Hippa And How Philosophers Would Have Viewed It

We've all received "Privacy Practices" notices from our physicians but many people do not understand how the Health Information Privacy Accountability Act of 1996 (HIPAA) and other laws that affect how our personal information is handled have evolved during the last few years. In the past, our medical information was not as protected as it is today. The Department of Health and Human Services (HHS) set out to empower patients. HHS wanted to give patients access to their medical records and give the patient more control over how their personal information is used and disclosed.

Historically, medical ethics have respected patients' need for confidentiality while authorities have sought the disclosure of certain contagious illnesses to preserve public health. The last several decades have seen major changes in the practice of medicine, such as computerization. The latest major development in this area was in 1996, when HIPAA called for the creation of a controversial national medical database, in which each patient would have a unique medical identifier like a Social Security number. To ease concerns about security and privacy, the legislation stipulated that HHS protect this health information. Out of this change come the new HIPAA rules for medical privacy.

Congress gave HHS the responsibility of setting up the guidelines that would govern information in the medical field. These guidelines affect health plans, providers who verify eligibility and enroll patients electronically, pharmacies, doctors, and other health care providers. While HIPAA was drafted in 1996, the medical field was not forced to comply with the federal standards until April 14, 2003. HIPAA was passed to help protect and safeguard the security and confidentiality of a person's health information. One part of HIPAA, the Privacy Rule, is designed to keep your medical information private and prevent unnecessary disclosures of your protected health information (PHI). This does not mean that your doctor can't talk to anyone about your health information. Your doctor can still disclose your PHI without your consent in many situations, especially if it is related to treatment, payment or health care operations. For example, if you break your leg, your doctor has to contact your insurance company about it so they can pay the medical bills. However, your credit card company does not need to be informed of the accident just because you used the card for payment of services.

Your health care provider is responsible for maintaining confidentiality as required by law. To ensure that your information is kept confidential, Congress provided civil and criminal penalties for covered entities that misuse personal health information. For civil violations of the standards, OCR may impose monetary penalties up to $100 per violation, up to $25,000 per year, for each requirement or prohibition violated. Criminal penalties apply for certain actions such as knowingly obtaining protected health information in violation of the law. Criminal penalties can range up to $50,000 and one year in prison for certain offenses; up to $100,000 and up to five years in prison if the offenses are committed under "false pretenses"; and up to $250,000 and up to 10 years in prison if the offenses are committed with the intent to sell, transfer or use protected health information for commercial advantage, personal gain or malicious harm.

So what if a physician feels that he "needs" to disclose information to someone else on a moral basis and this reason is not covered under the HIPAA rules? The physician is facing monetary penalties, criminal charges, and possibly losing their medical license. Under the HIPAA rules, a physician's hands are effectively tied and he is prevented from disseminating information to the appropriate people. In class, we discussed the case in which an AIDS patient refused to disclose his status to his sister who would be caring for him, thus possibly contracting the virus from her brother. Since the patient invoked patient/doctor privilege, the doctor has no choice but to not discuss the situation with the sister. He is able to suggest using universal precautions while caring for her brother, but he cannot tell her why under HIPAA rules. In order to allow the doctor to discuss the patient's medical status with his sister, the patient would have to sign a "consent to release of information" form before the doctor could proceed. This moral dilemma has faced many health care workers and some of the same issues have affected law enforcement officers when they transport patients from incarceration to the hospital and vice versa. The police officers have to abide by the same rules as medical facilities to protect the medical information of the inmate patient. Even though by not disclosing certain medical facts to other prisoners, the other prisoners are placed in jeopardy of being exposed to whatever disease the patient has. Inversely, the patient is protected from the other inmates from being discriminated against for his/her medical condition. In a way, this is the same position the physician is placed in. By not disclosing medical information, the physician places other people in jeopardy. However, if the physician discloses the information, the patient can be ostracized by his/her family because of this information and the physician would face punishment for not following the HIPAA policy. How would the philosophers we studied handle the fine line of disclosure that is present in today's medical field?

Plato: It holds that is always instrumentally rational for one to further one'sown interests and in that certain situations it is more rational to forego one's own interests providing others do so also than to behave in a straight forward rational way. The rules it is rational to accept providing all others accept them alsoÐ'--are simply the rules of morality. Therefore, it is rational to be moral. Plato states that rationality requires self-interested action. However, he notes the difference between perceived self-interest and actual self-interest and argues that any apparent conflict between rationality and morality is simply a conflict between one's perceived self-interest and the requirements of justice. Pursuing of one's actual self-interest never conflicts with the demands of morality. Since, for Plato, it is more rational to pursue one's real, than one's apparent, self-interest, rationality and morality do not conflict. It is rational to be moral. The connection between this conception of integrity and the conception of harmony discussed previously is obvious. The person with integrity is the person who can either resolve conflicts within himself in a fairly efficient way or prevent such conflicts from ever arising. He does this by relying on his