By John R. Williams.
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Extra info for Medical Ethics Manual 2nd Edition
Reasonable steps should be taken to minimize the harm and offence to the patient that may arise from the disclosure. It is recommended that the physician should inform the patient that confidentiality might be breached for his or her own protection and that of any potential victim. The patient’s co-operation should be enlisted if possible. In the case of an HIV-positive patient, disclosure to a spouse or current sexual partner may not be unethical and, indeed, may be justified when the patient is unwilling to inform the person(s) at risk.
The preferences may be found in an advance directive or may have been communicated to the designated substitute decision-maker, the physician or other members of the healthcare team. When an incompetent patient’s preferences are not known, treatment decisions should be based on the patient’s best interests, taking into account: (a) the patient’s diagnosis and prognosis; (b) the patient’s known values; (c) information received from those who are significant in the patient’s life and who could help in determining his or her best interests; and (d) aspects of the patient’s culture and religion that would influence a treatment decision.
Routine breaches of confidentiality occur frequently in most healthcare institutions. Many individuals – physicians, nurses, laboratory technicians, students, etc. – require access to a patient’s health records in order to provide adequate care to that person and, for students, to learn how to practise medicine. Where patients speak a different language than their caregivers, there is a need for interpreters to facilitate communication. In cases of patients who are not competent to make their own medical decisions, other individuals have to be given information about them in order to make decisions on their behalf and to care for them.