Informed Consent

Informed Consent

Introduction

The medical profession is filled with significant ethical issues, and this thus demands that any medical practitioner must always pay close attention to medical ethics to avoid violating the existing laws dictating their relationship with patients. Medical ethics, in general, is an approach that dictates moral principles applying values to the profession of medicine along with research. Medical ethics is a framework enabling professionals to make sound and ethical decisions in practice in case there is any misperception or conflict. The significance of medical ethics cannot be stressed enough, especially when it comes to examining clinical circumstances that may have several potential courses of action. These ethics help professionals explore a particular problem using facts, value, and logic in deciding the most appropriate action that would not violate the laws governing the patients themselves. Some ethical issues can be straightforward in determining right from wrong.

However, others can be very perplexing like determining the level of confidentiality when dealing with a patient’s information, and how to handle the case of informed consent so that the involved parties have full knowledge of possible consequences. Medical professionals are always requested by law to keep their patients’ information confidential and only share this information when there is informed consent from the patient. Nonetheless, it is still challenging to determine whether breaching of confidentiality can be justifiable, and this thus presents many professional with an ethical challenge. The paper will argue that violations of confidential information are legitimate because it can promote the well-being of the public and as long as it can be proven that the benefits of the decision outweigh the risk..

Confidentiality

Confidentiality remains to be a central topic in preserving the relationship between healthcare practitioners and their patients. Privacy is a fundamental ethical behaviour in medical practice, and it can help in promoting the quality of services offered. The idea emanates from the fact that practitioners need accurate and up-to-date information from the patients concerning their status of health and their perspective towards the services provided. However, this is unachievable if the patient does not trust the doctors or the nurses. Lack of trust will cause the patient to withhold certain information from the professionals out of the fear of their data being easily shared to third parties.

Robinson (2016), explained that professional individuals in the field of healthcare delivery have ethical and legal responsibilities of safeguarding the confidentiality of any information regarding the clients under their care. The clinical researcher in his article further extended to explain that even scholars and any person involved in the field of human research are also obligated to protect the privacy of their clients participating in their clinical studies or research projects. It hence points to the idea that the law is stringent in protecting patients and participating individuals in research, especially when it comes to disclosing personal and private information.

One of the critical challenges often facing the concept of confidentiality is the idea of dealing with children or incompetent leaders. However, Hodgson, Mendenhall & Lamson (2015), mentioned that various federal statutes bind all members of healthcare delivery professionals to the duty of protecting the confidential information of the clients. Among them is HIPAA. All healthcare providers must always adhere to the principles and guidelines of Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (Privacy Rule) setting a baseline of protecting certain identifiable health information. Cohen and Mello (2018) extended to explain that the Privacy Rule of HIPAA forbids any covered unit from unveiling confidential health information concerning the sound and adult clients not unless the involved party authorizes it. However, the limitation can only be breached in cases where the prohibition can result in unnecessary interference with quality care, national priorities, or public benefits. Therefore, confidentiality is a crucial element because it allows free flow of information between the patients and the healthcare providers hence remaining a core duty of medical practice.

Informed Consent

As already established, open and honest communication is an integral element in the relationship between professionals and clients because it helps in building and sustaining the relationship. One of the core medical ethics indicates that it is a fundamental ethical requirement that healthcare delivery professionals deal honestly and openly with the clients at all times, and part of this communication entails informed consent (Grove, Burns & Gray, 2015). Informed consent is a fundamental right of every patient, and it involves the patient having full knowledge of what the medical professionals are proposing to do, the nature and aim of the proposal, and the anticipated perils and benefits. Informed consent can be understood from the perspective that it is the bidirectional course of communication between a healthcare provider and a patient resulting in the patient authorizing or agreeing to undertake specific medical procedures or interventions (Grove, Burns & Gray, 2015). It is thus essential to identify that since treatment regimen is always an ongoing process, consent is therefore also an ongoing process capturing discussions and understanding in every step of care, billing, and follow-up.

Informed consent is especially necessary given the fact that the patient may not be aware that when a healthcare provider is present, they are engaging in conversations that could result in assessment, diagnosis and treatment (Grove, Burns & Gray, 2015). Usually, when a medical practitioner fails to obtain informed consent from the patient before they perform a test or a medical procedure, then they can easily be sued for battery, which is a form of assault.

Nevertheless, this does not mean that anyone can make an informed consent. It thus draws down to the critical components of informed consent. Informed consent must ensure that the client is capable of making decisions, the healthcare professional discloses all information to the client, both parties must understand pertinent details, and the client must voluntarily provide consent without coercion (Hardicre, 2015). Therefore, within informed consent, legally competent patients have the legal and moral right to decline treatment, and this is valid even if the patient makes a wrong decision that may result in grave consequences or death. However, informed consent is not only limited to treatment but also in research, and researchers are required to get informed consent from the identified population (Hardicre, 2015). The informed consent helps the people involved in clinical trials to have full knowledge about the study before they decide whether they want to participate or not.

Breaches of Confidentiality

A violation of confidentiality often happens when information of data provided by one party to another in confidence is unveiled to another party without the other party’s consent. The breach of confidentiality can happen either orally, in writing, or sometimes in an informal meeting between different groups. The violation of privacy tends to be common mainly in the medical field, military, and sometimes even in business. Privacy, as already seen, often guarantees that authorized people can only access the shared information. Breach of confidentiality in the medical practice involves the idea that a medical professional exposes anything that the client informed them during the treatment process, or even after the death of the client (Hardicre, 2015). A breach of confidentiality in medical professions is punishable under federal laws. However, this does not mean that there have never been cases of a medical practitioner violating the privacy of the patients. Though certain circumstances can allow for the breach of confidentiality by a medical profession, it is still questionable whether this is justifiable. Arguably, the violation of privacy is unethical regardless of the party that gains from it, because then it shows that the rights of the victim are no longer valid before the law. The argument posits that the disclosure of the client’s information should only be made available if the patient freely agrees without coercion. However, this scenario lacks the idea of representation. The argument does not consider the state of the patient and why it would be necessary to breach their confidentiality. Proponents of breaches of confidentiality base their arguments on utilitarian argument suggesting that a patient or client may have an affected conscious level, and this justifies the disclosure on the presumption of implied consent. The ethical decision of breaching confidentiality thus lies in understanding the patient’s right to privacy against the welfare of the community. The balance demands that one must consider the potential good against harm.

Similarities and Differences

The two concepts refer to processes that involve ethical concern, and they are both concerned with the rights of the patients. The main objective of the two ideas is to protect the patient from being either manipulated or misused by the medical practitioners. It is from this perspective that it is evident that they both aim to draw a line defining the limitations of the practitioners regarding their relationship with the clients. Confidentiality ensures that the medical professionals or the researchers do not use the patients or clients’ information for their benefit at the cost of the clients. In turn, this grants the patients the right to exercise their privilege over their information and data. The same can be said of informed consent. The idea behind informed consent is to avoid manipulation of the practitioners. Informed consent strives to ensure that the medical professionals respect the rights of the clients even if it is not right with them and thus protecting the clients’ sense of autonomy. It, therefore, shows that the critical similarity between the two concepts is in the argument of protecting the clients from exploitation by the medical professionals.

The other similarity can be found in the violation of the confidential information. In both cases, it is arguable that it is not right to breach confidentiality or violate informed consent. Care must ensure that the patient receives the utmost care, and the new practice of patient-centred care drives this. The modern practices that focus on the patients dictate that the needs and wants of the patients must always be respected and addressed, not according to the desires of the practitioners, or third parties, but according to the patients. Therefore, there is no justification for violating the client’s confidential information. The client’s confidential information in this context refers to the fact that their medical information should not be shared by a third party to decide on their treatment or care. A breach of confidentiality will affect the ability of the practitioners to offer the desired quality of care, as this will lead to a distorted relationship without adequate flow information (Robinson, 2016). Violating the informed consent also falls within the same lines, and it is arguably unethical. The whole idea behind informed consent is ensuring that the patient or the client receives the treatment or participates if it is all right with them. It is an act of exercising an individual right of autonomy. The same applies to the current approach in the practice of patient-centred care. By gaining informed consent, the medical professionals adhere to the fact that they are practising the concern that the patient needs and not what the hospital thinks is right for the clients. It thus rejects the idea that a violation of informed consent is justifiable.

Though so far it has been evident that the similarities are prevalent in why breaches of confidentiality are not justifiable, the similarities can also be found in why it is legitimate, and these are identified in the components of both confidentiality and informed consent. It is crucial to understand that the client’s confidentiality is not absolute. The moral basis of the patient’s confidentiality is consequentialist. It means that the fundamental ethical consideration of confidentiality is to enhance the patient’s welfare and thus improving secure public health. However, certain occasions present themselves possible for breaching this idealism. One is when the patient is not competent. In the context of confidentiality, a breach of privacy is potential if the patient is unable to give his consent because their conscious level is affected. Thus, the law determines this as implied consent. The same is evident in the concept of informed consent. There are groups of individuals whose right to informed consent can be breached and these individuals who are incompetent to offer informed consent. The same applies to anyone determined to be medically incompetent and not in the right mind to make reasonable decisions and arguments.

The other similarity is present in the disclosure required by the law. If judicial proceedings require certain information concerning a client, then it cannot amount to a penalty for breach. Nonetheless, this is only allowed if the information is to prevent or detect crime and the Police and Criminal Evidence Act 1984 gives the police the right to access any medical information that would have previously been considered confidential as long as they have a warrant obtained by a judge (Robinson, 2016). The same does not apply to informed consent. There are cases where the law allows violation of breaching of informed consent and such include when interrogating a criminal or a party that might help in preventing crime. In such a case, the law applies the theory of utilitarianism whereby the right can be determined from wrong by considering the outcome of the process such as saving the general public from an act of malice hence justifying the highest good for the most significant number. In both concepts, it is evident that the law justifies the violation of confidential information because the benefits of gaining this information outweigh the shortcomings of violating the individual’s right.

The main difference, however, is found in the age of the patient or client. Violating informed consent is justifiable when dealing with children without parents or guardians. A child is considered to be underage, and thus they cannot make reasonable decisions regarding the health and well-being, and therefore in the absence of the parent, a breach of autonomy can be violated for the benefit of the client. In the case of children, it is the parents who provide informed consent, and the children are only allowed to permission, which refers to their willingness to participate in the identified procedure. However, the same approach does not apply to confidentiality. Confidentiality does not consider age as long as the identified client is of sound mind. Confidentiality mainly deals with the question of the right to privacy when it comes to medical information, and children just as adults, have the same rights under the federal law. It means that their confidential information should be respected with the same approach as that of adults. In such a case, the breach of confidentiality is only allowed if the party freely agrees for the violation to proceed, but they must be fully aware of the disclosure.

Conclusion

The offered assessment of confidentiality and informed consent regarding whether violations of confidential information are justified revealed that the circumstances under which the justification is allowed outweigh why the breaches cannot be justified. The main reason why violations of intimate knowledge are justified is that the breaching usually is for the greater good. The medical professionals are aware of the existing laws and policies guiding their practice against breaching confidentiality and informed consent. Therefore, any decision made against these is to either to help the patients or for the benefit of the public good. It is, however, essential to recognize that the latter is only justifiable if there is court orders overpass the client’s rights for the public good. Besides, even in violating confidential information, there are protocols to follow, which are often either determined by the organization, local, state or federal government. Therefore, by considering the theory of utilitarianism and the arguments both on similarities and difference highlighted in this paper, violations of confidential information are justifiable.

References

Cohen, I., & Michelle, M. (2018). “HIPAA And Protecting Health Information In The 21St Century”. JAMA 320 (3): 231-236. doi:10.1001/jama.2018.5630.

Grove, S. K., Burns, N., & Gray, J. (2015). Understanding Nursing Research: Building an Evidence-Based Practice (6th ed.). St. Louis, MO: Elsevier Saunders.

Hardicre, J. (2015). Valid informed consent in research: an introduction. British Journal of Nursing, 23(11), 564–567. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107866572&site=ehost-live&scope=site

Hodgson, J., Mendenhall, T., & Lamson, A. (2015). “Patient And Provider Relationships: Consent, Confidentiality, And Managing Mistakes In Integrated Primary Care Settings.”. Families, Systems, & Health 31 (1): 28-40. doi:10.1037/a0031771.

Robinson, E. (2016). “No Confidence: Confidentiality, Ethics And The Law Of Academic Privilege”. Communication Law And Policy 21 (3): 323-381. doi:10.1080/10811680.2016.1184917.