Strengthening Health System Responses to Gender-based Violence in Eastern Europe and Central Asia

A resource package

Confidentiality vs. mandatory reporting

Confidentiality and information sharing


Practitioners who are called upon to deal with a woman who has been the survivor of gender-based violence are in a delicate situation. They are caught between their duty to protect the patients’ health and the obligations of professional confidentiality. The law does provide for reporting dangerous situations in certain cases, with the survivor’s consent. Medical practitioners should act in accordance with their professional responsibility and personal conscience.
Keeping information confidential:

 

  • It is vitally important that information on gender-based violence is kept confidential. Without confidentiality, women are less likely to talk about their experiences. Their physical safety can depend on it.
  • Confidentiality is particularly important in general practice, where health professionals might treat other members of a woman’s family – including the perpetrator, who can use information to track down a survivor of GBV or a survivor of trafficking.
  • But it’s important to understand – and to explain to women who reveal that they are experiencing violence – that there are limits to confidentiality. For example, if there is reason to suspect children are at risk, safeguarding and protection should take precedence over confidentiality.


Safe information sharing
There will also be occasions when information about cases of gender-based violence should be made available – either because it is required by law (if records are being used as evidence in a court case, for example) or to help support agencies tailor services to meet a family’s needs (for advocacy or carrying out a risk assessment, for example). Health care providers will need to make a careful decision about whether to share information in a given situation. It’s not always easy to balance confidentiality against the interests of disclosure.

  • Being particularly wary of situations in which confidentiality could accidentally be broken. For example, if a trafficking victim, a survivor or a child who is staying at a shelter spends time in a hospital and the human trafficker or violent father visits, care workers should take care that records that are on display do not include a contact address or any other information that could help a perpetrator track down people he has previously abused.
  • Health care providers should only consider giving information to reputable agencies – never to individuals making enquiries about a woman’s circumstances.
  • The only acceptable reason for sharing information is to increase a woman’s safety and that of her children. Even then, only relevant information should be shared.
  • A woman’s permission is usually necessary to share information.
  • Depending on the national legislation. It might be the case that according to the legislation it is permissible to pass information to another agency in situations where:
    – the courts request information about a specific case; or
    – there is significant risk of harm to the woman, her children or somebody else if information isn’t passed on.
    – If care workers do pass on information without the survivor´s permission, they should be completely sure that this decision doesn’t place somebody at risk of greater violence. Health care providers will need to be able to justify your decision.
    – If the patient appears to be in imminent danger or in such a state of vulnerability as to make him or her incapable of acting, the doctor is required to contact the legal, administrative or hospital authorities in order to protect the survivor from the aggressor as rapidly as possible.
  • If the person concerned is a minor of 15 years or less, or a person who is unable to protect him or herself due to age or his or her physical or psychological state, the care worker is in most countries required to share information with relevant agencies to ensure protection of the minor.


Source: adapted from Department of Health (UK 2005): Responding to domestic abuse: a handbook for health professionals