Within this essay will be discussed, the focus will be on the need to maintain confidentiality as a legal and professional aspect of care provision and how this impacts trust within the associated doctor (PA) - Relationship with the patient. In particular, the focus will be on areas where confidentiality is breached, both in situations where there is a legal mandate in situ, and particularly where there is no legal status per se but precedence has been recognized in common law . Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Confidentiality has been at the heart of medicine since its inception, indeed an essential tenant of the Hippocratic Oath states: Whatever, in relation to my profession I will not disclose the practice, or not in relation to it, that I see or I hear in the lives of men, which should not be spoken of abroad, for I believe that everything should be kept secret. Hippocrates reflects the importance and value of confidentiality in the PA-patient relationship, the core of which is honoring the ethical principle of autonomy: allowing an individual to have control over decisions regarding his or her medical treatment and providing choice over what happens to the information it provides (Nixson 2017). All staff working in the NHS are bound by a legal duty of confidentiality to protect any personal information they may come into contact with, this is not only a requirement of an employee's contract of employment but also a requirement under law common confidentiality and the Data Protection Act 1998 (Hywel Dda University Health Board 2015). In order for there to be an effective PA-Patient relationship, it is necessary for the patient and society as a whole to have trust in the system: Trust is an essential part of the doctor-patient relationship and confidentiality is fundamental for this. Patients may avoid seeing their doctor or underreport symptoms if they believe their personal information will be disclosed by doctors without consent or without having some control over when or how much information is shared. PA In order to provide safe and effective care, the patient should feel comfortable telling his secrets, his most intimate thoughts and being honest. The patient should be able to expect that any information communicated will result in the strictest confidentiality, on occasions where it is necessary to breach confidentiality this should be an exception to the rule and for the 'greater public good', especially as the patient should be aware of this. aware of any violation and to whom (Brazier&Cave 2011). There are many situations where confidentiality is acceptably breached in medicine, including where a patient has given consent, where there is an actual threat or serious harm, for example in order to protect children or vulnerable adults or, e.g. , disclosure in the "public interest". Just as the general public thinks these are ethically acceptable violations (Jones 2003), there are statutes that mandate certain violations of the law. For example, there is a legal obligation under the Public Health (Control of Disease) Act 1984 combined with the Health Protection (Notification) Regulations 2010 requiring PAs not only to treat patients with named diseases within a range strict criteria, but are obliged to inform the relevant local body, such as Public Health Wales. The public as a whole recognizes the importance of such breaches of confidentiality since it is a generally accepted premise that disclosurewhether for the public good, it could be argued that as such it makes the law easier to pass in the first place (Herring 2017), public health takes priority over personal privacy in order to minimize the spread of such infections. Where breach of confidentiality becomes controversial is where there is no legal duty to disclose. It has been recognized that the law surrounding this area is haphazard (Pattison 2014)) and less than satisfactory (Herring 2017) due to few established precedents in the Common Law and yet there exist a large number of governing statutes which can often contradict each other with levels of importance (Stanton 2018). The key statutes are the Data Protection Act (2018) and the Human Rights Act (1998). Herring points out that professional bodies such as the GMC have clear guidance on how their members (including PAs) should act in breach and that the courts in turn have in some ways mirrored the professional guidance of the Common Law. It should be noted that this lack of clarity in the law may also prevent people from initiating future proceedings as such by questioning the ethics of such regulations. (Herring 2017). The landmark case in common law which specifically addresses breach of confidentiality within a healthcare context as such by establishing current precedence is W v Eggell (1990). At Eggell, W had been convicted of manslaughter and detained under the Mental Health Act (MHA) (1983). W had requested an independent report from a psychiatrist (Egdell) for an upcoming mental health tribunal. Eggell wrote in his report that W continued to be extremely dangerous stating that those currently responsible for his care did not seem to realize how dangerous W actually was, as evidenced by his continued obsession with explosives. W's attorney exercised his legal right and chose not to include this report in the hearing. Eggell then breached patient confidentiality by sending his report to both the Home Office and the director of the institution where W was detained. Eggell believed he was acting in good faith and believed it was morally and professionally legitimate to breach W's confidentiality in order to protect the public from the clear risks W posed to significantly harm others. Eggell won his case in the court of appeal but with the important provision that W is entitled to a certain degree of confidentiality, i.e. that Eggell cannot write about the case in a newspaper article, sell it to a newspaper, 'gossip' with colleagues or write a book. In each of these situations appropriate measures would be needed to protect W's identity, which, considering the importance of this case to date, would be exceptionally difficult to do. The extensive discussion around this case highlights areas of significance, namely: the threat of real and serious danger to the public: there must be compelling evidence of the likelihood of serious harm and the risk must be continuous. For example, a past risk is not enough. This might be seen in a woman with postpartum depression (PPD) who expresses a desire to harm her newborn, experiencing these feelings during a pregnancy does not necessarily imply that she would have these thoughts in future pregnancies or even suffer from PPD. Any disclosure made should be limited to the minimum information necessary to protect the public and interested persons who have a legitimate interest in the matter. (Brazier 2011) in the example above, disclosing to social services that the mother has expressed a desire to cause harm to her child is legitimate, which would not be relevant to thediscussion with social services is the fact that the mother underwent breast augmentation surgery thirteen years earlier or alternatively informed the breast surgeon of the mother's express intention to cause harm. In the recent case of ABC v St George's Healthcare NHS Trust, South West London and St George's Mental Health Trust, Sussex Partnership NHS Foundation Trust (2017) the issue of duty of care in relation to breach of confidentiality was explored. ABC's father was convicted of manslaughter. He was sentenced to a hospital order under the MHA (1983), a few years after the sentence he was diagnosed with Huntington's disease, a chronic, progressive and fatal neurological disorder. Specific to the case is that Huntington's disease is a hereditary condition in which the child of a parent affected by the disease also has a 50% chance of developing the disease. concerns and discussion with the father of his medical team, he expressly prohibited from disclose his condition to ABC. ABC was later accidentally informed of her father's diagnosis after giving birth to a baby boy. Following the disclosure of the news, ABC underwent tests and the illness was also confirmed. The ABC has lodged a "wrongful birth" claim in the High Court against the NHS organizations involved in her father's care. The basis of her claim was that her father's confidentiality should have been breached and as a result she would terminate the pregnancy on the basis that she would eventually become seriously ill and also that the child would potentially have a 50% chance of inheriting the disease. The case was not heard in the High Court as a "strike out" order was accepted. This decision was later overturned by the Court of Appeal, the decision was overturned on the basis that there is at least room to argue whether the existing law regarding doctors' duty of care should be extended to third parties. The judge specifically cited the professional genetic guidelines (Royal College of Physicians, The Royal College of Pathologists, The British society for Human genetics 2011) which clarify that there are professional obligations towards those who, despite not having an existing relationship with a clinician have a vital interest in the information that the clinician had obtained www.ukhumanrightsblog.com. As such, these obligations form a good basis for an extension of the legal duty of care to potentially affected persons. While the medical, legal and ethical communities await the ABC trial, much discussion surrounds the possible alternatives regarding the choice between preserving the confidentiality of one patient and also preventing harm to another, especially in the field of genetics, as tests are becoming more and more widespread. Nixson (2017) discusses whether the duty of care should also be extended to the "duty to warn", as it has been suggested that the greater harm resulting from maintaining confidentiality is borne by the relative, and therefore the relative's rights should prevail ( Dove, Chico, Fay, Laurie, Lucassen, Postan 2019). Some countries have already adopted this premise. For example, in Australia it is permitted to disclose genetic information without the patient's consent in circumstances where the doctor reasonably believes that disclosure is necessary to reduce or prevent a serious threat to the life, health or safety of another individual who is a genetic relative (Nixson 2017). This is also highlighted in (GMC 2018), which states that if a patient refuses to consent to the disclosure of information that would benefit others (e.g., 26 (2), 328-345.