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The community you serve is small, and as shown in the family you are currently advising, very dependent on the local airport for jobs. In fact, from time to time you consult for the airport authority on matters of occupational safety and injury prevention. Though that work relates more to issues of chronic back problems among workers and workers' compensation, you know the airport management well, and consider them very reasonable people. You are tempted to tell a colleague, without naming the sons, in the airport's personnel department, but you suspect your colleague will feel an obligation to pursue the matter.
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| What legal or moral duties, if any, do you have to disclose the sons' risk of Huntington's disease to their employer? |
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| Context |
The new HIPAA regulations recognize situations where privacy can be trumped by other social concerns, and in those instances, it allows, but does not require, certain types of disclosure. Disclosure may be allowed in situations already recognized by existing laws and regulations, including:
- Oversight of the health care system, including quality-assurance activities
- Public health
- Research, generally limited to instances when a waiver of authorization is independently approved by a privacy board or Institutional Review Board
- Judicial and administrative proceedings
- Limited law enforcement activities
- Emergency circumstances
- For identification of the body of a deceased person, or the cause of death
- For activities related to national defense and security
However, if existing laws do not require disclosure, individual providers must make their own judgments.
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| "What right does an employer have?" |
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 View | Read
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The doctor/patient relationship is considered a special, or "privileged," one, specially protected by the law because its success depends on open communication between the two parties. There is a strong assumption in American law that people have—or should have—the right to control information about themselves. Traditionally, the terms of the doctor/patient relationship have been defined by state laws, where most health and medical issues are governed. However, in December 2002, new federal privacy provisions were enacted, severely restricting the use and disclosure of private health information (National Standards to Protect Patients' Personal Medical Records, part of the Health Insurance Portability and Accountability Act of 1996). The enactment of the HIPAA privacy provisions seems to strengthen a patient's right to control information, though experts are debating its impact. The new HIPAA privacy regulations cover all personally identifiable health information for those protected, and experts are not yet sure what they will mean for confidentiality and the doctor/patient relationship. Violators of HIPAA's "Privacy Rule" can be fined up to $25,000 for civil offences, and for criminal offences, penalties climb up to $250,000 and a 10-year prison term.
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