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

The NHS Care Records Dilemma

I firstly wish to make a correction on the terminology ' shared’ that
the author, O.F. Norheim, has used in describing the NHS Care Records
Service (CRS). ‘Shared’ in the IT context is a rather ambiguous term and
may create the impression of unrestricted electronic access to patient
records. The CRS however is a centralised database, allowing for access by
authorised users sited in distributed physical locations.

Secondly, a valid point has been raised by Norheim concerning medical
ethics of such a healthcare system. I myself have wondered and discussed
with key players, NHS users and employees of the security and patient
confidentiality concerns. It is fair to say that there isn't enough
information out there for the public to decide whether an opt-in or opt-
out system is more appropriate. In my opinion freedom is a choice that one
opts for otherwise paternalism occurs by default from time of birth (take
a look at the political structure, social and market trends in the world).

In a society where there is too much information to take in and a
great percentage live a busy lifestyle, too busy to take the time to make
themselves healthier home cooked meals (with exception to the few health-
conscious individuals) one wonders what the cost effectiveness/ cost
benefit is for the financially constrained NHS in either endorsing freedom
of choice or soft paternalism.

Lastly, I am unconvinced that there is need to conclude by caveating
the NHS or rather the Department of Health (DoH) on what they are already
aware of. The Technical, legal and organisational safeguards are issues
any decent management of this level ought to have considered by this stage
of programme implementation.

It is simplistic and unhelpful to demand the NHS to “convincingly”
show their safeguards. I can reassure that the DoH are not short of
published "white papers" brimming with information on what is required of
the national programme, the challenge for the NHS is how to achieve what
is required.
I encourage Norheim to check out the DoH and NHS Confederation websites.

Competing interests:
None declared

Competing interests: No competing interests

24 June 2006
Maureen A Orlando
Health Informatics