Medical confidentiality and domestic abuse

K Law (General);RZ Other systems of medicine

Reed, Dominic ; Farmer, Lindsay

University:University of Glasgow

Department:School of Medicine, Dentistry & Nursing

关键词: Domestic abuse, medical confidentiality, medical ethics, privacy.;   

Others  :  http://theses.gla.ac.uk/81420/1/2020ReedDomPhD.pdf

来源: University of Glasgow

【 摘 要 】

This thesis investigates what medical confidentiality means in practice, in the context of a trial for domestic abuse. Despite the recent landmark case of WF (2016), which upheld a complainer’s right to privacy in relation to the use of their medical records, I demonstrate that medical records continue to be used routinely in criminal prosecutions in ways which undermine the supposed protections supported in WF. This points to the need for a more fundamental assessment of the underlying processes of the type that I have carried out in this thesis. There is no other research that properly takes account of these issues, while including the views of the survivors, as well as the front-line clinicians and lawyers involved. This thesis offers a fundamental exploration of how perceptions of medical confidentiality affect how records are made, sought and used in this context. Using data from twenty-eight in-depth interviews with survivors, clinicians and lawyers, I show how medical confidentiality is routinely undermined in cases of domestic abuse and sexual violence. My research demonstrates the need for a new approach to the definition of medical confidentiality and a review of the ways that medical records are used in these kinds of cases. Interview responses are complemented by a questionnaire study, recounting survivors’ experiences with medical and legal services, alongside further quantitative data tracing the medical records requests made to an NHS health board. Throughout, I highlight issues with the consent process, finding that prosecution staff use the potential for failed convictions to encourage survivors to agree to their medical records being recovered and disclosed. The concept of relevance is also discussed, with my data bolstering accusations by other researchers that it is too widely interpreted, by legal professionals in particular. The potential for future legal proceedings is shown to have a powerful impact on the way confidentiality is perceived in the health service, with clinicians, on occasion, willing to amend practice to assist the chance of prosecutions succeeding. Overall, this thesis highlights the importance of medical confidentiality in survivors’ perceptions of the criminal justice process and the health service. Moving away from the simplistic assumptions that confidentiality has no effect on courtroom experiences, my research instead shows that diverging perceptions of confidentiality risk the disclosure of large amounts of sensitive medical information that in turn affects the chances of survivors engaging with clinicians and lawyers in future.