Ethical Considerations in Mandatory Disclosure of Data Acquired While Caring for Human Trafficking Survivors | Journal of Ethics | American Medical Association
Ethical Considerations in Mandatory Disclosure of Data Acquired While Caring for Human Trafficking Survivors | Journal of Ethics | American Medical Association
Ethical Considerations in Mandatory Disclosure of Data Acquired While Caring for Human Trafficking Survivors
Patrick L. Kerr, PhD and Rachel Dash, ACSW, MSW
Is Mandatory Reporting of Human Trafficking by Health Care Professionals Ethical?
In the US, protection of confidentiality of personal health information is codified in federal law [29]. Exceptions to these protections, such as disclosure for research, are also built into ethical guidelines and laws and are based on the principle of nonmaleficence. Provisions for exempting health information from confidentiality in specific circumstances ensure that the benefits of disclosure outweigh the risks [30]. In evaluating the potential risks and benefits of disclosure, the answer to the question of whether mandatory reporting of trafficking is ethical is “yes”; however, this must be cautiously qualified within a bioethics framework.
Beauchamp and Childress [31] have articulated four principles for ethical decision making regarding medical practice or research: (1) respect for autonomy, defined as a person’s capacity for autonomous/independent decision making; (2) nonmaleficence (“do no harm”); (3) beneficence (“do good” when ethical and feasible); and (4) justice, defined as the equitable distribution of benefits, risks, and costs. Through this bioethical lens, mandated reporting of trafficking must be contextualized. Respect for autonomy, the balance of good versus harm done, and distribution of justice would be situationally dependent. The priority in applying these principles to practice would be a risk/benefit analysis for the individual patient. Health care professionals must be given specific criteria to use in determining if reporting trafficking will pose undue risks to the individual patient to whom they are providing care. Criteria could include whether reporting unduly deprives the survivor of autonomy in the disclosure of health information, whether benefits of reporting this survivor’s information would outweigh the risks of doing so, and whether the potential harm prevented is equal to or greater than the potential harm done.
Conclusion
Future legislation or policies at the state or federal level regarding mandated reporting of trafficking by health care professionals must balance the importance of goals such as increased accuracy of data with respect for the needs of the patient. In conclusion, we offer the following recommendations for the process of developing such policies:
Trafficking survivors must be part of development of such a policy.
Research on the potential short- and long-term impacts of mandated reporting on trafficking survivors must be conducted before proceeding with policy development.
Legislation for mandated reporting of trafficking must include funding for appropriate training of health care professionals in identification and reporting of trafficking and funding streams for publicly funded health care services for survivors.
Models of informed consent that meet the unique needs of diverse trafficking survivor populations must be implemented.
A trafficking registry with minimal identifying data should be the first choice considered among public health surveillance methodologies.
Human trafficking is a complex phenomenon, the nature and effects of which are just beginning to be fully understood. Mandated reporting of human trafficking presents both opportunities for better addressing this problem as well as risks. A thoughtful survivor-informed process for developing a system for mandated reporting will be necessary for balancing the needs and goals of all respective stakeholders, including survivors, health care professionals, policymakers, and the general public.
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Ethical Considerations in Mandatory Disclosure of Data Acquired While Caring for Human Trafficking Survivors
Patrick L. Kerr, PhD and Rachel Dash, ACSW, MSW
Is Mandatory Reporting of Human Trafficking by Health Care Professionals Ethical?
In the US, protection of confidentiality of personal health information is codified in federal law [29]. Exceptions to these protections, such as disclosure for research, are also built into ethical guidelines and laws and are based on the principle of nonmaleficence. Provisions for exempting health information from confidentiality in specific circumstances ensure that the benefits of disclosure outweigh the risks [30]. In evaluating the potential risks and benefits of disclosure, the answer to the question of whether mandatory reporting of trafficking is ethical is “yes”; however, this must be cautiously qualified within a bioethics framework.
Beauchamp and Childress [31] have articulated four principles for ethical decision making regarding medical practice or research: (1) respect for autonomy, defined as a person’s capacity for autonomous/independent decision making; (2) nonmaleficence (“do no harm”); (3) beneficence (“do good” when ethical and feasible); and (4) justice, defined as the equitable distribution of benefits, risks, and costs. Through this bioethical lens, mandated reporting of trafficking must be contextualized. Respect for autonomy, the balance of good versus harm done, and distribution of justice would be situationally dependent. The priority in applying these principles to practice would be a risk/benefit analysis for the individual patient. Health care professionals must be given specific criteria to use in determining if reporting trafficking will pose undue risks to the individual patient to whom they are providing care. Criteria could include whether reporting unduly deprives the survivor of autonomy in the disclosure of health information, whether benefits of reporting this survivor’s information would outweigh the risks of doing so, and whether the potential harm prevented is equal to or greater than the potential harm done.
Conclusion
Future legislation or policies at the state or federal level regarding mandated reporting of trafficking by health care professionals must balance the importance of goals such as increased accuracy of data with respect for the needs of the patient. In conclusion, we offer the following recommendations for the process of developing such policies:
Trafficking survivors must be part of development of such a policy.
Research on the potential short- and long-term impacts of mandated reporting on trafficking survivors must be conducted before proceeding with policy development.
Legislation for mandated reporting of trafficking must include funding for appropriate training of health care professionals in identification and reporting of trafficking and funding streams for publicly funded health care services for survivors.
Models of informed consent that meet the unique needs of diverse trafficking survivor populations must be implemented.
A trafficking registry with minimal identifying data should be the first choice considered among public health surveillance methodologies.
Human trafficking is a complex phenomenon, the nature and effects of which are just beginning to be fully understood. Mandated reporting of human trafficking presents both opportunities for better addressing this problem as well as risks. A thoughtful survivor-informed process for developing a system for mandated reporting will be necessary for balancing the needs and goals of all respective stakeholders, including survivors, health care professionals, policymakers, and the general public.
READ MORE
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