privacy and confidentiality

In the terse legal maxim of Warren and Brandeis (1890), privacy is simply "the right to be left alone." More broadly, privacy can be thought of as describing conditions of limited accessibility to various aspects of an individual -- both physical and informational.

Definitions of privacy include the capacity to be physically alone (solitude); to be free from physical interference, threat or unwanted touching (assault, battery); or to avoid being seen or overheard in particular contexts. Privacy also refers to the capacity to control when, how and to what degree information about oneself is communicated to others.

A broad range of social and legal institutions set the terms of privacy, and societies can and do lay out the boundaries very differently. New technologies can challenge old understandings of privacy, as, for example, new computer and communications systems are doing today.

The problems posed by evolving technology are not new: The famous "right to be left alone" quote comes to us from a world where privacy was seen as threatened by, among other things, the technologies that allowed still photographs to appear in mass-circulation newspapers.

Confidentiality is closely related to privacy, but not identical. It refers to the obligations of individuals and institutions to use information under their control appropriately once it has been disclosed to them. One observes rules of confidentiality out of respect for, and to protect and preserve, the privacy of others.

Information disclosures can come in the context of an intimate relationship, such as between close friends. Or they can occur in the context of a professional relationship, such as that between doctor and patient. The implicit and explicit terms of the latter "privacy contract" are conditioned by custom, legal and regulatory strictures, and professional norms.

The ethical principal of autonomy or self determination requires respect for each individual’s choices about uses and disclosures of his/her own information, as it does for privacy generally. But individual control must obviously be weighed against other goals achievable only by limits on privacy.

Privacy may be "traded" for truly collective goods -- such as, in the health sector, use of individual data for medical research, or to protect unknowable others by mandating reporting of certain diseases (public health surveillance).

Tradeoffs may also be presented to each individual -- e.g., the ability to secure appropriate medical treatment (requiring disclosure of symptoms and behavior), or to obtain reimbursement from third-party payers for that treatment.

The concepts associated with privacy and confidentiality bring forward a very complex set of considerations, definitions and expectations, which often complicate the problem of achieving consensus on particular policies. The definitions here are necessarily brief -- and would not necessarily secure universal agreement.

Whether privacy is a "right," for example, is a matter of some debate. Privacy is enumerated as a right in documents such as the Universal Declaration of Human Rights and the constitutions of many US states (such as Florida). It does not receive specific mention in the US federal Constitution, however, though some feel it is implied within/by the Bill of Rights.

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   © 2002-2006 Contributing authors and University of Miami School of Medicine