The arrival of a sick person to the doctor - the event itselfin itself sacred, which can be compared with the secret of confession. Putting the patient information for purely medical purposes, the physician voluntarily or involuntarily confronted with a deeply personal or even hidden information. The doctor becomes a witness that patients hide even from their loved ones.
Instead, patients expect not only from doctorsprofessional help and compassion, but also as a matter of course, privacy. So the daily reality of health worker becomes a medical mystery.
The concept of medical confidentiality
Medical secrecy - the concept is as old as themedicine itself. The first principles of the doctor-patient relationship were formulated by the ancient Greek physician Hippocrates (460-377 gg. BC). "Whatever the treatment, as well as without treatment, I never saw or heard about any of the people's lives that should not disclose, I keep silence about believing these things secret." These are enshrined in the Hippocratic Oath regulations were the starting point for creating other health care professional and moral codes.
Over time, the medical secret has ceased to be amoral concept, it has acquired the status of law. Safety of medical confidentiality is guaranteed by law, and for its disclosure established legal responsibility.
The modern concept of medical confidentialityrecorded in the International Code of Medical Ethics, existing since 1949. It says: "The doctor should keep in absolute secrecy all that he knows about his patient, by virtue of trust extended to him."
However, by definition, Russian encyclopedia"Medical secret - it is the duty of health workers not to disclose become known to them by virtue of their profession information about patients, their intimate and family life. Information about the diseases reported in cases where this is required by the health interests of the population. "
From this definition, it follows that not everythe mystery of the patient the doctor is obliged to keep. The physician should like to listen to the voice of his own conscience, determining what information may be important not only for the individual patient, but to save the life and health of others. And this decision doctor takes, relying not only on their professional knowledge, but also on moral criteria.
Disclosure of medical secrets
Famous Russian doctor and writer V. Veresaev in the book "Diary of a doctor" wrote: "If secrecy threatens harm to society or others the patient, the doctor not only can, but must break the secret. However, in each case, the physician should be able to give patients and their own conscience accurate and comprehensive answer, on what grounds he violated the secret entrusted to him the sick "(Collected Works V. Veresaev -. M., 1961). Difficulties arise morally, when the doctor tries to interpret the law from his point of view, which may prevail or the public interest or the interests of the individual patient.
It is acutely the question of moral choice is put inthe context of HIV / AIDS. Girl 15 years old was admitted to the department of infectious hospital for routine examination. She HIV. On admission she reminded doctors of the confidentiality of her HIV status. Within a few days Woman visiting her boyfriend. She asks the doctor to inform the guy was not her true diagnosis, and the diagnosis "tonsillitis". Surrounding the medical staff aware of the responsibility entrusted to them: the girl is clearly hiding his diagnosis, and the young man probably does not know that his HIV status may soon turn out to be positive, or those already in the result of their intimate relationship.
Can I tell the boy the girl on the diagnosis? How to touch up on his idea of the need to be tested for HIV?
For a quarter century of HIV / AIDS of the exclusiveHe moved into the category of diseases epidemic. It has affected all countries and affect the course of human history. Ukraine ranks first in Europe in terms of the spread of infection. In 2006, compared with 2005, the number of HIV-infected persons has increased by 1.2 times. Officially registered about 73 thousand cases of HIV infection. However, the true number of HIV-infected and AIDS patients is much higher than the actual number of registered and can be up to 1.4 percent of the adult population of Ukraine.
Talking about HIV / AIDS, we can not limitepidemic diseases. According to Lily Hyde (editor of "HIV / AIDS News" newsletter information and resource center for the International Alliance of HIV / AIDS), the HIV epidemic is thriving in a society where there is prejudice and ignorance. I conducted a survey in 2002 showed a complete ignorance of the problem: prevalence, scope of coverage, displays and even pathways. From this is born another epidemic - an epidemic of fear. A victim of this epidemic - Society. While this problem does not concern us personally, the world is divided into "us" and "them." "We" fear "them" refers to both victims, sinners, and sometimes, it must be confessed, if not just criminals. The problem of discrimination was the main difficulty AIDS since the epidemic began.
Parents of the girl from the city of Simferopol died of AIDS, the elderly grandmother issued guardianship, not wanting to give his granddaughter in a shelter. Deciding to draw a girl in the garden, my grandmother always been refused at the mere mention of HIV-positive status of the child under the pretext of "not enough beds."
And how, without fear to treat such a case, when at the beginning of the epidemic in one of the cities of Crimea pregnant woman He was forced to give birth in the morgue?
That notorious stigma. Stigma (literally - "shortcut", "stigma") - a social label that completely changes the attitude to other people and to themselves, causing only treat the person as a carrier of undesirable quality.
Stigma "manifests" itself in two ways. The external manifestation of it - it's an unfair negative attitude towards people living with HIV. The consequence of this is the gut reaction of these sick people to the cases of humiliation and discrimination: they avoid testing and conceal their status. That, in turn, increases again outer kegatiznuyu reaction.
The problem of medical confidentiality in terms of the rights
Returning to the issue of patient confidentiality.
In one of the CRH Crimea came aboutHIV-infected people from the area of the hospital. Nurse infectious cabinet signed a document on the list of people living with HIV non-disclosure of data (people living with HIV). Looking through the list of HIV-infected, she stumbles upon a Name her niece of the groom. Girl about anything not suspect. Before the wedding, remain a week.
According to Art. 130 of the Criminal Code of Ukraine, "the intentional (conscious) for the creation of another person's risk of infection by human immunodeficiency virus or other incurable disease dangerous to life" a criminal offense. But what about my aunt? She subscribed to the secrecy of the diagnosis; the disclosure also lead to criminal liability under Art. 132 of the Criminal Code.
Everyone has the right to privacy andhealth, freedom and security. Medical secrecy - is also a question of human rights. And if you consider the medical confidentiality in this context, we will inevitably face a conflict of rights.
With sufficient legalregulation, the issue remains unresolved - both at the level of personal relationships of every individual and the state as a whole. When empowering a population group oppressed the rights of others.
And how things work in the medical field? Medical workers make up a professional risk of HIV infection. "HIV-positive has every right to tell or not to tell about their status ... nurses must observe the same precautions regardless of HIV-infected people or not."
It can be arbitrarily long talk about a significantinfective dose for HIV infection, and care about safety, about the perception of all patients as potentially infected with HIV. But the reality is that even disposable gloves in hospitals is still not enough. And cases of occupational exposure is, and not exotic.
It is equivalent to a bowl of weights? One - the possibility of contracting a fatal disease, on the other - the psychological trauma?
No easy answers. And if they can be? ..
I'm in my practice helps the Biblical story of Jesus and the woman taken in adultery. He defended her, accepted and supported - and opened her heart to meet him.
Trust - is the key that opens grace. A "grace rises above the court."