Medical Secret And Confidentiality: Ethical Conflicts

Medical Secret and Confidentiality: Ethical Conflicts

The medical secret

Professional secrecy is the legal obligation that certain professions have to keep the information they have received from their clients. Unlike in other types of confidentiality, professional secrecy is maintained even in a trial.

Among these professionals, the lawyer, the doctor, the nurse, the psychologist, the journalist or the social worker among others stand out among others.

It is worth mentioning that as far as medicine is concerned, this duty goes back many years, in fact, it is mentioned in the Hippocratic oath: “Everything that you see or hear in my profession or outside it, I will keep it with great stealth". So the medical secret is linked to medicine since its inception.

Medical secret, confidentiality, intimacy as moral value and within the legal framework, is protected in the Universal Declaration of Human Rights and in national medical codes, since it is a duty that is born from the profession and public interest. The main objective is to guarantee the safety of the sick, the honor of families and dignity. It is an obligation in all medical areas, even the death of the patient does not exempt from the duty of medical secrecy.

Currently, the codes consider that this standard is not absolute, that is, that there are particular situations in which professional secrecy is not applicable, even in many cases those exceptions are specifically set.

Why is there what to respect it?

It is an obligation of confidentiality, which is imposed in order to achieve absolute confidence between the professional and those who come to him. For doctors, it is based on respect for the patient’s privacy and thus consolidate a good medical-patient relationship, which is one of the pillars in the medical act.

The doctor take all the necessary measures to avoid the dissemination of all the information he has acquired in the exercise of his profession. This is not just an ethical principle, but is collected in most world laws and their violation can lead to legal consequences.

Professional secrecy is confident, it is an explicit or implicit promise made before receiving confidence. The secret then becomes strictly confidential or professional.

Are there limits in professional secrecy?

Although medical secret is one of the pillars of trust in the relationship between doctor and patient, there are controversial situations that require reflecting on the need to share certain information.

Who is communicated? Only and taking into account prudence, revelation can be done:

• To relatives if the revelation is useful to treatment or when it comes to minors or mentally unable people.
• To health authorities when the health of the family and community and the judicial authorities in cases with specific judicial mandate is in danger.

Broadly speaking, the exceptions that allow the doctor to reveal the medical secret are:

• Mandatory Declaration Diseases.
• Birth and death certification.
• If, by not revealing the secret, a greater damage to the patient or other people was generated: “The well -founded possibility of avoiding serious damage to third parties constitutes ethical justification to be able to reveal confidential information when, after putting all the means there is noAnother way to avoid damage ".
• · When the doctor is harmed by maintaining the secret, as long as he will not harm third parties.
• · In case of ill -treatment, especially towards childhood.
• · If required from the College of Physicians that the doctor in question testifies.
• By legal imperative.

Special consideration situations. Possible ethical conflicts

The psychiatric patient

The doctor must fulfill the duty of caution if possible due to stigmatization. The aggressive psychiatric patient is exceptional and always, before any revelation it is necessary.  

The infectious-contagious patient

For example, HIV -infected patient who, despite warnings, refuses to take precautions in relationships with his partner. The conflict between two values is clearly raised: that of the protection of health or life of third parties against the right that the patient has to privacy and confidentiality. Should sexual couples be informed about the patient’s situation?

• This conflict poses various questions to take into account.
• Can affect third parties
• Does the person follow the treatment? Can the virus transmit?
• Take protection measures?
• The stigma that involves the disease

Reflecting on the different aspects of the conflict, it is established that: if the patient refuses to adopt protection measures or communicate to his partner his condition of seropositivity, it would be one of the cases in which the revelation of medical secrecy would be justified. It would be advisable to inform the patient about the consequences to understand the reason for revealing the information in order not to damage the medical-patient relationship.

Patient in a situation of transitory disability (I.T.). 

Although the exceptions to the duty of secrecy are considered in the doctrine of the Constitutional Court itself, by establishing that confidentiality is not an absolute or unlimited right the debate on the limits of medical secrecy, it has become remarkable today. The trigger factor of this social debate has been the accident of the Germanwings aircraft of March 24, 2015 in which a sick co -pilot had hidden the company that had the medical decline due to psychiatric illness, case we comment in greater detail later. 

In addition, this situation should be considered similar to the bus driver, trains or any profession that entails a risk to third parties in the event that the professional is in a situation of transitory disability and should not do that work. It is necessary to insist on the possibility of communication in these cases in order to avoid these situations.

Aptitude certificates (driving, weapons use)

A clearer example would be the reviews to obtain or renew the driving cards, which can be applied to all types of licenses that require adequate psychophysical aptitude. This could solve establishing a connection between primary and hospital (both public and private) and approved centers. 

In this way, professionals could warn that the person’s health conditions have changed, and that it is necessary. For example, there are medications with which you should not use machinery as indicated in the prospects.

The sick doctor

The doctor must be in full psychophysical conditions to be able to do their job. The health problems of the doctor that involve the most risk are those that represent a greater social stigma such as mental disorders and addictions.

Article: The secret would yield to avoid damage to third parties

As commented on the article on which we have based our work, the trigger for the social debate has been the accident of the Germanwings plane, which occurred on March 24, 2015 in which a sick co -pilot had hidden the company that hadMedical leave due to psychiatric disease.

Following this, we begin to think of flexible medical secret especially in risk professions. In the case of the pilot with schizophrenia, he should be in the hands of his company’s doctor. To do this, there are already systems to attend professionals who are not in full faculties and thus guarantee a safe service.

According to the Constitution, the right to privacy and confidentiality has the support of international statements on human rights and bioethics, in addition to being a constitutional right in Spain.

On the other hand, it is important to consider in a cautious way the medical secret in the workplace and communicate it in really necessary situations. The possibility of dismissal or labor discrimination must.

Other conflicts that are emerging, are due to the great advances of the molecular diagnosis, with which the possible diseases that a person can suffer can be detected. If that information was not dealing with due care could have serious consequences regarding work.

In short, careful regulation is necessary in these situations in which the limits of secret must be considered based on the possible consequences with the objective of protecting both the patient and the society and the responsible doctor itself.

conclusion

The Central Commission of Deontology shows that neither the medical secret, nor the right to privacy, nor the right to confidentiality are absolute. Deontology, ethics, regulations and current legislation support and protect the doctor so that, in the exceptions described, the revelation of medical secrecy does not constitute a reason for lack or infraction.

In short, it is necessary to establish situations in which medical secret can be communicated, especially in the most controversial and sensitive cases that we have already commented on. In this way, numerous risks and damage to the different protagonists of the medical act can be avoided.

Situations in which we conflict with the patient can arise and we could damage the medical-patient relationship so we would have to try to correctly inform about the consequences of their situation. If you get to understand the reason for our actions, trust should not be altered. Even so, you always have to take into account the balance between the benefit and damage when considering disseminating confidential information.

Finally, it is necessary to comment that apart from these special situations, medical secret and confidentiality are aspects of the medical act that should not be violated since they consolidate the trust that patients have in professionals.

Bibliography

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2. Professional Secret [Internet]. It is.Wikipedia.org. 2019 [Cited 8 November 2019]. Available from: https: // is.Wikipedia.org/wiki/secret_profesional
3. Cárdenas Arévalo J . The medical secret [Internet]. CARDENASHISTORIAMEDICINA.net. 2019 [Cited 8 November 2019]. Available from: http: // www.CARDENASHISTORIAMEDICINA.Net/Ethics/Secretomedic.htm
4. The revelation of medical secret must be something exceptional and justified |Doctors and patients [Internet]. Doctors andpacents.com. 2019 [Cited 8 November 2019]. Available from: http: // www.doctors andpacents.com/ARTICLE/LA-REVELATION-DEL-SECRET-MEDICO-DEBE-SER-ALGO-EXCEPTIONAL-Y-JUSTIFY