An individual's health records are among the most sensitive records she will ever possess. Many ethical issues are involved in the management of these records. They include determining who has rightful access to this private information and how to prevent unauthorized access.
Electronic Medical Records
President Bush began the push to convert medical records from paper folders and documents to electronic files. President Obama has continued this effort. While well-managed computer files present advantages by increasing efficiency and reducing cost, the major ethical concern involves securing the files against data-entry mistakes, viruses and Trojans and unauthorized access from inside and outside the medical office. Other concerns involve the limited nature of electronic records, which are often limited to "yes" or no" responses, allowing no leeway for the extensive doctors' and nurses' notes that often supplement patient histories documented on paper.
Advances in DNA research have made it possible to isolate the genetic sources of many serious diseases. These discoveries have raised a number of issues concerning who should have access to this potentially explosive information. For instance, some insurance companies offer discounts to members who submit to DNA screening and show none of these genetic markers. However, that same information could be used to deny insurance coverage. In the hands of landlords or employers, it could be used to discriminate against would-be tenants or eliminate potential job applicants.
One especially sensitive category of medical information concerns the use of legally prescribed medications and illegal drugs. Many workplaces screen applicants for evidence of drug use before making a final job offer. But someone who has undergone successful treatment for drug addiction can suffer discrimination if his past drug use comes to light. The courts have shown some willingness to disclose this aspect of a patient's medical history, for instance, when considering criminal charges. Prosecutors in Florida gained partial disclosure of the medical records for conservative talk radio host Rush Limbaugh in 2005 as they considered bringing criminal charges against him.
HIV-positive individuals as well as those suffering from full-blown AIDS are vulnerable to discrimination if their HIV status becomes known. From housing discrimination to job loss to denial of insurance coverage, disclosure of HIV-positive status or a diagnosis of AIDS can have devastating effects on an infected individual. Confidential and anonymous HIV testing is one way to avoid this problem, and many jurisdictions consider a person's HIV status to be a protected privacy right. However, HIV status is a routinely included question when applying for health insurance.
The Duty to Warn
In 1976, the Supreme Court of California ruled in the landmark Tarasoff v. The Regents of the University of California case that the school had not fulfilled its duty to warn Titiana Tarasoff of the imminent danger she faced from a mentally unbalanced schoolmate and former boyfriend who had stalked and killed her. The man had made threats toward Tarasoff during counseling sessions with a university mental health worker, but Tarasoff wasn't warned of this. As a consequence, many states adopted standards whereby mental health professionals must balance the need for client-therapist or doctor-patient confidentiality with a duty to warn third parties that they might be in danger.
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