Rischitelli D G
Division of Occupational Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205, USA.
J Occup Environ Med. 1995 May;37(5):583-93. doi: 10.1097/00043764-199505000-00006.
Ethical dilemmas involving confidentiality issues are frequently encountered in occupational medicine. The occupational physician faces a unique challenge because in many circumstances, a physician-patient relationship, in the ordinary or legal sense, may not exist. The occupational physician often faces a conflicting interest between the employees' desire for privacy and the employer's legitimate need to know. The occupational physician must carefully balance these interests for the benefit of society and the parties involved. Occupational physicians also work in a wide variety of practice situations, and the ethical and legal duty of confidentiality may vary substantially with these roles. This article provides an overview of the ethical and legal requirements of confidentiality in the workplace. The constitutional, statutory, and common law framework governing the treatment of employee medical information, as well as defenses to liability, are discussed. Recent legislative changes such as the Americans with Disabilities Act, and new challenges such as the proper handling of HIV information, present unique confidentiality problems.
职业医学中经常会遇到涉及保密问题的伦理困境。职业医生面临着独特的挑战，因为在许多情况下，普通意义或法律意义上的医患关系可能并不存在。职业医生常常面临员工对隐私的需求与雇主合理知情权之间的利益冲突。为了社会和相关各方的利益，职业医生必须谨慎地平衡这些利益。职业医生还在各种各样的执业环境中工作，保密的伦理和法律义务可能因这些角色而有很大差异。本文概述了工作场所保密的伦理和法律要求。讨论了管理员工医疗信息处理的宪法、法规和普通法框架，以及责任抗辩。近期的立法变化，如《美国残疾人法案》，以及新的挑战，如对艾滋病毒信息的妥善处理，都带来了独特的保密问题。
