Iranian Journal of Medical Ethics and History of Medicine

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Confidentiality is anonymity of gamete or embryo donors to the recipients and resulted children and Vice Versa. In this article, I formulated the question about confidentiality through two main questions: 1- Ethically speaking, should the information about the characteristics and identity of donors be kept in specific organizations to be accessible for who considered having the right of access in the future? 2- Are receivers ethically obliged to inform their children about their biological origin? In this article, I assess the subject from Deontological, Utilitarianistic and Principalistic approaches and conclude that it is the right of such children to be informed about their biological origin. Of course in Iran, such ethical obligation should be suspended until the problems relating the heritage are solved.

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Confidentiality is one of the oldest principles of the medical profession that impacts on the relationship between physician and patient, the personal interests of patient and physician and consequently social welfare. While emphasizing the necessity of confidentiality, religious teachings consider disclosure of others' secrets a sin that deserves punishment thereafter. Nowadays, medical developments and the invention of new diagnostic and therapeutic procedures as well as the vastness of the informatics world make disclosure of patients' secrets easier than ever. This review article is the result of a descriptive study, and the information was collected using reliable library and internet resources. It will first expound the concepts and principles of confidentiality in medical ethics as well as Islamic ethics, and will then proceed to a comparative review of the similarities and differences in these two sets of­­­­ ethical views on the issue of confidentiality. In addition to the emphasis of medical ethics and Islamic ethics on the necessity of confidentiality in order to win public trust, both sets of teachings cover two areas of personal and public discretion, while in Islamic ethics, the issue extends to a third from, namely religious confidentiality. This makes Islamic ethics more comprehensive in the sense that based on Islamic teachings, the person who keeps someone's secret will also be rewarded in the Hereafter. Also, in medical ethics, only the behavior of the health staff is evaluated and their moods and motives are not taken into consideration, while Islamic ethics pays attention to human dispositions and therefore confidentiality is more stable and can maintain its efficiency without external supervision.

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Secrecy or confidentiality has always been considered a crucial issue in the medical profession. Secrecy is a common and essential principle among patients and physicians, and is highly emphasized in professional ethical codes and guidelines.This case report is based on an actual case in Medical Ethics Grand Rounds in Tehran Children's Medical Center, with a glance at the boundaries and challenges of keeping and revealing the secrets of the patients.Case Scenario: In this report, a neonate with withdrawal symptoms was admitted to the hospital. After routine examinations by the medical team, they found the neonate’s mother was addicted and had concealed her addiction from her husband and her family. To facilitate treatment of the infant, they discussed the matter with the mother in order to get accurate information. The mother’s denial on one hand, and the need for accurate and comprehensive information necessary to begin treatment on the other caused a challenge to keeping or disclosing the mother’s secret. Here the medical team assumes responsibility to obtain the information from the mother, convince her and win her cooperation, and finally share the secret with the spouse to help their ill neonate.Although respect for patients’ confidentiality is an imperative issue for physicians and healthcare workers, it is not an unequivocal requirement. Due to logical and religious reasons and based on each specific case, it is necessary to make decisions that are more reasonable and less harmful to the patients and their families. Naturally the staff is required to keep the secrets of their patients permanently.

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Confidentiality is an inevitable pillar of the history of the physician-patient relationship. Misunderstanding of this principle not only causes harm to sanctity of the medical profession, but also can damage the quality of the therapeutic relationship, and more broadly public health. The keystone of this negative effect is the potential harm to the patients’ trust and confidence. Generally, the Western school tends to agree that respecting patient confidentiality is essentially desirable. Islam also respects and emphasizes confidentiality, and has general and some specific recommendations about the importance of secrecy and concealment of people’s secrets. Overall, despite strong agreement about the importance of the principle, some ethical theories do not insist on maintaining confidentiality under any circumstance. This paper is an attempt to describe the importance of confidentiality in the medical profession considering the approach of both absolutists and relativists in practice.Absolutists believe that the intrinsic desirability of implementing the principle of confidentiality in all cases is the same and without any exception, but the issue is about not giving just priority to other conflicting moral values.Additionally, the absolutists believe that breaching this principle in practice cannot be permissible due to some serious long-term and mostly hidden complications such as patients’ failure or delay to seek medical assistance or advice and/or withholding important information and so forth. Overall, according to empirical evidence and rational considerations, adherence to absolute confidentiality seems more desirable to absolutists. Unlike absolutists, in relativists’ concept of confidentiality, insisting on maintaining the secret will not be allowed in certain cases, and those cases are considered exceptions of the rule of confidentiality.The most important reasons for falling into the wrong orientation of relative confidentiality seem to be precipitance to attain the desired result, poor communication skills, ignorance of the consequences, and being headstrong.

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Medical professionalism has recently received attention in Iran, so we aimed to assess it in a single specialty educational hospital.In the present study, we evaluated observation of medical ethics principles from the viewpoints of physicians, nurses and patients. Eight principles of medical ethics were evaluated in these three groups through modified questionnaires containing 43 questions for physicians, 42 questions for nurses, and 25 questions for patients. The mean scores of those principles are as: enhancing professional efficiency (68.7 ± 23), confidentiality (67.9 ± 21), maintaining an appropriate relationship with the patients (61.7 ± 21), improving access to services (59.6 ± 21), distributing limited resources fairly (60.2 ± 25), knowledge production (61.4 ± 23), promotion of trust through management of conflicts of interests (64.8 ± 23), and perform professional responsibilities (59.6 ± 23). There were significant differences in the two parameters of “enhancing professional efficiency” and “confidentiality” between the viewpoints of the patients and the viewpoints of physicians and nurses (P < 0.0001). The difference in “maintaining an appropriate relationship with the patients”, “improving access to services”, and “distributing limited resources fairly” was significant between the viewpoints of the nurses and that of the patients and physicians. The viewpoints of the nurses and patients were significantly different only in “knowledge production”, “promotion of trust through management of conflicts of interest”, and “perform professional responsibilities” (P < 0.0001). With respect to these significant differences, the nurses’ viewpoint regarding “enhancing professional efficiency” may be more dependable due to their more accurate knowledge of the physicians’ performance and more extensive contact with them. This has also resulted in significant differences between nurses and patients or physicians in other principles as well.

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Confidentiality has long been protected in criminal law as an important ethical principle. With regard to the issue of sexually transmitted diseases, however, health care providers are faced with certain challenges. On the one hand, it is their obligation and duty to respect patient confidentiality, and on the other hand, the possibility of transmission of infection to sexual partners is a rather significant phenomenon. Therefore, health care providers have a crucial role in terms of the conflict of interests and legal duties with respect to sexually transmitted diseases.Medical mandatory reporting to state authorities accompanied by personally identifiable information of the infected person is another controversial issue in the field of confidentiality, which will be discussed in this article by studying various trends in statutes and precedents. It seems that throughout the world, there are two major trends in this respect: in some states, principles of confidentiality are observed even if the patient is infected by sexually transmitted diseases, unless it is inevitable for the safety of third parties such as sexual partners in a narrow implementation of Acts. States like Iran, France and Thailand are examples of such governments. In some countries, however, partner notification and compulsory notification by personally identifiable information of patients are mandatory for epidemiologic reasons. The United States, Australia and Ukraine are some of the countries that fall within this category. In Iranian legal system, the duty to respect confidentiality is emphasized and partner notification cannot be considered as a legal duty and therefore it is not legally permitted. Merely in emergency condition and under a narrow interpretation of law and by resort to patients informed consent, necessity and explicit law permission, breaching of confidentiality is justified.

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Protecting patient’s secrets and private information such as disease name and diagnosis can play an important role in establishing trust in the treatment team. The present study aimed to investigate the issues surrounding the confidentiality of patients’ disease names and diagnoses in hospitals affiliated with Mazandaran University of Medical Sciences.

This was a cross-sectional study conducted on 216 patients in internal, surgical and women’s wards who had been hospitalized for at least 24 hours. Research tool was a questionnaire consisting of two parts: demographic data, and questions on the disclosure or confidentiality of information such as disease names. Patients' views were investigated through simple sampling method, and data were analyzed using SPSS software and chi-square test. Of the 216 patients entered in the study, 122 (56.5%) were male and 94 (43.5 %) were female. Participants were aged between 16 and 80, and their mean age was 47 ± 18.6 years.

The results showed that 49 (22.7 %) of the patients did not approve of an open display of their disease names and diagnoses above their beds, while a difference was observed between male and female patients in this regard (P < 0.50).  Moreover, there was no relationship between patients’ educational levels and their perspective on other patients’ caregivers finding out about their disease names or diagnoses (P < 0.578).

In this study, a significant percentage of patients were found to be opposed to the disclosure of their diagnoses and disease names. Considering that this phenomenon may prevail among special disease or emergency room patients, it is recommended that authorities take measures against disclosure of patients’ disease names and diagnoses.

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Confidentiality is considered as a principle commitment of all health care professionals. Respecting confidentiality creates and maintains the trust between patients and health professionals.

Patients should be assured that their information will be kept confidential unless there is a persuasive reason. Confidentiality originates from principle of patient’s autonomy, and there is no need to be requested frankly by patient.

All of the patient’s information is naturally secret unless the patient gives consent to disclosure. In this article we aimed at reviewing challenges of confidentiality in pharmacy practice in addition to presenting the national and international guidelines in this regard. The pharmacists as the last link of the treatment team are receiving a wide range of information about their patients. Therefore respecting confidentiality in pharmacy practice should be considered as a very important requirement and it seems that privacy and confidentiality is at the primary rack of ethical and legal issues in pharmacy. Obviously fundamental challenges are existent in the pharmacy which remained unsolved. In this regards all those challenges should be determined, analyzed and practiced. In the paper we introduced some challenges including challenges related to the physical environment, pharmaceutical consultation, patients confidentiality in presence of patients family, etc and presented national and international guidelines which assists in dealing with the challenges.

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Privacy and confidentiality are the inalienable rights of every human being to preserve his dignity. This issue should be considered in all levels of medical interventions. In the healthcare system, based on respect for privacy and confidentiality, patients decides what information to provide to their physicians. However, if a patient does not provide necessary information to his physician this may impact the diagnosis and treatment. This study aims to evaluate patients’ attitude regarding privacy and confidentiality in healthcare delivery. The result helps policy makers to establish appropriate relations between healthcare providers and patients by realizing its strengths and weaknesses.
This cross-sectional study was carried out on 200 patients, selected in a systematically random way, in Imam Khomeini and Shariati hospitals in Tehran the capital of Iran in 2010. The data were collected directly from patients by trained interviewers based on a questionnaire survey. In order to analyze the data based on the scores of the attitude, patients’ attitudes were classified into three groups of negative, slightly positive, and positive and were evaluated by using various statistical tests.
In result, 56.5% (113) of participants were females and 43.5% (87) were male. In this study, it was found 71 (35.5%) patients were “strongly agree” that male physician can examine female patients and 99 (49.5%) patients were “agree”. Fifty three patients were “strongly agree” that physician may consult with his assistant through training (without the patient's permission) and 103 patients were “agree”. Participants’ attitude about disclosing the patient’s information if a he has threaten self-harm or harm to another person was as follow, 45 (22.5%) patients were “strongly agree”, 82 (41.0%) patients were “agree” and 56 (28.0%) patients had “no comment”. In this study, in general 36 (18.0%) patients had “negative”, 162 (81.0%) patients “slightly positive”, and 2 (1.0%) patients had “positive attitude” towards privacy and confidentiality in healthcare settings.
In conclusion, the study population possessed a moderate attitude towards privacy and confidentiality. These results show that in addition to performing further studies, patients’ attitude towards privacy and confidentiality should be adequately improved.
 

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Confidentiality in AIDS patients is one of the necessities of medical ethics, which has attracted the attention of policymakers in the health field in the last few decades because, on the one hand, it increases the trust between patients and doctors. On the other hand, it encourages them to adhere to treatment and do necessary care to patients in order to prevent the transmission of the disease to others. However, it may lead to a breach of benevolence and others’ right to health and cause problems in providing health care.  Here we discuss a practical solution for this problem through a clinical case presentation.

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One of the most important patient rights is to respect the patients’ autonomy and their participation in the process of treatment decision-making. This is of particular importance for the patients in the emergency department, who require due care in differential diagnosis leading to illness and death. However, the problem arises when this right is negligently ignored and despite the fact that it seems a simple matter, it is difficult to manage and control. Accordingly, this study aimed to investigate this issue through the case report of a patient diagnosed with acute abdomen. Moreover, an attempt was made to briefly review how negligence occurs, its causes and consequences, as well as its management strategies. In this report, the results highlighted the importance of patient participation, obtaining informed consent from the patient in the entire treatment process (diagnosis, treatment, rehabilitation, and prevention), and maintaining privacy and confidentiality regarding all medical and non-medical information of patients that are provided to the treatment staff in verbal, written, partial, and even electronic forms, especially in sensitive and stigmatizing cases. It seems that there are certain strategies to manage such negligence including timely detection, investigation of the causes and consequences, compensation for the damage, enhancing the cultural competence of the treatment staff, developing relevant local guidelines and instructions, having an efficient system with the support of the organization for handling it, and strengthening communication skills and teamwork.

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