Confidentiality

Except in certain situations, patients have a right to expect that information about them that is learned in the special relationships that exist in health care will be kept confidential. This confidentiality acknowledges both the human dignity of the person and his or her autonomy. From an ethical perspective, health care professionals have an obligation to share information learned about patients only with others involved in the patients' care who have a direct need to know. Even "anonymous" references to patients should be avoided in public places, such as hospital elevators and cafeterias, to avoid the possibility that someone present may determine the identity or diagnosis of the person being discussed. Sometimes, however, health care professionals are obliged to relay otherwise confidential information to others. This occurs in the following circumstances:

1. Reporting communicable diseases.
2. Reporting suspected abuse of children, the elderly, or spouses.
3. Reporting information for workers' compensation cases.
4. Reporting gunshot wounds or other injuries that appear to be evidence that a crime has taken place.
5. Court testimony.

Other circumstances when confidentiality may be breached are more ethically challenging. For example, if an HIV+ patient refuses to tell his or her partner of the infection, the health care professional must balance the patient's right to confidentiality against the health and safety of that other person. It is ethical to breach confidentiality in this kind of circumstance if (1) there is a high probability of significant harm coming to another party; (2) every effort has been made to address the problem without violating confidentiality; (3) there is good reason to believe that violating confidentiality will offer significant protection to another person; and (4) it would be reasonable to act in this way in any similar circumstance. In addition, the patient should be given the chance to divulge this information first, with the understanding that the health care professional will otherwise do so.

One does not need to be a health care employee to have an ethical responsibility to respect the confidentiality of others. Harm can be done if gossip about a hospital roommate, or about someone seen in a physician's waiting room, for example, filters out into the community. The common good is protected when all involved guard the legitimate confidentiality rights of others.