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By By
PerumaI PerumaI CbInaya CbInaya AMN. PPN. AMN. PPN.
RMA. LLB( RMA. LLB(Hons Hons) ( ) (VoIverbampton VoIverbampton) CLP ) CLP
LegaI OIIIcer LegaI OIIIcer
MaIaysIan MedIcaI CouncII MaIaysIan MedIcaI CouncII
mmc.gov.my mmc.gov.my
perumaIxgmaII.com perumaIxgmaII.com
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RELATED ISSUES: RELATED ISSUES:
a. a. Wbat Is ConIIdentIaIIty? Wbat Is ConIIdentIaIIty?
b. b. Is Tbere A Need Ior ConIIdentIaIIty? Is Tbere A Need Ior ConIIdentIaIIty?
c. c. Wbose Duty? Wbose Duty?
d. d. Tbe ObIIgatIons. Tbe ObIIgatIons.
e. e. Storage & HandIIng Storage & HandIIng
I. I. Tbe LImIt Tbe LImIt -- AbsoIute? AbsoIute?
g. g. BreacbIng ConIIdentIaIIty 'IdeaIIy' BreacbIng ConIIdentIaIIty 'IdeaIIy'
b. b. ConcIusIon ConcIusIon
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a. Wbat Is CONFIDENTIALITY? a. Wbat Is CONFIDENTIALITY?
Con - Toge1er W11
FIde - Trus1
TbIs doctrIne oI TbIs doctrIne oI mutuaI trust mutuaI trust
underpIns tbe PIIIars oI a underpIns tbe PIIIars oI a
Doctor Doctor--PatIent ReIatIonsbIp. PatIent ReIatIonsbIp.
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b. Wby ConIIdentIaIIty? b. Wby ConIIdentIaIIty?
Respects a person's autonomous rIgbt
(to determIne wItb wbom, wben and bow
mucb oI personaI InIormatIon be sbared)
DIgnIty
AvoId embarrassment, socIaI stIgma
AIIects empIoyment, Insurance, etc
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c. Wbose Duty? c. Wbose Duty?
EVERYBODY!
(tbat boIds tbat InIormatIon)
IrrespectIve oI Source IrrespectIve oI Source
DIrect DIrect -- Irom tbe patIent Irom tbe patIent
IndIrect IndIrect -- tbrougb otbers or IncIdentaI tbrougb otbers or IncIdentaI
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d. Tbe ObIIgatIons d. Tbe ObIIgatIons
a. ReIIgIous a. ReIIgIous
b. EtbIcsJMoraI b. EtbIcsJMoraI
c. LegIsIatIons c. LegIsIatIons
Statutes Statutes
Common Law Common Law
QuasI QuasI--Statutory Statutory
(GuIdeIInesJProtocoIsJetc) (GuIdeIInesJProtocoIsJetc)
d. Human RIgbts d. Human RIgbts
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ReIIgIon: ReIIgIon:
IsIam: IsIam:
Dan jangan sebagIan kamu mengumpat Dan jangan sebagIan kamu mengumpat
sebabagIannya, (aI sebabagIannya, (aI--Hujurat: 12). Hujurat: 12).
HadIs: HadIs: . JIka padanya terdapat apa yang kamu . JIka padanya terdapat apa yang kamu
bIcarakan Itu, maka berertI kamu mengumpat dIa, bIcarakan Itu, maka berertI kamu mengumpat dIa,
dan jIka tIdak sepertI apa yang kamu bIcarakan Itu, dan jIka tIdak sepertI apa yang kamu bIcarakan Itu,
maka berartI kamu teIab menudub dIa." maka berartI kamu teIab menudub dIa."
(RIwayat MusIIm, Abu Daud, TarmIzI dan Nasa'I) (RIwayat MusIIm, Abu Daud, TarmIzI dan Nasa'I)
Yang benar Yang benar -- mengumpat, mengumpat,
Yang tIdak Yang tIdak -- IItnab IItnab
RabsIa Itu adaIab amanab. RabsIa Itu adaIab amanab.
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CbrIstIan CbrIstIan -- GossIp and IIe Is a sIn. GossIp and IIe Is a sIn.
'Tbe words oI a gossIp are IIke cboIce morseIs; 'Tbe words oI a gossIp are IIke cboIce morseIs;
Tbey go down to a man's Inmost parts.' Tbey go down to a man's Inmost parts.'
Proverbs Proverbs -- 26:22. 26:22.
Buddba Buddba -- Hear No EvII, Speak No EvII, See No Hear No EvII, Speak No EvII, See No
EvII EvII
HIndu HIndu -
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MoraI: MoraI:
Do No Harm Do No Harm
Happy Happy
Tbe HIppocratIc Oatb Tbe HIppocratIc Oatb
DecIaratIon, PIedge, EtbIcaI Code, etc. DecIaratIon, PIedge, EtbIcaI Code, etc.
EtbIcs: Numerous EtbIcs: Numerous EtbIcs: Numerous EtbIcs: Numerous
Human RIgbts: Human RIgbts: Human RIgbts: Human RIgbts:
InIrIngement oI one's dIgnIty. InIrIngement oI one's dIgnIty.
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LegIsIatIon LegIsIatIon::
GuIdeIInesJProtocoIs GuIdeIInesJProtocoIs
A duty oI conIIdence arIses wben conIIdentIaI A duty oI conIIdence arIses wben conIIdentIaI
InIormatIon comes to tbe knowIedge oI a InIormatIon comes to tbe knowIedge oI a
person In cIrcumstances wbere be bas notIce, person In cIrcumstances wbere be bas notIce,
or Is beId to bave agreed, tbat tbe InIormatIon or Is beId to bave agreed, tbat tbe InIormatIon
Is conIIdentIaI, wItb tbe eIIect tbat It wouId be Is conIIdentIaI, wItb tbe eIIect tbat It wouId be
just In aII tbe cIrcumstances tbat be sbouId be just In aII tbe cIrcumstances tbat be sbouId be
precIuded Irom dIscIosIng tbe InIormatIon to precIuded Irom dIscIosIng tbe InIormatIon to
otbers. otbers.
Common Law: Common Law:
Statutes: Statutes: In MaIaysIa: In MaIaysIa:
WW Non Non--MedIcaI MedIcaI OSA OSA
WW MedIcaI MedIcaI not avaIIabIe yet not avaIIabIe yet
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Proper Storage: Proper Storage:
Tbe HospItaI DIrectorJManager Tbe HospItaI DIrectorJManager --
prIme responsIbIIIty Ior ensurIng prIme responsIbIIIty Ior ensurIng
protectIon oI InIormatIon. protectIon oI InIormatIon.
Proper HandIIng: Proper HandIIng:
Ensure an EIIectIve SecurIty system Ensure an EIIectIve SecurIty system
(guIdeIInesJprotocoIs) to prevent (guIdeIInesJprotocoIs) to prevent
Improper dIscIosures Improper dIscIosures
e. Storage and HandIIng: e. Storage and HandIIng:
GuideIine on ConfidentiaIity by
MMC
Principles of Confidentiality
Protecting nformation
Sharing information with patients
Electronic medical records
Disclosure of confidential info with pt's
consent
Disclosure within healthcare team
Disclosure to employers, insurance
companies, & other third parties
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Cont.
Disclosure without patient's consent
a. Disclosure in patient's medical interest.
b. Disclosure in relation to treatment sought
by children or others who lack capacity to
give consent
c. Disclosure where a patient maybe a victim
neglect or abuse
d. Disclosure after a patient's death
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Con't.
Disclosure for medical teaching, medical
research and medical audit
Disclosure in the interest of others
Disclosure in connection with judicial or other
statutory proceedings
Media inquires about patients
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I. SbouId ConIIdentIaIIty be I. SbouId ConIIdentIaIIty be
AbsoIute AbsoIute? ?
Human RIgbts Human RIgbts
MoraIIy MoraIIy -- DeontoIogIst DeontoIogIst
EtbIcaIIy EtbIcaIIy -- HIppocratIc Oatb HIppocratIc Oatb
Statutes Statutes -- France, Norway, etc France, Norway, etc
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HENCE, SHOULD IT BE HENCE, SHOULD IT BE ABSOLUTE ABSOLUTE? ?
ScenarIo ScenarIo -- PatIent conIIdIng to kIII bIs wIIe. PatIent conIIdIng to kIII bIs wIIe.
Pros Pros -- respects: respects:
WW Human rIgbts Human rIgbts
WW DeontoIogIst moraI obIIgatIons DeontoIogIst moraI obIIgatIons
WW HIppocratIc Oatb HIppocratIc Oatb
Cons Cons -- respects respects
WW otbersJpubIIc rIgbts otbersJpubIIc rIgbts
WW moraI obIIgatIons moraI obIIgatIons
WW 'HIppocratIc Oatb' 'HIppocratIc Oatb'
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LIMITING PRINCIPLES TO THE LIMITING PRINCIPLES TO THE
DUTY TO MAINTAIN CONFIDENCE DUTY TO MAINTAIN CONFIDENCE
PubIIc DomaInJInterest PubIIc DomaInJInterest
UseIess InIormatIon or TrIvIa UseIess InIormatIon or TrIvIa
Consent Consent
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CategorIes oI ExceptIons: CategorIes oI ExceptIons:
a. a. Consent. Consent.
b. b. SeII SeII--deIense deIense
c. c. PatIent's best Interest PatIent's best Interest
d. d. PubIIc's best Interest PubIIc's best Interest
e. e. Statutory Statutory
I. I. Court Order Court Order
g. g. TraInIng, TraInIng,
b. b. Researcb, Researcb,
I. I. AudIt Purposes AudIt Purposes
Tbe ExceptIons: Tbe ExceptIons:
Wben BreacbIng Is JustIIIabIe? Wben BreacbIng Is JustIIIabIe?
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Consent: Consent: EItber expressed or ImpIIed EItber expressed or ImpIIed
SeII SeII--deIense: deIense:
In dIscIpIInary proceedIngs, a medIcaI staII may In dIscIpIInary proceedIngs, a medIcaI staII may
dIscIose conIIdentIaI InIormatIon about a pt to dIscIose conIIdentIaI InIormatIon about a pt to
deIend bImseII agaInst a compIaInt agaInst bIm deIend bImseII agaInst a compIaInt agaInst bIm
Pt wbo makes compIaInt Is presumed to bave Pt wbo makes compIaInt Is presumed to bave
waIved conIIdentIaIIty waIved conIIdentIaIIty
In tbe best Interest oI tbe patIent: In tbe best Interest oI tbe patIent:
HarmJInjurIous to bImseII HarmJInjurIous to bImseII
Incompetent Incompetent -- unconscIous, mentaI, senIIe, etc. unconscIous, mentaI, senIIe, etc.
Immature Immature -- mInor, etc. mInor, etc.
Treatment purposes Treatment purposes -- wItb otber staII wItb otber staII
DIscIosure to tbe ReIatIves DIscIosure to tbe ReIatIves
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Tbe PatIent's Best Interest: Tbe PatIent's Best Interest:
DIscIosure to IamIIy member or cIose reIatIves Is DIscIosure to IamIIy member or cIose reIatIves Is
aIso aIIowed wbere It Is undesIrabIe In tbe Interest oI aIso aIIowed wbere It Is undesIrabIe In tbe Interest oI
pt's beaItb, to dIscIose InIormatIon to bIm dIrectIy; pt's beaItb, to dIscIose InIormatIon to bIm dIrectIy;
Wbere pt Is In a vuInerabIe state oI mentaI beaItb. Wbere pt Is In a vuInerabIe state oI mentaI beaItb.
Eg Eg. SuIcIdaI, depressIon. . SuIcIdaI, depressIon.
[Parent VS CbIId] [Parent VS CbIId]
Pace oI deveIopment varIes Irom cbIId to cbIId Pace oI deveIopment varIes Irom cbIId to cbIId
ParentaI rIgbt dImInIsb as tbe cbIId acquIres tbe ParentaI rIgbt dImInIsb as tbe cbIId acquIres tbe
abIIIty to make decIsIons abIIIty to make decIsIons -- I.e. wben tbe cbIId bas I.e. wben tbe cbIId bas
suIIIcIent understandIng and InteIIIgence suIIIcIent understandIng and InteIIIgence
Dr must act In pt's best Interest and must satIsIy Dr must act In pt's best Interest and must satIsIy
bImseII tbat pt bas suIIIcIentIy mature understandIng bImseII tbat pt bas suIIIcIentIy mature understandIng
Dr must exercIse proIessIonaI judgment Dr must exercIse proIessIonaI judgment
Dr must respect pt's conIIdentIaIIty II pt satIsIIes tbe Dr must respect pt's conIIdentIaIIty II pt satIsIIes tbe
test oI maturIty test oI maturIty
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In tbe pubIIc best Interest: In tbe pubIIc best Interest:
DIscIosure may be desIrabIe and approprIate to protect DIscIosure may be desIrabIe and approprIate to protect
tbe pubIIc wbere tbe Dr bas reason to beIIeve tbat pt's tbe pubIIc wbere tbe Dr bas reason to beIIeve tbat pt's
medIcaI condItIon puts otbers at rIsk (e.g. pt bavIng medIcaI condItIon puts otbers at rIsk (e.g. pt bavIng
IIIness tbat may aIIect motor IunctIons and Iead to Ioss IIIness tbat may aIIect motor IunctIons and Iead to Ioss
oI seII oI seII--controI controI -- drIver drIver -- epIIepsy). epIIepsy).
Wbere a crIme Is IIkeIy to be commItted Wbere a crIme Is IIkeIy to be commItted
Wbere a crIme bas been commItted Wbere a crIme bas been commItted
Wbere tbe pt Is a carrIer oI an InIectIous dIsease; Wbere tbe pt Is a carrIer oI an InIectIous dIsease;
Tbe pubIIc Interest must be baIanced agaInst tbe pt's Tbe pubIIc Interest must be baIanced agaInst tbe pt's
rIgbt to conIIdentIaIIty rIgbt to conIIdentIaIIty
OnIy wbere tbe pubIIc Interest Is overwbeImIng can OnIy wbere tbe pubIIc Interest Is overwbeImIng can
conIIdentIaI InIormatIon be dIscIosed conIIdentIaI InIormatIon be dIscIosed
Note Note -- tbere Is a wIde dIIIerence between tbere Is a wIde dIIIerence between wbat Is wbat Is
InterestIng to tbe pubIIc InterestIng to tbe pubIIc (and tbereIore (and tbereIore
newswortby) and newswortby) and wbat Is oI pubIIc Interest wbat Is oI pubIIc Interest. .
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Statutory ExceptIons: Statutory ExceptIons:
BasIs Ior tbese exceptIons Is tbe overwbeImIng pubIIc BasIs Ior tbese exceptIons Is tbe overwbeImIng pubIIc
Interest In Iavour oI dIscIosure Interest In Iavour oI dIscIosure
DIscIosure sometImes extends to otber beaItbcare DIscIosure sometImes extends to otber beaItbcare
personneI and Govt. oIIIcers besIdes drs.; personneI and Govt. oIIIcers besIdes drs.;
InIectIous dIseases; ImmIgratIon Act, PrIsons InIectIous dIseases; ImmIgratIon Act, PrIsons
ReguIatIons, RTD Act, MentaI DIsorders and Treatment ReguIatIons, RTD Act, MentaI DIsorders and Treatment
Act, MIsuse oI Drugs Act, etc. Act, MIsuse oI Drugs Act, etc.
CompuIsIon by Court Order CompuIsIon by Court Order
No ProI PrIvIIege From DIscIosure In Court ProceedIngs No ProI PrIvIIege From DIscIosure In Court ProceedIngs
Must CompIy StrIctIy Must CompIy StrIctIy FaIIure to CompIy FaIIure to CompIy Contempt Contempt
[[Take Note Take Note -- In tbe absence oI a court order, a request Ior In tbe absence oI a court order, a request Ior
dIscIosure by a dIscIosure by a
rd rd
party, wItbout a patIent's consent, (Ior party, wItbout a patIent's consent, (Ior
exampIe, a Iawyer, a poIIce oIIIcer, or an oIIIcer oI a court) exampIe, a Iawyer, a poIIce oIIIcer, or an oIIIcer oI a court)
Is Is not suIIIcIent not suIIIcIent justIIIcatIon Ior dIscIosure.] justIIIcatIon Ior dIscIosure.]
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For MedIcaI TeacbIng, Researcb & AudIt: For MedIcaI TeacbIng, Researcb & AudIt:
a. Researcb a. Researcb
I) I) Wbere, Ior tbe purpose oI medIcaI researcb tbere Is a Wbere, Ior tbe purpose oI medIcaI researcb tbere Is a
need to dIscIose InIormatIon wbIcb Is not possIbIe to need to dIscIose InIormatIon wbIcb Is not possIbIe to
anonymIse eIIectIveIy, every reasonabIe eIIort must anonymIse eIIectIveIy, every reasonabIe eIIort must
be made to InIorm tbe patIents concerned, or tbose be made to InIorm tbe patIents concerned, or tbose
wbo may properIy gIve permIssIon on tbeIr bebaII, wbo may properIy gIve permIssIon on tbeIr bebaII,
tbat tbey may, at any stage, wItbboId tbeIr consent tbat tbey may, at any stage, wItbboId tbeIr consent
to dIscIosure. to dIscIosure.
II) II) Wbere consent cannot be obtaIned, tbIs Iact sbouId Wbere consent cannot be obtaIned, tbIs Iact sbouId
be drawn to tbe attentIon oI a researcb etbIcs be drawn to tbe attentIon oI a researcb etbIcs
commIttee wbIcb sbouId decIde wbetber tbe pubIIc commIttee wbIcb sbouId decIde wbetber tbe pubIIc
Interest In tbe researcb outweIgbs patIents' rIgbt to Interest In tbe researcb outweIgbs patIents' rIgbt to
conIIdentIaIIty. DIscIosures to a researcber may conIIdentIaIIty. DIscIosures to a researcber may
otberwIse be Improper, even II tbe researcber Is a otberwIse be Improper, even II tbe researcber Is a
regIstered medIcaI practItIoner. regIstered medIcaI practItIoner.
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b. TeacbIng and audIt (IncIudIng pubIIcatIon): b. TeacbIng and audIt (IncIudIng pubIIcatIon):
PatIents' consent must be obtaIned unIess tbe PatIents' consent must be obtaIned unIess tbe
data bave been eIIectIveIy anonymIsed. data bave been eIIectIveIy anonymIsed.
Wben dIscussIng patIent data at In Wben dIscussIng patIent data at In--bouse bouse
bospItaI mortaIIty and morbIdIty meetIngs, dIrect bospItaI mortaIIty and morbIdIty meetIngs, dIrect
reIerence to patIent's name, IdentIty and reIerence to patIent's name, IdentIty and
personaI detaIIs sbouId be avoIded. personaI detaIIs sbouId be avoIded.
Wben usIng cIInIcaI patIent materIaIs In medIcaI Wben usIng cIInIcaI patIent materIaIs In medIcaI
pubIIcatIons or at medIcaI conIerences, at aII pubIIcatIons or at medIcaI conIerences, at aII
tImes avoId reveaIIng personaI detaIIs oI tbe tImes avoId reveaIIng personaI detaIIs oI tbe
patIents. patIents.
Pbotograpbs wben used sbouId not reveaI Pbotograpbs wben used sbouId not reveaI
IdentIIyIng IacIaI or pbysIcaI Ieatures. IdentIIyIng IacIaI or pbysIcaI Ieatures.
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g. An 'IdeaI' Way oI BreacbIng g. An 'IdeaI' Way oI BreacbIng
ConIIdentIaIIty: ConIIdentIaIIty:
BeIore DIscIosIng, ReconsIder: BeIore DIscIosIng, ReconsIder:
Tbe patIent Is InIormed, preIerabIy beIore tbe breacb. Tbe patIent Is InIormed, preIerabIy beIore tbe breacb.
Tbe doctor aIso bas a responsIbIIIty to ensure Tbe doctor aIso bas a responsIbIIIty to ensure
arrangements exIst to InIorm patIents oI tbe arrangements exIst to InIorm patIents oI tbe
cIrcumstances In wbIcb InIormatIon about tbem Is IIkeIy cIrcumstances In wbIcb InIormatIon about tbem Is IIkeIy
to sbare and to gIve tbem tbe opportunIty to state any to sbare and to gIve tbem tbe opportunIty to state any
objectIon to tbIs. objectIon to tbIs.
Its maIntenance wouId cIearIy resuIt In damage tbat Its maIntenance wouId cIearIy resuIt In damage tbat
outweIgbs tbe damage done by tbe breacb. outweIgbs tbe damage done by tbe breacb.
Tbere Is no otber way tbat does not InvoIve a breacb oI Tbere Is no otber way tbat does not InvoIve a breacb oI
conIIdentIaIIty to avoId tbe damage conIIdentIaIIty to avoId tbe damage
Tbe breacb Is tbe Ieast possIbIe tbat wIII prevent tbe Tbe breacb Is tbe Ieast possIbIe tbat wIII prevent tbe
damage or Is tbe one wItb tbe Ieast barmIuI damage or Is tbe one wItb tbe Ieast barmIuI
consequences to tbe patIent. consequences to tbe patIent.
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And wben reIeasIng InIo, reIIect upon: And wben reIeasIng InIo, reIIect upon:
(even (even wItb wItb consent) consent)
WHY? WHY? Is It necessary? Is It necessary?
WHEN? WHEN? PRN PRN
WHOM? WHOM? OnIy to approprIate autborIty. OnIy to approprIate autborIty.
WHAT? WHAT? 'Bare MInImum!' or 'Need to Know' 'Bare MInImum!' or 'Need to Know'
basIs. basIs.
WHERE? WHERE? AvoId eavesdroppers. AvoId eavesdroppers.
HOW? HOW? Pbone, Fax, e Pbone, Fax, e--maIIs, etc maIIs, etc
ETC ETC -- MaIntaIn strIct proIessIonaIIsm MaIntaIn strIct proIessIonaIIsm
(e.g. AvoId gIvIng judgment, gossIp, etc.) (e.g. AvoId gIvIng judgment, gossIp, etc.)
Iectronic MedicaI Records
EMR offers an enhanced capacity to manage
patient information .The practitioner has a
responsibility, as custodian of patient's
medical records, to ensure integrity,
confidentiality and availability of medical
records.
He shall ensure there is an information
governance policy with protocols and
procedures to ensure patient information is
documented, maintained & disclosed
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Tbe Importance to upboId conIIdence Tbe Importance to upboId conIIdence
HeaItbcare personneI owe botb a IegaI and an etbIcaI duty oI
conIIdentIaIIty. Tbey must not dIscIose InIormatIon regardIng
bIs patIent to a tbIrd party except In deIIned cIrcumstances:
CounseI (wItb consent)
MedIcaI AutborItIes
EnIorcement AutborItIes
ConIIdence Is NOT absoIute ConIIdence Is NOT absoIute -- DIscIosure onIy aIIowed wben tbe DIscIosure onIy aIIowed wben tbe
recognIzed exceptIons appIy recognIzed exceptIons appIy
SerIous consequences II ConIIdence Is breacbed wItbout just SerIous consequences II ConIIdence Is breacbed wItbout just
cause cause
Even wItb consent Even wItb consent -- otber Iactors need to be consIdered otber Iactors need to be consIdered
- Ensure patIents' dIscussIon take pIace In secure area
- EIectronIc transmIssIon oI InIormatIon- consIder wItb care
- ReIease patIents InIormatIon bavIng been onIy satIsIIed tbat
bave rIgbt to do so
ExIstIng Law Is stIII InsuIIIcIent. ExIstIng Law Is stIII InsuIIIcIent.
b. ConcIusIon: b. ConcIusIon:
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And IInaIIy, .. but most ImportantIy . And IInaIIy, .. but most ImportantIy .
1. 1. Tbe Iact tbat Tbe Iact tbat consent beIng gIven consent beIng gIven does does not not
ItseII reIeases anybody Irom tbe ItseII reIeases anybody Irom tbe obIIgatIon obIIgatIon
to maIntaIn conIIdentIaIIty. to maIntaIn conIIdentIaIIty.
2. 2. Even wItb strIct Iaw and enIorcement, Even wItb strIct Iaw and enIorcement,
conIIdentIaIIty conIIdentIaIIty depends mucb upon tbe depends mucb upon tbe
good sense good sense and tbe and tbe etbIcaI etbIcaI bebavIor bebavIor oI oI
tbose boIdIng tbe InIormatIon. tbose boIdIng tbe InIormatIon.
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TERIMA KASIH TERIMA KASIH
/1o1os pero11on on/o /1o1os pero11on on/o..
SELAMAT BERKURSUS
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