Health Care Privacy and the Surveillance State: The Struggle for Balance
by Fred Fortin
Health care privacy is part of the bigger picture of a society’s respect for human rights and individual persons. Balancing privacy, security as well as transparency and openness is a cultural and political challenge for any nation. Surveillance is the modern compromise for living in a dangerous world. But how much, who, where and when are choices and decision-points by authorities that affect us all. And consequently, the way we manage the tensions between privacy and legitimate surveillance generally, will impact the way we think about the privacy of medical information.
Privacy International has come out with their international privacy rankings and determinations of the world’ leading surveillance societies. The 2007 rankings indicate “an overall worsening of privacy protection across the world, reflecting an increase in surveillance and a declining performance of privacy safeguards.” One category the report is the surveillance of “medical and financial movement” in which countries like the U.S. and the U.K. (and others) are deemed countries with the worst records providing “weak protections of financial and medical privacy.”
A few weeks ago I attended the World Healthcare Innovation and Technology Conference (WHIT 3.0) where a different perspective was being advocated, namely that health care privacy laws were too strict and impeding progress in the implementation of information technologies and new media that’s needed to improve quality, access and constrain cost. Figures such as Adam Bosworth were unequivocal: Government is “trading off the deaths of hundreds of thousands of people to prevent the exposure of very few” with these laws against “possible and rare risks to privacy.” In that conference, no one contested his position. I could imagine a very different conference, say of privacy or health care activists, who would find Bosworth’s position an extreme one indeed.
I once visited a thriving hospital in Beijing where patients were lined up outside just to get services. Once inside the hospital physician’s office, they sat across the desk from the doctor along with the next few patients in the waiting line, who watched and even participated in an open door, open seating and open discussion of the patient’s problems. Certainly a surprise to westerners, but it is a normal practice at many of China’s public hospitals.
The point is, the struggle to find balance in this area is going to run up against a strong phalanx of opinion and cultural differences no matter where one sits. And it is by no means clear or self-evident, despite all manner of strong assertions to the contrary, where that balance point resides.
