Breaking confidentiality to meet legal obligations

Breaking patient confidentiality can occur in certain situations where legal obligations take precedence. These instances are typically regulated to ensure confidentiality is broken only when necessary to protect public interest, legal mandates, or the patient's well-being.

The importance of patient confidentiality

Patient confidentiality is vital for several reasons:

• Trust: The doctor-patient relationship relies heavily on trust. Patients are more likely to disclose sensitive and personal information if they believe their data will remain confidential. 
• Ethical practice: Healthcare providers follow a strict code of ethics, such as the Hippocratic Oath, which includes maintaining patient confidentiality. 
• Legal obligations: In many countries, patient confidentiality is protected by law. For instance, the Health Insurance Portability and Accountability Act (HIPAA) in the United States sets strict guidelines on how healthcare information can be used and disclosed.
• Psychological comfort: Knowing that personal information is secure gives patients peace of mind, helping them feel more comfortable and willing to seek healthcare services when needed.

However, there are exceptional situations where the need for confidentiality is outweighed by legal or ethical obligations to disclose patient information. 

See also: Safeguarding patient confidentiality during information requests

When can confidentiality be legally broken?

Mandatory reporting of infectious diseases

One of the most common situations where confidentiality may be breached is when healthcare providers are legally required to report specific infectious diseases. Many countries maintain a list of diseases that must be reported to public health authorities. 

Examples of reportable diseases include:

• Tuberculosis (TB)
• Human Immunodeficiency Virus (HIV)
• Sexually transmitted infections (STIs) like syphilis and gonorrhea
• COVID-19
• Measles

“The county or state health department will try to find the source of many of these illnesses, such as food poisoning. In the case of sexually transmitted diseases (STDs), the county or state will try to locate sexual contacts of infected people to make sure they are disease-free or are treated if they are already infected,” writes MedlinePlus.

In such cases, the disclosure of patient information is necessary to protect public health. For instance, during the COVID-19 pandemic, healthcare providers were required to report positive cases to public health authorities to facilitate contact tracing and containment efforts. Although this involves breaking patient confidentiality, it is legally justified by the need to prevent a wider health crisis.

Reporting abuse or neglect

Another exception to confidentiality occurs in situations of suspected abuse or neglect. Healthcare providers are legally required to report cases where they suspect a patient, especially vulnerable individuals like children or the elderly, is being abused or neglected.

For example, if a healthcare provider suspects that a child is being physically, emotionally, or sexually abused, they are obligated to report this to child protective services or law enforcement. Similarly, elder abuse or neglect in nursing homes must be reported.

Although it involves breaching patient confidentiality, the primary aim is to safeguard the individual's well-being.

See also: How HIPAA compliant emails can help survivors of abuse

Duty to warn and protect

Healthcare providers may also have a legal obligation to break confidentiality if they believe a patient poses a serious and imminent threat to another person or the public. This is known as the “duty to warn and protect.”

The landmark case Tarasoff v. Regents of the University of California (1976) set the precedent for this exception. In this case, a patient disclosed to a therapist that they intended to harm a third party. The therapist did not warn the third party, who was later killed. The court ruled that healthcare providers must warn potential victims if they believe a patient poses a credible threat.

In practice, this means that if a patient expresses an intention to harm someone, the healthcare provider must notify the intended victim and law enforcement. While this breaks confidentiality, it is legally mandated to prevent harm.

Court orders and subpoenas

There are instances where confidentiality may be broken due to legal proceedings. Courts may issue orders or subpoenas that compel healthcare providers to disclose patient information.

For example, in a lawsuit where medical records are relevant to the case, a court may order the healthcare provider to release the patient’s health information. In such cases, healthcare providers must comply with the court order, even if it involves breaking confidentiality. However, healthcare providers must only disclose the information requested in the subpoena or court order to minimize the impact on the patient's privacy.

Read also: Can covered entities share patient information without a court order? 

Worker’s compensation cases

In worker’s compensation claims, healthcare providers may be required to disclose medical information to relevant parties, such as employers or insurance companies, to determine eligibility for compensation.

For example, if a worker is injured on the job and seeks compensation, their healthcare provider may need to submit medical records that detail the injury. The disclosure of this information, although a breach of confidentiality, is legally justified to ensure that the worker receives appropriate compensation for their injury.

Preventing harm to the patient

In some cases, breaking confidentiality is necessary to prevent harm to the patient themselves. If a healthcare provider believes that a patient is at risk of self-harm, suicide, or engaging in dangerous behavior, they may need to disclose this information to family members, law enforcement, or mental health professionals to intervene.

Go deeper: When can confidentiality be broken?

Balancing legal obligations and ethical responsibilities

While these exceptions to confidentiality are legally mandated, healthcare providers must still handle such disclosures with care and respect for the patient's privacy. The following principles can help guide healthcare providers in balancing legal obligations with ethical responsibilities:

• Minimize disclosure: Only the necessary information should be disclosed. For instance, if a court orders the release of medical records, only the relevant portions of the records should be shared.
• Inform the patient: When possible, patients should be informed when their confidentiality is going to be breached. For example, a healthcare provider can explain to a patient why they are legally obligated to report an infectious disease to public health authorities.
• Document the disclosure: Healthcare providers should keep detailed records of any breach of confidentiality, including the reasons for the disclosure and the information that was shared. This documentation can protect the provider in case of legal disputes.

See also: HIPAA Compliant Email: The Definitive Guide

FAQs

What is patient confidentiality in healthcare?

Patient confidentiality refers to the ethical and legal obligation of healthcare providers to keep patient information private. 

Are there any protections for healthcare providers who break confidentiality?

Yes, healthcare providers who breach confidentiality to fulfill legal obligations, such as mandatory reporting or preventing harm, are generally protected from legal liability. However, they must follow the appropriate legal and ethical procedures and document their actions.

What are the consequences of not complying with legal obligations to break confidentiality?

Failure to meet legal obligations, such as not reporting an infectious disease or not warning someone of imminent harm, can have serious consequences for healthcare providers. They could face legal action, fines, loss of licensure, or other penalties, depending on the jurisdiction and the severity of the case.