Duty Of Confidentiality Research Articles

Contraception in adolescence and the perimenopause

<h2>Abstract</h2> There are no contraceptive methods that are contraindicated on the basis of age alone. For a woman of any age, efficacy and compliance are optimized if she is using her own choice of method. Nevertheless, there are special issues that must be taken into account by clinicians advising adolescent or perimenopausal women about contraceptive choices. For adolescents, specific legal and ethical issues pertain. Clinicians must document that they have applied the Fraser criteria in assessing a young woman's competence to provide valid consent. Clinicians must be alert to child protection issues and familiar with local procedures, and must understand their duty of confidentiality and circumstances in which confidentiality may have to be breached. Although no contraceptive methods are contraindicated, risks and benefits must be weighed in making choices. Considerations of efficacy and compliance mean that the progestogen-only pill is generally less suitable. Concern about bone mineral density must be balanced against user-independence if considering depot medroxyprogesterone acetate. Beneficial effects on bone mineral density and acne favour combined oral contraception. In the perimenopause, special issues centre on the dilemmas of when contraception can be stopped and concurrent HRT. In general, any woman can safely stop contraception at age 55 years. An algorithm to assist decision-making about stopping contraception at younger ages is provided. A progestogen-only method can safely be used alongside HRT to provide effective contraception.

Lawful disclosure of confidential information

The last article considered the duty of confidentiality and the various ways in which health professionals could be held accountable for unjustified breaches of confidentiality. This article considers what those lawfully justified situations cover. The main justifications for disclosure include: consent of the patient; the interests of the patient; court order; statutory requirement; and public interest.

Patient confidentiality, clinical data and NHS research – a researcher’s guide

More stringent research governance in the NHS has led to an increased focus on the importance of patient confidentiality. But relatively low levels of knowledge of the Data Protection Act and common law duty of confidentiality among some researchers and research managers cause difficulties in getting research projects off the ground. The authors outline the main issues surrounding research, data protection and patient confidentiality, and provide guidance for researchers, clinicians and managers on how to conduct research appropriately.

Patient confidentiality, clinical data and NHS research - a researcher's guide.

More stringent research governance in the NHS has led to an increased focus on the importance of patient confidentiality. But relatively low levels of knowledge of the Data Protection Act and common law duty of confidentiality among some researchers and research managers cause difficulties in getting research projects off the ground. The authors outline the main issues surrounding research, data protection and patient confidentiality, and provide guidance for researchers, clinicians and managers on how to conduct research appropriately.

Data protection rights and preserving confidentiality

The last two articles considered the right of others under Data Protection legislation to access a patient's records and the right to access medical reports for employment or insurance purposes. This article considers the duty of confidentiality and the provisions of the Data Protection Act 1998, which protect the confidentiality of health records.

Contraception in adolescence

There are no contraceptive methods that are contraindicated on the basis of age alone. For a woman of any age, efficacy and compliance are optimized if she is using her own choice of method. Nevertheless, there are special issues that must be taken into account by clinicians advising adolescents about contraceptive choices. Specific legal and ethical issues pertain. Clinicians must document that they have applied the Fraser criteria in assessing a young woman’s competence to provide valid consent. Clinicians must be alert to Child Protection issues and familiar with local procedures; they must understand their duty of confidentiality and circumstances where confidentiality may have to be breached. Although no contraceptive methods are contraindicated, risks and benefits must be weighed in making choices. Considerations of efficacy and compliance mean that the progestogen-only pill is generally less suitable for young women, who have inherently high fertility and may have chaotic lifestyles. If considering depot medroxyprogesterone acetate, concern about bone mineral density must be balanced against user-independence. Beneficial effects on bone mineral density and acne favour combined oral contraception.

Confidentiality in Arbitration and the Public Interest Exception

> These three give place in court of conscience > > Fraud, accident, and breach of confidence1 THE QUESTION whether arbitral proceedings are, or ought to be confidential, has been the source of much academic debate and was recently reviewed by the ICC Commission on Arbitration.2 In much of Europe the prevailing view is that arbitral proceedings are confidential. However, even if they are confidential, that confidentiality cannot be absolute. As noted by Paulsson and Rawding, this would result in a paradox.3 If the parties to an arbitration ever sat down and thought about the issue of confidentiality, they would inevitably conclude that neither of them would want a rule that arbitrations were confidential without exception. The parties may need to show the award to insurers or to a parent company. The parties may also want to enforce the award if it is not honoured and the only way to do this is in the courts, which will often be a public forum. In a number of countries which adopt the position that arbitrations are confidential there will be a list of exceptions to the confidentiality obligation. Some countries consider that where the arbitration raises issues which have a public interest, then this should be an exception to the confidentiality obligation. This ‘public interest exception’ has been considered recently in three international arbitrations. On each occasion the argument that there ought to be a public interest exception was rejected. This article does not seek to re-visit the question of whether there is or ought to be a duty of confidentiality in arbitration.4 Its focus is on one question; namely, should there be an exception to the duty of confidentiality where the arbitration raises issues of public interest? English common law has consistently maintained that a duty of confidentiality exists …

Nurse prescribing and the issue of patient confidentiality

During the course of their practice, nurse prescribers are given intimate and personal information about their patients, but generally they are required not to disclose this information. Nurses have a legal and professional obligation to maintain confidentiality, however, this obligation is not absolute. There are circumstances where confidential information can, and occasionally must, be disclosed. This article outlines the legal basis for the duty of confidence and the exceptions to that duty which allow a nurse prescriber to disclose confidential information about patients.

Legal Dimensions of Adolescent Sexuality

The ethical and legal obligations with respect to treating a minor can be confusing, particularly in the areas of consent to treatment, confidentiality, and parental involvement. The clinician must be aware of the appropriate course of practice when the patient is an adolescent seeking care for contraception, pregnancy, or sexually transmitted infections. This article examines a number of ethical and legal issues that arise when providing reproductive and sexual health care to an adolescent and offers recommendations for the physician’s most appropriate courses of action regarding adolescent patients and the age of consent to sexual activity, reporting of child abuse, provision of reproductive and sexual health care to a minor, assessing an adolescent’s capacity to consent to treatment, the physician’s duty of confidentiality, and the exceptions to the rule of confidentiality.

Managing Familial Risk in Genetic Testing

Increasing numbers of people are seeking genetic testing and uncovering information that directly concerns their biological relatives as well as themselves. This familial quality of genetic information raises ethical quandaries for physicians, particularly related to their duty of confidentiality. In this article, the American Medical Association's Council on Ethical and Judicial Affairs examines the informed consent process in the specific context of genetic testing, giving particular consideration to the handling of information that has consequences for biological relatives. Furthermore, it addresses the question of whether physicians' obligation to warn biological relatives ever should override the obligation to protect patient confidentiality.

Keeping secrets: confidentiality and the community nurse.

The dilemma faced by Lucy Russell is one that is frequently faced by nurses in primary care, although generally the facts are far less dramatic. The common concern is what course of action is open to nurses when faced with a demand for information concerning a patient. In particular, under what circumstances can the professional duty of confidence be breached?

Aegis v. European Re and the Confidentiality of Arbitration Awards

CONFIDENTIALITY IS often perceived as one of the great advantages of arbitration. However, whether an implied obligation of confidentiality arises out of the private nature of arbitration remains highly controversial. In its recent decision in the case of Aegis v. European Re 1 the Privy Council, while achieving an entirely desirable and commercially sensible outcome, left unanswered many of the hotly debated questions regarding confidentiality in arbitration. A general principle of confidentiality in arbitration under English law was outlined in Dolling-Baker v. Merrett and another 2 where it was held that there exists, subject to exceptions and qualifications, an implied obligation of non-disclosure by the parties due to the very nature of arbitration. In the 1998 case of Ali Shipping Corp . v. Shipyard Trogir 3 it was held that a party to an arbitration is subject to an implied obligation of confidence not to make use of material generated in the course of the arbitration outside that arbitration. The decision confirmed that there is a general obligation of confidentiality in arbitration by implication of law. Lord Justice Potter rejected the notion that confidentiality is in any way dependent on the inherently private nature of the material generated in the course of an arbitration. In this sense, Ali Shipping confirmed that, rather than being a necessary corollary of the privacy of arbitration, an independent obligation of confidentiality attaches to arbitration as a matter of law, in that a duty of confidentiality is ‘a term which the law will necessarily imply as a necessary incident of a definable category of contractual relationship’ and ‘which arises “as the nature of the contract itself implicitly requires” ’.4 In the particular context of arbitration awards, Colman J. in Hassneh Insurance v. Mew 5 concluded that an award and the reasons contained in that …

Toward a Unified Theory of Professional Regulation

The Bar has addressed several issues in recent years that impact the legal profession's structure, including rules relating to multidisciplinary practice, multijurisdictional practice, and client solicitations. Unfortunately, theories of legal ethics have not focused on these rules, but have instead concentrated on regulations that govern how lawyers represent their clients, such as the duty of confidentiality or rules against the presentation of perjured testimony. This article contends that, by applying ethics theories to the structural rules, an additional justification emerges for more progressive regulations. Specifically, the article concludes that traditional theories can supplement existing calls for multidisciplinary practices, more liberal unauthorized practice rules, and more permissive regulations of client solicitation.

Medical information, confidentiality and a child’s right to privacy

Following the Gillick case in 1986, it was recognised that mature minors were owed a duty of confidentiality in respect of their medical information. Subsequent cases confirmed that the duty was also owed to non-competent children, including infants, but without explaining the basis for finding the existence of such a duty and its scope. It is particularly unclear when and upon what legal basis a doctor could disclose information to parents when their child wished to keep it confidential. This paper will examine the law of confidentiality as it applies to children, identifying issues which are problematic. Developments in the law of personal confidences which have taken place as a result of the Human Rights Act 1998, and the recognition of Article 8 rights as part of the law, will be reviewed and analysed from the perspective of the duty of confidence owed to children in respect of their medical information. Finally, the paper will offer an explanation of a basis for disclosure to parents which minimises violations of a minor's autonomy.

Holding the chancellor to account: political speech and medical staff

This paper develops and updates an earlier paper in this journal on freedom of speech for National Health Service (NHS) staff (Vickers, 1999). It focuses on the importance of political speech for those who work in the NHS, in the light of the major increase in spending on the NHS announced by the Chancellor of the Exchequer in the 2002 budget. It argues that the speech of those who work in the NHS is of great political importance and assesses the extent to which this would be recognized in legal action that might be taken against staff who engage in political debate. In particular, the implications of the changes to the professional duty of confidence owed by nursing staff in the new Nursing and Midwifery Council Code of Conduct, introduced in June 2002, is considered. Relevant new case law under the European Convention on Human Rights (ECHR) is also considered.

Domestic violence and the midwife: can you report it?

This article looks at the evidence relating to the incidence of domestic violence. It discusses whether the victims are entitled to a duty of confidentiality in respect of the violence, considers their rights under Article 8 of the European Convention of Human Rights, and concludes that midwives would be lawfully justified in reporting reasonable belief that violence is occurring. It also considers the Home Office consultation paper on domestic violence.

Misuse of Genetic Information: The Common Law and Professionals' Liability

As scientific advances take place in mapping the human genome, probing minds have voiced concern about discrimination on the basis of genetic makeup in employment and insurance. The issue has been addressed in numbers of western countries, usually by strong proscriptions against use of genetic information based upon principles of privacy. The article argues that an evolutionary approach in prescribing legal norms to actual abuses is more satisfactory. Placing responsibility on professionals through their duty of confidence may be particularly efficacious in preventing abuses while allowing the optimal disclosure of socially useful information. It is recognized that social norms will also govern the use of genetic information. More generally, the law of torts will implicate the disclosure and use of genetic information.

Step 46: Duty of confidentiality

The Data Protection Act 1998 was considered in an earlier Steps article (Dimond, 2000). Unlike the earlier legislation in the 1984 Act, the 1998 Act applied to computerised and manually-held records. There were concerns that so tightly were disclosure rules set under the 1998 Act, that such collections of data as the National Cancer Register could actually be illegal. In the light of this, the Government sought to regulate the situation. Powers were given to the Secretary of State (SoS) under Section 60 of the Health and Social Care Act 2001 to make regulations on disclosure of patient information.

Confidentiality in International Commercial Arbitration

The issue of confidentiality is key to the successful practice of international commercial arbitration. The confidentiality of arbitration proceedings is a reason for resorting to arbitration, as distinct from litigation.1 It is a collateral expectation of parties to an arbitration that their business and personal confidences will be kept. Despite its central importance, confidentiality cannot be assumed in all jurisdictions. It is therefore critical that arbitrators be fully informed about the legal and policy issues surrounding confidentiality in order to appropriately resolve disputes concerning those aspects of the arbitration that should, or should not, be confidential. It is widely viewed that confidentiality is one of the advantageous and helpful features of arbitration. Nevertheless, there is no uniform answer in national laws as to the extent to which the participants in an arbitration are under the duty to observe the confidentiality of information relating to the case. Moreover, parries that have agreed on arbitration rules or other provisions that do not expressly address the issue of confidentiality cannot assume that all jurisdictions would recognise an implied commitment to confidentiality. Furthermore, the participants in an arbitration might not have the same understanding as regards the extent of confidentiality that is expected. Therefore, the arbitral tribunal might wish to discuss that with the parties and, if considered appropriate, record any agreed principles on the duty of confidentiality. (United Nations Commission on International Trade Law.)2 This article is intended to alert both arbitrating parties and fellow arbitrators to the importance of confidentiality in international commercial arbitration. Drawing on the author's experience, the intent is to share with other arbitrators the complex and sometimes conflicting conceptions of arbitral confidentiality. Sections II and III of the article explore concerns about confidentiality, the conflict between the need for transparent decision-making and to preserve private confidences …

Pregnant minors: confidentiality issues and nurses' duties.

Abortions in those under 16 years of age raise the issue of what to do in the face of a request that the young person's parents not be involved. The first question in such cases is whether or not the young person is competent to request confidentiality. A younger person who is competent is owned the same duty of confidentiality as an adult. In practice this means that some such requests can be granted straightforwardly. However, in many cases the teenager's pregnancy raises concern about child abuse. In the face of a serious crime the obligation to respect confidentiality is overridden. This creates a dilemma. We cannot respect confidentiality fully in such cases, but a policy of failing to do so may lead young people to seek (illegitimate) help elsewhere. Therefore, reform of the current system may be needed.