Block 2 VLE

Question 1

Name the legal framework governing disclosure of patient information

Answer 1

1. Common Law of Confidentiality
2. Data Protection Act 1998
3. Human Rights Act 1998
4. Administrative Law

Question 2

Describe the underlying ethical principles on which confidentiality is based

Answer 2

1. Autonomy – my information, my life, I’ll decide 2. Privacy
2. Identity
3. Promise keeping/dishonesty/trust

Question 3

Identify situations when confidentiality may be breached and justifications for doing so

Answer 3

1. Disclosures with Consent
   - For the purposes of a patient’s healthcare;
   - Clinical audit;
   - Employers, insurers, government department;
2. Disclosures Required by Law
   - Notification of cases of certain infectious diseases;
   - At request of certain regulatory bodies;
   - If ordered by a judge;
3. Disclosures Justified by the Public Interest
   - Gunshot and knife wounds
   - DVLA
   - Education/Research?
4. Serious communicable diseases
   - Encourage consent to disclosure, if consent refused, respect decisions but consider
   - risk of infection to medical staff – standard infection control procedures?
   - partner – sexual contact with patient
   - risk of infection/harm
   - inform of intended disclosure – does not conflict with
   autonomy

Question 4

Identify situations when a doctor is legally required to disclose information to a third party

Answer 4

Disclosure in the public interest

1. disclosure can protect individuals or society from risks of serious harm
2. Police should be informed when a person arrives with a gunshot wound, or wound from a knife attack.
3. This enables police to assess risk to patient, to staff, and to others
4. May not have to disclose personal info such as name

Ordered by judge
e.g. personal info about patient who has come in with a gunshot wound

Drivers and the DVLA – regulatory bodies
1. Legal responsibility for deciding whether a person is medically unfit to drive
2. Make efforts to persuade patient to stop driving
3. if they do not - Notify patient of intention to inform DVLA
and confirm in writing when it has been done
4. contact the DVLA and disclose relevant medical
information to the medical adviser

Notification of cases of certain infectious diseases

Question 5

Explain the concept of therapeutic privilege and its ethical justification

Answer 5

1. Information provision helps to promote their autonomy, maintains trust etc.
2. Vital for informed consent.
3. But in some situations, telling a patient something may
   cause them harm;
4. Therefore an ethical argument in favour of, in specific
   circumstance, withholding information during consent
   process.
5. But this is done for the patient’s benefit.

Problems:
1. Who is best positioned to determine what is best for a patient?
a. The doctor
b. The patient
c. Anyone else?
2. Does undermining autonomy harm a patient?
3. What if something goes wrong, directly related to the
withheld information

Question 6

Describe GMC guidance on raising concerns about professional practice and patient safety

Answer 6

1. Follow the process at your institution
2. First raise the concern with your manager/senior (eg.
   Consultant, Clinical or medical director, or a practice
   partner;
3. If your concern is about that person you may need to go to
   the clinical governance lead;
4. Doctors in training, it may be a named person in Deanery
   or clinical supervisor;
5. Document your concerns.

Question 7

Differentiate between the statutory duty of candour and the professional duty of candour of an individual doctor

Answer 7

1. “Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress”
2. “As a doctor… you must be open and honest with patients, colleagues and your employers”
3. Inform before things go wrong e.g. about care, risks, potential benefits/ If it does go wrong: harm caused, consequences currently and harm/distress in the future.

Legal duty
1. Statutory institutional duty
2. Set out in statute therefore legal requirement - Health and
Social Care Act 2008: Regulation 20 (2014)
3. Formal process triggered by incident resulting in harm to
patient.
a. Level of harm (no, low and significant ) b. Cause and effect

Question 8

Describe the ethical principles and values that underpin the moral obligation to be truthful

Answer 8

1. moral duties derived from moral theories
2. respect of autonomy
   a.
   sharing of information
   - Requires openness at all stages of contact with
   patients, info about diagnosis/prognosis, progress,
   things go wrong.
   - Information necessary for informed consent
   - Make informed decisions
3. Ethical duty to be honest and open with patients Doctor-patient relationship built on trust that drs will be open and honest

Question 9

Identify and critique any limits to the moral obligation to disclose relevant information to patients about their care

Answer 9

1. Autonomy: But in some situations, telling a patient something may cause them harm – withholding info in best interest of patient.
2. Ethical duty to be open and honest: you only have to tell patients relevant information –but this raises the question of what is relevant.