08/01/2014

Privacy and Confidentiality Learning Objectives

(Privasi dan Kerahasiaan)
• Mahasiswa mampu menjelaskan definisi serta perbedaan
antara privasi (privacy) dan kerahasiaan (confidentiality)

• Mahasiswa mampu menjelaskan pentingnya menghargai

privasi dan kerahasiaan pasien.

• Mahasiswa mampu menjelaskan beberapa pengecualian yang

dapat dibenarkan dalam kaitannya dengan kerahasiaan pasien

Dr. Amalia Muhaimin, MSc. (Bioethics)

Department of Bioethics, School of Medicine
Faculty of Medicine and Health Sciences
Universitas Jenderal Soedirman
Blok Bioethics and Health Law 2
1/6/2014 2
Kedokteran Unsoed

Topics
1. Definitions of ‘privacy’ and ‘confidentiality’.
2. Reasons for respecting privacy and confidentiality.
3. Duty of healthcare providers to protect the privacy of Can you give any example related
patients. to “privacy” in everyday life?
4. Duty of healthcare providers to maintain confidentiality
(aka. ‘professional secrecy’).
5. Which information should be confidential?
6. Justified breaches of confidentiality
7. Special circumstances of research

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 3 1/6/2014 4
Kedokteran Unsoed Kedokteran Unsoed

1. Definitions
Privacy (Privasi):
• The right to be left alone (hak untuk tidak diganggu)

• The right of an individual or a group to be free from intrusion

from others, and includes the right to determine which
information about them should be disclosed to others

• The capacity to be physically alone (solitude); to be free from

physical interference, threat or unwanted touching (assault,
battery); or to avoid being seen or overheard in particular
contexts

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 5 1/6/2014 6
Kedokteran Unsoed Kedokteran Unsoed

1
 08/01/2014

CONFIDENTIALITY:
What is “confidentiality”? • An attribute of personal information requiring that it not be
disclosed to others without sufficient reason

• Confidentiality is closely related to privacy, but not identical.

• One observes rules of confidentiality out of respect for, and to

How is privacy protect and preserve, the privacy of others
related to confidentiality? • It refers to the obligations of individuals and institutions to
use information under their control appropriately once it has
been disclosed to them.

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 7 1/6/2014 8
Kedokteran Unsoed Kedokteran Unsoed

2. Reasons for respecting privacy and confidentiality

a. Individuals ‘own’ their information: it is essential to their

personal integrity.

b. For many people privacy is an essential aspect of their

dignity; invading their privacy against their will is a violation
of their dignity.

c. Respect for others requires protecting their privacy and the

confidentiality of information about them.

d. Doctors need patients’ trust!

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 9 1/6/2014 10
Kedokteran Unsoed Kedokteran Unsoed

• Cases:
• A few weeks after an Orlando woman had her doctor perform
some routine tests, she received a letter from a drug company
promoting a treatment for her high cholesterol. (Orlando
Sentinel, November 30, 1997).

• A 30-year FBI veteran was put on administrative leave when,

without his permission, his pharmacy released information
about his treatment for depression. (Los Angeles Times,
September 1, 1998)

“The new hidden cameras will allow us o see if anyone is (UC Davis Health System)
violating our privacy policy by reading someone else’s email” http://www.ucdmc.ucdavis.edu/compliance/guidance/privacy
/example.html

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 11 1/6/2014 12
Kedokteran Unsoed Kedokteran Unsoed

2
 08/01/2014

3. Duty of health care providers to protect 4. Duty of health care to maintain confidentiality
the privacy of patients
• The duty of maintaining confidentiality (‘professional
 ask patient’s permission to examine him/her secrecy’) has been part of Western medical ethics
unclothed since Hippocrates

 should ensure that an unclothed patient cannot • Preceded the notion that privacy is a right
be viewed by passers-by  What do you think?

 etc… • Ethics courses in non-Western countries should

discuss the source of medical confidentiality in their
cultures

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 13 1/6/2014 14
Kedokteran Unsoed Kedokteran Unsoed

5. Which information should be confidential?

• Confidentiality extends to all personal (health)

information, including genetic data
When can information
• UNESCO International Declaration on Human Genetic be disclosed?
Data: “…all medical data, including genetic data and
proteomic data, regardless of their apparent
information content, should be treated with the
same high standards of confidentiality”

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 15 1/6/2014 16
Kedokteran Unsoed Kedokteran Unsoed

6. Justified breaches of confidentiality Justified breaches…

a. Sharing information for patient care
• In hospital setting  access to the patient’s chart
• Outside hospital  family members need patient
information to provide care and/or to protect
themselves
b. Using interpreters
• An interpreter will need access to information about
the patient; interpreters should be bound to observe
confidentiality
c. Teaching medical students
• Observation & discussion of patients is a necessary part of
medical education; students should be informed of their
obligation to maintain confidentiality
d. Mandatory reporting
 Health care practitioners should be familiar with the law
• Infectious diseases,
• Suspected child abuse,
• Suspected family abuse
 Patients should be informed that their information has to be
reported to the appropriate authorities

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 17 1/6/2014 18
Kedokteran Unsoed Kedokteran Unsoed

3
 08/01/2014

Justified breaches… 7. Special circumstances of research

e. Serious danger to others
• patient threaten to harm others, by violence /sexual contact
• patient has a transmissible disease such as HIV
f. Genetic information
• Do other individuals with the same genetic makeup (close family
members) have a right to a patient’s genetic information?
• Physicians should consult national regulations/ guidelines
g. With patient or guardian consent
• This should generally be obtained for all breaches of
confidentiality and renders the breach acceptable ethically.
Blok Bioethics and Health Law 2
1/6/2014
Kedokteran Unsoed
a. Disclosure of personal health information  requires prior
consent of the research subject;
b. Anonymized information  consent for disclosure? 
refer to national regulations/guidelines, otherwise
international guidelines such as the Declaration of Helsinki
c. Communities and individuals have a right to privacy 
information should be kept confidential, especially when
disclosure may be harmful to the community.
d. Scientific publication should respect confidentiality to the
greatest extent possible  consent is always required
when an research subject can be identified in a publication
Blok Bioethics and Health Law 2
19 1/6/2014 20
Kedokteran Unsoed

Case studies

• Your 36-year-old patient has just tested positive for HIV. He

asks that you not inform his wife of the results and claims he
is not ready to tell her yet.

• A 75-year-old woman shows signs of abuse that appears to be

inflicted by her husband. As he is her primary caregiver, she
feels dependent on him and pleads with you not to say
anything to him about it. How is this case different from Case
1? How would you handle this situation?

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 21 1/6/2014 22
Kedokteran Unsoed Kedokteran Unsoed

Reference
• UNESCO. Bioethics Core Curriculum. Section 1:
Syllabus. UNESCO 2008. Available at:
http://unesdoc.unesco.org/images/0016/001
636/163613e.pdf

Blok Bioethics and Health Law 2 Blok Bioethics and Health Law 2
1/6/2014 23 1/6/2014 24
Kedokteran Unsoed Kedokteran Unsoed