Defining the Limits of Medical Privacy Within the US Departments of Defense and Veterans Affairs

Clinicians caring for active duty military personnel, especially those working for the Department of Defense, must grapple with ethical conflicts arising from dual agency—the clinician’s simultaneous obligation to both the patient and to the military organization and mission. Striking the appropriate balance between competing patient expectations, ethical principles and mission imperatives is not always straightforward. Federal law, military regulation and policy all define circumstances where a patient’s protected health information may—or in some cases must—be shared with third parties. The Veterans Health Administration health system generally mirrors the policies and practices of the civilian sector with regard to information sharing. However, in the active duty military community, demands such as deployment readiness, mission capability, and the requirement for ready access to weapons place additional constraints on the degree to which confidentiality may be maintained. These circumstances and the laws, policies and regulations defining them create greater limits to the patient’s medical privacy. This chapter explains the limits of confidentiality defined by current military policy, regulation and law. With greater knowledge of these parameters health care providers may be able to more fully engage their patients in frank discussions about the implications of their treatment decisions and may be more confident that any information they release is shared in a manner consistent with the expressed limits.