Confidentiality: moral obligation or outmoded concept?

The frequency with which casual breaches of confidentiality occur in hospitals suggests that relatively few health care professionals regard confidentiality as a matter of serious moral concern. A number of factors contribute to this laxness. First, breaches are almost never motivated by malice. Second, the person who breached confidentiality will probably be unaware of any harm that may result or of his or her role in having caused it. Third, such harm likely will consist of feelings of shame and embarrassment--consequences that lack moral seriousness for many persons. Finally, the sheer quantity of patient information that is supposed to be confidential, combined with the number of personnel who have a legitimate "need to know," militates against any serious attitude toward confidentiality. But confidentiality is a serious moral issue. An essential element of self-identity is the right to choose who has access to the intimate details of our lives. To undermine that right is to undermine individual autonomy. A number of steps can be taken to strengthen a hospital's commitment to confidentiality: Upon admission, nonemergency patients should be informed of who will have access to their medical record and why. patients should be asked who should be kept informed of the details of their medical condition and who should be denied such details. Health care professionals should not be intimidated by persons who demand patient information but have no clear right to it. Such individuals should be referred to someone who can determine whether they are entitled to the information.