27 August 2013
The importance of a doctor’s duty of confidentiality to vulnerable adult patients has been underlined in new BMA ethics guidance.
The association has produced recommendations to help health professionals in England and Wales treat adults who are being abused and do not want confidential information disclosed, even if it will help protect them from harm.
It seeks to address some of the dilemmas for doctors caring for vulnerable patients who retain capacity under the terms of the Mental Capacity Act 2005, such as whether patients are making a free and informed choice about confidentiality or whether they are acting under pressure from their abusers.
BMA board of science chair Baroness Sheila Hollins said: ‘It is so important that doctors are fully aware of how to use the Mental Capacity Act and of their duties of confidentiality to vulnerable adults, as well as to adults who do have capacity.
‘This guidance carefully guides doctors on how to deal with some of the issues involving consent in disclosure of information.’
Value of confidentiality
The guidance, Vulnerable Adults and the Disclosure of Confidential Information, points out that although the duty of confidentiality is owed to all patients, it can be very important to people who may be at risk of harm.
‘If people subject to abuse do not feel they can trust their doctors to keep their confidences they may be less likely to visit them,’ it says.
‘Vital opportunities to help and support them may therefore be lost. Where adults consider themselves to be at risk from those close to them, they may also be concerned that a disclosure of information may put them at greater risk.’
The guidance points out that a doctor’s duty to keep patient information confidential is not absolute. But it says that information relating to adults who retain capacity should only be shared where the individual consents to such disclosure or ‘where it can be justified in the public interest or where there is other lawful authority, such as a court order or statute’.
The guidance points out that, where a patient makes a decision which is not in their best interests, the doctor should sensitively explore the reasons behind it and the possibility of referral to confidential groups or organisations that support vulnerable adults.
The BMA notes that it becomes particularly difficult if a competent adult is adamant about such a decision, and suggests doctors who are concerned they may be open to future criticism should discuss the issue with their colleagues. They should also take contemporaneous notes of the decision, the reasons behind it and any discussions the doctor themselves have had with colleagues or defence bodies.
The guidance also covers disclosure of information about adults without capacity under the Mental Capacity Act.
‘Decisions can either be made by an attorney acting under a health-and-welfare lasting power of attorney, or, in the absence of an attorney, relevant health professionals can make a decision based upon an assessment of the individual’s “best interests”,’ it says.
It adds: ‘Any “best-interests” assessment will ordinarily involve discussion with those close to the individual. In relation to domestic abuse, however, care has to be taken to ensure that anyone consulted who is close to the individual is, in fact, acting in his or her interests.’
Read Vulnerable Adults and the Disclosure of Confidential Information