MEDICAL SECRECY AND ITS PRINCIPLES
1/.INTRODUCTION-DEFINITION
- Throughout history, people have wanted to entrust the secret of their private lives to certain people with special authority, which makes doctors privileged confessors of private life.
- The most famous and oldest written expression of medical confidentiality in the world is contained in the Hippocratic Oath,
- It can be summed up as follows: “admitted inside houses, my eyes will not see what happens there and a tongue will dry up the secrets that will be entrusted to me.”
- In the event of a breach of confidentiality, the doctor incurs criminal, civil and disciplinary liability.
2/. BASIS OF MEDICAL CONFIDENTIALITY:
- Legal rules:
Article 301 of the CPA:
“Doctors, surgeons, pharmacists, midwives or any other persons who are custodians of secrets by their functions and who, except where the law obliges them or the authorities to act as informers, have revealed these secrets, are punished by imprisonment of one to six months and a fine of 5,000 to 20,000 DA.”
- Article 206/01: Medical confidentiality guarantees respect for the dignity of the patient and the protection of his or her personality.
- Art 206/02: the obligation of professional secrecy is general and absolute except for legal derogation.
- Art 206/03: the obligation to report abuse against children, minors and persons deprived of their liberty.
- Art 206/04: the expert or requested doctor is not bound by secrecy for the purpose of his mission.
- Art 206/05: no disclosure of facts of the secret even if the doctor is a witness in court unless the patient authorizes it.
- Ethical rules:
- Article 36 of the CD: medical confidentiality applies to all doctors and dental surgeons unless the law provides otherwise.
- Article 37 of the CD: medical confidentiality covers everything that the doctor has seen, understood, heard or has been confided to him.
- Article 38 of the CD: the doctor must ensure that the requirements of confidentiality are respected by the auxiliaries. Article 39 of the CD: the doctor must protect any medico-legal document against any indiscretion.
- Article 40 of the CD: during scientific publication, confidentiality is respected: the patient must not be identified.
- Article 41 of the CD: medical confidentiality persists even after the death of the patient except to assert a right
3/. PERSONS REQUIRED TO SECRET:
A-Medical staff:
1- Nursing staff:
- Attending physicians, medical students on placement (external, internal in a hospital setting), dentists, pharmacists.
- Midwives, All other people contributing to care: medical auxiliaries (nurses, physiotherapists)
- By extension in a hospital environment, the service is bound by secrecy.
2-Non-healthcare staff: this will then concern:
- Medical advisors from social security funds;
- Occupational physicians; insurance company physicians; expert physicians.
B-Non-medical personnel:
- The secretary of the private doctor.
- The doctor is responsible for the non-medical staff who assist him (for example: the secretary has knowledge of the patients’ files, the agent)
4/.THE AREA OF MEDICAL SECRECY:
- Medical confidentiality concerns everything that has been seen
- Information entrusted, information included, or even anything that could have been interpreted during medical practice.
- For this, we can say that it concerns the patient’s statements, diagnoses, therapies, medical records or files, but also conversations overheard at home during a medical visit.
- The offence of breach of medical confidentiality is constituted when the disclosure is effective and intentional.
MEDICAL SECRECY AND ITS PRINCIPLES
5/.EXEMPTION FROM SECRECY:
A/- Relative exemptions:
- Criminal abortion: Under Article 301 of the Penal Code, “the doctor is not liable to punishment if he reports a criminal abortion”
- Reporting drug addiction: The doctor is authorized to report cases of drug addiction that he becomes aware of during his consultation.
B- absolute exceptions
- Child abuse: The doctor must report it.
- Notifiable diseases.
- Reporting of work accidents and occupational diseases .
- Requests for military pensions: the certificate is issued at the request of the soldier or his beneficiaries to establish a right during his lifetime or after his death .
- Compulsory placement and examinations: To initiate compulsory hospitalization, the psychiatrist sends a request to the wali, setting out the detailed pathological signs presented by the patient and which justify his request.
- As for the ex officio examination, any doctor can certify mental disorders presented by the patient and request the examination of the latter.
- Detoxification treatment: the doctor of the detoxification treatment hospital must inform the judicial authorities of the results of the treatment.
- Declaration of birth and death.
- Crimes against state security.
- Special cases: Computers and confidentiality: The importance of computer tools in recording data relating to patients and their monitoring, their data is subject to medical confidentiality; they can be extracted and/or modified voluntarily or accidentally. The doctor must provide access codes to the computer for which he is responsible.
MEDICAL SECRECY AND ITS PRINCIPLES
6/.CONCLUSION:
- Medical confidentiality is an obligation imposed on doctors, pharmacists and dental surgeons; this obligation is moral, general and absolute.
- This obligation of secrecy is one of the essential causes of the medical contract.
- Medical confidentiality is a patient’s right; it covers everything the doctor has seen, heard and understood in the exercise of his duties.
- Medical confidentiality is established in the interest of the patient: the patient’s death does not release the doctor from his obligation.
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