Breaking Patient Confidentiality: Comparing Chilean and French Viewpoints Regarding the Conditions of its Acceptability

Abstract

The study examined the conditions under which lay people and health professionals living in Chile find it acceptable for a physician to break confidentiality to protect the wife of a patient with a sexually transmitted disease (STD). One hundred sixty-nine lay persons, 10 physicians, 17 psychologists, and 11 paramedical professionals indicated the acceptability of breaking confidentiality in 48 scenarios. The scenarios were all possible combinations of five factors: disease severity (severe, lethal); time taken to discuss this with the patient (little time, much time); patient’s intent to inform his spouse about the disease (none, one of these days, immediately); patient’s intent to adopt protective behaviors (no intent, intent); and physician’s decision to consult an STD expert (yes, no), 2 x 2 x 3 x 2 x 2. The study also compared Chilean and French views, using data gathered previously in France. A cluster analysis conducted on the overall set of raw data revealed groups of participants that found breaking confidentiality “always acceptable” (9%), requiring “consultation with an expert” (5%), “depending on the many circumstances” (70%), and “never acceptable” (11%)”. Despite clear differences in legislation and official codes of ethics between their two countries, Chilean and French lay people did not differ much in their personal convictions regarding the circumstances in which patient confidentiality can be broken or must not be broken. By contrast, Chilean physicians, in agreement with their code of ethics, were much less supportive than French physicians of complete respect of patient confidentiality in all cases

Is it Acceptable for a Psychologist to Break A Young Client Confidentiality?

“…Finally, participants endorsing the always acceptable position tended to give absolute priority to the parents' responsibility, and to the benevolence principle, as far as this principle is interpreted as doing anything that can result in having positive consequences for the client (e.g., initiating a therapeutic process under parental control). This findings is fully consistent with early finding on Chilean people's views regarding medical confidentially (Olivari et al, 2011).…”

“…Five psychologists endorsed the Depends mainly on client's age position, which also was not in contradiction with the code of ethics because the code is silent about minor clients. This tendency to oppose breaking of confidentiality, at least for adults, is largely consistent with Chilean physicians' views regarding medical confidentially (Olivari et al, 2011). The positions taken by these clusters of participants-who, aside from the Chilean psychologists, were lay people without medical training-reflect remarkably well the basic principles of bioethics (Beauchamp & Childress, 2001).…”

Prohibition, Regulation or Free Market: A Mapping of Colombian People’s Perspectives Regarding National Drug Policies

“…This technique uses all data points and is less susceptible to outliers and the distance measure used than other techniques. Recent applications of this clustering technique in studies bearing on big societal issues similar to the present one can be found in Heimann et al (2014), López-López et al (2012), Olivari et al (2011) and Neto et al (2013). As we expected to find at least three qualitatively different clusters, a three-cluster solution was first tested.…”

Medición funcional en el dominio de la ética empírica

“…Durante los últimos veinte años se han realizado una serie de estudios empíricos utilizando el marco metodológico de la medición funcional. Estas investigaciones han analizado las posiciones de expertos o no-expertos en relación con cuestiones acuciantes como (a) la comunicación de malas noticias a los pacientes enfermos (Igier et al, 2015); (b) la aceptabilidad de la ruptura de la confidencialidad (Olivari et al, 2011); (c) el racionamiento de tratamientos caros o escasos (Nann et al, 2012); (d) la aceptabilidad del tratamiento involuntario (Lhermite et al, 2015) o de la hospitalización involuntaria (Guedj et al, 2012); (e) la aceptabilidad de las técnicas de reproducción asistida (Muñoz Sastre et al, 2016); (f) la donación de órganos y la trasplantación (Fraux et al, 2020); (g) la cuestión del aborto (Muñoz Sastre et al, 2015), y (g) la aceptabilidad de la experimentación con animales no humanos (Muñoz Sastre et al, 2020). La mayoría de estos estudios se han realizado con muestras de occidentales (Muñoz Sastre & Mullet, 2019), pero algunos de ellos se han llevado a cabo en África Occidental , en América Central (Morales et al, 2010), en América del Sur (Pineda Marín & Mullet, 2020), en la India (Kamble et al, 2012), en Oriente Medio (Ahmed et al, 2010) y en el Sudeste Asiático (Nann et al, 2012).…”