In order for you to get access to the wounded and sick, you have to sh · Medical

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3 In order for you to get access to the wounded and sick, you have to share information with the host-nation authorities and/or the UN about the identities of the patients in your care. Do you share the information?

Specific Topic(s):

• This scenario covers the ethics of information sharing and patient confidentiality.

• The discussion also considers the legal circumstances whereby healthcare professionals have duty to share information.

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ –

8. Health-care personnel respect patients’ right to confidentiality. It is ethical for health-care personnel to disclose confidential information only with the patient’s consent or when there is a real and imminent threat of harm to the patient or to others.

9. Health-care personnel make their best efforts to ensure respect for the privacy of the wounded, sick and deceased, including avoiding the use of health care for the wounded and sick, whether civilian or military, for publicity or political purposes.

Geneva Conventions:

Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts (Protocol I), 8 June 1977.

Article 16. General protection of medical duties, Para 3. No person engaged in medical activities shall be compelled to give to anyone belonging either to an adverse Party, or to his own Party except as required by the law of the latter Party, any information concerning the wounded and sick who are, or who have been, under his care, if such information would, in his opinion, prove harmful to the patients concerned or to their families. Regulations for the compulsory notification of communicable diseases shall, however, be respected.

Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), 8 June 1977.

Article 10 General protection of medical duties, Para 3 and 4.

3. The professional obligations of persons engaged in medical activities regarding information which they may acquire concerning the wounded and sick under their care shall, subject to national law, be respected.

4. Subject to national law, no person engaged in medical activities may be penalized in anyway for refusing or failing to give information concerning the wounded and sick who are, or who have been, under his care.

Customary IHL:

Rule 26. Punishing a person for performing medical duties compatible with medical ethics or compelling a person engaged in medical activities to perform acts contrary to medical ethics is prohibited. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_cha_chapter7_rule26

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS - https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

A PHYSICIAN SHALL respect a patient’s right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality.

WMA Declaration of Lisbon on the Rights Of The Patient: https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/#:~:text=Every%20person%20is%20entitled%20without,with%20his%2Fher%20best%20interests.

8. Right to confidentiality

a. All identifiable information about a patient’s health status, medical condition, diagnosis, prognosis and treatment and all other information of a personal kind must be kept confidential, even after death. Exceptionally, descendants may have a right of access to information that would inform them of their health risks.

b. Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the law. Information can be disclosed to other health care providers only on a strictly “need to know” basis unless the patient has given explicit consent.

Discussion:

Review of the question: This question concerns the right of a patient to confidentiality versus the right of ‘the authorities’ to be provided with information about patients.

Interpretation of the principles/policy from the references:

• There is a clear obligation under International Humanitarian Law and ethics for healthcare professionals to protect patient sensitive information.

• There may be occasions in which it is in the best interest of the patient or the ‘public’s health’ for information to be shared with ‘the authorities’.

Framework for answering the scenario/question:

• What information is requested by the host-nation authorities and/or the UN?

• Are there existing legal or information sharing agreements that cover these circumstances?

• Is there a clear justification for the information requested that is in the best interests of the patient, the public’s health or legal precedent?

• Are there arrangements to protect the information provided and to ensure that it will not be used for any purposes other than which it was collected?

Further discussion points

• Give examples of reasons to release patient identifiable information [prevention/detection of serious crime, notification of infectious disease, prevention of risk to others (e.g. failure to comply with medical aspects of driving regulations), approved/consented release of information for medical research]

• Are there unique military circumstances in which patient identifiable information might be shared by the medical services that would not apply to civilians?

Author: Professor Martin Bricknell