When can doctors share information without a patient&#39;s explicit consent? I'm curious about patient confidentiality, in non-emergency situations. When and who can a doctor disclose medical information about a patient to, and when do they need consent? At the university I used to go to there was a medical clinic on campus and though I sometimes saw different doctors, they all had all of my medical history. I asked about it and they said it's confidential, but confidential to the clinic. What are the laws regarding this? I also found out they changed the university policy so the counselling department can share information with the doctors (and vice-versa). Seeing as the counselling department helps with things like course selection (and not just mental problems) does that mean if I asked a counselor if I needed a course, he would know I only have one kidney? What laws apply to situations like this where confidential information in one entity (medical office) decides to share it without the consent of the patients to another entity (the counselling dept.)?
http://www.healthinfoprivacybc.ca/confidentiality/when-can-and-cant-they-tell-others is a pretty good summary. Different rules apply to private practices than public clinics and hospitals. I will assume that the clinic on campus is private. This is a summary of the summary about who your information can be shared with: Health care professionals can share information within your "circle of care". Specifically, they are allowed to assume your consent to this but you can explicitly withdraw that consent. This would include doctors within the same practice. Admin staff can access your information for administrative purposes. Anyone you have authorised them to share it with e.g. relatives, friends etc. The Medical Services Plan for billing and admin If you are unable to drive If there is suspected of child abuse If you are wounded by a gun or a knife If you are a danger to others For your specific questions: I asked about it and they said it's confidential, but confidential to the clinic. Correct, unless you explicitly revoke this. the counselling department can share information with the doctors This is tricker, these people may be either within your "circle of care" or they may be part of the same organisation. Notwithstanding, councillors are not doctors and are governed by the everyday laws related to confidentiality i.e. information given in confidence is confidential and everything else isn't. If you are told the limits of the confidentiality i.e. they tell the doctor, then those are the limits unless you renegotiate them. he would know I only have one kidney? Well you said "the counselling department can share information with the doctors" and this would require the information going the other way i.e. the doctor sharing with the councillor. Even if this type of sharing was OK in general (and I'm not sure it is, see above); the information shared should only be what is required for the councillor to do their job - the number of kidneys you have is probably irrelevant to this. What laws apply to situations like this where confidential information in one entity (medical office) decides to share it without the consent of the patients to another entity (the counselling dept.)? Well, we are not sure there are 2 entities: legally there may only be 1 - the university. Anyway, the laws are the Personal Information Protection Act and common law (Smith v. Jones, [1999] 1 SCR 455)
No You say you won't disclose personal information, therefore, you can't disclose personal information. Now, if your privacy policy said &quot;We won't disclose your personal information except ...&quot; then, so long as you did the &quot;...&quot; that would be fine (subject to privacy law).
The federal HIPAA law generally gives patients the right to obtain copies of their medical records. I would expect test results to be included. According to the link above: A provider cannot deny you a copy of your records because you have not paid for the services you have received. However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records. If you think these rules have been violated, you can file a complaint with the federal Office of Civil Rights.
This very much depends on where you are. Different jurisdictions have wildly different laws about this. Some places are very permissive. You can record a conversation that you aren't even a party to so long as nobody has any reasonable expectation of privacy. In others, affirmative consent is required from every party to a conversation before it's legal to record it. The laws run the entire spectrum. Some places allow you to record anything you're a party to without permission, but you can't record others' conversations. Some places require you to disclose, but not obtain explicit permission. Some allow you to record but restrict who you can disclose it to. Some allow you to record or ban recording only under certain circumstances. It's a really wide gamut of laws. Since you don't say where you are, who you're recording, or why, there's no way to really answer the question. Here's a good rundown on the United States. This Wikipedia article covers lots of different countries, but only with regard to phone calls.
In California, psychologists are regulated under Ch 6.6 within Division 2 (Healing Arts) of the Business and Professions Code. §2902 identifies the essential restriction on the business practice, stating that &quot;A person represents himself or herself to be a psychologist when the person holds himself or herself out to the public by any title or description of services...&quot; using various forms of the word 'psychologist', as well as &quot;when the person holds himself or herself out to be trained, experienced, or an expert in the field of psychology&quot;. In order to say that you are a psychologist, you have to hold a professional psychologists's license. Likewise to hold yourself out as a nurse, you need a nurse's license. A consequence of being a licensed psychologist is that under the Confidentiality of Medical Information Act, you may assess a patient's mental state, and you must keep that information confidential. A life coach cannot make a diagnosis, and cannot prescribe cures for mental conditions. §2908 in particular allows other people to do some of what psychologists do: Nothing in this chapter shall be construed to prevent qualified members of other recognized professional groups licensed to practice in the State of California, such as, but not limited to, physicians, clinical social workers, educational psychologists, marriage and family therapists, licensed professional clinical counselors, optometrists, psychiatric technicians, or registered nurses, or attorneys admitted to the State Bar of California, or persons utilizing hypnotic techniques by referral from persons licensed to practice medicine, dentistry, or psychology, or persons utilizing hypnotic techniques which offer avocational or vocational self-improvement and do not offer therapy for emotional or mental disorders, or duly ordained members of the recognized clergy, or duly ordained religious practitioners from doing work of a psychological nature consistent with the laws governing their respective professions, provided they do not hold themselves out to the public by any title or description of services incorporating the words “psychological,” “psychologist,” “psychology,” “psychometrist,” “psychometrics,” or “psychometry,” or that they do not state or imply that they are licensed to practice psychology; except that persons licensed under Chapter 13.5 (commencing with Section 4989.10) of Division 2 may hold themselves out to the public as licensed educational psychologists. Analogously, we can talk about the law here without running afoul of UPL laws, because &quot;talking about the law&quot; is not the same as &quot;practicing law&quot;. It is a fairly formalistic distinction, but I or a life coach can talk about what would be good for your soul, as long as I don't claim to be a psychologist dispensing professional advice.
This is a valid question that comes up from time to time. The answer can be a bit fuzzy and the law on questions 1 and 2 is often not well spelled out. This answer refers only to U.S. legal history without much customization for Maryland in particular, so I may omit references to some relevant Maryland specific statutes or cases of which I am not aware. Often there is no statutory guidance or there is only inconclusive or vague statutory guidance. There is often also little appellate case law precedent to provide guidance. The issue comes up far more often than it is litigated, in part, because these issues tend to become moot before they can be resolved by a precedent creating appellate court, and because statutes addressing the issue tend to be recent and not yet litigated, or non-existent. These issues are often highly time sensitive and don't have an economic prize to spend money litigating over are often not litigate to the maximum extent. Court rulings when cases are presented to them often depend a lot on the procedural context of the way the issue comes up, how the issue is framed by the litigants, and upon the court's gut feelings and upon unwritten social norms. For example, one recent case involving the ability of a priest to visit a man who was sick with COVID-19 in a Maryland hospital notwithstanding hospital visitation policies was resolved in the context of a complaint to the Maryland Office of Civil Rights and would not be generally applicable to an intrafamily dispute as opposed to an allegation of religion based discrimination. The hospital's opinion is often given outsized weight, since it is a &quot;neutral&quot; party in a family dispute, has a vested interesting in having litigation resolved that is more economic than that of the family members, and is likely to have counsel that is most familiar with the issues presented. this is true even though often, a hospital has a religious affiliation or is for some other reason specific to the facts of a case is not truly a &quot;neutral&quot; party in a visitation dispute and takes a position for a non-medical reason. As a young lawyer at a law firm that represented a hospital, I handled cases like these for a hospital when they came up for a couple of years, because nobody more experienced wanted to deal with these emotionally draining and time consuming conflicts with few monetary rewards for the hospital, and because the stakes from the hospital's perspective were low, so junior associate attorneys could be trusted with this cases. Appellate courts also often frame these decisions as fact bound case by case questions decided under general considerations applicable to all forms of injunctive relief in civil cases, rather than questions presenting more general questions of law to which general policy rules apply. Furthermore, the conceptual foundation in which we think about the authority of different family members over an incapacitated person at common law has shifted materially since the 19th century when these issues started to arise, and mostly hasn't been formally discussed by the courts as applied to these particular situations in the meantime. So, even when there are old precedents governing these situations, there is doubt regarding whether they are still good law, because the old precedents are based upon assumptions about spousal and parental and family member rights that no longer hold in other areas of the law. See also an analysis of issues of visitation and medical decision making for disabled persons, primarily under the federal Americans with Disabilities Act and related regulations, with footnotes particular to Maryland's state laws on the subject. Can E block B, C and D from visiting A in the hospital? What legal authorization form(s) can person A fill out and provide to B, C and D to prevent that from happening if this is a serious concern? The right of a private individual to visit someone in a hospital is usually not codified into law and is usually a matter of hospital policy within reason, acting in the best interests of its patients from a medical perspective. Usually E could only block B, C and D from visiting A in the hospital (1) with the cooperation of the hospital based upon its own policies (since as a practical matter, the hospital is generally in control of the situation and has broad authority to restrict access to its patients for health reasons), or (2) with a restraining order or protective order obtained from a court, or (3) as a legal guardian appointed by a court of person A (who generally has the authority to decide who their ward can interact with). In old common law cases (usually mid-19th century or earlier, but sometime in the early 20th century), the spouse of a married person (sometimes only the husband of a wife, but not vice versa), or the parents of an unmarried minor or unmarried person more generally, had the rights of a legal guardian with respect to an incapacitated person, and a family member had authority to make decisions for an incapacitated person as next of kin, in the absence of a parent or spouse. But, for the most part, this is no longer legally enforceable law. The Married Women's Property Acts of the late 19th century and early 20th century generally eliminated the authority of a spouse to act as legal guardian of an incapacitated spouse without a court order, sometimes subject to cases of &quot;necessities&quot;, and control of personal family property like a marital residence, household goods, or vehicle titled in a spouse's name alone that the competent spouse used in the ordinary course prior to the incapacity. The authority of a parent or next of kin person to take action for an incapacitated person without a court order was largely abrogated by state probate codes establishing court procedures for guardianship and conservatorship appointments for incapacitated people giving spouses, parents and next of kin priority, but not authority in the absence of a court order, except in the case of minor, unmarried, unemancipated minor children. And, even then, it is rare for statutes for expressly grant parents that authority over the children by statute and the authority is merely assumed as background common law to other statutes limiting that authority in cases of child abuse or child neglect, and some kinds of decisions still need court approval even in the case of parents of unemancipated, unmarried minor children. Documents specifically authorizing visitation are rare (I've never seen one in real life outside a civil union of a same sex couple), although states with &quot;civil union&quot; laws enacted before same sex marriage was legalized, often expressly afford a civil union partner visitation rates with priority over other family in hospitals, despite the fact that the status quo law is often ill defined. Hospital policies that denied visitation to de facto civil union partners were an important driving force in causing civil union legislation to be adopted with the support of legislators who didn't have a strong feeling about gay rights as an overall matter and who were otherwise indifferent to the economic rights of civil union matters but adopted the rights of married couples because it was the mindless default way to adopt a body of pre-existing law with little serious thought or fact rich informed deliberation. This is, in part, because visitation is not a matter over which a patient at a hospital has unilateral decision making power. Hospitals generally have their own policies regarding visits to patients. See, e.g.,, discussing the University of Maryland's hospital visitation policy. Usually, a hospital will honor a patient's reasonable request to not allow someone to visit them (out of general respect for patient autonomy). But, a hospital will often decline to allow a patient to have visitors out of concern for the best interests of the health of the patient even when a patient would like to have a visitor (e.g. a hospital would often refuse to allow someone with a recent positive COVID-19 test to enter an Intensive Care Unit (ICU) even if the patient would like to visit that person). Even here, however, the conceptual foundation behind traditional hospital practices related to visitation have shifted. The modern view is to more strongly respect the personal autonomy interests of a hospital patient than hospitals did in the past (the trend started to shift more strongly to a patient autonomy mindset in the late 1950s and gradually shifted toward greater patient autonomy in that time frame, particularly, following the deinstitutionalization of the mentally ill). Hospitals are loathe to create a situation where their express statutory, contractual, and/or common law authority to regulate visitation could be overridden by a patient, and laws related to hospital visitation are rarely adopted by a legislature over the objection of the hospital lobby. What legal authorization form(s) can person A fill out and provide to B and C so that they get precedence in medical decision-making authority over E? Many hospitals would give E priority over B and C and D in making medical decisions for A, if A is incapacitated and there are no court orders or legal documents that provide otherwise, as a matter of policy. And, these policies are often traceable to the mindset associated with the old common law rules that no legal have binding legal effect. But some states have a scheme in which the hospital makes unilateral decisions in the best interests of the patient as they see it, unless B, C, D and E (and possibly other people designated by mutual agreement) jointly agree on who should make those decisions. See, e.g., Colorado Revised Statutes § 15-18.5-103 (Proxy decision-makers for medical treatment authorized--definitions). On paper, Colorado is such a state, although in practice, a hospital would offer listen to a spouse over other family anyway. I don't know if Maryland is such a state. I could not easily locate any statute in Maryland governing medical decision-making authority for an incompetent patient in the absence of a health care power of attorney or the equivalent or a guardianship proceeding, although my search was not exhaustive. A document commonly known either as a medical power of attorney, or a health care power of attorney, or a health care proxy designation made by a competent person who does not have a legal guardian appointed for them at the time, can designate someone such as B and C to have priority over E in making medical decisions for them. This document would be controlling absent a court order to the contrary, and usually a court would give authority to the person named in that document (although a court is almost never required to do so without regard to the suitability of the person seeking court ordered decision making power).
Because the law of negligence has developed to include a duty of care between physicians and patients and the standard of care encompasses the things you describe. The common law conceives of the doctor and patient in such a close relationship of neighbor-ness that it makes sense to impose such a duty. The harm that flows from breach of that duty is often reasonably foreseeable. Another distinction is that you come to a physician with an illness and expect care and they purport to deliver it. Their care and advice is often not a product/service that you might have the option of not buying. There is no competing legal duty that pulls the physician in any other direction than to meet the standard of care. There is no corresponding duty of care between an instructor and student to instruct any particular syllabus content. It would be a novel addition to the common law if this were to be recongized. There is no standard of care dictating the content of the syllabus. Any obligation to deliver a particular syllabus would be placed on the professor by the university (perhaps further dicated by professional accrediting bodies). I do not foresee the common law developing to include such a duty of care between professor and student. The value of academic freedom weighs against the law imposing a strict duty on syllabus content and the kind of harm that might flow from presenting out-of-date information is vague and not often reasonably foreseeable. Such a duty could give rise to a spectre of of indeterminate liability. And it isn't clear that the interest in presenting the latest and current theories always outweighs the interest in presenting a historical perspective. These are all reasons why I highly doubt the common law would ever evolve to recognize the duty you're proposing.
The primary question is whether remaining silent would constitute a breech of medical ethics. The pertinent ethical principle is AMA Opinion 2.15 One of the requirements is that the donor be assigned an advocate team whose interest is the donor, not the patient, and these should generally be distinct individuals in order to avoid conflict of interest. Assuming that the donor's team is aware of this fact, they have a duty to disclose it, since it materially affects the donor's willingness to donate the organ. The ethical opinion does not specifically address &quot;patient breaking up with a directed donor&quot;, but there is a general obligation to share information, and it would probably be found to be a breach of medical ethics to suppress relevant non-medical information. The ethics of directed donation from live donors is not well-developed. I will mention that Potential donors must be informed that they may withdraw from donation at any time before undergoing the operation and that, should this occur, the health care team is committed to protect the potential donor from pressures to reveal the reasons for withdrawal. If the potential donor withdraws, the health care team should report simply that the individual was unsuitable for donation. From the outset, all involved parties must agree that the reasons why any potential donor does not donate will remain confidential for the potential donor’s protection. In situations of paired, domino, or chain donation withdrawal must still be permitted. Physicians should make special efforts to present a clear and comprehensive description of the commitment being made by the donor and the implications for other parties to the paired donation during the informed consent process. Neither team can tell the patient that the reason the girlfriend withdrew was because they ratted him out (anyhow, we can suppose she said something to him on her own). The hospital knows this fact, and has both a duty to the patient to solve a medical problem but also to the donor to be sure that the consent is informed. The hospital would be suppressing a fact relevant to the donor's willingness to undergo the operation, which is a breach of duty. This fact is not protected by HIPAA, or any other California statute, so does not supersede the obligation to reveal relevant facts.