Information relating to adults with capacity should only be shared without consent where it is in the public interest or where there is other lawful authority such as a court order or statute.
Some legal statutes permit - although they do not require - the disclosure of confidential information in certain circumstances.
The Data Protection Act 1998 and the Crime and Disorder Act 1998 for example both permit disclosure of information to other organisations such as the police, local authorities, social services and government bodies.
If health professionals are contacted by police, social services or their partner organisations and they are uncertain whether disclosure is a statutory requirement, they should ask the person or body applying for the information to specify the nature of their lawful authority. In the absence of lawful authority, ordinarily, health professionals should only disclose information where the patient has given consent or there is an overriding public interest.
An example of a partner organisation is a Multi-Agency Risk Assessment Conference (MARAC). This is a meeting convened to discuss the highest risk domestic abuse cases in any given area with a view to creating a safety plan for each victim. MARACs operate in England, Wales and Northern Ireland. Information will usually be shared amongst a number of local agencies including health, police, housing and social services.
This guidance stresses the legal and ethical requirement to respect the choices of competent adults.
In the BMA's view, information relating to adults who retain capacity under the terms of the Mental Capacity Act 2005 (MCA) should only be shared where the individual consents to the disclosure, where it can be justified in the public interest or where there is other lawful authority, such as a court order or statute.
A disclosure in the public interest is likely to be justified where it is essential to prevent a serious and imminent risk to public health, national security, to protect other people from risks of serious harm or death, or to prevent or detect serious crime. Other people here may include, for example, children in the house who may be at risk of serious harm.
A public interest disclosure will only be justified where it is necessary and proportionate. Any health professional disclosing information in these contexts must have a reasonable belief that it is likely to achieve the desired result and must only disclose as much information as is necessary to achieve it.
Public interest disclosures where only the vulnerable adult is at risk are discussed in the section below.
This guidance stresses the legal and ethical requirement to respect the choices of competent adults. Victims of domestic abuse are frequently vulnerable, sometimes extremely so, even though they may retain the cognitive abilities to make decisions on their own behalf.
As part of the consent-seeking process, where a vulnerable adult is making a decision that is seriously at odds with an objective assessment of his or her interests, health professionals should sensitively explore the reasons behind the decision. This could include exploration of the possibility of confidential referrals to groups or organisations that offer support to vulnerable adults.
It is only when the health professional has properly explored the patient's circumstances and the reasons behind the apparent refusal that they should consider some of the options discussed below. Health professionals should also seek advice from colleagues in these circumstances.