Kaplan Ofer
Department of Surgery A, Tel Aviv Medical Center, Tel Aviv, Israel.
Harefuah. 2004 Apr;143(4):295-9, 317, 316.
The duty to maintain medical confidentiality is one of the fundamental and well-known obligations imposed on physicians, and is incorporated in the Law of Patient's Rights 1996 (the Law). Medical confidentiality applies to information conveyed to a physician for medical purposes trusting that the physician will not disclose it. The patient's identity and financial arrangements are not confidential. Any physician who breaches this duty may face civil, disciplinary or criminal lawsuits. The Law, as well as specific provisions in other rulings, defines the exceptions to the duty of upholding medical confidentiality. According to these provisions there are special circumstances in which a physician may, and even should, transfer medical data relating to his/her patients. One of these exclusions is the patient's consent to reveal the information. This article presents the legal infrastructure of medical confidentiality, and the means and circumstances in which medical confidentiality can be waived. Waiver of medical confidentiality does not constitute permission to convey all the information to one and all, and the Law determines that only the data required for specific purposes should be transferred. The way by which the patient waives his right for confidentiality is not defined by the Law or by regulations. A patient's consent to waive his right for confidentiality can be allegedly obtained in writing, orally or by behavior. It seems that the appropriate manner of waiving medical confidentiality is in writing. The waiver form should specify the nature and extent of information that can be conveyed, and it must be signed by the patient. The doctor is also responsible to ensure privacy during the transmission of the data. Specific subjects which are associated with the duty to maintain medical confidentiality are also discussed in this paper. In cases when a man's life or safety is at stake, the duty of a physician to protect life overweighs his duty to entrusted confidentiality. In such cases, the physician should transfer the information even if the patient did not waive his right for secrecy. This obligation also applies to patients who suffer from specific diseases, for example HIV. The duty to maintain medical confidentiality is relevant to the patient's relatives. Obtaining written consent to convey the information to family members is not practical. However, it is recommended that a physician should provide the information only to relatives he knows, and only when he can reasonably assume that the patient will agree.
维护医疗保密的义务是强加给医生的基本且广为人知的义务之一,并被纳入1996年《患者权利法》(该法)。医疗保密适用于为医疗目的而传达给医生且相信医生不会披露的信息。患者的身份和财务安排不属保密内容。任何违反此义务的医生可能面临民事、纪律处分或刑事诉讼。该法以及其他裁决中的具体规定界定了维护医疗保密义务的例外情况。根据这些规定,在某些特殊情况下,医生可以甚至应该传递与其患者相关的医疗数据。其中一个例外是患者同意披露信息。本文介绍了医疗保密的法律框架,以及可以放弃医疗保密的方式和情形。放弃医疗保密并不构成允许向所有人传达所有信息,该法规定仅应传递特定目的所需的数据。患者放弃保密权的方式未由该法或法规界定。患者放弃保密权的同意据称可以通过书面、口头或行为方式获得。似乎放弃医疗保密的适当方式是书面形式。弃权表格应具体说明可以传达的信息的性质和范围,并且必须由患者签字。医生还有责任在数据传输过程中确保隐私。本文还讨论了与维护医疗保密义务相关的具体主题。在某人的生命或安全受到威胁的情况下,医生保护生命的义务重于其受托保密的义务。在这种情况下,即使患者未放弃其保密权,医生也应传递信息。这一义务也适用于患有特定疾病(例如艾滋病毒)的患者。维护医疗保密的义务与患者的亲属有关。获得向家庭成员传达信息的书面同意并不实际。然而,建议医生仅应向其认识的亲属提供信息,并且仅在他能够合理假定患者会同意的情况下提供。