Privacy, Confidentiality, and Secret Keeping in Health PDF

Ethics Privacy, Confidentiality and Secret Keeping Concepts in Health Onur TURAN, Lectuter Privacy, Confidentiality and Secret Keeping Concepts in Health Learning Outcomes; 1. Defines the concept of privacy in health. 2. Explains ethical issues related to patient confidentiality...

Ethics Privacy, Confidentiality and Secret Keeping Concepts in Health Onur TURAN, Lectuter Privacy, Confidentiality and Secret Keeping Concepts in Health Learning Outcomes; 1. Defines the concept of privacy in health. 2. Explains ethical issues related to patient confidentiality and confidentiality in healthcare. Privacy Privacy is a word derived from the Arabic word "haram" (forbidden), which means "things that are prohibited and require responsibility to be done" and includes all information that should remain confidential to those who are confidential to a person. Turkish Language Society privacy → “confidentiality”, “state of being confidential” The Latin word for the concept of privacy or confidentiality is "privatus" and is defined as "the ability of an individual or a group to separate themselves or information about themselves and thus be selective in expressing themselves." Privacy Privacy is used for things that are prohibited to be touched or violated, and includes confidentiality, immunity, secret area, etc. It includes everything that belongs to the person and is not shared with third parties. Privacy means the confidentiality of private life and the preservation of all personal rights that third parties should not know. Privacy Private life basically consists of three parts: common, private and confidential. The common area, the position, and behavior of the person in society; Private space is the space that the individual shares with his/her family and close circle; Confidential area, on the other hand, can be expressed as the area that the person does not want to be known by other people, and that belongs only to himself.  The right to privacy, one of the Patient Rights, Patient important rights of patients, is one of Privacy and Scope of the issues that has been emphasized a lot lately. Patient Privacy Significant changes are being made in both public and private hospitals to protect the right to privacy. Patient privacy refers to the confidentiality of all patient information.  Entering a patient's private space Patient Rights, Patient means being close enough to learn all Privacy and Scope of about his illness and, in some cases, his private life. Patient Privacy Healthcare professionals who are directly involved in the diagnosis and treatment of the patient have the power to enter the patient's private area.  In addition, healthcare professionals are Patient Rights, Patient able to access the patient's secrets that Privacy and Scope of are unknown to anyone, and sometimes even the patient himself Patient Privacy does not know, during the diagnosis and treatment process. At this point, it is very important that this information about the patient remains confidential and this confidentiality is ensured. Patient Rights, Patient Privacy and Scope of Patient Privacy Hippocratic oath; “I will hide and not talk about things that I see and hear, whether during the patient's treatment or outside the treatment, [but] are in the possession of people that cannot be talked about outside.” Similarly, patient privacy still maintains its importance today and is accepted as an important element of patient rights.  The right to privacy is an issue that Patient Rights, Patient must be taken into consideration at Privacy and Scope of every stage of healthcare. Patient Privacy It is a right that requires great attention during disease history (anamnesis), diagnosis, treatment, post-treatment and even after death. Privacy is a value that must be protected not only while people are alive but also after they die. Patient Rights, Patient Privacy and Scope of Patient Privacy Patient privacy and confidentiality is an issue that is the responsibility of healthcare professionals and should be taken into consideration in accordance with the principles of medical ethics. Patient Rights, Patient Privacy and Scope of Patient Privacy Due to the nature of health services as a service offered as a team, all health professionals in the team should show due diligence in this regard. It is necessary to protect the information about the health status of the patient, keep it confidential and ensure its flow only between authorized persons. Article 21 of the Patient Rights Regulation «Patient Privacy» It is essential to respect the patient's privacy. The patient may also explicitly request that his/her privacy be protected. Any medical intervention is performed by respecting the patient's privacy. Death does not give the right to violate privacy. If it is necessary for those who are not directly involved in the treatment of the patient to be present during medical intervention in health institutions and organizations where training is provided; The patient's consent for this is obtained before or during the treatment. Article 21 of the Patient Rights Regulation «Patient Privacy» The right to respect and demand for privacy; a) Medical evaluations regarding the patient's health status are carried out confidentially, b) Examination, diagnosis, treatment and other procedures that require direct contact with the patient are carried out in an environment of reasonable confidentiality, c) Allowing a relative to be present in cases where there is no medical risk, d) Persons who are not directly involved in the treatment should not be present during medical intervention, e) Not to intervene in the patient's personal and family life unless the nature of the disease requires it, f) It covers keeping the source of health expenses confidential. Patient Rights, Patient Privacy and Scope of Patient Privacy It is clear that the patient's right to privacy is not limited to keeping and protecting the secret of medical or personal information. Not keeping unrelated persons in the environment, Keeping the source of health expenditures confidential, If there are those who are not directly related to the treatment, obtaining the consent of the patient beforehand, Issues such as providing a reasonable confidentiality environment should also be considered within the scope of patient privacy. The unit where the patient will be treated is particularly important when assessing the environment of reasonable confidentiality. Patient Rights, Patient Privacy and Scope of Patient Privacy It is useful to specifically evaluate the principles regarding the right to privacy in health services on a unit basis. While in polyclinics, the physician and the patient must be alone and there are no third parties, the same obligation does not apply in the intensive care unit and in emergency situations. For this reason, care should be taken to protect patients' physical privacy and medical information as much as possible in the intensive care unit and emergency departments. Patient Rights, Patient Privacy and Scope of Patient Privacy Some of the other issues to be taken into consideration within the scope of patient privacy; Knocking on the door before entering the patient room, Apart from medical records, the patient's hygiene habits, Information about sexual preferences or broken family relationships is not shared. Privacy in Health Confidentiality in medicine means that the patient limits the circulation of information provided to his or her caregivers and that the patient unambiguously and explicitly approves this by giving the patient a specific reason for healthcare professionals to share this information. In reality, it is not possible for patients to provide real and complete information to the physician/nurse/health professional without confidentiality. Privacy in Health Confidential information about the individual cannot be given to the patient's spouse, relatives or friends without his/her consent. However, in cases arising from the patient's medical condition, it may be possible to transfer information to his/her relatives. For example; Information about an unconscious patient can be shared with his/her spouse. Privacy in Health The systems where patient information is kept allow access by many personnel. Depending on the type and content of the information, people may think that more attention should be paid to their privacy, so even on the same issue, patients' attitudes towards sharing information with healthcare professionals may vary. Privacy in Health Although patient health information is mandatory for medical treatment and care, in some cases it may not be necessary for professionals to have access to all information, and situations may arise where some patients refuse access to all of this data. In this context, a good balance should be established between the need for health information and respect for the privacy of personal information. Privacy in Health In a study about permissions given in electronic health records; More than half of the patients (57%) did not restrict access to information, 36% of patients restricted access to all personal data in their electronic health records. Health professionals? How to Get More Information? As a result of the mutual trust relationship, the patient must have the belief that the information he provides will remain confidential, The patient should be free to make decisions regarding his or her own care without being pressured. Must trust that the data collected during medical treatment and care will be protected, The patient should not subject his or her body to any unnecessary or embarrassing practices. Privacy in Health Since health information is based not only on objective observations, diagnosis, and test results, but also on subjective impressions such as the patient's lifestyle and habits, disclosure of this sensitive information can damage people's reputation, bring material and moral losses to individuals, and even lead to personal humiliation. In fact, careless behavior when talking about patients, making phone calls or accessing electronic data in areas such as elevators and cafeterias can also pave the way for privacy violations. Privacy in Health It has been determined that the most common reason for privacy violations occurs due to the disclosure of clinical and/or personal data to medical personnel who are not involved in the clinical treatment and care of the patient or to people outside the hospital, and the identified incidents occur mostly in common areas such as corridors, elevators and changing rooms. Therefore, it is unethical to share identifiable patient information in public areas. Privacy in Health health professionals; Communication, sharing of patient-specific assessments, and training should be provided on the confidentiality of patients' medical records (such as laboratory tests and reports of imaging modalities). The patient's confidentiality continues even when not treated by the physician. In this context, patient confidentiality can be examined in five sub-dimensions. 5 Sub-Dimensions of Patient Confidentiality 1. Patient confidentiality is not absolute. Although confidentiality is an important ethical and legal responsibility, it is not absolute. Therefore, situations may arise where patients' personal data are disclosed. Personal data may be shared in cases where the patient has given explicit or implicit consent, or where the patient is not competent to give consent, but sharing of personal data is permitted by a legal regulation in cases where disclosure would benefit the person (or in cases where public interest is at stake). 5 Sub-Dimensions of Patient Confidentiality 2. Expressed or implied. Disclosure of patient information may be explicit or implicit (implicit, not explicit). A patient gives express consent when he agrees to have his information used or disclosed. In addition, even if the patient does not express it directly, it is implied consent not to make any noise about the medical procedures without consent and to make an inference that he may allow the use of his information. 5 Sub-Dimensions of Patient Confidentiality 3. The patient's general health condition. It is important for the physician to evaluate whether the patient has the capacity to decide on the disclosure of his or her information and how his or her existing illnesses affect this situation. 5 Sub-Dimensions of Patient Confidentiality 4. Disclosures required by the statute. If the doctor requests patient information by law or if this information is requested from the doctor by the court, the disclosure of the data is required. At this point, it is important for the physician to disclose only patient information regarding the request. If possible and if it will not disrupt the process, the patient should be informed about the statements made to the court. 5 Sub-Dimensions of Patient Confidentiality 5. Disclosure as required by law. Many laws; It allows the sharing of patient information for reasons such as notification of infectious diseases, prevention of terrorism, and provision of health and social care services. Keeping Secrets The Hippocratic Oath states, "I will not disclose my patient's information to anyone and will keep them secret." The Code of Deontology, which came into force in 1960, gives the following provision on secrecy: “The doctor and dentist cannot disclose the secrets he has learned through the practice of his profession and art unless there is a legal obligation. In cases presented at medical meetings or mentioned in publications, the identity of the patient cannot be disclosed.» Keeping Secrets On the other hand, the Patient Rights Regulation, which came into force in our country in 1998, addresses the issue of confidentiality and confidentiality as follows: “The information obtained due to the provision of health services cannot be disclosed in any way, except as permitted by law. Even if it is based on the consent of the person, disclosing information in cases that result in a complete waiver of personal rights, transfer of these rights to others or excessive limitation does not remove the legal liability of the person disclosing them. Disclosure of information that may harm the patient without a legally and morally valid and justified reason also requires legal and criminal liability of the staff and other people. Identity information of the patient cannot be disclosed without his consent in activities carried out for research and educational purposes.» Keeping Secrets Is “keep a secret” mandatory under all circumstances in practice? Is "keep a secret" an absolute value that cannot be exchanged for anything? Keeping Secrets It is seen in ethical discussions that keeping a secret is not seen as an absolute obligation. In principle, it is generally accepted that there are two exceptions: 1. Other person/s will be harmed. 2. It is a matter of protecting the health of society. Despite these exceptional situations, which are not very complicated when viewed in principle, the real difficulty is how to detect these exceptional situations during applications. Ethics in practice is problematic, in which situations and cases this rule can be violated. Today, this is one of the most difficult problems in medical ethics. Keeping Secrets Based on the principled situation, a "ready-made prescription" cannot be presented that will determine in advance how the physician should behave with the cases he encounters in his professional life. The physician and healthcare professional will evaluate each case on its own, in line with ethical principles and rules, reach a conclusion and act accordingly. (Perhaps he will seek help from an ethics consultant or hospital ethics committee). Keeping Secrets 65-year-old male patient with metastatic prostate cancer. He refuses hormone and drug therapy. He asks his doctor not to tell his wife that he will hide his illness from his wife. 32-year-old male patient. He has an autosomal dominant disease that is not yet symptomatic (Huntington's disease, 50% chance of transmission to her child). He doesn't want his newly married wife to know about it. The physician knows that the patient's wife very much wants to have children. A 27-year-old HIV-positive male patient does not want his wife/partner to know about this situation. Contemporary Issues in Confidentiality The situation of a “pure” doctor-patient relationship seems to have disappeared. The rule of secrecy makes this ethical principle more critical in today's conditions where health services are provided as a team service. The fact that medical records are stored in computer systems provides an opportunity for a large number of "indifferent" people to enter the patient's information. Contemporary Issues in Confidentiality Another important point that can be mentioned at this point regarding the protection of patient information is that medical information is also of interest to non-health institutions and fields. For example, insurance companies, employers or research institutions also want to obtain patient information as part of their business. Knowing patient information gives others the opportunity to exploit the patient. Contemporary Issues in Confidentiality During interventions in emergency situations, the patient's privacy and confidentiality should be protected to the greatest extent possible. Medical interventions should be performed in a way that best protects auditory and visual privacy. Another situation regarding patient confidentiality is when the physician suspects domestic violence. A physician who suspects domestic violence should discuss the issue in detail with his patient and, if necessary, send him to a place where he can receive appropriate support/consultancy. However, the issue of confidentiality should not override concerns about the patient's physical health.  Thanks Questions?