Legal Aspects of Medical Secrecy in the Republic of Armenia

The person who has special knowledge always has power over the person who does not have that knowledge. This rule also applies to the doctor-patient relationship. The doctor’s special knowledge is of special value to the patient and therefore any patient is “naked physically and emotionally” before his physician, which puts him in an extremely dependent position. And our Armenian legislator must establish such rights and responsibilities for the parties of legal relations, so that the patient is protected by certain rights in principle, and the doctor is bound by certain responsibilities at the legislative level.

Doctors have an important legal obligation of confidentiality, which is also a classic requirement of medical ethics.

The essence of medical confidentiality is the following: doctors are not allowed to share information with patients about their medical condition without their consent. Only those who are directly related to the patient’s treatment have the right to become familiar with the patient’s information. To give a complete picture, let’s take as an example the discussion with the doctor about the patient’s treatment information with nurses, student interns, etc. This is not a breach of confidentiality because it is done in the patient’s best interest, for the patient’s benefit, because the information is discussed with such persons who are directly related to the patient’s care.

Thus, the term “doctor-patient confidentiality” refers to the confidentiality of the doctor-patient relationship.

The legislator enshrined doctor-patient confidentiality in law in order to encourage the patient to be more candid with the doctor, which will facilitate diagnosis and treatment.

The patient’s right for medical secrecy of medical personnel is enshrined in Article 5 of the Law of RA “On Medical Care, Service to Population” from March 04, 1996.

The medical institution and its employees are obliged to respect the confidentiality of the medical information without the patient’s consent, except the cases envisaged by the legislation of the Republic of Armenia. Due to the fact that the legal relations between the doctor and the patient are of civil law nature, the principles of equality of the parties, dispositiveness, actionable way to protect their rights and interests are applicable to them.

In theory, medical secrecy seems very understandable and accessible, but in practice there are a number of questions: what information constitutes medical secrecy?  Who is obligated to maintain secrecy? Is information received from all persons or only from the patient/relatives and relatives/administration of the medical institution considered to be confidential, etc.?

First of all, let’s clarify what exactly is the subject of medical secrecy in the Republic of Armenia.

According to Armenian legislation, the subject of doctor-patient confidentiality should be any information that is discovered during the research, diagnosis and treatment of the patient’s health condition.

Doctors can receive such information from almost any person: from the patient or his/her relatives, as a result of tests, examinations, observations, medical history or other documents, as well as from their medical colleagues.

The subject of medical confidentiality in the Republic of Armenia is any medical and pharmaceutical employee, as well as students of medical and other higher educational institutions and technical schools of the Republic of Armenia, who undergo practical training in the medical institutions of the Republic of Armenia.

Subjects are also those individuals who have become aware of the information about a patient in the manner prescribed by the RA Law. In particular, such subjects are state bodies, to which the medical institution is obliged by law to provide the necessary information.

Sometimes there are situations when it is necessary to provide information, which constitutes medical secrecy of a patient, to the respective subjects without the patient’s or his legal representative’s consent. In connection with this circumstance, the Armenian legislator has established situations in which doctors are not only able but also obliged to provide information that constitutes medical secrecy.

Thus, the provision of information by the employees of a medical institution without the consent of the patient or the patient’s legal representative is allowed in the Republic of Armenia if:

There is a threat of the spread of infectious diseases, mass poisoning

There are grounds to believe that harm to the patient’s health has been inflicted as a result of violent acts.

Medical workers in such cases are obliged to pass information to law enforcement agencies.

Medical assistance is provided to a minor or an incapacitated person.

Provision of information in the above cases is not an obligation for doctors, but rather for the heads of medical institutions, i.e. only the heads of medical institutions are obliged to provide information about the illness of citizens-patients to the relevant subjects. But information about the intimate and family life of patients under no circumstances allowed by any law of the Republic of Armenia to disclose.

It should also be noted that the heads of medical institutions are not obliged to provide information about all of the patients’ diseases to the relevant subjects. Only with the purpose of preventing the spread of diseases, managers are obliged to do so when it is in the interest of protecting the health of the Armenian population. For example, if a patient is diagnosed with a dangerous infection or a mass poisoning, in such cases it is allowed to provide information that constitutes medical secrecy.

The Armenian legislator has established the circle of subjects, according to whose requirements the heads of medical institutions in the Republic of Armenia must report patient information. Such subjects include investigative and judicial bodies, because they are responsible for solving crimes, etc. For example, during the investigation of cases related to murder, bodily injuries of any severity, and illegal abortions, persons from investigative and judicial bodies need that information, which is held exclusively by medical workers due to their position and profession for solving crimes. It turns out that sometimes confidential information can be disclosed by the decision of a judicial body of the Republic of Armenia.

The legal norm enshrined in Article 7 of the RA Law “On Medical Care, Population Services” establishes the rule of providing information about a patient’s state of health.

The doctor or other official of the medical institution is obliged to provide the patient with information about his or her state of health in a form that he or she can understand. This information includes any information about the results of the patient’s examination, the presence of any disease, the diagnosis and prognosis, methods of examination and treatment, the presence of risks, possible options for medical intervention, its consequences, the results of the treatment undertaken and possible complications in the future.

If a patient refuses to receive the above information regarding his or her health, an appropriate entry must be made in the medical record in order to avoid future conflicts of any kind with the patient.

But what should we, common people, do in Armenia, if our right to the confidentiality of the information related to our state of health was violated by the relevant persons?

Definitely it is necessary to apply to the court of RA to demand compensation of moral damage in civil legal proceedings and to demand the prosecution of the offender in criminal legal proceedings.

But if in addition to moral damage, the victim also suffered property damage, he/she has the right to demand compensation for property damage from the court at the same time.

The judicial body of the RA determines the amount of money to be compensated to the injured person, taking into account the moral distress caused.

To summarize the above, the duty of medical workers to preserve information about patients that constitutes medical secrecy does not end with the end of the patient’s treatment. This obligation is incumbent upon health care providers until such time as the information becomes publicly available for some reason.