Unlocking Public Health Data: Navigating New Legal Guardrails and Emerging AI Challenges.

Here, we analyze the public health implications of recent legal developments - including privacy legislation, intergovernmental data exchange, and artificial intelligence governance - with a view toward the future of public health informatics and the potential of diverse data to inform public health actions and drive population health outcomes.

The Ninth Amendment: An Underutilized Protection for Reproductive Choice.

Concern about individual rights and the desire to protect them has been part of our nation since its founding, and continues to be so today. The Ninth Amendment was created to assuage the Framers' concerns that enumerating some rights in the Bill of Rights would leave unenumerated rights unrecognized and unprotected, affirming that those rights are not disparaged or denied by their lack of textual support. The Ninth Amendment has appeared infrequently in our jurisprudence, and Courts initially construed it rather narrowly. But starting in the 1960s, the Ninth Amendment emerged as a powerful tool not just for recognizing unanticipated rights, but for protecting or expanding even enumerated rights. The right to privacy--encompassing the right to contraception and abortion--the right to preserve the integrity of your family, the right to vote, the right to own a firearm as an individual--all these rights have been asserted under and found to be supported by the Ninth Amendment. In its Dobbs v. Jackson Women's Health decision overturning Roe, the Supreme Court found that there is no right to abortion because it is not in the Constitution. But the potential of the Ninth Amendment is such that reproductive choice need not be mentioned in the Constitution to be protected. Reproductive choice may rightfully be considered as part of a right to privacy, an unenumerated right that nevertheless has abundant precedent behind it. The Ninth Amendment, and its counterparts found in many state constitutions, has the power to protect not just reproductive choice, but all of our fundamental rights.

Without Due Process of Law: The Dobbs Decision and Its Cataclysmic Impact on the Substantive Due Process and Privacy Rights of Ohio Women.

Since the overturning of prior abortion precedents in Dobbs v. Jackson Women's Health Organization, there has been a question on the minds of many women in this country: how will this decision affect me and my rights? As we have seen in the aftermath of Dobbs, many states have pushed for stringent anti-abortion measures seeking to undermine the foundation on which women's reproductive freedom had been grounded on for decades. This includes right here in Ohio, where Republican lawmakers have advocated on numerous occasions for implementing laws seeking to limit abortion rights, including a 6-week abortion ban advocated for and passed by the Ohio Republican legislature and signed into law by Ohio Governor Mike DeWine. Despite this particular ban being successfully challenged and stayed, significant problems persist regarding due process rights for women in Ohio, particularly in the aftermath of Justice Thomas's concurrence in Dobbs advising the Court to revisit prior precedents, such as Griswold v. Connecticut providing for the right to contraception. If the Court were to revisit and strike down Griswold, it would further undermine privacy and due process rights that have been granted to women across this country, including here in Ohio, for decades. Justice Thomas's concurrence, while merely dicta, encapsulates a Court that has become increasingly hostile to treasured fundamental rights for women, a hostility mirrored in numerous Republican legislatures, including right here in Ohio.

The Dead Unborn, Postmortem Privacy Cases, and Abortion Rights.

The privacy of the dead is an interesting area of concern for bioethicists. There is a legal doctrine that the dead can't have privacy rights, but also a body of contrary law ascribing privacy rights to the deceased and kin in relation to the deceased. As women's abortion privacy is under assault by American courts and legislatures, the implications of ascribing privacy rights to embryos and fetuses is more important than ever. Caution is called for in this domain.

When Parents Request Nondisclosure: Rights of Adolescents to Access Their Health Information and Implications of the 21st Century Cures Act Final Rule.

AbstractDespite broad ethical consensus supporting developmentally appropriate disclosure of health information to older children and adolescents, cases in which parents and caregivers request nondisclosure continue to pose moral dilemmas for clinicians. State laws vary considerably regarding adolescents' rights to autonomy, privacy, and confidentiality, with many states not specifically addressing adolescents' right to their own healthcare information. The requirements of the 21st Century Cures Act have raised important ethical concerns for pediatricians and adolescent healthcare professionals regarding the protection of adolescent privacy and confidentiality, given requirements that chart notes and results be made readily available to patients via electronic portals. Less addressed have been the implications of the act for adolescents' access to their health information, since many healthcare systems' electronic portals are available to patients beginning at age 12, sometimes requiring that the patients themselves authorize their parents' access to the same information. In this article, we present a challenging case of protracted disagreement about an adolescent's right to honest information regarding his devastating prognosis. We then review the legal framework governing adolescents' rights to their own healthcare information, the limitations of ethics consultation to resolve such disputes, and the potential for the Cures Act's impact on electronic medical record systems to provide one form of resolution. We conclude that although parents in cases like the one presented here have the legal right to consent to medical treatment on their children's behalf, they do not have a corresponding right to direct the withholding of medical information from the patient.

COMMENTARY: Protecting healthcare privacy: Analysis of data protection developments in India.

Patient privacy is essential and so is ensuring confidentiality in the doctor-patient relationship. However, today's reality is that patient information is increasingly accessible to third parties outside this relationship. This article discusses India's data protection framework and assesses data protection developments in India including the Digital Personal Data Protection Act, 2023.

Privacy Barriers in Health Monitoring: Scoping Review.

BACKGROUND: Health monitoring technologies help patients and older adults live better and stay longer in their own homes. However, there are many factors influencing their adoption of these technologies. Privacy is one of them. OBJECTIVE: The aim of this study was to provide an overview of the privacy barriers in health monitoring from current research, analyze the factors that influence patients to adopt assisted living technologies, provide a social psychological explanation, and propose suggestions for mitigating these barriers in future research. METHODS: A scoping review was conducted, and web-based literature databases were searched for published studies to explore the available research on privacy barriers in a health monitoring environment. RESULTS: In total, 65 articles met the inclusion criteria and were selected and analyzed. Contradictory findings and results were found in some of the included articles. We analyzed the contradictory findings and provided possible explanations for current barriers, such as demographic differences, information asymmetry, researchers' conceptual confusion, inducible experiment design and its psychological impacts on participants, researchers' confirmation bias, and a lack of distinction among different user roles. We found that few exploratory studies have been conducted so far to collect privacy-related legal norms in a health monitoring environment. Four research questions related to privacy barriers were raised, and an attempt was made to provide answers. CONCLUSIONS: This review highlights the problems of some research, summarizes patients' privacy concerns and legal concerns from the studies conducted, and lists the factors that should be considered when gathering and analyzing people's privacy attitudes.

Protecting Privacy of Pregnant and LGBTQ+ Research Participants.

This Viewpoint summarizes existing federal regulations aimed at protecting research data, describes the challenges of enforcing these regulations, and discusses how evolving privacy technologies could be used to reduce health disparities and advance health equity among pregnant and LGBTQ+ research participants.

Health Care AI and Patient Privacy-Dinerstein v Google.

This Viewpoint summarizes a recent lawsuit alleging that a hospital violated patients' privacy by sharing electronic health record (EHR) data with Google for development of medical artificial intelligence (AI) and discusses how the federal court's decision in the case provides key insights for hospitals planning to share EHR data with for-profit companies developing medical AI.

[The procedural aspects of postmortem defense of non-material goods of patient].

The protection of privacy of patient that is applying for medical care, diagnostics and treatment is one of the main pillars of implementation of medical activities. However, despite sufficient volume of legal regulation of lifetime respect of privacy of examination, observation and facts of medical intervention, in practice occur situations when privacy ceases to be such after death of the patient. The article is based on results of content-analysis of normative legal acts (n = 11), scientific publications (n = 52), cases of judicial practice (n = 8). The problem of non-observance of privacy becomes especially actual after death of person whose name is widely known. Having no possibility to impact on causes and modes of obtaining and propagating such specific information, the deceased, one's illness, stages of treatment, struggle for life, resources spent, clinics and specialists involved become object of close attention of various subjects (mas media, Internet communities) that use obtained information for speculative purposes at the expense of fixation of inhumane public replicas and increase of number of browsing. Despite prohibition provided for by law of dissemination of information constituting privacy of applying for medical care, after death of patient and application of measures of legal liability for fact of such a disclosure, information leak occurs regularly and information that got into common access frequently discredit good name of the deceased or develop other problems that are subjects to legal protection, for family members and legal successors. Yet, circumstances of transfer of information of limited access by medical organization (data leakage) or by intent of medical worker are difficult to be proved. Therefore, in judicial practice there are practically no such cases. At that, after death of famous people, juristic community regularly faces problems of protecting personal rights and non-material values from the side of relatives, legal successors and other interested persons. On the basis of formal logical method and system analysis method of disputable situations, possible perspectives of applying for judicial protection, procedural characteristics of procedure of applying for protection and possible composition of participants are presented.

AI Chatbots, Health Privacy, and Challenges to HIPAA Compliance.

This Viewpoint examines the privacy concerns raised by medical uses of large language models, such as chatbots.

The Challenges for Regulating Medical Use of ChatGPT and Other Large Language Models.

This Viewpoint discusses how regulators across the world should approach the legal and ethical challenges, including privacy, device regulation, competition, intellectual property rights, cybersecurity, and liability, raised by the medical use of large language models.

Wiretap laws and the perioperative physician - The current state of affairs.

BACKGROUND: Wiretapping laws generally govern the legality of surreptitious or unconsented audio recording or other interception of face-to-face conversations, telephone calls, and other oral or wire communications. Many of these laws were originally passed in the late 1960s or 70s, and many have since been modified or amended. Wiretap laws vary from state to state within the United States, and many clinicians as well as patients are often unaware of the scope and implications of these laws. CASE EXAMPLES: We provide three hypothetical case examples to illustrate scenarios in which wiretapping laws come into play. METHODS: Through a review of current legislation, we compiled relevant wiretapping statutes for each state, as well as the potential civil remedies and criminal punishments that could be imposed for violations. We include the results of targeted research related to cases in which rights or claims under applicable wiretap statues have been asserted in the context of medical encounters and healthcare practice. RESULTS: We classified thirty-seven out of 50 states (74%) as one-party consent state laws, nine out of 50 states (18%) as all-party consent state laws, and the remaining four states (8%) as "Mixed". Remedies and punishments for violations of state wiretapping laws generally can involve civil or criminal fines and/or potential incarceration. Cases in which healthcare practitioners have asserted rights under wiretap laws remain rare. CONCLUSIONS: Our findings demonstrate heterogeneity with regard to the wiretapping laws state-to-state. The majority of punishments for violations involve fines and/or potential incarceration. Given the wide variability in state legislature, we suggest that anesthesiologists know their state's wiretapping law.

Cruzan after Dobbs: What Remains of the Constitutional Right to Refuse Treatment?

In 2022, the U.S. Supreme Court removed constitutional protection from the individual's right to end a pregnancy. In Dobbs v. Jackson Women's Health Organization, the Court invalidated previous rulings protecting that right as part of the individual liberty and privacy interests embedded in the U.S. Constitution. Now, many observers are speculating about the fate of other rights founded on those interests. The Dobbs ruling conflicts with the Court's 1990 Cruzan decision restricting the government's power to interfere with personal medical choices. The language and reasoning in Dobbs and Cruzan offer guidance on how the Court might address future cases involving the right to refuse life-sustaining treatment. The decisions also point to policy strategies for preserving that right.

[When quality improvement clashes with privacy regulations]. / Wanneer kwaliteitsverbetering botst met privacyregels.

Continuity in patient care is crucial but is not a 'given' in complex circumstances when several health care professionals are involved in a clinical trajectory. Discontinuity may make it difficult to follow a patient's clinical course, which can be instructive and providing useful feedback on professional performance. Hence, it is a good clinical habit to check on patients after the care has been taken over by others. However, too strict interpretation of privacy laws and regulation may hamper this valuable practice. Obviously, protection of medical information and patients' privacy is vital, however, this should not apply to health care professionals that were involved in earlier phases of a patient's care as they should be considered having a continuing care relationship with the patient. Interestingly, a vast majority of patients themselves have no concern at all when professionals that were involved in earlier phases of their care access their information.