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Patient Privacy Rights Extend Beyond U.S. Borders, Ethicists Say

John Commins, for HealthLeaders Media, February 22, 2011

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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2 comments on "Patient Privacy Rights Extend Beyond U.S. Borders, Ethicists Say"


Wanda (2/23/2011 at 2:57 PM)
Privacy rights article is certainly food for thought. I travel at least once per year doing medical clinics in 3rd world countries with church or christian mission work related. I have never posted these on face book but always take pictures and share in other formats promoting volunteerism to other professionals. Most clients coming for care are very eager to have their photo taken, in fact. I personally do not have an ethical problem related to photos being shared. It is for a greater good. Standards of care: When you are working in a romote area in the feild in a foreign country you do the best and most good you can do with the supplies and equipment you have with you. There is no way you can practice medicine in the feild to the same standard of care you do in a clean sterile office or hospital. You do use universal precautions and not jeperdize r the patient's or your own safety in the feild and good common nursing or medical judgement. To qoute an unknown scource, "It is what it is." Some care is better than no care. Thank God for volunteers. They pay their own way, they take their own purchased or donated supplies and they do more good in a weeks worth of free care clincs than they probably do in 6 months in their regular jobs. And the people they serve are greatful and appreciate the care they are given.

MCF (2/22/2011 at 10:33 AM)
Privacy is a relative thing. I have traveled extensively and trying to explain a picture or the internet in some areas is not even comprehendible. In addition, some cultures privacy is not even understood. Life is transparent, nudity is common, and ownership does not exist. We need to stop trying to force our "ethical codes" - which are flawed, into the world and get over ourselves as the "enlightened".