Patient Privacy Rights Extend Beyond U.S. Borders, Ethicists Say
Every year, students from all health fields work in clinics in medically underserved nations, such as the Dominican Republic, Haiti, and Ecuador. It's a chance to get hands-on experience in a patient-care setting and help people who sometimes travel days for care.
HIPAA doesn't apply to patients outside of the United States, says Lindsay Thompson, MD, an assistant professor of pediatrics in the College of Medicine, and a lead author of the report. If a nation has privacy laws in place, doctors must follow them when practicing there.
In addition, Thompson says, doctors are ethically bound to follow the laws of the state or country where they practice. "We in the medical profession have to be held to a different standard. Our actions, however altruistic they are, could have some unintended consequences," Thompson said.
Ruben Ayala, MD, a primary care physician and medical officer with Operation Smile, which provides corrective facial and oral surgery for children in developing nations, said his organization has strict guidelines for using pictures of its patients.
"Anything we put on the Web site or anything we put out in mailings or videos, all of that done only after we double- and triple-check that we have permission from the patients or their parents to do so. Not everybody is eager to tell their story," Ayala says.
"A few years ago we modified our informed consent. In a lot of these countries there isn't a culture of informed consent. These patients, we realized, there is always a chance that because they are poor or don't have access they would think that if they don't say 'yes,' they won't get the surgery. We have to make sure they understand that if they say 'yes' to any pictures that will not increase the changes of their child having surgery, and if they say 'no' that does not decrease the chances of their child having surgery," Ayala says.
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