Confidentiality

Confidentiality has been an important value in health care since recorded time. Patients expect their health care providers to respect their privacy. This includes keeping confidential any information that patient does not wish to be revealed. This fosters trust and honesty, respects the patient's dignity, and protects the patient from the harm or embarrassment. In general, it is good practice to get the patient's permission before revealing information to any person who does not need that information in order to care for the patient.

Occasionally, there may be a situation where one believes that confidentiality must be broken. Confidentiality can be broken if required by law. However, there may be cases where breaching confidentiality is necessary to protect the welfare of the individual and/or others. The usual justification for the latter type of breach is that:

1. The harm is serious in nature.
2. There is no reasonable means of preventing the harm while preserving the patient's confidentiality.
3. There is a high probability of the harm occurring.
4. One must act in the manner which constitutes the least infringement of confidentiality possible, commensurate with preventing the harm.
5. One should minimize the effects of the breach in confidentiality.

The five criteria above are based on ethical principles, not law. However, much of the case law regarding confidentiality follows this line of reasoning. So for example, the desire to gossip about a colleague's pregnancy test results does not justify breaching confidentiality according to the five criteria.

Pennsylvania Act 148, our state statute on the confidentiality of HIV information, follows these five principles in indicating when and how a physician might disclose HIV related information to a patient's unprotected sexual partners. Below is a summary of this act.

Pennsylvania Law: Confidentiality of HIV Related Information, Act 148

Summary: This law only applies to physicians. A physician does not have a duty to identify, locate, or notify any contact. The decision is up to the physician. He/she may disclose HIV-related information if all of the following conditions are met:

1. The physician has counseled the subject regarding the need to notify the contact, and the physician reasonably believes the subject will not inform the contact or abstain from sexual or needle-sharing behavior which poses a significant risk of infection to the contact.
2. The physician reasonably believes disclosure is medically appropriate, and there is significant risk of future infection to the contact.
3. The physician has informed the subject of his/her intent to make such a disclosure.
4. The disclosure is made to a known contact of the subject, without disclosing the identity of the subject or the means of transmission. So, for example, one might say, "I have reason to believe that you may have been exposed to the AIDS virus." The goal is for the contact to be tested and to take precautions against getting infected. It is possible to achieve these goals without revealing the subject's name.