Author: Neha Kharb, Chandigarh University
To the point
In today’s world data travel faster than ambulance services and in healthcare Right to Privacy is one of the important fundamental right for patients in terms of confidentiality. The question that comes here Is data of a patient really confidential? because one of the important essential and obligation of healthcare and law is ethical and procedural as well. It is important essential of patient-doctor relationship. When individuals seek medical care, they often go for it during their most vulnerable moments—disclosing intimate details of their physical and mental health, which with further disclosure can absolutely destroy their mental health and the right to privacy both on the same plate. Without confidence that this information will be safeguarded, patients may withhold critical details, leading to misdiagnosis, inappropriate treatment, and public health risks. From ancient ethical traditions to modern digital legal frameworks, the concept of confidentiality has evolved from raw to rock—but its foundational role remains unchanged and we still have the confidentiality issues.
Abstract
This article is mainly focusing on the multi-sourced frameworks of legal ethics in health law with absolute focus on patient confidentiality. We will be discussing all the statutory protections, landmark cases, emerging data threats and the practices to maintain ethical integrity in a world increasingly driven by data.
Use of legal jorgon
Ethically, this duty is embedded in fundamental rights, professional oaths and codes. This concept of confidentiality is enshrined in one of the fundamental rights that is Right to Life (Article 21) which recoganises the right to privacy under the landmark Supreme Court ruling. The Confidentiality has evolved from the Hippocratic Oath an antique identity of professional oaths dealing with physicians respecting their patients secrets to the modern times, American Medical Association’s Code of Medical Ethics emphasizing on moral imperative. Confidentiality is also strongly tied up with human rights principle because the right to privacy is enshrined in international instruments such as the Universal Declaration of Human Rights and regional treaties like the European Convention on Human Rights which clearly gives confidentiality a stronger grip. The term Consent is explicitly included in “patient confidentiality” as it refers to the legal and ethical duty of healthcare professionals to keep the personal and medical information of the patient safe and non-disclosure without the clear consent of the patient. This principle is a fundamental aspect of medical ethics and health law, ensuring that sensitive health information remains safe and secure. But can only be disclosed under legally permissible circumstances. The complete healthcare profession is based upon trust and by complying with patient confidentiality the fiduciary relationship between the patent and the doctor remains solid. Breaching confidentiality can lead to legal consequences, loss of professional licenses, and reputational damage. Though there are certain exceptions to it. Such as
Public health concerns (in case of serious outbreaks of the disease)
Legal obligations (in case of court orders)
Risk (in cases where danger poses to themselves and others)
Under healthcare there must be proper balance between both law and ethics. Patients do have the right to control their information and make informed healthcare decisions without fear of disclosure as this right to information only applies to the patient. Breaching confidentiality can damage trust in the healthcare system and discourage patients from seeking medical care and a serious breach of trust. Medical licencing bodies such as medical councils, nursing boards also require the professionals to uphold the confidentiality and enforce confidentiality policies through compliance programs and training sessions.
The proof
Hippocratic Oath 400 BCE
The very first legal framework to protect the confidentiality we had in Global ethics. Hippocratic Oath is not a law in itself, but the principles enshrined in the oath have had a profound influence on the development of both ethical codes of conduct and legal obligations for healthcare professionals.
This laid the strict confidentiality in medical practice, asserting that doctors must not disclose information learned during the course of treatment.
This ethical commitment predates any formal legal framework and strongly influences professional codes as the American Medical Association (AMA) Code of Medical Ethics, the Medical Council of India (now NMC) Code of Ethics, the World Medical Association’s Declaration of Geneva, a modern reaffirmation of the Hippocratic Oath
And it also laid fiduciary duty owed by doctors to patients, unauthorized disclosure as a civil tort and helped in development of HIPAA (USA), GDPR (Europe), and the Information Technology Act (India) lately.
Common Law Pre- 1900s
It played foundational and evolutionary role in establishing both legal ethics and the principle of patient confidentiality in modern healthcare in England & Common Law countries which was evolved from the landmark judgement of Horne v. Patton. Common law courts were also the first ones to balance confidentiality with public interest with a Landmark Case: Tarasoff v. Regents of the University of California
European Convention on Human Rights (1950)
Article 8 of this convention focused on the concept of right to respect for private and family life. Cases like Z v. Finland , MS v. Sweden lead to Establishment of health information as among the most sensitive types of personal data and requires exceptionally strong protection and defined consent and necessity for data- sharing. Later, this influenced the Medical Council guidelines across EU, Hospital privacy protocols, Cross-border health data sharing rules European Convention on Human Rights didn’t invent medical confidentiality because at that time its bricks where already laid but it transformed it from a moral obligation into a legal right.
Health Insurance Portability and Accountability Act (HIPAA), 1996
By the U.S. Congress in 1996, HIPAA was originally designed to improve portability of health insurance and reduce fraud and abuse in healthcare which later laid down its foundational and transformative role in establishing legal ethics and patient confidentiality in modern healthcare particularly in the digital era. This HIPAA resulted in
Establishing the Concept of “Protected Health Information” (PHI) which includes: Patient names, addresses, diagnoses, test results, billing info, and anything that can identify an individual
Privacy Rule (2003 Implementation) – Ethical Gatekeeping of Health Data which established “covered entities” to obtain patient consent before sharing PHI, minimum necessary standard for only sharing the essential data and created ethical boundries.
Security Rule (2005 Implementation) which laid down main focus on administrative, physical, and technical safeguards to protect electronic PHI (ePHI).
And many more such developments have been made all because of HIPAA.
Information Technology Act, 2000 (India)
This Act is not health-specific but it provides a legal framework for protecting digital health data, which is increasingly central to medical recordkeeping and telemedicine. Which resulted in development of concept of patient confidentiality such as: Compensation for failure to protect data Under section 43A, Punishment for disclosure of information without consent Under section 72A, Definition of Sensitive Personal Data under IT Rules, 201, Bridging the Ethical and Legal Gaps (like the Hippocratic Oath or MCI regulations)
Indian Medical Council Regulations, 2002
These regulations are not merely guidelines they codified Confidentiality as an Ethical and Legal Duty under regulation 7.14 , laid Foundation for Professional Accountability, balancing it with public interest, strengthen the fiduciary relationship between doctor and patient. All of this together now has the quasi-legal status and are enforceable through disciplinary action, including suspension or revocation of medical licenses. Additionally the Justice K.S. Puttaswamy v. Union of India drew a constitutional basis for patient confidentiality, especially in context of Aadhaar and data protection.
General Data Protection Regulation (GDPR), 2018
It is the most powerful and influential data protection frameworks globally as it laid down the Informed and explicit consent under article 6 and 9, concept of data Minimization and Purpose Limitation under (Article 5), Right to Access and Portability (Articles 15 & 20), Right to Erasure (Right to Be Forgotten) – Article 17, Data Security & Breach Notification (Articles 32–34), Accountability and Documentation Obligations (Article 30 & 35), Cross-Border Data Transfers – Article 44, and at the end it also laid a global benchmark for model of protection of patient confidentiality.
Digital Personal Data Protection Act (India, 2023)
This act bought life to the healthcare sector in India as it brings clarity and enforcement power to the right to data privacy. It provided a Legal Recognition of Health Data as “Sensitive Personal Data”. It threw light on Purpose Limitation of data required and Consent Framework, Right to Access and Correction of Personal Health Records, Obligation on “Data Fiduciaries” (e.g., Hospitals, Labs, Insurers), Children’s and Disabled Persons’ Health Data Protection, and specifically the Grievance Redressal and Oversight Mechanism which is putting Fines up to ₹250 crore for violations.
Laws Case
Horne v. Patton (1974)
laid the foundation for the recognition of confidentiality as a legally binding obligation by establishing that a doctor’s unlawful disclosure of medical information constituted a violation of the law.
Tarasoff v. Regents of the University of California (1976)
After a patient disclosed murderous intent, a therapist neglected to alert a possible victim. Later, the victim was slain. brought forward the idea of a “duty to warn” or a violation of confidentiality that serves the public good. It outlined the protection of third parties from grave damage as a significant ethical exception to confidentiality.
Z v. Finland (1997)
An HIV-positive woman’s private medical records were revealed during a public criminal trial. outlined the stringent need and proportionality requirements for disclosing sensitive health information. strengthened privacy protections for information under the European Convention on Human Rights’ Article 8.
MS v. Sweden (1997)
Without the woman’s knowledge or consent, her employer’s insurance company was given access to her medical data. decided that unapproved health data transfers are a violation of Article 8’s privacy protections. emphasized the importance of obtaining individual consent before sharing any health-related data.
Justice K.S. Puttaswamy v. Union of India (2017)
This case was the first one to recoganise the Right to Privacy as a fundamental right under Article 21 of the Indian Constitution. This have played a crucial role in establishing patient confidentiality within India’s constitutionally guaranteed right to privacy. The legal foundation for maintaining confidentiality in the era of digital health records was established by this historic decision.
Conclusion
In today’s healthcare, the idea of patient confidentiality has evolved into a fundamental component of both ethical and legal norms. It represents the dedication of healthcare providers and institutions to respecting people’s autonomy, dignity, and trust. This duty goes beyond morality; it is now codified in laws that hold organizations and professionals responsible for violations. Confidentiality is crucial for both safeguarding private health information and promoting candid dialogue between patients and healthcare professionals, both of which are necessary for precise diagnosis, successful treatment, and patient trust in the system. Confidentiality faces significant difficulties in the era of digital records and data-driven healthcare, including complicated public safety issues, hacks, and unauthorized disclosures. In response to these demands, the changing legal landscape has incorporated confidentiality into international human rights standards, regulatory laws, and constitutional principles. Institutional rules, ethical codes, and data protection regulations now work together to prevent the misuse of individuals’ private health information while permitting appropriate exceptions under certain guidelines. Furthermore, healthcare providers are now legally recognized fiduciaries bound by responsibility, consent, and informed decision-making, not just custodians of patient data. Confidentiality has evolved from a passive pledge to an active, enforceable right as patients gain more authority over their own data and have the
ability to access, update, and manage it.
FAQS
Why is patient confidentiality crucial in the medical field, and what does it mean?
Unless agreement is obtained for disclosure, healthcare providers are required by law and ethics to maintain patient confidentiality, which includes keeping a patient’s personal and medical information private. It is crucial because it fosters open communication, guarantees respectful treatment, fosters trust, and shields patients from stigma, prejudice, and improper use of their medical records.
Does preserving patient confidentiality have any exceptions?
Yes, there are some circumstances in which disclosing patient information without consent is required or permitted, including:
a. Public health risks, such as outbreaks of infectious diseases
b. Legal responsibilities (such as court orders)
These exceptions must be strictly used to ensure that disclosure is appropriate and essential in situations where there is a risk of harm to oneself or others (such as suicide or homicidal intent).
In what ways is patient data in India protected by the Digital Personal Data Protection Act (DPDPA), 2023?
The DPDPA requires informed consent for the collection and use of health data and classifies it as sensitive personal data. In addition to imposing legal obligations on healthcare providers (data fiduciaries) to secure and use data solely for appropriate purposes, it grants patients the right to access, amend, and delete their data. It also offers a redressal procedure and penalties for violations.
If a patient’s medical privacy is violated, what should they do?
Patients have the option to complain to the relevant healthcare facility or provider. If professional misconduct is implicated, they can also submit a lawsuit under the Information Technology Act, Consumer Protection Act, or Medical Council in India, or they can contact the Data Protection Board created under the DPDPA.
How can medical professionals maintain privacy in a digital setting?
Providers need to adopt safe telemedicine systems, make sure staff members are trained, have robust cybersecurity protections in place (firewalls, encryption, access restrictions), and get patients’ express agreement before exchanging patient data. Maintaining ethical and legal compliance also requires regular audits and a breach response mechanism.
