Medical confidentiality ethics in light of the Islamic legal maxim "Harm Must Be Eliminated" : a juridical analysis

Abstract

Medical confidentiality is a foundational tenet in the delivery of effective healthcare, since the Hippocratic era. It is widely recognized that medical confidentiality can be breached for the protection of the patient and/or others, if the maintenance of confidentiality causes serious harm. However, the potential harms in the maintenance and disclosure of patient confidentiality are yet to be systematically identified and studied, particularly from a Shariah perspective. Legal mandates, ethical codes and professional guidelines have fallen short in explaining the procedures that doctors must follow when encountering situations where conflicting interests arise; nor are there clear directions in explaining procedures when faced with specific circumstances. The current research aims to address this problem in theory and provide practical solutions, subsequently adding value to existing research on the application of Islamic legal maxims, as well as medical confidentiality from the Shariah perspective. Employing research methods – namely: exploratory analysis, content analysis, critical analysis, thematic analysis and inferential analysis – this research aims to: 1) critically identify potential harms in the protection and disclosure of medical confidentiality, explored from the perspectives of patients, doctors and third parties; 2) to analytically scrutinize ‘harm’ in view of Islamic jurisprudence and to methodically study the Islamic legal maxims related to harm elimination; and, 3) to experiment with the implementation of a framework based on the Islamic legal maxims, on issues related to medical confidentiality, in an attempt to eliminate or effectively reduce harms. The major findings of the research are: 1) there are several considerable harms – moral, physical, psychological, financial, familial, direct, indirect, private and public – to the patient, doctor and/or third party, in the protection and disclosure of medical confidentiality; 2) Islamic jurisprudence deals with harm extensively, to the extent that it includes all possible and considerable harms that may be caused or suffered. Consequently, the Islamic legal maxims related to harm elimination are decisively essential for prevention, elimination or minimization of harm; and, 3) a harm elimination framework, based on the Islamic legal maxims, is relevant in eliminating or effectively reducing potential harms in protection of medical confidentiality and its disclosure.