Ethics Armed forces doctor

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4. Confidentiality

Key messages

  • Doctors owe a duty of confidentiality to all of their patients, including after death.
  • The duty of confidentiality applies equally to the health information of fellow members of the UK armed forces as it does to civilian patients.
  • It may be necessary for doctors to explain their duty of confidentiality to patients and offer reassurances that their information will be kept confidential.
  • Any identifiable information relating to a patient should be kept confidential, unless there is a compelling legal reason why it should not be.
  • Doctors must be prepared to justify any decision to disclose information without the patient’s consent.

 

In almost every profession – whether it’s law or journalism, finance or medicine… people rely on confidential communications to do their jobs. We count on the space of trust that confidentiality provides. When someone breaches that trust, we are all worse off for it.  

Hillary Clinton, US Secretary of State

Who is owed a duty of confidentiality and what information is confidential?

Doctors owe a duty of confidentiality to all of their patients, including after death. All information that, directly or indirectly, might identify a patient is subject to this duty. This includes information that is written, visually or audio recorded, or simply held in a doctor’s memory.

Depending on the particular situation and the identity of the patient concerned, different pressures may be placed on the military doctor’s duty of confidentiality. There will be circumstances where a doctor will not receive any information, such as name or date of birth, about a civilian patient treated in an emergency, before that patient is transferred out of his or her care. In contrast, where doctors have an ongoing therapeutic relationship with members of their own unit, they will potentially hold a substantial amount of confidential information and may, on occasion, be asked by the military chain of command to disclose it.

In each scenario, the doctor’s duty of confidentiality remains the same. Any identifiable information relating to a patient, whether civilian or military, should be kept confidential, unless there is a compelling reason why it should not be (see below). The duty of confidentiality applies equally to information relating to treatment given in an established healthcare facility, such as a hospital or clinic, and emergency treatment delivered elsewhere.

 

Why is the duty of confidentiality important?

Respect for confidentiality is central to the development of trust between doctors and patients. In circumstances where patients may be more inclined to mistrust doctors, for example because they are part of a foreign military force, explaining the doctor’s duty of confidentiality, and reassuring patients that their information will be kept confidential, can help to build trust and emphasise the distinction between medical and military intervention. It is also important that fellow members of the UK armed forces know that the duty of confidentiality applies to their medical treatment.

Certain patients, for example those being detained, may be vulnerable to abuse of their medical information. Doctors should therefore be especially careful to ensure the confidentiality of all personal medical information, including any medical records, where a detainee is subject to interrogation, or could be at a later stage.

 

When can confidential information be disclosed?

Patients must be able to expect that information about their health will be kept confidential unless there is a compelling reason that it should not be. The duty of confidentiality is not absolute. Confidential information can be disclosed where:

  • the patient has capacity and consents to the disclosure; or
  • it is required by law; or
  • it is justified in the public interest (the General Medical Council gives the example of there being a potential public interest in protecting individuals or society from risks of serious harm, such as serious communicable diseases or serious crime).

There is also a presumption that information can be disclosed to fellow health professionals involved in the provision of treatment to the patient, on the basis of implied consent. Where particularly sensitive information is concerned, for example involving sexually transmitted disease or psychiatry, this presumption should be confirmed explicitly by asking the patient if he or she consents.

Find out about making a disclosure in the public interest

 

Case study: 'What's wrong with him, doc?'

A senior officer from the military chain of command asks you what exactly is wrong with a member of your unit who you have been treating since his admission to the medical facility the previous day.

Are you able to reveal what you know about your patient?

Based on the information provided here, it should be explained to the senior officer that, because of the duty of confidentiality, it is not possible to meet the request for medical information unless the patient consents to it. As in occupational health settings, the doctor may specify the practical implications of the patient’s condition, for example that he is not fit for active duty, but without giving clinical details.

Clinical information about an individual’s diagnosis or treatment is confidential. The confidentiality of all patients must be respected unless one of the exceptions applies. Although a senior officer is making the request, there is no presumption in favour of disclosing information without consent, as the individual is not a health professional involved in the provision of treatment to the patient. Further information is needed in order to determine whether disclosure is required by law or justified in the public interest. It may be that the patient has capacity and would be willing to consent to the disclosure, in which case the information can be released.

 

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Ethical decision making for doctors in the armed forces tool kit (PDF)