Confidentiality

A professional duty, stemming from the standards of the profession, that requires the protection of information revealed by the patient to the professional. Confidentiality should not be confused with privacy. Privacy applies to individuals with respect to others, whereas confidentiality applies only to relationships between or among persons and institutions. Further, privacy concerns control over access to and disclosure of information that is normally controlled by the individual, whereas confidentiality concerns the redisclosure of information by the person to or for whom the individual’s privacy was relinquished. Confidentiality should be further distinguished from the concept of privilege. Whereas confidentiality is a professional duty, physician-patient privilege is only a testimonial privilege that may permit an individual to refuse to disclose medical information in court.

Though each patient has ultimate control over information that pertains to him or her, the duty to maintain confidentiality (see Ethical and Religious Directives, n. 34) is not necessarily violated when a patient's information is disclosed to appropriate individuals or agencies. It is commonly and erroneously assumed that disclosing information to others who have a need for or right to that information is an exception to confidentiality. Rather, confidentiality requires that a patient’s disclosed information is shared only with those who have a moral or legal right or need to know the information for the patient’s good, for preventing harm to others, or for the common good. On this basis, some states require that cases and incidences of venereal disease, contagious diseases, poisoning, abortion, child abuse, wounds inflicted by violence, and industrial accidents be reported to the state health department or other public agencies.

The basis for the duty of confidentiality is: (1) inherent respect for an individual’s privacy and autonomy; (2) the emphasis on trust in the professional-patient relationship; (3) the element of promise; (4) the good of society; and (5) prevention of harm to the patient or others. [Sources: Junkerman, LJ and Schiedermayer, DL, Practical Ethics for Students, Interns, and Residents: A Short Reference Manual. (Frederick, Md: University Publishing Group, 1994), 17-18. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Summing Up: Final Report on Studies of the Ethical and Legal Problems in Medicine and Biomedical and Behavioral Research (Washington, D.C.: The Commission, 1983), 36-37. Furrow, BR, Greaney, TL, Johnson, JH, et al., Health Law: Cases, Materials and Problems, 3^rd ed. (St. Paul: West Group, 1997), 374.]

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