Practice?  Key Terms Confidential Information Confidential information is usually understood to be private information that a person shares with another on the understanding that it will not be disclosed to third parties.  Confidentiality Generally, if institution/person ‘A’ holds information about person ‘B’, then person ‘C’ cannot obtain that information in the normal course of events without the consent of person ‘B’  HISTORICAL DEVELOPMENT – THE CONCEPT OF CONFIDENTIALITY The doctor’s duty to keep patient information confidential has been a cornerstone of medical ethics since the time of Hippocrates. The Hippocratic Oath allowed no exception to the duty of confidentiality – confidentiality was an absolute duty Contemporary codes of medical ethics allow for justified breaches of confidentiality (i.e. ethically & legally) WMA The WMA Declaration on the Rights of the Patient “All identifiable information...and all other information of a personal kind must be kept confidential, even after death.” WMA International Code of Medical Ethics “It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can only be removed by a breach of confidentiality.” THE LEGAL BASES OF CONFIDENTIALITY The right to privacy is a fundamental human right and medical confidentiality is a practical expression of that right 1. Human Rights Law: UN Universal Declaration of Human Rights (Article 12) Charter of Fundamental Rights of the European Union (Articles 7 & 8) 2. Bunreacht na hÉireann – The Constitution of Ireland Article 40 - “personal rights” 3. Decisions of the Courts, e.g. McGee v Attorney General (1974) Guide to Professional Conduct and Ethics (2009) Irish Medical Council, Section D Consent to Medical Treatment Kennedy v Ireland (1987) Medical Council The following slides are taken from the Guide to Professional Conduct and Ethics for Registered Medical Practitioners 8th Edition 2019 issued by the Irish Medical Council Medical Council Confidentiality No. 29 Confidentiality is central to the trust between you and your patients and a core element of the doctor/patient relationship. However, sharing information, in appropriate circumstances, is also important, both for patient care and for the safety of the patient and others. You should protect your patients’ privacy by keeping records and other information about patients securely. You should guard against accidental disclosures. Medical Council Confidentiality No. 29 Before sharing or disclosing any identifiable information about patients, you must take into account the Freedom of Information (FOI) principles (see Appendices A and B). You must be clear about the purpose of the disclosure and that you have the patient’s consent or other legal basis for disclosing information. You must also be satisfied that: you have considered using anonymised information (information that does not identify the patient), and you are certain that it is necessary to use identifiable information; you are disclosing the minimum information to the minimum number of people necessary; and the person or people to whom you are disclosing the information know that it is confidential and that they have their own duty of confidentiality. Medical Council Disclosure with consent No. 30 Where a patient is capable of making their own decisions about their healthcare, you must get their consent before giving information that identifies them: – to the patient’s relatives and close friends. While the concern of the patient’s relatives and close friends is understandable, you must not disclose information to them without the patient’s consent. If the patient does not consent, you should respect their decision, except where failure to disclose information would put the patient or others at risk of serious harm; – for research. In some cases it may be possible to give coded (pseudonymised ) data, which you can disclose without explicit 15 consent. The Data Protection Commissioner has published a guide to using health data in research; Ethics assessment in IPCP As part of your Portfolio, you will need to reflect on a patient encounter at the start of Semester 2, in which you considered an ethical principle (Portfolio 2.a.) Examples of ethical principles you can include are: – Consent – Confidentiality – Autonomy – Beneficence – Non-maleficence Covered in Semester 2 of IPCP – Justice RECOMMENDED READING Beauchamp, T. & Childress, J. (2013) Principles of Biomedical Ethics Oxford University Press, Chapter 8. British Medical Association (BMA). (2008). Confidentiality and disclosure of health information toolkit. http://www.bma.org.uk/ethics/confidentiality/confidentialit ytoolkit. General Medical Council (2009) Confidentiality. Glen, S. (1997). Confidentiality: a critique of the traditional view. Nursing Ethics, 4(5), 403-406. Irish Medical Council (2019) Guide to Professional Conduct and Ethics RECOMMENDED READING HSE (2013), Data Protection and freedom of Information Legislation: Guidance for Health Service Staff. Mills, S. (2007) Clinical Practice and the Law 2nd edition Dublin, Tottel. Robinson, D. J., & O’Neil, D. (2007). Access to health care records after death. JAMA: Journal of the American Medical Association, 297(6): 634-636. http://jama.ama- assn.org/