Client confidentiality : perspectives of students in a healthcare training programme

• Published date: 01 May 2016
• Author: N. Nortje,J. De Jongh
• Pages: 31-34
• Date: 01 May 2016
• DOI: 10.10520/EJC189481

ARTICLE

May 2016, Vol. 9, No. 1 SAJBL 31

Condentiality is an important and shared human

value in Western bioethics and is included in inter-

national bioethical guidelines including the Helsinki

declaration, Belmont report, guidelines of the Council

for the International Organization of Medical Sciences

(CIOMS), and many others.[1] The obligation of the physician to pre-

serve as condential any information regarding his patient was rst

mentioned in the Hippocratic Oath: ‘What I may see or hear in the course

of the treatment or even outside of the treatment in regard to the life

of men, which on no account one must spread abroad, I will keep to

myself, holding such things shameful to be spoken about’.[2] How ever,

the Hippocratic Oath has been criticised for enabling doctors to be

selective in keeping medical condentiality. The Geneva Declaration

(1948) clearly stated that the physician shall preserve condentiality

on all he knows about the patient even after his death.[2]

Confidentiality is an ethical and a legal matter. In South Africa (SA),

the origin of this legal position reflects a liberal individualistic dialogue

as encapsulated in the Bill of Rights of the Constitution of the Republic

of South Africa[3] and the National Health Bill.[4] The legal approach

to confidentiality is based on an individualistic perception of patient

autonomy in that patients are viewed as separate from others and free

from social constraints when making informed choices, as long as they

do not harm others.[5] Benchmark judicial decisions have influenced

medical confidentiality at large, such as the British example of the

trial of the Duchess of Kingston in 1776. This trial reveals that the case

that became the foundation of modern interpretations of medical

confidentiality arose from little more than an attempt by a private

surgeon, Caesar Hawkins, to secure his personal interests and status as

a gentleman in eighteenth century high society.[6]

One of the most difficult issues medical health professionals face in

their practice is a conflict between professional duties. Such a conflict

may arise when they know that a patient’s medical information has

implications for family members but their professional duty to keep

the information in confidence prevents them from disclosing it.[5]

However, research conducted in several countries, including England,

Australia, Canada, and the USA demonstrates the importance of

medical confidentiality to patients. Findings suggest that patients

who believe that their confidentiality will be respected are more

likely to seek treatment, discuss problems openly, and return for

follow-up care.[7]

Absolute privacy, that is to say complete confidentiality of all

in for mation that the patient reveals to the healthcare provider, is

neither possible nor desirable in the practice of medicine.[8] Effective,

responsible medical treatment requires that we achieve a balance

between disseminating patient information and keeping it private.

Breaching confidentiality can be acceptable or required by medical

authorities when failure to act could lead to physical harm either

to the patient or to people in contact with that patient.[1] This is

illustrated by the Tarasoff case[9] (where bodily harm was inflicted on

Tatiana Tarasoff by a fellow student, who told a psychiatrist about it,

which resulted in her death) and the case for progressive, infectious

diseases, where the healthcare provider or researcher has a duty

to protect the health of those who may be at risk. The ethics of

public health has become more critical in an era of viral and multi-

drug-resistant bacterial epidemics[10] such as the recent outbreak of

Ebola. Although students understand what respecting confidentiality

means, as laid down by the SA legal system, they often face ethical

dilemmas as to when and to whom they may disclose information.

Confidentiality, in the healthcare system of a developing country

such as SA, can often not be given the same precepts as in Western

countries. The investigation of the ethical principle of confidentiality

is especially relevant to students in SA:

Client condentiality: Perspectives of students in a

healthcare training programme

N Nortjé,1 DPhil; J de Jongh,2 PhD

1 Department of Psychology, University of the Free State, Bloemfontein, South Africa

2 Department of Occupational Therapy, University of the Western Cape, Cape Town, South Africa

Corresponding author: Nico Nortjé (nortjenico@gmail.com)

Background. Condentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most

dicult issues health professionals face in their daily eldwork practice is a conict between their professional duties, as illustrated in keeping

a patient’s medical information condential, and having empathy with a family member’s need to know. This moral dilemma is dicult for

students to circumvent and therefore this paper presents healthcare students’ perspectives of condentiality.

Methods. We aimed to explore healthcare students’ views and experiences of condentiality as an ethical principle by adopting a qualitative

explorative approach. Purposeful sampling was under taken where specic individuals with specic experiences were identied. Data were

collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged.

Conclusion. Condentiality, as with other ethical principles, is an important obligation of a good client-therapist relationship as identied by

students. However, the students’ responses illustrate that it cannot be absolute, and cognisance must be taken as to when it is acceptable, and

even desirable, to override condentiality because of conicting, greater duties.

S Afr J BL 2016;8(1):31-34. DOI:7196/SAJBL.460