Intended for healthcare professionals


Soft paternalism and the ethics of shared electronic patient records

BMJ 2006; 333 doi: (Published 29 June 2006) Cite this as: BMJ 2006;333:2
  1. Ole Frithjof Norheim, professor (
  1. Division for Medical Ethics and Philosophy of Science, Department of Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway

    It's ethically sound for patients to opt out

    The NHS is planning to make patients' health records more easily accessible using a network of integrated databases.1 This will, we may reasonably expect, improve quality of care and efficiency, reduce paperwork, and sometimes even save lives. The ultimate aim is to benefit patient health and welfare.2

    Easier access to medical data from a “single resource shared by everyone” also makes patients vulnerable. Patient records contain sensitive private information that can, if not handled correctly, harm the patient. Should all citizens by default be included in the new electronic records service with the possibility to “opt out” if they prefer, or should people be asked to “opt in” only if they want to? The Royal College of General Practitioners strongly recommends “opt in” with reference to the ethical principle of informed, explicit consent, whereas Connecting for Health, the agency building the new electronic records service, recommends “opt out.”3

    To impose electronic records on members of …

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