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10 Appendices

Appendix (v)

Medical conidentiality, consent and disclosure

Nigel Grifiths

All the classic codes of medical practice imply some 2. Sharing of information with others providing care, or
qualiication of an absolute duty of professional secrecy, for the continuation of care. It is generally accepted

that medical matters disclosed in conidence, should not that medical information will need to be passed to those

be disclosed generally. Depending on the country in which organising ongoing or follow-up care in the patient’s own
the seafarer is hospitalised, jurisdictional issues surface as country, or those associated with organising the seafarer’s

to how conidentiality is addressed. A general common law repatriation to his homeland. Whilst treating doctors may

duty is imposed on a doctor to respect the conidences of obtain consent to disclose from the patient directly if
his patient.possible, inter-disciplinary dialogue is seen as appropriate

In an age of computerisation, progression of medical and necessary for the continuity of care. In the UK the

information to be regarded as ‘data,’ subjects it to data laws. General Medial Council recognises this in permitting
Further, disclosure may be seen as breaching the ‘right to the sharing of information with other practitioners

respect for private life’ as contained in, for example Article 8 who assume responsibility for clinical management of

of the European Convention on Human Rights.the patient, and to the extent that the doctor deems it
Speciic statutes exists in many countries whose laws have necessary for the performance of their particular duties,

originated from the Napoleonic Code (France, Benelux, etc.), with other care professionals who are collaborating with

and there, medical information is treated as sacrosanct by the doctor in his patient’s management.
the medical professional with an almost absolute imperative 3. Other reasons for disclosure:

on non-disclosure. It is in these countries that clubs perhaps • When communicable/infectious diseases are diagnosed
encounter the most resistance to disclosure and have the in accordance with public health law, including

most dificulty in establishing what is wrong with the mandatory reporting

seafarer and his clinical management.• On the direction of a Judge for judicial proceedings
There are three exceptions, so let us look at the • When direct identiiable threat to life or serious harm

exceptions to the rule and how conidentiality can be is made evident to medical professionals by mentally

addressed in the context of the hospitalised seafarer.ill patients
1. Clearly, if a seafarer has given his consent to disclosureThere are cases when the patient refuses medical

of medical information then it is reasonable for such treatment. It could be that a foot has to be amputated for

information to be passed on. The irst instrument in the well-being of the patient but that the patient refuses. If
obtaining the consent to release is to request that emergency surgery or other life-saving treatment is required,

the patient himself (if he is able, or the next of kinevery attempt should be made to reason with the patient

if not) signs a declaration that he has no objectionand obtain the proper consent in writing. There will be times
to the passing of information to speciied parties, when consent cannot be obtained, for example when the

which may include the correspondent, ship owner,patient is unconscious. In such instances the doctor is bound

club or their medical adviser. With this release, a copy to follow the best interest factor in determining treatment,
retained by the patient, a second by the hospital and from which a substituted judgment must serve as the

the third by the agent, medical information may be basis of consent. The weight of the family’s opinion, whilst

forthcoming. However, in some instances, even though valuable, if they are thousands of miles away may not be
the consent to disclosure is obtained, that hospitalsuficiently informed to override the best interest.

may well be reluctant to pass on the information to If a seafarer refuses to follow medical advice, it is very

non-professionals and it is at this juncture that clubs important that this is documented and is brought to the
should appoint their medical advisers to intercede on member’s/ Club’s attention immediately. If seafarers request

their behalf. This is especially so in the jurisdictions an alternative treatment to that recommended by the doctor,

mentioned, if the patient is extremely ill (when the this should be carefully considered and brought to the
concern is that an agent would be unable to handle the Club’s attention. Terms of treatment, whilst not wishing to

information), if the information is sensitive, and even encroach on the patient’s autonomy, treatment must also be

more so if it involves a diagnosis such as HIV or AIDS.in keeping with terms of the Club for reimbursement to the

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