Development of the he althcare system in Russia is expected to significantly improve the quality of care provided. But regulation of the "doctor-patient" relationship plays an important role, which, alas, still remains in its infancy. Therefore, for many, medical secrecy is a mysterious and unclear concept.
Medical ethics
Doctors restore lost he alth to people, but at the same time they become carriers of various personal information that helps to treat the patient. A person will not be frank on such topics with outsiders, and the doctor needs to be frank. The problem is that, as a rule, this is a stranger who you don’t want to trust such personal information without guarantees that it will not go further. What to do?
Medical ethics, or deontology, comes to the rescue. It regulates the relationship between the doctor and the patient, and it is by her that the staff should be guided in various controversial issues. It is believed that the basic principles of medical deontology were formulated by Hippocrates inhis famous oath.
Medical ethics includes issues of responsibility for the he alth and life of patients, relationships with relatives of patients, as well as in the medical community as a whole, the admissibility of communication with patients beyond business. But the most relevant topics in recent years have become such topics as euthanasia and medical secrecy. These are indeed very serious problems, but their solution should be regulated not only by morality. This is especially evident in the last question.
What is medical secrecy?
The definition of this concept is quite simple. Medical (medical) secret is all the information that a physician receives in the process of treating a patient and cannot be transferred to third parties. It would seem that everything is clear, but in reality everything is not so simple. Most patients have relatives, children, parents. After all, it is impossible for the mother of a one-year-old child to say that information about his he alth is not available to her? Or can a doctor keep silent about the fact that his patient, for example, has signs of infection with the plague, because in this way he indirectly contributes to the outbreak of the epidemic? And what specific information does not need to be disclosed to third parties? These are all complex ethical questions to which each person can offer their own answers.
Fortunately, it has been clear for a long time that these problems cannot be done without legal registration. Of course, this does not give a clear algorithm of actions in any situation, but it can set limits,which you need to focus on.
Legal regulation
The legal basis for medical secrecy comes from Art. 23, 24 of the Constitution of the Russian Federation, which protect the right to keep personal and family information secret. In addition, relatively recently, another legal act has come into force that regulates the protection of information that the patient transmits to the physician. This is federal law No. 323-FZ of November 21, 2011, which states what a medical (medical) secret is and what constitutes the information included in it. There is also judicial practice, although it is somewhat difficult to draw unambiguous conclusions from its analysis - there is simply very little of it.
As for the state of affairs in this area in Europe and the United States, medical secrecy and informing the patient are regulated somewhat differently. In America, there are no laws at the federal level; each state decides this issue in its own way. As for European states, the legal foundations for the protection of personal information, including medical confidentiality, are contained in criminal codes, and their history goes back to the 17th century and earlier. Thus, to date, in some countries, for example, France and Germany, the regulation of the handling of information transmitted from the patient to the doctor is sufficiently detailed and specific.
What is confidential information?
Medical confidentiality is, as it has already become clear, some personal information that the patient passes on to his doctor. And Russian legislation specifies what exactly constitutes thisinformation:
- the fact of applying to a medical organization;
- physical and mental he alth;
- diagnoses and forecasts;
- any other information provided by the patient or revealed during examination/treatment.
The main subjects, i.e. persons who have access to personal data, are employees of a medical facility, including trainees and pharmacists, as well as those who receive such information from doctors, such as investigators and other law enforcement officials.
And yet, under certain circumstances, disclosing medical information is perfectly legal. But they should be considered in a little more detail.
Access to personal data
Non-disclosure of medical secrets is generally the norm. However, there are circumstances in which information may be disclosed to third parties. These include the following cases:
- The patient is under 15 years of age. In this case, information about the state of his he alth is transmitted to his parents or legal representatives.
- Incapacity. The patient is unable to express his will due to physical or mental condition.
- There is a serious threat of the spread of infectious disease.
- Investigation of accidents at work or in an educational institution.
- Reporting information about bodily harm to law enforcement.
- With written consent - for scientific research.
- Exchange of information between medicalinstitutions.
- Quality control of care provided.
- As requested by law enforcement.
In addition, in some cases, relatives and friends of the patient can also access such information: with or without his written permission, if he has not expressed a desire to the contrary, especially if the prognosis of his disease is extremely unfavorable. But medical ethics at the same time dictates the need to provide information in the most delicate form.
Consequences of disclosure
It seems obvious why medical confidentiality is so important. The law protects the tranquility of citizens and punishes illegal access to information of this nature. It also provides for liability if confidentiality is not respected:
- Disciplinary, that is, a remark or reprimand from the employer, in serious cases, dismissal with an appropriate entry in the work book.
- Civil law - monetary compensation to the injured patient.
- Administrative (Art. 13.14 of the Code of Administrative Offenses of the Russian Federation) - imposition of a fine up to 5 thousand rubles.
- Criminal (part 2 of article 137 of the Criminal Code of the Russian Federation), the maximum punishment is imprisonment for up to 5 years.
About timing
The current international and Russian legislation does not define a specific period of time during which the disclosure of medical secrets is impossible. Of course, this does not apply to the above-mentioned exceptional cases. The only thing that legal acts clearly define is that the death of a patient is not a reason for disclosing information, so medical secrecy must be kept even after its fact has been established.
In Russia and abroad
In the post-Soviet space, unlike in Europe and the United States, the legal regulation of access to medical information is still poorly developed. Despite the fact that the mentioned laws have already been introduced, there is little control over their implementation. At the same time, the introduction of an electronic card system and the complete rejection of paper records are both a field for abuse by medical personnel and a danger of hacking databases and gaining access to personal data from the outside. Probably, if the implementation matches the idea, the result will be excellent. But it is somewhat premature to talk about this, especially when it comes to medical institutions that are part of the CHI system.
