When safety and confidentiality collide

When safety and confidentiality collide.

How do we decide what to do?

Many organizations, in Ontario in particular, are reviewing their policies to enhance patient and staff safety. Recent legislation has required health care organizations to rethink their attitudes to risk and to take positive steps to protect workers and patients from violence and other risks to health. At a recent ethics committee meeting at a small hospital in rural Ontario the patient safety co-ordinator brought forward two proposals for discussion.

The first concerned the spread of infection, in particular antibiotic resistant organisms. The proposal was to identify patients who had tested positive for MRSA, VRE or C. Difficile by highlighting their names on their identification wristband. (Alternatives had been suggested such as coloured wristbands, but the method of highlighting had been proposed as the least intrusive option.) Easy visual identification of a patient who had tested positive for these infections would allow the staff who came into contact with that patient to take additional precautions as required.

The second concerned patients who had a history of violence. The proposal here was to have such patients wear a white wristband. The reasoning here was the same: staff (and patients, volunteers and visitors?) would readily be able to identify a patient who was believed to have the potential for future violence and they would be able to take steps to protect themselves.

In each of these proposals there is a clear clash between the desire to promote safety and the rights of a patient to privacy and confidentiality. Under what circumstances should safety and the minimisation of risk trump a patient’s expectations of, or rights to, privacy?

What do you think?