Privacy and Confidentiality

Abstract

Confidentiality is an age-old feature of health care, particularly in the Western tradition: what is said or done within the therapeutic encounter should remain between patient and provider. In modern times, medical confidentiality has been regulated either by deontological rules, in the Anglo-Saxon tradition, or by public law (Criminal Code), as with the French “secret médical.” A third orientation is now to see confidentiality as a dimension of human rights (public health in general is going in this direction). Confidentiality has as its first goal protecting the interests of the patient: the patient is the master/ruler of that “secrecy”; that is, he or she decides freely whether to disclose whatever data related to his or her health or treatment, how and when. In most legal systems and in addition to the duty to inform spontaneously and completely the patient, the provider cannot refuse to transmit medical data to others if the patient requests it.

The emphasis on respect of the patient’s privacy is relatively new, flowing from the dignity recognized in all human beings. For centuries, medical practice was marked by paternalism, sometimes authoritarian and not likely to welcome criticisms or refusal of care. Until recently, the patient’s privacy was often, practically, a minor concern of care providers. Today, biomedical (e.g., in genetics, communicable diseases) and social developments give rise to delicate questions in terms of an individual’s privacy and his or her responsibility regarding possible impacts on the health and welfare of others and the community. To be kept in mind are issues about the right of providers to have their privacy respected.