The Ethics of Sharing: Practitioner concerns about recording in shared health records, and how they should be resolved

Abstract

Health information is sensitive, and some information – such as details of abuse or trauma, alcohol or drug dependence, sexual or mental health problems – is particularly sensitive. Recording this information in shared health records, where can be accessed by multiple health providers, might plausibly cause concerns for health practitioners. They may experience a tension between recording comprehensively and protecting the privacy of clients. This thesis addresses the concerns of practitioners about recording sensitive information in shared health records, and how they should be resolved. The research combines qualitative interviews with health social workers about their recording practices with philosophical reflection on the moral values that should guide recording and sharing. The tradition of pragmatism supports an approach that combines empirical research with ethical reasoning. Health social workers expressed that they recorded sensitive details if they were relevant to health. Recording should be accurate, distinguish between fact and opinion, and neutral or non-judgemental. It was important to participants that they recorded and shared information in a way that was predictable to clients. I argue that these principles are morally defensible and should be applied in a framework of professional virtue. The principles indicate that the record is ethically significant as a means by which future judgements are made about clients and their care, judgements that should be made appropriately.