THERE is an alarming tendency in Pakistan to disclose the day-to-day health conditions and treatment of ‘important patients’. This is in complete violation of basic medical ethics. It is unfortunate that both the politicians and medical professionals are part of this disturbing trend, as we have seen of late.
In the field of healthcare, medical professionals are obligated to abide by a set of basic, universally acknowledged principles of medical ethics. These include autonomy, beneficence and non-maleficence, justice and confidentiality.
The history of patient confidentiality dates as far back as ancient Greece and is attributed to Hippocrates — hence, it is known as the Hippocratic Oath. It is a pledge that all doctors are meant to uphold, and declares: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.”
It is on the basis of these ethical standards that trust is formed between patients and their doctors, the former comfortable with the understanding that the information they provide shall be kept confidential.
The breach of patient confidentiality in high-profile cases is an alarming trend.
This trust is crucial to disclosing required information by patients for appropriate medical treatment. The lack or loss of this trust leads to non-disclosure or incomplete disclosure of information by patients, which can seriously jeopardise the management of patients’ treatment.
Confidentiality is defined as “the state of keeping or being kept secret or private”, while medical confidentiality is defined as the “non-disclosure of the private information of a patients to another person”.
The substantive rule of bioethics is that the information a patient reveals to a healthcare provider is private, and that there are limits on how and when such information can be disclosed to a third party, and that this may only be done with the express permission of the patient. It is normally allowed only to those who need to know about a patient’s condition for medical purposes.
In routine hospital practice, many individuals have access to patients’ medical data, but all are enjoined to keep such information, including patients’ medical records, confidential. In fact, confidentiality should be maintained even if a patient dies.
Patients provide various kinds of important information to their healthcare providers, including particularly personal information. There is an implicit understanding that any information disclosed by a patient during the course of the patient-physician relationship will be kept confidential by the physician to the greatest possible degree.
Any breach of this trust will seriously affect the patient’s attitude in providing further information to the doctor that might prove necessary for making the correct diagnosis and planning appropriate treatment. Thus, it may adversely affect patient care. The same is true for any investigation carried out in the process of making a diagnosis.
Confidentiality is an extremely important right of the patient and a primary ethical responsibility of healthcare providers. Patients’ information can only be revealed in certain situations, but even in such situations, it is always preferable that the information is disclosed with the consent of the patient.
In rare cases, confidentiality may be breached when required by the prevailing law, or the need to protect the life of an individual, or when there is a serious threat to the public. Medicine and law do not always work in harmony, however, and one of the most common sources of conflict between these two arise on the issue of medical confidentiality. Disclosures may also have important social implications, which must be considered.
From the point of view of religion too a breach of confidentially is frowned upon. For instance, according to Islamic principles, matters discussed in private meetings are confidential and must not be disclosed beyond that meeting. Again, certain tenets may permit a breach of confidentiality, but only to the concerned parties and for specific reasons.
Talking to the media about any information of a patient’s clinical condition or their investigation is against medical ethics and may have serious medical and social implications for not only that patient but also anyone else who seeks healthcare services.
It is imperative that all political workers and medical professionals take care to uphold the principle of confidentiality. Combining medicine and politics may have serious short- and long-term implications for society at large. Consider that we are still living with the awful consequences of a vaccination campaign being used for political purposes a few years ago — it seriously jeopardised all efforts to eradicate polio from Pakistan.
The writer is dean of faculty of health sciences at Peshawar Medical College.
Published in Dawn, November 24th, 2019
