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Few will argue that confidentiality of the patient medical record is a real concern, particularly at a time when demands for information from the medical record are numerous and constantly increasing. However, the recommendations of the Privacy Protection Study Commission, if implemented, could cause severe problems for hospitals. The author discusses those recommendations and why they cause concern.
Drug use is a complex social phenomenon involving the drugs which are used, the people using them, the context in which they are acquired and used, and the social construction of drug use by society and by governments. It is a popular yet controversial behavior which elicits extreme public opinion. Discourse about drug use is often polarized, emotional, and divisive. This is most evident in the approaches used or proposed to control drug use and the risks and harms associated with its use and control. Despite this, there is almost no discourse about the human rights of drug users. This Article addresses this issue by examining the privacy rights of drug users, their vulnerability to use drugs and to be harmed by using them, and the deprivation of opportunities for drug users to exercise their rights. This Article will also analyze disabilities attributable to drug use, as well as situations in which the human rights of drug users are likely to be infringed.
There is renewed professional and popular interest in the questions surrounding the legality of assisted suicide. With the U.S. Supreme Court's decision in the Cruzan case, the legal questions will be determined by state courts and legislatures. This article examines the arguments underlying the claim for legalization of assisted suicide. Although it appears to come within the confines of privacy, assisted suicide constitutes a more radical change in the law than its proponents suggest. Assisted suicide in the context of its own complexities and other problems facing society, represents a dubious advance in patient rights or social justice.
The purpose of this article is to describe implications of the Health Information Portability and Accountability Act of 1996 (HIPAA) for nurses engaged in human and health services research. In general, a person's private health information (PHI) may only be disclosed for treatment, payment, and business procedures related to healthcare service delivery. Access and/or use of the same information for research purposes necessitates another layer of review and may require a separate process of authorization. A brief historical overview of regulatory requirements regarding health information privacy and security standards for the electronic transformation of data and protection of electronically kept medical records is discussed and related to the role and responsibilities of researchers and organizations where research is conducted. In addition, a generic document template adaptable for use by an individual or organization is presented that can provide a quick, systematic review of HIPAA compliance when a research proposal is being developed or is received that seeks access to PHI.
OBJECTIVES: To study prospectively the attitudes and behaviors of heterosexual couples undergoing donor insemination. DESIGN: Couples undergoing donor insemination completed psychological questionnaires before treatment regarding psychiatric symptoms, self-esteem, marital adjustment, and their attitudes about privacy or disclosure. PARTICIPANTS: Forty-one of 82 heterosexual couples participated. MEASURES: A donor insemination questionnaire, a self-esteem scale, the Brief Symptom Inventory, and the Dyadic Adjustment scale were used. RESULTS: Psychiatric symptoms, self-esteem, and marital adjustment were all in the normal range. The amount of time taken by the couple to decide to do donor insemination was not related to reported psychiatric symptoms, self-esteem, marital adjustment, or marital satisfaction. Ninety-five percent of the couples believed a psychological consultation should be a mandatory part of the donor insemination treatment. The greatest concern the couples had about the donor child was its genetic and medical background. Thirty-eight percent of the couples did tell or planned to tell others about using donor insemination to conceive, and only 27% of the couples planned to tell the child of his or her donor origin. CONCLUSIONS: The results of this study support those of others, which have indicated that the majority of donor recipients are psychologically well adjusted and have average marital adjustment. In addition, this prospective study replicated the findings of other retrospective studies, indicating that most donor insemination recipients do not plan to tell the child of his or her donor origin. Additional prospective studies are needed to determine if attitudes and behavior regarding disclosure change over time.
The 1996 Jaffee v Redmond US Supreme Court decision established a privilege for psychotherapeutic communications in the federal courts. The new privilege has both substantive and symbolic importance. In its strongly worded opinion in Jaffee v Redmond, the US Supreme Court made clear that confidentiality in psychotherapy takes precedence over certain other important societal goals. The new Health Insurance Portability and Accountability Act (HIPAA) medical privacy rule promulgated by the Department of Health and Human Services relies on Jaffee v Redmond in providing additional legal protections for confidential psychotherapy. Both the US Supreme Court's Jaffee v Redmond ruling and the HIPAA rule support the ethical protection of confidentiality of conversations between psychiatrists and patients.
STUDY OBJECTIVE: To investigate changes that most surgical suites will need to make in the process of giving reports to family members on the day of surgery by the compliance date (April 14, 2003) of the privacy regulations of the Health Insurance Portability and Accountability Act (HIPPA) of 1996. DESIGN: Systematic review of the medical literature on ways in which providing information to family members changes their anxiety. MEASUREMENTS: The endpoints of the controlled studies included Spielberger State Anxiety. The observational studies reported percentages of family members with a specific concern. MAIN RESULTS: An in-person progress report can reduce family members' anxiety, but this is not always. A personal approach is superior to providing pagers or a phone call. Observational studies suggest that family members want information specific to their relative, particularly if the case is running later than expected. Statistical methods exist to provide such an estimate of the time remaining in surgical cases. CONCLUSIONS: Surgical facilities should strive to provide in-person progress reports to family members while their relatives are undergoing surgery. To satisfy HIPAA regulations, the staff and physicians who talk to family members in the waiting room will need to determine first if the patient has agreed to the release of information. As hospital information systems are updated to assure that this process is HIPAA-compliant, facilities can also incorporate the relevant statistical methods.
The clinical use of pharmacogenetic drugs will require that a sample of a patient's DNA be tested before a drug is prescribed. Although pharmacogenetic tests pose fewer risks than genetic tests for disease mutations, they might still reveal personal information that could be used adversely to a patient's interests. Informed consent and privacy of pharmacogenetic test results may be essential in most clinical uses of pharmacogenetic drugs.
As the new human genetics continues its dramatic expansion into many laboratories and medical institutions, the concern for the protection of the personal privacy of individuals who participate increases. It seems that even the smallest of laboratories must confront the issue of how to protect the genetic and phenotypic information of participants in their research. Some have promoted the use of anonymity as a way out of this dilemma. But we are reminded by others that the future cannot be predicted, and that future benefits may be lost when the links to these benevolent volunteers are gone forever. More recently, some ethical bodies have suggested, without specific recommendations, that a reversible third-party encryption system may be a solution to this problem. However, they have not provided a route or even examples of how to proceed. We present here the Icelandic approach to this issue by developing a third-party encryption system in direct collaboration with the Data Protection Commission (DPC) of Iceland. We have incorporated the encryption system within our sample collection and storage software, which minimises inconvenience but enhances security. The strategy assures a barrier between the laboratory and the outside world that can only be crossed by the DPC.
This report is based on an interpretative study that explored the meaning of space to adolescents in the hospital environment. Through designing their own adolescent ward and discussing their designs in an interview, participants articulated their spatial needs in the ward environment. This paper addresses the private space issues of the adolescent patient in the ward environment. Issues that are discussed include the use of the telephone, the bathroom, and the bedroom, and additional facilities needed to enhance privacy in the ward.
Public health officers have to write a medical certificate for public authorities requesting them to do so. This certificate is to contain all the results of medical examinations required for the respective purpose, thus enabling the recipient authorities to take the decisions incumbent on them, such as those judging fitness for service or entitlement to claim. In case the persons concerned agree, a transmission of data is admissible independent of statutory provisions. However, this should always be oriented towards minimum data transmission. Nevertheless, lack of consent or even an adverse intention of the person concerned cannot serve as a blockade in so far as the public health officer has complied with current criminal and data privacy regulations.
We argue that while presidential candidates have the right to medical privacy, the public nature and importance of the presidency generates a moral requirement that candidates waive those rights in certain circumstances. Specifically, candidates are required to disclose information about medical conditions that are likely to seriously undermine their ability to fulfill what we call the "core functions" of the office of the presidency. This requirement exists because (1) people have the right to be governed only with their consent, (2) people's consent is meaningful only when they have access to information necessary for making informed voting decisions, (3) such information is necessary for making informed voting decisions, and (4) there are no countervailing reasons sufficiently strong to override this right. We also investigate alternative mechanisms for legally encouraging or requiring disclosure. Protecting the public's right to this information is of particular importance because of the documented history of deception and secrecy regarding the health of presidents and presidential candidates.
Despite its growing role in survey research, the telephone survey has been largely neglected with respect to the design and testing of statistical procedures for assuring response privacy (e.g., randomized response techniques). This paper demonstrates that such procedures are no less feasible to administer in telephone surveys than in face-to-face surveys. Both randomized response techniques and alternatives to randomized response are considered.
The social world of the aged SRO tenant is described and analyzed. Charteristic features include an impoverishment of social roles and relationships which result in a "world of strangers". Dominant norms of SRO life which preclude the establishment of intimacy are examined; these include prescriptive norms of privacy, freedom, and utilitarianism
BACKGROUND: The Health Insurance Portability and Accountability Act (HIPAA) privacy regulations, which became effective on April 14, 2003, should have a significant impact on the conduct of nursing research. APPROACH: The requirements of the regulations are discussed in three key areas of the research process, accessing data (including recruitment and using medical records), creating data (including intervention studies, survey, and interview research), and disclosing data to others such as colleagues at other institutions. RESULTS: N/A. DISCUSSION: HIPAA will certainly impact nurses' ability to conduct research but to an unknown degree.
This article details what nurse administrators must know about the Health Insurance Portability and Accountability Act (HIPAA) that rewrites the rules on privacy, medical record confidentiality, and protected health information (PHI). Nurse administrators are responsible for knowing what information can be given to patients, families, the coroner, the media, courts, police, clergy, and attorneys. Implementation will require education to understand the intricacies of the law. The law carries substantial penalties for failure to comply.
To avoid legal penalties, health care providers must comply with the HIPAA privacy regulations by April 14, 2003.
While agreeing that proper confidentiality measures are necessary when handling patient records, author discusses finding a balance between privacy and the benefits of using patient data to improve quality and to control costs.