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Muhsin SM. Islamic Jurisprudence on Harm Versus Harm Scenarios in Medical Confidentiality. HEC Forum 2024; 36:291-316. [PMID: 36609719 PMCID: PMC9825058 DOI: 10.1007/s10730-022-09503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/08/2023]
Abstract
Although medical confidentiality is widely recognized as an essential principle in the therapeutic relationship, its systematic and coherent practice has been an ethically challenging duty upon healthcare providers due to various concerns of clinical, moral, religious, social, ethical and legal natures. Medical confidentiality can be breached to protect the patient and/or others if maintaining confidentiality causes serious harm. Healthcare professionals may encounter complicated situations whereby the divulgence of a patient's confidential information may pose a threat to one party whereas the concealment of such information may cause harm to another. After deliberating on the Islamic concept of harm (ḍarar), this paper focuses on the dual duty and conflicts of interests faced by healthcare professionals in the practice of medical confidentiality. Referring to serious infectious diseases with a special mention of AIDS, this study also provides discourse on how healthcare professionals deal with difficult scenarios of conflicts of interests and ethical dilemmas.
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Affiliation(s)
- Sayyed Mohamed Muhsin
- Department of Fiqh and Uṣūl al-Fiqh, International Islamic University Malaysia, Kuala Lumpur, Malaysia.
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2
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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3
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics 2024; 153:e2024066326. [PMID: 38646690 DOI: 10.1542/peds.2024-066326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is an essential component of high-quality health care for adolescents and young adults and can have an impact on the health care experiences and health outcomes of youth. Federal and state laws, professional guidelines, and ethical standards provide a core framework for guidance in the implementation of confidentiality protections in clinical practice. This policy statement provides recommendations for pediatricians and other pediatric health care professionals, clinics, health systems, payers, and electronic health record developers to optimize confidentiality practices and protections for adolescents and young adults across the spectrum of care.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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4
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Duffourc MN, Gerke S. Health Care AI and Patient Privacy-Dinerstein v Google. JAMA 2024; 331:909-910. [PMID: 38373004 DOI: 10.1001/jama.2024.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
This Viewpoint summarizes a recent lawsuit alleging that a hospital violated patients’ privacy by sharing electronic health record (EHR) data with Google for development of medical artificial intelligence (AI) and discusses how the federal court’s decision in the case provides key insights for hospitals planning to share EHR data with for-profit companies developing medical AI.
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Affiliation(s)
| | - Sara Gerke
- Penn State Dickinson Law, Carlisle, Pennsylvania
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5
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Kashetsky N, Mar K, Liu C, Rivers JK, Mukovozov I. Fotografie in der Dermatologie - ein Scoping Review: Praktiken, Skin of Color, Patientenpräferenzen und medizinisch-rechtliche Überlegungen. J Dtsch Dermatol Ges 2023; 21:1102-1108. [PMID: 37845067 DOI: 10.1111/ddg.15129_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 04/13/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungDie klinische Fotografie ist essentiell für die Dermatologie. Es gibt jedoch keine umfassende Aufarbeitung der Literatur zur Fotografie in der Dermatologie. Dieser Scoping Review soll die Literatur zu fotografischen Praktiken in der Dermatologie, der Fotografie stark pigmentierter Haut (Skin of Color), Patientenpräferenzen und medizinisch‐rechtlichen Überlegungen zusammenfassen. Die Datenbanken Embase, MEDLINE, PubMed und Evidence Based Medicine wurden im Einklang mit der PRISMA‐Erweiterung für Scoping Reviews durchsucht. Insgesamt wurden 33 Studien zusammengefasst. Die klinische Fotografie wird häufig für die Markierung von Biospiestellen, Beurteilung, Diagnostik, Krankheitsüberwachung, Bewertung des Ansprechens auf die Behandlung, medizinische Ausbildung, Forschung, das Einholen kollegialer Ratschläge und in der Teledermatologie eingesetzt. Obwohl es in der dermatologischen Fotografie weiterhin kaum Darstellungen von Skin of Color gibt, sind fotografische Überlegungen für dunklere Hauttypen verfügbar. Die meisten Patienten unterstützen die medizinische Fotografie. Dabei besteht der Wunsch, dass klinische Fotografien vom eigenen Arzt aufgenommen und bevorzugt klinikeigene Kameras und keine persönlichen Geräte verwendet werden. Relevante medizinisch‐rechtliche Fragestellungen umfassen Bedenken hinsichtlich des Datenschutzes, der Verwendung persönlicher Geräte und der Dokumentation der Einwilligung. Die Fotografie in der Dermatologie entwickelt sich ständig weiter und findet immer breitere Anwendung. Verbesserte Verfahren und Innovationen werden Menschen aller Hautfarben zugute kommen. Die Einhaltung der Zustimmung und des Datenschutzes muss gewährleistet werden, um die zunehmende Einfachheit der Bildaufnahme und ‐freigabe aufrechtzuerhalten.
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Affiliation(s)
- Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Neufundland und Labrador, Kanada
| | - Kristie Mar
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Kanada
| | - Chaocheng Liu
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Kanada
| | - Jason K Rivers
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Kanada
- Pacific Derm, Vancouver, British Columbia, Kanada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Kanada
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6
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Levi M. [When quality improvement clashes with privacy regulations]. Ned Tijdschr Geneeskd 2022; 166:D6551. [PMID: 35138758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Continuity in patient care is crucial but is not a 'given' in complex circumstances when several health care professionals are involved in a clinical trajectory. Discontinuity may make it difficult to follow a patient's clinical course, which can be instructive and providing useful feedback on professional performance. Hence, it is a good clinical habit to check on patients after the care has been taken over by others. However, too strict interpretation of privacy laws and regulation may hamper this valuable practice. Obviously, protection of medical information and patients' privacy is vital, however, this should not apply to health care professionals that were involved in earlier phases of a patient's care as they should be considered having a continuing care relationship with the patient. Interestingly, a vast majority of patients themselves have no concern at all when professionals that were involved in earlier phases of their care access their information.
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Affiliation(s)
- Marcel Levi
- Amsterdam Universitair Medische Centra, afd. Inwendige Geneeskunde, Amsterdam
- Contact: Marcel Levi
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Freeberg MA, Fromont LA, D’Altri T, Romero AF, Ciges J, Jene A, Kerry G, Moldes M, Ariosa R, Bahena S, Barrowdale D, Barbero M, Fernandez-Orth D, Garcia-Linares C, Garcia-Rios E, Haziza F, Juhasz B, Llobet O, Milla G, Mohan A, Rueda M, Sankar A, Shaju D, Shimpi A, Singh B, Thomas C, de la Torre S, Uyan U, Vasallo C, Flicek P, Guigo R, Navarro A, Parkinson H, Keane T, Rambla J. The European Genome-phenome Archive in 2021. Nucleic Acids Res 2022; 50:D980-D987. [PMID: 34791407 PMCID: PMC8728218 DOI: 10.1093/nar/gkab1059] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 12/27/2022] Open
Abstract
The European Genome-phenome Archive (EGA - https://ega-archive.org/) is a resource for long term secure archiving of all types of potentially identifiable genetic, phenotypic, and clinical data resulting from biomedical research projects. Its mission is to foster hosted data reuse, enable reproducibility, and accelerate biomedical and translational research in line with the FAIR principles. Launched in 2008, the EGA has grown quickly, currently archiving over 4,500 studies from nearly one thousand institutions. The EGA operates a distributed data access model in which requests are made to the data controller, not to the EGA, therefore, the submitter keeps control on who has access to the data and under which conditions. Given the size and value of data hosted, the EGA is constantly improving its value chain, that is, how the EGA can contribute to enhancing the value of human health data by facilitating its submission, discovery, access, and distribution, as well as leading the design and implementation of standards and methods necessary to deliver the value chain. The EGA has become a key GA4GH Driver Project, leading multiple development efforts and implementing new standards and tools, and has been appointed as an ELIXIR Core Data Resource.
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Affiliation(s)
- Mallory Ann Freeberg
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Lauren A Fromont
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Teresa D’Altri
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Anna Foix Romero
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Jorge Izquierdo Ciges
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Aina Jene
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Giselle Kerry
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Mauricio Moldes
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Roberto Ariosa
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Silvia Bahena
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Daniel Barrowdale
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Marcos Casado Barbero
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Dietmar Fernandez-Orth
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Carles Garcia-Linares
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Emilio Garcia-Rios
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Frédéric Haziza
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Bela Juhasz
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Oscar Martinez Llobet
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Gemma Milla
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Anand Mohan
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Manuel Rueda
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Aravind Sankar
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Dona Shaju
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Ashutosh Shimpi
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Babita Singh
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Coline Thomas
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Sabela de la Torre
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Umuthan Uyan
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Claudia Vasallo
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Paul Flicek
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Roderic Guigo
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Arcadi Navarro
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
| | - Helen Parkinson
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Thomas Keane
- European Molecular Biology Laboratory - European Bioinformatics Institute (EMBL-EBI), Hinxton CB10 1SD, UK
| | - Jordi Rambla
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Dr Aiguader 88, Barcelona 08003, Spain
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Dove ES, Taylor MJ. Signalling Standards for Progress: Bridging the Divide Between a Valid Consent to Use Patient Data Under Data Protection Law and the Common Law Duty of Confidentiality. Med Law Rev 2021; 29:411-445. [PMID: 34270741 PMCID: PMC8500295 DOI: 10.1093/medlaw/fwab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article, we analyse the legal components of disclosing confidential patient information under the UK's common law duty of confidentiality (CLDoC) and processing personal (health) data under the UK's General Data Protection Regulation (GDPR) and Data Protection Act 2018. We describe the ostensible divide between the CLDoC and data protection law when it comes to the requirements of a valid signal of consent by a patient to use and disclose patient information, obtained by a health professional in the context of direct care, for health care and health research purposes. Ultimately, our analysis suggests that we are saddled, at least in the medium term, with two regimes operating with different standards of a valid consent-while putatively protecting similar interests. There is, however, opportunity for progress. It is possible to improve professional guidance on the interaction between the regimes and to achieve significant normative alignment without aligning the signalling standard for consent; this would promote consistent protection of reasonable expectations of patients across both regimes. Further coherence would require aligning not only the standard, but also the role played by consent under each regime. Here we argue that, in relation to direct care, any such shift should be away from consent as the normal justification. In relation to health research, on the contrary, it should be toward consent as the normal justification for use and disclosure of patient information under both the CLDoC and data protection law.
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Affiliation(s)
| | - Mark J Taylor
- Melbourne Law School, University of Melbourne, Australia
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Abstract
EU data protection law and medical research ethics overlap in scope and content in numerous instances in which personal data are processed in medical research. It is not always the case, however, that the conditions outlined by the two rule-sets precisely coincide. In the past few years, this lack of confluence has led to confusion as to how the two rule-sets should best relate to one another. This confusion has led to different approaches to the relationship being taken, on occasion leading to counter-intuitive conclusions. Unfortunately, there has hitherto been little effort to provide clarity to this confusion. In this regard, this article attempts to provide a general normative framework aimed at facilitating optimally cogent and just reconciliations of EU data protection law and medical research ethics.
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Affiliation(s)
- Dara Hallinan
- Intellectual property rights in distributed information infrastructures, FIZ Karlsruhe - Leibniz Institute for Information Infrastructure, Hermann-von-Helmholtz-Platz 1, 76344, Eggenstein-Leopoldshafen, Germany
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10
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Neilan AM, Salvant Valentine S, Knopf AS. Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus Prophylaxis. N Engl J Med 2021; 385:1034-1041. [PMID: 34496178 DOI: 10.1056/nejmcpc1909626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anne M Neilan
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Sheila Salvant Valentine
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Amelia S Knopf
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
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11
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Foster C, Gilbar R. Is there a New Duty to Warn Family Members in English Medical Law? ABC V ST George's Healthcare NHS Trust and Others [2020] EWHC 4551. Med Law Rev 2021; 29:359-372. [PMID: 33694361 DOI: 10.1093/medlaw/fwab006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford OX1 3UL, UK
| | - Roy Gilbar
- School of Law, Netanya Academic College, Netanya, Israel
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12
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Affiliation(s)
- Anita L Allen
- From the University of Pennsylvania School of Law, Philadelphia
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13
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Thoral PJ, Peppink JM, Driessen RH, Sijbrands EJG, Kompanje EJO, Kaplan L, Bailey H, Kesecioglu J, Cecconi M, Churpek M, Clermont G, van der Schaar M, Ercole A, Girbes ARJ, Elbers PWG. Sharing ICU Patient Data Responsibly Under the Society of Critical Care Medicine/European Society of Intensive Care Medicine Joint Data Science Collaboration: The Amsterdam University Medical Centers Database (AmsterdamUMCdb) Example. Crit Care Med 2021; 49:e563-e577. [PMID: 33625129 PMCID: PMC8132908 DOI: 10.1097/ccm.0000000000004916] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Critical care medicine is a natural environment for machine learning approaches to improve outcomes for critically ill patients as admissions to ICUs generate vast amounts of data. However, technical, legal, ethical, and privacy concerns have so far limited the critical care medicine community from making these data readily available. The Society of Critical Care Medicine and the European Society of Intensive Care Medicine have identified ICU patient data sharing as one of the priorities under their Joint Data Science Collaboration. To encourage ICUs worldwide to share their patient data responsibly, we now describe the development and release of Amsterdam University Medical Centers Database (AmsterdamUMCdb), the first freely available critical care database in full compliance with privacy laws from both the United States and Europe, as an example of the feasibility of sharing complex critical care data. SETTING University hospital ICU. SUBJECTS Data from ICU patients admitted between 2003 and 2016. INTERVENTIONS We used a risk-based deidentification strategy to maintain data utility while preserving privacy. In addition, we implemented contractual and governance processes, and a communication strategy. Patient organizations, supporting hospitals, and experts on ethics and privacy audited these processes and the database. MEASUREMENTS AND MAIN RESULTS AmsterdamUMCdb contains approximately 1 billion clinical data points from 23,106 admissions of 20,109 patients. The privacy audit concluded that reidentification is not reasonably likely, and AmsterdamUMCdb can therefore be considered as anonymous information, both in the context of the U.S. Health Insurance Portability and Accountability Act and the European General Data Protection Regulation. The ethics audit concluded that responsible data sharing imposes minimal burden, whereas the potential benefit is tremendous. CONCLUSIONS Technical, legal, ethical, and privacy challenges related to responsible data sharing can be addressed using a multidisciplinary approach. A risk-based deidentification strategy, that complies with both U.S. and European privacy regulations, should be the preferred approach to releasing ICU patient data. This supports the shared Society of Critical Care Medicine and European Society of Intensive Care Medicine vision to improve critical care outcomes through scientific inquiry of vast and combined ICU datasets.
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Affiliation(s)
- Patrick J Thoral
- Department of Intensive Care Medicine, Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Jan M Peppink
- Department of Intensive Care Medicine, Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Ronald H Driessen
- Department of Intensive Care Medicine, Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | | | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Lewis Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Executive Committee, Society of Critical Care Medicine, Mount Prospect, IL
| | - Heatherlee Bailey
- Department of Emergency Medicine, Durham VA Medical Center, Durham, NC
- Executive Committee, Society of Critical Care Medicine, Mount Prospect, IL
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Executive Committee, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Maurizio Cecconi
- Executive Committee, European Society of Intensive Care Medicine, Brussels, Belgium
- Department of Anaesthesia and Intensive Care, Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Matthew Churpek
- Department of Medicine, University of Wisconsin, Madison, WI
| | - Gilles Clermont
- Department of Critical Care Medicine, CRISMA Laboratory, University of Pittsburgh, Pittsburgh, PA
| | - Mihaela van der Schaar
- University of Cambridge, Cambridge, United Kingdom
- Alan Turing Institute, London, United Kingdom
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
- Data Science Section, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Executive Committee, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Vrije Universiteit, Universiteit van Amsterdam, Amsterdam, The Netherlands
- Data Science Section, European Society of Intensive Care Medicine, Brussels, Belgium
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Abstract
Since 1980. the Supreme Court of Canada has handed down two judgments which have had a major impact on the law of informed consent in this country. These are Reibl v. Hughes and Hopp v. Lepp. The doctrine of therapeutic privilege, the subject of this article, was discussed in both cases. But, in order to examine this doctrine, first, a brief explanation of the Court's more fundamental ruling on the doctrine of informed consent is needed.The Basic Structure of Informed Consent and Therapeutic PrivilegeCiting and relying on the United States case of Canterbury v. Spence, the Supreme Court of Canada changed the reference point for establishing the standard to be used to determine the legally required scope of disclosure of information to a patient in order to obtain his or her informed consent. Previously, this standard had been set according to the information that “the reasonable physician in the same circumstances” would disclose. It became what “the reasonable patient in those circumstance? would want to know, which encompasses information concerning “the nature of the proposed operation, its gravity, any material risks and any special or unusual risks attendant upon the performance of the operation.”
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15
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Abstract
Daniel E Ho and colleagues explore the legal implications of using artificial intelligence in the response to covid-19 and call for more robust evaluation frameworks
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Affiliation(s)
- Mark Krass
- Stanford Law School, Stanford University, Stanford, CA, USA
- Department of Political Science, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Peter Henderson
- Stanford Law School, Stanford University, Stanford, CA, USA
- Department of Computer Science, Stanford University School of Engineering, Stanford, CA, USA
| | - Michelle M Mello
- Stanford Law School, Stanford University, Stanford, CA, USA
- Stanford Health Policy and Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David M Studdert
- Stanford Law School, Stanford University, Stanford, CA, USA
- Stanford Health Policy and Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel E Ho
- Stanford Law School, Stanford University, Stanford, CA, USA
- Department of Political Science, Stanford University School of Humanities and Sciences, Stanford, CA, USA
- Stanford Institute for Human-Centered Artificial Intelligence, Stanford, CA, USA
- Stanford Institute for Economic Policy Research, Stanford, CA, USA
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16
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Gómez Arias PJ, Abad Arenas E, Arias Blanco MC, Redondo Sánchez J, Galán Gutiérrez M, Vélez García-Nieto AJ. Medical and Legal Aspects of the Practice of Teledermatology in Spain. Actas Dermosifiliogr (Engl Ed) 2021; 112:127-133. [PMID: 33035496 PMCID: PMC7537602 DOI: 10.1016/j.ad.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022] Open
Abstract
Teledermatology is now fully incorporated into our clinical practice. However, after reviewing current legislation on the ethical aspects of teledermatology (data confidentiality, quality of care, patient autonomy, and privacy) as well as insurance and professional responsibility, we observed that a specific regulatory framework is still lacking and related legal aspects are still at a preliminary stage of development. Safeguarding confidentiality and patient autonomy and ensuring secure storage and transfer of data are essential aspects of telemedicine. One of the main topics of debate has been the responsibilities of the physicians involved in the process, with the concept of designating a single responsible clinician emerging as a determining factor in the allocation of responsibility in this setting. A specific legal and regulatory framework must be put in place to ensure the safe practice of teledermatology for medical professionals and their patients.
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Affiliation(s)
- P J Gómez Arias
- UGC de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, España.
| | - E Abad Arenas
- Departamento de Derecho Civil, Facultad de Derecho, Universidad Nacional de Educación a Distancia, Madrid, España
| | - M C Arias Blanco
- Consultorio de Villaharta. UGC La Sierra. Distrito Córdoba-Guadalquivir, Córdoba, España
| | - J Redondo Sánchez
- Centro de Salud Lucano. UGC Lucano. Distrito Córdoba-Guadalquivir, Córdoba, España
| | - M Galán Gutiérrez
- UGC de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, España
| | - A J Vélez García-Nieto
- UGC de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Reina Sofía, Córdoba, España
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17
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Goffin T. European Court of Human Rights. Eur J Health Law 2021; 28:103-107. [PMID: 33652381 DOI: 10.1163/15718093-12423532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Tom Goffin
- Faculty of Health Law and Health Sciences, University of Ghent Ghent Belgium
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19
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Theodos K, Sittig S. Health Information Privacy Laws in the Digital Age: HIPAA Doesn't Apply. Perspect Health Inf Manag 2020; 18:1l. [PMID: 33633522 PMCID: PMC7883355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The notion of health information privacy has evolved over time as the healthcare industry has embraced technology. Where once individuals were concerned about the privacy of their conversations and financial information, the digitization of health data has created new challenges for those responsible for ensuring that patient information remains secure and private. Coupled with the lack of updated, overarching legislation, a critical gap exists between advancements in technology, consumer informatics tools and privacy regulations. Almost twenty years after the HIPAA (Health Insurance Portability and Accountability Act) compliance date, the healthcare industry continues to seek solutions to privacy challenges absent formal contemporary law. Since HIPAA, a few attempts have been made to control specific aspects of health information including genetic information and use of technology however none were visionary enough to address issues seen in today's digital data focused healthcare environment. The proliferation of digital health data, trends in data use, increased use of telehealth applications due to COVID-19 pandemic and the consumer's participatory role in healthcare all create new challenges not covered by the existing legal framework. Modern efforts to address this dilemma have emerged in state and international law though the United States healthcare industry continues to operate under a law written two decades ago. As technology continues to advance at a rapid pace along with consumers playing a greater role in the management of their healthcare through digital health the privacy guidance provided by federal law must also shift to reflect the new reality.
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Affiliation(s)
| | - Scott Sittig
- is assistant professor School of Computing, University of South Alabama
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Dawson L, Benbow N, Fletcher FE, Kassaye S, Killelea A, Latham SR, Lee LM, Leitner T, Little SJ, Mehta SR, Martinez O, Minalga B, Poon A, Rennie S, Sugarman J, Sweeney P, Torian LV, Wertheim JO. Addressing Ethical Challenges in US-Based HIV Phylogenetic Research. J Infect Dis 2020; 222:1997-2006. [PMID: 32525980 PMCID: PMC7661760 DOI: 10.1093/infdis/jiaa107] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/06/2020] [Indexed: 12/29/2022] Open
Abstract
In recent years, phylogenetic analysis of HIV sequence data has been used in research studies to investigate transmission patterns between individuals and groups, including analysis of data from HIV prevention clinical trials, in molecular epidemiology, and in public health surveillance programs. Phylogenetic analysis can provide valuable information to inform HIV prevention efforts, but it also has risks, including stigma and marginalization of groups, or potential identification of HIV transmission between individuals. In response to these concerns, an interdisciplinary working group was assembled to address ethical challenges in US-based HIV phylogenetic research. The working group developed recommendations regarding (1) study design; (2) data security, access, and sharing; (3) legal issues; (4) community engagement; and (5) communication and dissemination. The working group also identified areas for future research and scholarship to promote ethical conduct of HIV phylogenetic research.
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Affiliation(s)
- Liza Dawson
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Nanette Benbow
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Faith E Fletcher
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Amy Killelea
- National Alliance of State and Territorial AIDS Directors, Washington, District of Columbia, USA
| | - Stephen R Latham
- Yale Interdisciplinary Center for Bioethics, New Haven, Connecticut, USA
| | - Lisa M Lee
- Virginia Tech, Blacksburg, Virginia, USA
| | - Thomas Leitner
- Los Alamos National Laboratory, Los Alamos, New Mexico, USA
| | - Susan J Little
- University of California at San Diego, San Diego, California, USA
| | - Sanjay R Mehta
- University of California at San Diego, San Diego, California, USA
| | | | - Brian Minalga
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Art Poon
- University of Western Ontario, London, Ontario, Canada
| | - Stuart Rennie
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Patricia Sweeney
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lucia V Torian
- New York City Department of Health, New York, New York, USA
| | - Joel O Wertheim
- University of California at San Diego, San Diego, California, USA
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21
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Knox R. Fourth Amendment Protections of Prescription Drug Monitoring Programs: Patient Privacy in the Opioid Crisis. Am J Law Med 2020; 46:375-411. [PMID: 33413012 DOI: 10.1177/0098858820975531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The opioid crisis is one of the largest public health problems in the history of the United States. Prescription drug monitoring programs ("PDMPs")-state databases containing the records of all prescriptions for controlled substances written in the state-have emerged as a means to track opioid prescribing and use. While PDMPs are typically used as a tool for physicians to inform their prescribing practices, many states also permit law enforcement to access PDMPs when investigating controlled substance distribution, often without prior judicial approval. Such law enforcement use of PDMPs raises serious questions of patient privacy. The Fourth Amendment protects individuals from unreasonable searches and seizures where they have a reasonable expectation of privacy and has been interpreted to require law enforcement have probable cause and a search warrant before infringing upon an individual's reasonable expectation of privacy. Several courts have held that patients have no reasonable expectation of privacy, or a severely diminished expectation of privacy, in their prescription drug records held in PDMPs. As support, courts rely on the third-party doctrine because the information is disclosed to physicians and then held by the state; the highly regulated nature of the prescription drug industry; and the statutory framework of the Controlled Substances Act. Such analysis disregards patients' expectation of privacy in their personal health information, the confidentiality in the physician-patient relationship, and the resulting patient incentives not to seek care. Therefore, this Article argues that law enforcement must have probable cause and a search warrant to access PDMPs because the exceptions to the Fourth Amendment's probable cause and warrant requirements do not apply.
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Affiliation(s)
- Ryan Knox
- Senior Research Fellow, Solomon Center for Health Law and Policy at Yale Law School. J.D., 2019, New York University School of Law; B.S., Health Science, 2016, Boston University. For helpful conversations and comments on earlier drafts of this article and the moot court problem which inspired this article, I would like to thank Nicholas Bagley, Mary Ann Chirba, Ariel Geist, Randy Hertz, Orin Kerr, Sylvia Law, Madhu Swarna, the staff of the N.Y.U. Moot Court Board, the judges and competitors in the 2019 Wendell F. Grimes Moot Court Competition at Boston College Law School, and the staff and anonymous peer reviewer of the American Journal of Law and Medicine. An extra special thank you to Mary Ann Chirba, who supervised my work on the moot court problem that inspired this piece and gave extensive comments on earlier drafts of this article. All opinions and errors are my own
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22
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The Physician's Responsibility: An Important Decision on Professional Secrecy. JAMA 2020; 324:1685. [PMID: 33107931 DOI: 10.1001/jama.2019.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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23
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Abstract
Smartphone apps to track SARS-CoV 2 infections need to fulfill certain minimal requirements to guarantee privacy and justify their use under data protection laws.
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Affiliation(s)
- Corrette Ploem
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Jeanine Suurmond
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam
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25
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Véliz C. Not the doctor's business: Privacy, personal responsibility and data rights in medical settings. Bioethics 2020; 34:712-718. [PMID: 32060936 PMCID: PMC7587002 DOI: 10.1111/bioe.12711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 10/28/2019] [Accepted: 12/03/2019] [Indexed: 05/27/2023]
Abstract
This paper argues that assessing personal responsibility in healthcare settings for the allocation of medical resources would be too privacy-invasive to be morally justifiable. In addition to being an inappropriate and moralizing intrusion into the private lives of patients, it would put patients' sensitive data at risk, making data subjects vulnerable to a variety of privacy-related harms. Even though we allow privacy-invasive investigations to take place in legal trials, the justice and healthcare systems are not analogous. The duty of doctors and healthcare professionals is to help patients as best they can-not to judge them. Patients should not be forced into giving up any more personal information than what is strictly necessary to receive an adequate treatment, and their medical data should only be used for appropriate purposes. Medical ethics codes should reflect these data rights. When a doctor asks personal questions that are irrelevant to diagnose or treat a patient, the appropriate response from the patient is: 'none of your business'.
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Affiliation(s)
- Carissa Véliz
- University of OxfordUehiro Centre for Practical EthicsWellcome Centre for Ethics and HumanitiesFaculty of PhilosophyUnited Kingdom of Great Britain and Northern Ireland
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26
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Nys H. European Court of Human Rights. Eur J Health Law 2020; 27:405-410. [PMID: 33878721 DOI: 10.1163/15718093-12423529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Herman Nys
- Editor-in-Chief, European Journal of Health Law Professor Emeritus of Health Law, KU Leuven Leuven First Vice Chair, European Group on Ethics in Science and New Technologies, European Commission Brussels Belgium
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27
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Affiliation(s)
- Sirina Keesara
- From the Clinical Excellence Research Center, Stanford University School of Medicine (S.K., A.J., K.S.), and the Stanford University Graduate School of Business (K.S.) - both in Stanford, CA
| | - Andrea Jonas
- From the Clinical Excellence Research Center, Stanford University School of Medicine (S.K., A.J., K.S.), and the Stanford University Graduate School of Business (K.S.) - both in Stanford, CA
| | - Kevin Schulman
- From the Clinical Excellence Research Center, Stanford University School of Medicine (S.K., A.J., K.S.), and the Stanford University Graduate School of Business (K.S.) - both in Stanford, CA
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Flanagin A, Bauchner H, Fontanarosa PB. Patient and Study Participant Rights to Privacy in Journal Publication. JAMA 2020; 323:2147-2150. [PMID: 32484519 DOI: 10.1001/jama.2020.3590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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29
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Affiliation(s)
- Elias Ghossoub
- Dr. Ghossoub is an Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Faculty of Medicine and The Medical Center, Beirut, Lebanon. Dr. Newman is a Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, Saint Louis University, Saint Louis, MO.
| | - William J Newman
- Dr. Ghossoub is an Assistant Professor of Clinical Psychiatry, Department of Psychiatry, American University of Beirut, Faculty of Medicine and The Medical Center, Beirut, Lebanon. Dr. Newman is a Professor of Psychiatry, Department of Psychiatry and Behavioral Neurosciences, Saint Louis University, Saint Louis, MO
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30
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31
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Bonifazi F, Volpe E, Digregorio G, Giannuzzi V, Ceci A. Machine Learning Systems Applied to Health Data and System. Eur J Health Law 2020; 27:242-258. [PMID: 33652397 DOI: 10.1163/15718093-bja10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The use of machine learning (ML) in medicine is becoming increasingly fundamental to analyse complex problems by discovering associations among different types of information and to generate knowledge for medical decision support. Many regulatory and ethical issues should be considered. Some relevant EU provisions, such as the General Data Protection Regulation, are applicable. However, the regulatory framework for developing and marketing a new health technology implementing ML may be quite complex. Other issues include the legal liability and the attribution of negligence in case of errors. Some of the above-mentioned concerns could be, at least partially, resolved in case the ML software is classified as a 'medical device', a category covered by EU/national provisions. Concluding, the challenge is to understand how sustainable is the regulatory system in relation to the ML innovation and how legal procedures should be revised in order to adapt them to the current regulatory framework.
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Affiliation(s)
- Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Elisabetta Volpe
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | | | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Bari Italy
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Altavilla A, Giannuzzi V, Lupo M, Bonifazi D, Ceci A. Ethical, Legal and Regulatory Issues of Paediatric Translational Research. Call for an Adequate Model of Governance. Eur J Health Law 2020; 27:213-231. [PMID: 33652400 DOI: 10.1163/15718093-bja10010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The lack of paediatric medicines, including innovative and advanced ones, is a long-lasting and well-known problem at European and international levels. Despite the existing legal frameworks and incentives, children remain deprived of many kinds of therapy because of challenges faced in appropriately study and tailoring medicinal and other products for them. In this context, the necessity to foster paediatric research addressing unsolved and uncovered issues within a 'translational approach' has appeared. This article, after having clarified the concept of translational research in the perspective of the establishment of a European paediatric research infrastructure (RI), will identify and point out ethical, legal and regulatory issues particularly relevant in a children's rights perspective. It concludes asking for the setting up of an adequate model of governance within a future RI, including adequate and independent ethical oversight and a pluridisciplinary common service dealing with ethical, legal and societal issues relevant for children.
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Affiliation(s)
- Annagrazia Altavilla
- Espace Éthique Méditerranéen/PACA-Corse, Assistance Publique Hôpitaux de Marseille/Aix-Marseille Université Marseille France TEDDYChair
- TEDDY (European Network of Excellence for Paediatric Research) Pavia Italy
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus Bari Italy
- TEDDY (European Network of Excellence for Paediatric Research) Pavia Italy
| | - Mariangela Lupo
- TEDDY (European Network of Excellence for Paediatric Research) Pavia Italy
| | - Donato Bonifazi
- TEDDY (European Network of Excellence for Paediatric Research) Pavia Italy
- Consorzio per Valutazioni Biologiche e Farmacologiche Bari Italy Coordinator, European Paediatric Translational Research Infrastructure (EPTRI)
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus Bari Italy
- TEDDY (European Network of Excellence for Paediatric Research) Pavia Italy
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Herveg J, Altavilla A. Introducing Key Elements Regarding Access to Personal Data for Scientific Research in the Perspective of Developing Innovative Medicines. Eur J Health Law 2020; 27:195-212. [PMID: 33652399 DOI: 10.1163/15718093-bja10011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This article aims at opening discussions and promoting future research about key elements that should be taken into account when considering new ways to organise access to personal data for scientific research in the perspective of developing innovative medicines. It provides an overview of these key elements: the different ways of accessing data, the theory of the essential facilities, the Regulation on the Free Flow of Non-personal Data, the Directive on Open Data and the re-use of public sector information, and the General Data Protection Regulation (GDPR) rules on accessing personal data for scientific research. In the perspective of fostering research, promoting innovative medicines, and having all the raw data centralised in big databases localised in Europe, we suggest to further investigate the possibility to find acceptable and balanced solutions with complete respect of fundamental rights, as well as for private life and data protection.
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Affiliation(s)
- Jean Herveg
- CRIDS (Research Centre on Information, Law & Society), Faculty of Law, University of Namur Namur Belgium Bar of Brussels
| | - Annagrazia Altavilla
- Lawyer, responsible for International Relations, Espace Éthique Méditerranéen/PACA-Corse, Assistance Publique Hôpitaux de Marseille/Aix-Marseille Université Marseille France
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Abstract
"Big Data represents a challenge that points to the need for collective and political approaches to self-protection rather than solely individual, atomistic approaches."- Anita Allen, "Protecting One's Own Privacy in a Big Data Economy".
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35
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Beauvais M, Knoppers BM. When information is the treatment? Precision medicine in healthcare. Healthc Manage Forum 2020; 33:120-125. [PMID: 31505971 DOI: 10.1177/0840470419859017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Profoundly more data-intensive than conventional medicine, precision medicine's distinctive informational needs present new challenges for healthcare management. Data protection and privacy law are key determinants in precision medicine's future. This article examines legal and regulatory barriers to the incorporation of precision medicine into healthcare. Specific attention is paid to analyzing recent health privacy laws, court cases, and medical device regulations. Considering the challenges identified, recommendations and guidance are crafted for health leaders with reference to domestic and international initiatives.
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Affiliation(s)
- Michael Beauvais
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Abstract
This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed.
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Affiliation(s)
- Joseph H Kahn
- Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA.
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37
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McQuoid-Mason DJ. COVID-19 and patient-doctor confidentiality. S Afr Med J 2020; 110:461-462. [PMID: 32880552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023] Open
Abstract
Given the increasing numbers of ethical and legal issues arising from the COVID-19 epidemic, particularly in respect of patient-doctor confidentiality, doctors must explain to patients how the measures taken to combat the spread of the virus impact on their confidentiality. Patients must be reassured that doctors are ethically bound to continue to respect such confidentiality, but it should be made clear to them that doctors must also comply with the demands of the law. While the Constitution, statutory law and the common law all recognise a person's right to privacy, during extraordinary times such as the COVID-19 pandemic, confidentiality must be breached to a degree to halt the spread of the virus.
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Affiliation(s)
- D J McQuoid-Mason
- Centre for Socio-Legal Studies, University of KwaZulu-Natal, Durban, South Africa.
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38
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Affiliation(s)
- John Finch
- Freelance journalist specialising in legal and ethical issues in healthcare
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39
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Prata Ribeiro H, Ponte A, Robalo Cordeiro F, Vieira F. [The New General Data Protection Regulation and Its Implications Regarding Clinical Information Requests to Healthcare Professionals]. ACTA MEDICA PORT 2020; 33:221-224. [PMID: 32238234 DOI: 10.20344/amp.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/20/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Henrique Prata Ribeiro
- Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Deputado da iniciativa Health Parliament Portugal 2020. Lisboa. Portugal
| | - André Ponte
- Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | | | - Fernando Vieira
- Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal
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40
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Thornton J. Judgment in ABC case rules on confidentiality. Lancet 2020; 395:771-772. [PMID: 32145779 DOI: 10.1016/s0140-6736(20)30494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Verhenneman G, Claes K, Derèze JJ, Herijgers P, Mathieu C, Rademakers FE, Reyda R, Vanautgaerden M. How GDPR Enhances Transparency and Fosters Pseudonymisation in Academic Medical Research. Eur J Health Law 2020; 27:35-57. [PMID: 33652409 DOI: 10.1163/15718093-12251009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The European General Data Protection Regulation (GDPR) has dotted the i's and crossed the t's in the context of academic medical research. One year into GDPR, it is clear that a change of mind and the uptake of new procedures is required. Research organisations have been looking at the possibility to establish a code-of-conduct, good practices and/or guidelines for researchers that translate GDPR's abstract principles to concrete measures suitable for implementation. We introduce a proposal for the implementation of GDPR in the context of academic research which involves the processing of health related data, as developed by a multidisciplinary team at the University Hospitals Leuven. The proposal is based on three elements, three stages and six specific safeguards. Transparency and pseudonymisation are considered key to find a balance between the need for researchers to collect and analyse personal data and the increasing wish of data subjects for informational control.
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Affiliation(s)
- G Verhenneman
- University Hospitals Leuven Leuven Belgium
- Centre for IP and IT Law, KU Leuven Leuven Belgium
| | - K Claes
- University Hospitals Leuven Leuven Belgium
- Department of Immunology, Microbiology and Transplantation, KU Leuven Leuven Belgium
| | - J J Derèze
- University Hospitals Leuven Leuven Belgium
| | | | - C Mathieu
- University Hospitals Leuven Leuven Belgium
| | | | - R Reyda
- University Hospitals Leuven Leuven Belgium
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Abstract
The individual right of access to one's own data is a crucial privacy protection long recognized in U.S. federal privacy laws. Mobile health devices and research software used in citizen science often fall outside the HIPAA Privacy Rule, leaving participants without HIPAA's right of access to one's own data. Absent state laws requiring access, the law of contract, as reflected in end-user agreements and terms of service, governs individuals' ability to find out how much data is being stored and how it might be shared with third parties. Efforts to address this problem by establishing norms of individual access to data from mobile health research unfortunately can run afoul of the FDA's investigational device exemption requirements.
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Affiliation(s)
- Barbara J Evans
- Barbara J. Evans, Ph.D., J.D., LL.M., is the Mary Ann and Lawrence E. Faust Professor of Law, a Professor of Electrical and Computer Engineering, and the Director of the Center for Biotechnology & Law at the University of Houston
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Dove ES, Chen J. To What Extent Does the EU General Data Protection Regulation (GDPR) Apply to Citizen Scientist-Led Health Research with Mobile Devices? J Law Med Ethics 2020; 48:187-195. [PMID: 32342746 DOI: 10.1177/1073110520917046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this article, we consider the possible application of the European General Data Protection Regulation (GDPR) to "citizen scientist"-led health research with mobile devices. We argue that the GDPR likely does cover this activity, depending on the specific context and the territorial scope. Remaining open questions that result from our analysis lead us to call for lex specialis that would provide greater clarity and certainty regarding the processing of health data by for research purposes, including these non-traditional researchers.
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Affiliation(s)
- Edward S Dove
- Edward S. Dove, Ph.D., is a Lecturer in Health Law and Regulation at the School of Law, University of Edinburgh. Jiahong Chen, Ph.D., is a Research Fellow in IT Law at Horizon Digital Economy Research, University of Nottingham
| | - Jiahong Chen
- Edward S. Dove, Ph.D., is a Lecturer in Health Law and Regulation at the School of Law, University of Edinburgh. Jiahong Chen, Ph.D., is a Research Fellow in IT Law at Horizon Digital Economy Research, University of Nottingham
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Gutierrez AM, Hofstetter JD, Dishner EL, Chiao E, Rai D, McGuire AL. A Right to Privacy and Confidentiality: Ethical Medical Care for Patients in United States Immigration Detention. J Law Med Ethics 2020; 48:161-168. [PMID: 32342781 DOI: 10.1177/1073110520917004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recently, John Doe, an undocumented immigrant who was detained by United States Immigration and Customs Enforcement (ICE), was admitted to a hospital off-site from a detention facility. Custodial officers accompanied Mr. Doe into the exam room and refused to leave as physicians examined him. In this analysis, we examine the ethical dilemmas this case brings to light concerning the treatment of patients in immigration detention and their rights to privacy. We analyze what US law and immigration detention standards allow regarding immigration enforcement or custodial officers' presence in medical exams and documentation of detainee health information. We describe the ethical implications of the presence of officers in medical exam rooms, including its effects on the quality of the patient-provider relationship, patient privacy and confidentiality, and provider's ability to provide ethical care. We conclude that the presence of immigration enforcement or custodial officers during medical examination of detainees is a breach of the right to privacy of detainees who are not an obvious threat to the public. We urge ICE and the US Department of Homeland Security to clarify standards for and tighten enforcement around when officers are legally allowed to be stationed in medical exam rooms and document detainees' information.
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Affiliation(s)
- Amanda M Gutierrez
- Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors
| | - Jacob D Hofstetter
- Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors
| | - Emma L Dishner
- Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors
| | - Elizabeth Chiao
- Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors
| | - Dilreet Rai
- Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors
| | - Amy L McGuire
- Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors
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45
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Tovino SA. Mobile Research Applications and State Data Protection Statutes. J Law Med Ethics 2020; 48:87-93. [PMID: 32342742 DOI: 10.1177/1073110520917033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article focuses on state privacy, security, and data breach regulation of mobile-app mediated health research, concentrating in particular on research studies conducted or participated in by independent scientists, citizen scientists, and patient researchers. Prior scholarship addressing these issues tends to focus on the lack of application of the HIPAA Privacy and Security Rules and other sources of federal regulation. One article, however, mentions state law as a possible source of privacy and security protections for individuals in the particular context of mobile app-mediated health research. This Article builds on this prior scholarship by: (1) assessing state data protection statutes that are potentially applicable to mobile app-mediated health researchers; and (2) suggesting statutory amendments that could better protect the privacy and security of mobile health research data. As discussed in more detail below, all fifty states and the District of Columbia have potentially applicable data breach notification statutes that require the notification of data subjects of certain informational breaches in certain contexts. In addition, more than two-thirds of jurisdictions have potentially applicable data security statutes and almost one-third of jurisdictions have potentially applicable data privacy statutes. Because all jurisdictions have data breach notification statutes, these statutes will be assessed first.
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Affiliation(s)
- Stacey A Tovino
- Stacey A. Tovino, J.D., Ph.D., is the Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
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46
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Abstract
At one time, specialized health privacy laws represented the bulk of the rules regulating genetic privacy, Today, however, as both the field of genomics and the content of privacy law change rapidly, a new generation of general-purpose privacy laws may impose new restrictions on collection, storage, and disclosure of genetic data. This article surveys these laws and considers implications.
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Affiliation(s)
- William McGeveran
- William McGeveran, J.D., is Associate Dean for Academic Affairs and Julius E. Davis Professor of Law at the University of Minnesota. He is the author of a casebook and many articles on data privacy law, and serves as reporter for a Uniform Law Commission project to draft a model state privacy law. Caroline Schmitz, J.D., graduated cum laude from the University of Minnesota Law School in May 2019. While in law school, she participated in the Data Compliance Practicum and the Consumer Protection Clinic. She now works for the Federal Trade Commission (FTC) in its Division of Privacy & Identity Protection. Caroline participated in co-authoring this article in her personal capacity, not as a representative of the FTC, and the views expressed are her own and not necessarily those of the Commission or any individual Commissioner
| | - Caroline Schmitz
- William McGeveran, J.D., is Associate Dean for Academic Affairs and Julius E. Davis Professor of Law at the University of Minnesota. He is the author of a casebook and many articles on data privacy law, and serves as reporter for a Uniform Law Commission project to draft a model state privacy law. Caroline Schmitz, J.D., graduated cum laude from the University of Minnesota Law School in May 2019. While in law school, she participated in the Data Compliance Practicum and the Consumer Protection Clinic. She now works for the Federal Trade Commission (FTC) in its Division of Privacy & Identity Protection. Caroline participated in co-authoring this article in her personal capacity, not as a representative of the FTC, and the views expressed are her own and not necessarily those of the Commission or any individual Commissioner
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47
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Wasser TD, Hu J, Danzig A, Yarnell-MacGrory S, Guzman JR, Michaelsen K. Teaching Forensic Concepts to Residents Using Interactive Online Modules. J Am Acad Psychiatry Law 2020; 48:77-83. [PMID: 31753964 DOI: 10.29158/jaapl.003890-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Psychiatrists without specialty forensic training routinely encounter forensic questions and treat justice-involved patients, which underscores the importance of adequate forensic training in general psychiatry residency. Some programs may face challenges providing adequate forensic instruction due to a lack of local forensic psychiatrists or other forensic resources. Novel training approaches are needed to fill this gap. This article describes the development, dissemination, and preliminary impact of two online learning modules designed to teach general psychiatry residents about basic forensic psychiatry principles: confidentiality and the duty to third parties. The modules are based on adult learning theory and synthesize clinically relevant vignettes from historically significant legal cases. We disseminated the modules nationally with built-in pre-tests and post-tests. The module responses demonstrate three significant themes: the modules reached learners across the United States; even advanced residents had relatively low subject matter knowledge prior to module completion; and module completion was associated with a significant improvement in resident learners' knowledge of these two topics. This work shows one potential avenue for filling gaps in forensic education within general psychiatry training, although further studies are needed to appreciate the impact of such educational interventions on clinical practice.
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Affiliation(s)
- Tobias D Wasser
- Dr. Wasser is Assistant Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut, and Chief Medical Officer, Whiting Forensic Hospital, Middletown, Connecticut. Mr Hu is an Undergraduate Student, and Drs. Danzig and Guzman are Psychiatry Residents, Yale School of Medicine, New Haven, Connecticut. Dr. Yarnell-MacGrory is Assistant Professor of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island. Dr. Michaelsen is Acting Assistant Professor, University of Washington School of Medicine, Seattle, Washington, and Attending Psychiatrist, VA Puget Sound Health Care System, Seattle, Washington.
| | - Jason Hu
- Dr. Wasser is Assistant Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut, and Chief Medical Officer, Whiting Forensic Hospital, Middletown, Connecticut. Mr Hu is an Undergraduate Student, and Drs. Danzig and Guzman are Psychiatry Residents, Yale School of Medicine, New Haven, Connecticut. Dr. Yarnell-MacGrory is Assistant Professor of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island. Dr. Michaelsen is Acting Assistant Professor, University of Washington School of Medicine, Seattle, Washington, and Attending Psychiatrist, VA Puget Sound Health Care System, Seattle, Washington
| | - Ayala Danzig
- Dr. Wasser is Assistant Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut, and Chief Medical Officer, Whiting Forensic Hospital, Middletown, Connecticut. Mr Hu is an Undergraduate Student, and Drs. Danzig and Guzman are Psychiatry Residents, Yale School of Medicine, New Haven, Connecticut. Dr. Yarnell-MacGrory is Assistant Professor of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island. Dr. Michaelsen is Acting Assistant Professor, University of Washington School of Medicine, Seattle, Washington, and Attending Psychiatrist, VA Puget Sound Health Care System, Seattle, Washington
| | - Stephanie Yarnell-MacGrory
- Dr. Wasser is Assistant Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut, and Chief Medical Officer, Whiting Forensic Hospital, Middletown, Connecticut. Mr Hu is an Undergraduate Student, and Drs. Danzig and Guzman are Psychiatry Residents, Yale School of Medicine, New Haven, Connecticut. Dr. Yarnell-MacGrory is Assistant Professor of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island. Dr. Michaelsen is Acting Assistant Professor, University of Washington School of Medicine, Seattle, Washington, and Attending Psychiatrist, VA Puget Sound Health Care System, Seattle, Washington
| | - Juan Rodriguez Guzman
- Dr. Wasser is Assistant Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut, and Chief Medical Officer, Whiting Forensic Hospital, Middletown, Connecticut. Mr Hu is an Undergraduate Student, and Drs. Danzig and Guzman are Psychiatry Residents, Yale School of Medicine, New Haven, Connecticut. Dr. Yarnell-MacGrory is Assistant Professor of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island. Dr. Michaelsen is Acting Assistant Professor, University of Washington School of Medicine, Seattle, Washington, and Attending Psychiatrist, VA Puget Sound Health Care System, Seattle, Washington
| | - Katherine Michaelsen
- Dr. Wasser is Assistant Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut, and Chief Medical Officer, Whiting Forensic Hospital, Middletown, Connecticut. Mr Hu is an Undergraduate Student, and Drs. Danzig and Guzman are Psychiatry Residents, Yale School of Medicine, New Haven, Connecticut. Dr. Yarnell-MacGrory is Assistant Professor of Psychiatry, Brown Alpert Medical School, Providence, Rhode Island. Dr. Michaelsen is Acting Assistant Professor, University of Washington School of Medicine, Seattle, Washington, and Attending Psychiatrist, VA Puget Sound Health Care System, Seattle, Washington
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48
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Abstract
Title X of the Public Health Act has provided access to confidential reproductive care for low-income adolescents and adults since 1970, helping to bring adolescent pregnancy rates to historic lows. Recent regulatory changes in program funding eligibility and provider counseling options may reverse this trend. This policy brief will address the history and impact of Title X funding on adolescent access to reproductive health care, explain the implications of these recent regulatory changes in Title X implementation, and encourage advocacy to protect health care provider practice and adolescent access to confidential care.
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Wolf LE, Hammack CM, Brown EF, Brelsford KM, Beskow LM. Protecting Participants in Genomic Research: Understanding the "Web of Protections" Afforded by Federal and State Law. J Law Med Ethics 2020; 48:126-141. [PMID: 32342774 PMCID: PMC7307001 DOI: 10.1177/1073110520917000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Researchers now commonly collect biospecimens for genomic analysis together with information from mobile devices and electronic health records. This rich combination of data creates new opportunities for understanding and addressing important health issues, but also intensifies challenges to privacy and confidentiality. Here, we elucidate the "web" of legal protections for precision medicine research by integrating findings from qualitative interviews with structured legal research and applying them to realistic research scenarios involving various privacy threats.
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Affiliation(s)
- Leslie E Wolf
- Leslie E. Wolf, J.D., M.P.H., is a Distinguished University Professor and Professor of Law at Georgia State University College of Law in Atlanta, Georgia and Director of the GSU Center for Law, Health & Society. Catherine M. Hammack, J.D., M.A., is an Associate in Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Erin Fuse Brown, J.D., M.P.H., is an Associate Professor of Law at the Georgia State University College of Law in Atlanta, Georgia. Kathleen M. Brelsford, M.A., Ph.D., M.P.H., is a Research Assistant Professor in the Department of Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Laura M. Beskow, M.P.H., Ph.D. is a Professor of Health Policy and the Anne Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at the Vanderbilt University Medical Center in Nashville, Tennessee
| | - Catherine M Hammack
- Leslie E. Wolf, J.D., M.P.H., is a Distinguished University Professor and Professor of Law at Georgia State University College of Law in Atlanta, Georgia and Director of the GSU Center for Law, Health & Society. Catherine M. Hammack, J.D., M.A., is an Associate in Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Erin Fuse Brown, J.D., M.P.H., is an Associate Professor of Law at the Georgia State University College of Law in Atlanta, Georgia. Kathleen M. Brelsford, M.A., Ph.D., M.P.H., is a Research Assistant Professor in the Department of Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Laura M. Beskow, M.P.H., Ph.D. is a Professor of Health Policy and the Anne Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at the Vanderbilt University Medical Center in Nashville, Tennessee
| | - Erin Fuse Brown
- Leslie E. Wolf, J.D., M.P.H., is a Distinguished University Professor and Professor of Law at Georgia State University College of Law in Atlanta, Georgia and Director of the GSU Center for Law, Health & Society. Catherine M. Hammack, J.D., M.A., is an Associate in Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Erin Fuse Brown, J.D., M.P.H., is an Associate Professor of Law at the Georgia State University College of Law in Atlanta, Georgia. Kathleen M. Brelsford, M.A., Ph.D., M.P.H., is a Research Assistant Professor in the Department of Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Laura M. Beskow, M.P.H., Ph.D. is a Professor of Health Policy and the Anne Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at the Vanderbilt University Medical Center in Nashville, Tennessee
| | - Kathleen M Brelsford
- Leslie E. Wolf, J.D., M.P.H., is a Distinguished University Professor and Professor of Law at Georgia State University College of Law in Atlanta, Georgia and Director of the GSU Center for Law, Health & Society. Catherine M. Hammack, J.D., M.A., is an Associate in Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Erin Fuse Brown, J.D., M.P.H., is an Associate Professor of Law at the Georgia State University College of Law in Atlanta, Georgia. Kathleen M. Brelsford, M.A., Ph.D., M.P.H., is a Research Assistant Professor in the Department of Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Laura M. Beskow, M.P.H., Ph.D. is a Professor of Health Policy and the Anne Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at the Vanderbilt University Medical Center in Nashville, Tennessee
| | - Laura M Beskow
- Leslie E. Wolf, J.D., M.P.H., is a Distinguished University Professor and Professor of Law at Georgia State University College of Law in Atlanta, Georgia and Director of the GSU Center for Law, Health & Society. Catherine M. Hammack, J.D., M.A., is an Associate in Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Erin Fuse Brown, J.D., M.P.H., is an Associate Professor of Law at the Georgia State University College of Law in Atlanta, Georgia. Kathleen M. Brelsford, M.A., Ph.D., M.P.H., is a Research Assistant Professor in the Department of Health Policy and a member of the core faculty of the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center in Nashville, Tennessee. Laura M. Beskow, M.P.H., Ph.D. is a Professor of Health Policy and the Anne Geddes Stahlman Chair in Medical Ethics in the Center for Biomedical Ethics & Society at the Vanderbilt University Medical Center in Nashville, Tennessee
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50
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Abstract
This article examines the privacy and security issues associated with mobile application-mediated health research, concentrating in particular on research conducted or participated in by independent scientists, citizen scientists, and patient researchers. Building on other articles in this issue that examine state research laws and state data protection laws as possible sources of privacy and security protections for mobile research participants, this article focuses on the lack of application of federal standards to mobile application-mediated health research. As discussed in more detail below, the voluminous and diverse data collected by some independent scientists who use mobile applications to conduct health research may be at risk for unregulated privacy and security breaches, leading to dignitary, psychological, and economic harms for which participants have few legally enforceable rights or remedies under current federal law. Federal lawmakers may wish to consider enacting new legislation that would require otherwise unregulated health data holders to implement reasonable data privacy, security, and breach notification measures.
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Affiliation(s)
- Stacey A Tovino
- Stacey A. Tovino, J.D., Ph.D., is the Judge Jack and Lulu Lehman Professor of Law at the William S. Boyd School of Law, University of Nevada-Las Vegas
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