Confidentiality and Consent. (Part 1)

African male doctor talking to patient

Today we want to tackle the issue about patient or medical aid scheme member Confidentiality and Consent.

Today lets chat about confidentiality and patient consent when it comes to health care and medical aid membership.

It is no secret that a few weeks ago we had it in public media that there were no less than four schools which requested that their students be subjected to medical tests which included HIV tests. We now want to establish the dynamics obtaining in the healthcare services sector which guide us on patient confidentiality and consent.

Let us start by defining the terms – patient confidentiality and consent. What do these terms mean?

Loosely speaking confidentiality refers to the deliberate protection of privileged information. Here we speak of someone knowing some bit of information about a particular subject matter and that information is not meant for public consumption. So it is the concealment of information. You know something but you are not willing to share that information to a third party.

Speaking from a medical/healthcare industry  background we talking of medical diagnosis, records, results and status of a particular patient or member of any medical aid society.

Meaning your personal medical data remains privileged information which only you and your attending trained and qualified medical practitioner should know.

Put simply, medical information remains medical information which only the patient and the medical practitioner should know. By extension some privileged  family carers will also be considered as qualifying to receive such information, if it is in the interest of the patient or for their protection from serious risk of death or serious harm.

Consent is the approval that the person holding privileged information is granted, cleared or approved to share it to the other person. In a normal setting both parties should have agreed and identified the external party who should receive such information. And they would have agreed that the external party should receive that information.

So a patient will have to know who else is supposed to know their medical information and how they will be told that information. So there should be an understanding as to how the information should  be packaged and delivered. Secondly it would be known for what purpose that information is being shared. In our world that information must be for the interest and benefit of the patient/medical aid member.

For starters I would question who generated the requests for medical tests to be conducted in the first place. According to the Medical Services Regulations of 2000 only a trained and qualified medical practitioner should raise a request for medical investigations and such request will be based on their proposed plan of action for their patient. They will be seeking to verify some factors which will help them deliver an efficient and effective remedy plan on their patient.

So in short it must be a medical practitioner who should generate a request for medical examination form.

Did the said schools have a medical practitioner or in-house medical facilities which would handle such requests or processes to handle requests for HIV testing and screening?

In this case now we don’t know yet if the schools have a medical practitioner on campus or an attending medical practitioner who raised the request forms on behalf of the schools. That still is a mystery.

However what is important to address in this case is what was the purpose. Giving the schools some good measured benefit of doubt, we would question the purpose for which the HIV tests were meant.

Morally that action comes out as a violation of confidential practice because from where I sit a school is a place for academic enrichment, not a place for medical practice. So one would question what the school sought to use that information for.

Given that concern I am expressing, were the schools in breach of confidentiality and consent principles?

I would look at the element of consent first. Were the students in consent with the process of having these HIV tests done? One would not expect the students to make that call because they are minors, perhaps we should then ask the parents. Did the parents consent to the HIV testing/screening of the pupils?

Assuming the parents consented, was the consent given in the interest of the pupils concerned. One would then assume that it was in the interest of the pupils because natural law suggests that every parent wants the best for their children.

So we can grant them the benefit of doubt and say it was in the interest of the pupils to have the medical tests done.

But that does not answer our question of whether the school was medically qualified to issue medical request forms for medical tests.

So then how was the principle of confidentiality applied in this case?

For me that is where I find some discomfort. I am still yet to establish if the tests were meant for enrolment processes or for some insurance cover purposes.

Where I find further discomfort on is who was meant to handle the information or the results from the testing practitioners. If there is an in-house medical practitioner at the schools that would be fine. If there wasn’t we will then demand answers on who was meant to handle the test results.

We would also further probe the use of the test results. Were the HIV test results meant to be a selection/enrolment criteria? If so that brings in an element of stigma and discrimination into focus.

Please share with us your thoughts about the subject Confidentiality and Consent.

Joseph Nkani.

Twitter: @joenkani


Mobile: 0772 415 660 or 0719 415 660

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