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Key Differences Between Fact and Opinion

We can hear Emerson wrangle with himself on this very point in the words of this journal entry:. MS Am Emerson says that nature is beautiful because it is alive, moving, reproductive. In nature we observe growth and development in living things, contrasted with the static or deteriorating state of the vast majority of that which is man-made. He cites natural structures as lacking superfluities, an observation that in general has been confirmed by the advancement of biology.

Furthermore, he says that whether talking about a human artifact or a natural organism, any increase of ability to achieve its end or goal is an increase in beauty. So in Emerson we might find the resources for seeing evolution and the drive to survive as a beautiful rather than an ugly process, governed by laws that tend to increase reproductive fitness and that we can understand through observation and inquiry. And lastly, Emerson points to the relation between what we take to be an individual and the rest of nature as a quality of the beautiful. All of these qualities of beauty seem to go beyond the mere impression of sensible forms that we started with, and what they require is what also served as the basis of truth and goodness in nature.

Think for instance of the geometric structure of a crystal, or snowflake, or nautilus shell. Or consider the complexity of the fact that the reintroduction of the wolf in Yellowstone National Park changed the course of the rivers due to a chain reaction of cause and effect through the food web, a process called a trophic cascade. There is thus an emotional or affective component in the beauty of the intellect just as there is in the immediate beauty of perception.

If we destroy the natural world, we take away the things that we can marvel at and experience awe towards in these two ways. And this experience of the beautiful through the intellect may reinforce our attributing value to nature here as well, but a deeper kind of value, the intrinsic value I talked about in the last essay. Those who are determined to break into a system can be thwarted only with thoughtful and comprehensive system safeguards. Although harm from this source is likely to occur rarely in comparison with others, the harm can be great because so many individuals are affected.

Further, the data holder can be severely damaged in the public's eye. One goal for an HDO must be to assure the public of reasonable, if not absolute, safety. A different harm can result from release of information when data are incomplete, inaccurate, or out of date. Examples are medical records or insurance claims on which diagnoses are listed or coded incorrectly e. Other problems involve diagnoses that were considered at one time and ruled out but are still listed as a final diagnosis, incorrect inferences drawn from diagnostic tests, and clinical distortions that result from coding limitations.

Data inaccuracies also arise from actions that are intended to be beneficial—for example, to protect the patient from a stigmatizing diagnosis, to permit insurance reimbursement for a test or procedure that might otherwise not be covered as in the case of preventive and screening tests , or to allow a frail patient to be treated on an inpatient rather than outpatient basis.

Observation - Wikipedia

The committee does not know how often these irregularities occur. Studies of the accuracy of medical records consistently show unintentional and sometimes intentional errors Burnum, , and medical records personnel and researchers report that errors and omissions are extremely common in all health records. Harm from such problems may range from trivial to severe.

Any reliance on databases for such social benefits as credit ratings or life insurance means that data that are incomplete, inaccurate, or false for example, when records of several different people are combined are not merely useless, they are pernicious. Such errors and omissions were not a major focus of the study committee. It should be noted, however, that the converse of this problem is that the more accurate and comprehensive the databases, the more pressure there will be for access, which in turn raises the chances of harm in the other categories already discussed.

Harm resulting from inaccurate or out-of-date data can be mitigated or prevented in a number of ways, including adequate and regular attention to the reliability and validity of database contents as described in Chapter 3. Allowing individuals to obtain, challenge, and correct their own records can also help to improve their accuracy. HDOs may pose a threat to privacy interests in four ways. The first arises through harm from secondary use. This includes the potential for stigmatizing and embarrassing patients; adversely affecting their opportunities for employment, insurance, licenses, and other benefits; undermining trust and candor in the health care provider-patient relationship; and defeating patients' legitimate expectations of confidentiality.

Second is the unpredictable effect that will be produced by the mere existence of HDOs as described. Third, HDOs may exacerbate societal concerns about the emergence of national, centralized personal record databases, which may be perceived as a national identification system or dossier. Issues concerning the Social Security number and its analogs are especially pertinent here. Finally, HDOs will need to be mindful of the possible effect that research uses may have on privacy.

In addition to the current risk of breaches of confidentiality and the risk of harm from inaccurate data inherent in the paper record, the existence of any accumulation of valuable data will spawn new users, new demands for access, and new justifications for expanded access. HDOs may unintentionally create a heightened risk of disclosure resulting with the new forms of data becoming available through the HDOs, new inquiries and types of inquirers, new uses, and new legal and governance structures. The mere presence of the HDO may, over time, encourage new practices or changes that may be harmful to at least some segments of the population.

HDOs must also realize that the more information it holds or can access, and the more valuable that information, the greater the temptation will be for others to acquire and covertly use the information. An HDO database becomes, in some sense, like a swimming pool or an abandoned refrigerator to a child-an overwhelming opportunity or, in legal terms, an attractive nuisance. Computerization poses problems for the protection of privacy and confidentiality, but it also offers new opportunities for protection. For example, access to records and to defined parts of records can be granted, controlled, or adapted on a need-to-know or function-related basis; this means that users can be authorized to obtain and use only information for which their access is justifiable.

It will also be possible to implement authentication procedures discussed below and to implement and publicize the use of methods to permit the HDO to know if anyone has browsed in the databases, who has done so, and which data were accessed. Automation could also greatly mitigate the disclosure that now occurs when, for instance, an entire medical record is copied to substantiate a claim for a single episode of care, and software could prevent the printing or transfer of database information to other computers.

Privacy advocates can be expected to express sharp concerns about the potential for HDOs to be linked with one another or with other types of personal databases such as the financial, credit, and lifestyle databases maintained by consumer reporting agencies and information services. One particular threat is the possible contribution of linked databases to development of a de facto national identification and data system.

Such a system would comprise a comprehensive, automated dossier on virtually every citizen. Conventional wisdom holds that after a personal information database is established, some consequences are inevitable Gellman, : expansions in permissible uses of the database; demands to link the database with complementary databases to improve the database product; and relaxations of confidentiality restrictions.

With respect to HDOs, privacy advocacy groups and the media are likely to be concerned that over time various regional HDOs will establish telecommunications links and that these entities will become a national network linkable to other financial and government records such as those serving the Social Security Administration or the Internal Revenue Service.

As potential users of HDO data files, many persons in these groups might regard this scenario as desirable and beneficial; as potential record subjects, however, most would probably be uncomfortable with this threat to their privacy.


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Once such a system were in place, some fear that both those with and without bona fide access would be able to call up a remarkably comprehensive and intrusive dossier comprising detailed biographic information, family history information, employment information, financial and insurance information, and, unless prevented, of course, medical record information about every citizen participating in the system.

In the view of many, this development would bring the nation perilously close to a national identification database. Indeed, at that point the "national" network would lack only a means of positive identification and a requirement that all citizens participate to constitute such a national identification system. Although many people carry credit or health insurance cards and have no objection to doing so, others would view any requirement that a special identification card must be carried by participating consumers with special alarm because such an instrument is thought to connote totalitarian values.

In the former Soviet Union, for instance, all Soviet citizens were required to carry an internal passport and to produce this passport upon request. In this way, the passport served not only to regulate internal travel but as a means of identification and social control Pipko and Pucciarelli, Admittedly, a few Western democracies employ national population registries and automated and centralized personal record data banks, but virtually all these systems are principally statistical and research systems, rather than systems that are used for administrative or investigative purposes.

In Sweden, for example, the press harshly criticized the linkage of cancer registry databases and abortion record databases for medical research purposes Stern, Moreover, European democracies that use unique personal identification numbers assigned at birth for each citizen have a history of the use of personal, numerical codes.

Even in Sweden and Germany, two European democracies that make extensive use of personal identification numbers to track individuals and link databases, personal identification numbers are not used as a standard universal numeric identifier for participation in all aspects of the society. In addition, reports are increasing of popular resistance in these countries to the use of universal numeric identifiers Stern, As Bennett comments in Regulating Privacy :.

The issue in these countries [Sweden and Germany] has been the incremental and surreptitious use of these numbers for ends unrelated to those for which they were created. Where proposals have been introduced for a new universal identifier accompanied by a personal identification card, such as in Germany and Australia, they have been met with strong resistance because of the belief that non-uniformity and non-standardization with all the attendant problems for administration, are vital to the maintenance of personal privacy.

Over the years the Congress, the press, and privacy advocates have fiercely resisted any proposal for the development of databases that appeared to facilitate establishment of a national identification or database system. Some observers urge that entities like HDOs eschew the use of any type of positive identification, such as a biometric identifier, and avoid the use of the Social Security number. The aim is to minimize the likelihood that HDOs will contribute intentionally or unintentionally to a national identification system or to the development of a standard universal identifier USDHEW, If the HDO initiative is viewed by opinion leaders as a precursor to the establishment of any type of automated, national identification or dossier system, the initiative will likely fail.

HDO proponents should take every practicable step to assure advocacy groups, the media, legislators, and the American people that the emergence of HDOs will not contribute to the development of a centralized, automated national dossier system or a national identification system through linkage with non-health-related databases or the gradual relaxation of confidentiality policies. The personal identifier ID used by an HDO to label each of the individuals in the database is a crucial issue.

It is related not only to past practices but will also be strongly influenced, if not mandated, by the health care reform actions now under way in the nation. Of necessity, identifiers are used in present health care systems. For practical purposes the identifier in many systems is either the person's Social Security number SSN or, as in Medicare, the Social Security number of an individual with a letter appended. The ideal personal identifier must, whatever its design, minimize or eliminate the risk of misidentification.

An ideal identifier would meet certain requirements, including the six discussed below. First, it must be able to make the transition easily from the present recordkeeping environment to one that will prevail in HDOs and under national health care reform. Further, organizations will need to know where to apply for new numbers, to verify numbers that patients give verbally, to track down uncertainties in identification, to find current mailing addresses, and to be able to backtrack errors and correct them.

This requirement also has technical dimensions. For example, if a new identifier contains more digits or characters or both than the 10 used for the Medicare identifier, there will be software repercussions in many systems, and redesign of data-capture forms may be necessary. Second, the identifier must have error-control features to make entry of a wrong number unlikely. Control implies that errors of many kinds are detectable and possibly correctable on the basis of the digits and characters in the ID alone.

Ideally it will protect against transpositions of characters and against single, double, or multiple errors. Error control is certain to be a system-wide requirement in any automated system. It will involve not only the structure of the ID itself, but also the processing software or the residual manual processes in every system that will have to use and verify the ID.

Third, the ID will have separate identification and authentication elements. The distinction between identification and authentication is made where strong security is required. Banks, for example, sometimes require an individual to provide his mother's maiden name; a personal identification number PIN is another authenticator.

In many, perhaps most, medical systems this distinction is not made, and a simple identifier e. In the future, however, some consideration should be given to separating these functions. The number of additional characters needed depends on the degree of error detection and correction that designers think is necessary for the circumstances. For example, a single check digit can identify an error but does not locate which digit is wrong or how. Moreover, it would not catch the common manual error of transposed characters.

A simple single-digit check can sometimes say a bad message is good. For such reasons, a single check digit is not a very strong error control mechanism. The issue of designing error codes becomes complex rapidly. It is essential, however, to realize that any error correction feature added to an established number such as the SSN will have hardware and software consequences—or both.

Error control is a system-level problem, not just an issue of the identifier per se. If one can arrange procedures so that the identifier is always known to be correct at the time it is entered into the automated system, then the problem within the system itself becomes simpler. The method of providing the identifier will result in higher or lower assurance of its accuracy: an individual's memory is probably the least assurance of correctness; an embossed card is better; and an electronic reader for the card is better still.

The present health care information infrastructure runs largely without external visible error controls. Although mainframes and communications equipment almost certainly have error controls to catch equipment malfunctions and communication faults, there is no error control on some, possibly much, of the data in the data base. It relies, instead, on people outside the system to detect errors—providers and patients—and risks major mistakes in processing. Fourth, the ID must work in any circumstance in which health care services are rendered, whether or not the situation was anticipated in the design of the system.

At a minimum, the ID must never be an impediment to the prompt, efficient delivery of health care.

Beauty in Nature

For example, it must work when the patient requiring health care is not able to cooperate e. Fifth, the ID must function anywhere in the country and in any provider's facilities and settings. By extension, it must also be able to link events that have occurred at multiple providers. Sixth, the ID must help to minimize the opportunities for crime and abuse and perhaps help to identify their perpetrators.

In President Franklin Roosevelt signed an executive order requiring federal agencies to use the SSN whenever a new record system was to be established. When Medicare legislation was passed in the s, the government adopted the SSN plus an appended letter as the Medicare health insurance number. Many experts regard this as a serious undermining of privacy protection because the many recordkeeping activities associated with health care delivery act to disseminate a piece of information that differs from the SSN by only an appended letter.

In the Privacy Act of —largely in response to the position of a Department of Health, Education, and Welfare USDHEW, committee that had studied the issue—Congress prohibited states from using the SSN for enumeration systems other than by authority of Congress; however, states already using it were allowed to continue.

The Tax Reform Act of undermined this position, however, by authorizing the states to use the SNN for a variety of systems: state or local tax authorities, welfare systems, driver's license systems, departments of motor vehicles, and systems for finding parents who are delinquent in court-imposed child-support payments OTA, In short, the government has caused the proliferation in the use of the SSN, sometimes by positive actions but sometimes by indifference or congressional failure to act.

Some government decisions, notably to use the SSN as the taxpayer identification number and as the basis of the Medicare number, forced its wide diffusion throughout the private sector through financial transactions and benefits payments. In this way—partly deliberately and partly inadvertently—a very sensitive item of personal information has become widely disseminated.

Organizations that use the SSN as a personal ID and that most citizens will deal with frequently include federal government agencies e. Organizations, especially those in the private sector, choose to use the SSN for a number of pragmatic reasons and for expediency. Organizations already hold the number legally in connection with tax, financial, and wage matters. Moreover, there are no prohibitions against its use as a personal identifier in the private sector.

Individuals usually have an SSN, or they can get one easily. In addition, people have become accustomed to willingly providing an SSN when asked; hence, its acquisition is a matter of merely asking, not legal compulsion. Although federal, state, or local governments usually require the SSN under law, private-sector requests serve the purposes and motivations of the organization.

The essential point is that the SSN is in extraordinarily wide use as a personal identifier. As a result, any given person is indexed in a huge number of databases by his or her SSN, and an unknown number of linkages and data exchange among such databases are routine business. If health care reform were to mandate a patient ID that is either the SSN or a closely related number, it will in effect have forced the last step of making the SSN into a truly universal personal ID. The choice of a personal ID that is satisfactory for the operational needs of health care delivery, but at the same time assures the confidentiality of medical data and the privacy of individuals is neither easy nor casual.

Superficially, the choice would be the SSN, Medicare number, or something similar simply because people are accustomed to using them, systems are used to handling them. The government would bear the burden of administering the enumeration system but would avoid the cost of creating a new one. For information management, however, the shortfalls of the SSN are well known. The following list is representative of the problems. This provides little security, and data commingling can occur that would result in erroneous records, mistaken conclusions and actions, and incorrect payments. The allowable entries in each of the three groups in a SSN are well known.

Thus, it is easy to counterfeit an SSN and have a high probability that it will not be challenged. It has no error correcting features. It is fallible to transpositions and single- or multiple-digit mistakes. The SSN is not coupled to an authenticator. Some organizations, such as banks, attempt to provide such a feature by using some ad hoc data element that an individual is likely to remember but is not common knowledge e.

The SSN circulates widely, particularly in the finance industry. It is relatively easy to acquire someone's number and to parlay it into a false identity that supports fraud or other malicious or illegal actions. There are often multiple holders of the same SSN, which introduces errors and clouds the records. Especially among less well-informed or immigrant households, the purpose of the number is not well understood or is colored by the role that a number might have played in another country or society.

Health Data in the Information Age: Use, Disclosure, and Privacy.

For example, all members of a household might use the same SSN because they believe it is intended to apply to all of them. Some numbers have achieved very wide use. The most famous is the ''wallet incident" in which a replica of an SSN card complete with a number was included in an inexpensive, widely sold wallet; an appreciable number of people improperly believed that this SSN was to be used.

The SSN is closely related to the Medicare identifier, which identifies virtually all members of the population over age Not everyone needing health care has an SSN; for instance, foreign visitors, newborn infants, and the indigent or homeless are all likely to lack SSNs. This would require that health care providers be prepared to assign substitute numbers. The crucial, almost overwhelming, objection to the SSN as a medical identifier, however, is that it has no legal protection, and because its use is so widespread, there is no chance of retroactively giving it such protection.

As a data element, it is not characterized by law as confidential; hence, organizations that use it are under no legal requirement to protect it or to limit the ways in which it is used. For all practical purposes its use is unconstrained, this makes the risk of commingling health data with all other forms of personal data enormously high. Through expenditures for medical research, the government and private sector indirectly contribute to third-party intrusions. Although epidemiological research was originally concerned with the causes and prevention of infectious diseases and focused chiefly on populations, such research has expanded to include chronic, noninfectious diseases with low rates of occurrence PPSC, a.

Progression of such ailments may be slow, and because their causes are frequently insidious, their study often requires medical surveillance of a substantial population at widely disparate times. In some cases, HDOs may serve research and statistical uses, and this raises consideration of how privacy interests might be affected. First, the benefits of such databases generally accrue not to the individual data subject but to society; this makes assessments of risks and benefits more complex because the person at risk is not the same as the beneficiary.

Second, research databases depend on the voluntary cooperation of subjects, providers, or both in providing accurate and reliable information. If patients or clinicians distrust the ability or willingness of HDOs to protect the confidentiality of information, they may intentionally withhold or distort information. Third, it will become extremely important to understand the implications of differing methods of data collection and sources of data—for instance, abstraction of primary records and analysis of claims databases compared with patient responses to surveys fielded by the HDO.

Each will have different sources of bias in the population reached, reasons for missing data, and accuracy. With respect to research and statistical studies, Congress and agencies of the federal government have acted to protect the interests of individuals who are subjects of research and statistical records developed under federal authority or with federal funds PPSC, a. A report from the National Research Council analyzes available technical and administrative procedures that can be taken to protect confidentiality of data while permitting legitimate data use.

A number of such disclosure limitation techniques are described: 1 collecting or releasing a sample of the data; 2 including simulated data; 3 "blurring" of the data by grouping or adding random error to individual values; 4 excluding certain attributes; 5 swapping of data by exchanging the values of certain variables between data subjects; 6 requiring each marginal total of the table to have a minimum count of data subjects; 7 using a "concentration rule" described in Chapter 3 ; and 8 using controlled rounding of table entries NRC, Whether these steps are sufficient in the HDO context requires reexamination.

Because HDO databases will include many elements of personal information collected for single, specific purposes and subsequently used for multiple, diverse purposes, they have the potential to conflict with the secondary use principle. If such secondary use does not, however, involve a decision about the individual, then the privacy threat is by no means as acute as it would be if the information were used to make a decision directly affecting the individual USDHEW, Individuals' interests have not been compromised, for example, when these data are used anonymously for statistical or research purposes and not for administrative decision making that will affect them directly.

Researcher access to HDO databases is addressed in the committee's recommendations. The committee examined existing law-constitutional, statutory, and common law-for its relevance to HDOs and its adequacy for protecting patient privacy. The committee also examined the way these laws might affect the design, establishment, and operation of HDOs.

It concludes that most of this body of law is unlikely to apply to HDOs. With the exception of laws regulating information considered sensitive, existing laws regulate recordkeepers and their recordkeeping practices; they do not regulate on the basis of either the content or the subject matter of a record.

The Truth About Right Living: A Personal Observation

Current law thus seeks to regulate the information behavior of health care providers, government recordkeepers, insurers, consumer reporting agencies, quality assurance organizations, and researchers. For this reason, it is important to understand how HDOs are likely to be viewed by the legal system-that is, in what legal context their recordkeeping will be seen. The committee believes that HDOs are unlikely to be treated as health care providers, payers, or quality assurance organizations.

If they are treated as medical researchers, very little in the way of standards would apply. Implications of being treated as either are described briefly below. HDOs may well have governmental status, and the legal implications of that status are described in more detail, with particular attention to the Privacy Act of The NAIC Model Act defines an insurance support organization as "any person who regularly engages, in whole or in part, in the practice of assembling or collecting information about natural persons for the primary purpose of providing the information to an insurance institution or agent for insurance transactions" emphasis added.

Because HDOs will likely provide information to insurance institutions on a regular basis in connection with insurance transactions defined in the NAIC Model Act as a determination of an individual's eligibility for insurance coverage, benefit, or payment , it is possible they will be considered insurance support organizations. First, the HDO could not disclose personal information about an individual without the written authorization of the individual or unless the disclosure was needed: to further an insurance function, provided there is no redisclosure; to a health care institution or health professional; to an insurance regulatory authority; to a law enforcement authority; in circumstances otherwise permitted or required by law; in response to compulsory process; for the purpose of a bona fide research study, provided that no individual can be identified in any subsequent research report; for marketing purposes; to consumer reporting agencies; to a group policyholder; to a professional peer review organization; or for a licensing activity.

Second, when subject consent is obtained, the HDO would have to assure that the consent has several properties: that it 1 is written in plain language; 2 is dated; 3 specifies the types of persons authorized to disclose information; 4 specifies the nature of the information authorized for disclosure; 5 names the institution authorized to disclose; 6 specifies the purposes for which the information is being disclosed; 7 specifies the length of time for which the authorization is valid; and 8 advises the individual whose information is the subject of the consent that the individual has a right to a copy of the consent form.

Third, the HDO would have to provide record subjects with a right of access to their records, either directly or through a health care professional designated by the individual. Fourth, the HDO would be required to provide individuals with rights of correction, amendment, and deletion. Fifth, the HDO could not maintain information concerning any previous adverse underwriting decision relating to the individual. Sixth, the HDO would be subject to the regulatory and investigatory powers of the state commissioner of insurance.

In states that have not adopted the NAIC Model Act, there is little or no statutory regulation of the information practices of insurance institutions or insurance support organizations Trubow, to apply to HDOs. In theory, the above requirements might not apply at all in those states, or they might apply piecemeal by virtue of state-specific situations. These statutes regulate the collection, use, and dissemination of personal information by consumer reporting agencies.

Federal law defines a consumer reporting agency as an organization that "regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties" FCRA 15 U. The FCRA defines "consumer report" as any written or oral communication that bears on consumers' credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living when that report "is used or expected to be used or collected in whole or part for the purpose of serving as a factor in establishing the consumer's eligibility for: credit or insurance to be used primarily for personal, family or household purposes" or used "in connection with a business transaction involving the consumer'' FCRA 15 U.

If data from an HDO are used only in connection with insurance claims determinations, the HDO should not, at least by virtue of the insurance claims function, be classified as a consumer reporting agency. If, however, HDOs were to acquire and supply personal financial information to health care providers to assist providers in making determinations about a patient's payment of a medical bill including the acceptance of a consumer's credit card or check or the allocation of charges between the patient and various health care payment programs , HDOs would be providing information for use "in connection with a business transaction involving the consumer.

This kind of action brings the party making the disclosure within the scope of the FCRA. These include limitations of the kind of personal information that could be collected and maintained; requirements with respect to consumer access to the database; restrictions on the disclosure of the information from the database; and a variety of administrative, civil, and criminal sanctions.


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  • The governmental or private status of an entity that maintains or uses personal record information is particularly significant for recordkeeping. Constitutional principles, legislative charter, statutory law, and regulations must be considered separately. If an entity has a governmental status, whether federal or state, constitutional privacy standards apply to the entity's handling of personal information. As noted earlier, various provisions of the U.

    Bill of Rights are aimed at protecting citizens from governmental abuse, and privacy rights are derived from limited case law e. For federal or state constitutional protections to apply, an HDO would have to be operated by a governmental entity or pursuant to a governmental charter. Even if HDOs are not operated by federal governmental entities, constitutional information privacy standards can affect their operations in two ways. First, HDOs may well operate under a state legislative charter.

    If that charter were to require the submission of personally identifiable medical record information on the part of record subjects, providers, or others , this statutory requirement provides a basis for a challenge on constitutional privacy grounds, just as did the reporting requirements in Whalen. Second, even if the HDOs are not statutorily chartered, constitutional information privacy concepts are used by the courts as benchmarks for assessing whether a privacy violation has occurred under common law or statute.

    Accordingly, if an HDO were challenged on tort or other common law or even statutory privacy theories, the extent to which the HDO violates constitutional informational privacy rights could well be influential in determining the outcome. In addition to any constitutional protections which will be limited at best , a body of statutory law would also apply to HDOs if they were considered to be public agencies.

    For example, federal agencies and agencies in every state are covered by freedom of information FOI or public records acts. These statutes are intended to make records held by government agencies available to the public. The federal FOIA, however, contains express language that exempts from disclosure "personnel and medical files and similar files the disclosure of which would constitute a clearly unwarranted invasion of personal privacy" 5 U.

    Most state freedom of information statutes include a similar exemption. Washington State's FOIA, for example, includes an exemption for medical records, pharmacy records, client records held by domestic violence programs, and various types of research data. The Washington courts have also held that medical records are exempt from disclosure under Washington's FOI statute. In addition, the federal government and approximately one-third of the states have adopted fair information practices and statutes covering governmental agencies within each jurisdiction.

    The federal Privacy Act prohibits federal agencies, or contractors acting on behalf of an agency, from disclosing information accessible by personal identifiers and contained in a system of records without the prior written consent of the individual concerned. Federal agencies and those in some states can, however, adopt special procedures that bar direct access to medical record data when officials have reason to believe that such access would be harmful to the subject Cleaver, ; Andrussier, The right to know about, challenge, control, and correct information about oneself are hallmarks of American privacy law.

    The five principles in the original code are enumerated in that report p. There must be no personal data recordkeeping systems whose very existence is kept secret. There must be a way for an individual to find out what information about him is in a record and how it is used. A particular responsibility therefore for each of you, and your colleagues, is to evoke among the young the desire for the act of faith, encouraging them to commit themselves to the ecclesial life that follows from this belief. It is here that freedom reaches the certainty of truth.

    In choosing to live by that truth, we embrace the fullness of the life of faith which is given to us in the Church. Clearly, then, Catholic identity is not dependent upon statistics. Neither can it be equated simply with orthodoxy of course content. It demands and inspires much more: namely that each and every aspect of your learning communities reverberates within the ecclesial life of faith. Only in faith can truth become incarnate and reason truly human, capable of directing the will along the path of freedom cf.

    Spe Salvi , In this way our institutions make a vital contribution to the mission of the Church and truly serve society. It is important therefore to recall that the truths of faith and of reason never contradict one another cf. In articulating revealed truth she serves all members of society by purifying reason, ensuring that it remains open to the consideration of ultimate truths.

    Drawing upon divine wisdom, she sheds light on the foundation of human morality and ethics, and reminds all groups in society that it is not praxis that creates truth but truth that should serve as the basis of praxis. Far from undermining the tolerance of legitimate diversity, such a contribution illuminates the very truth which makes consensus attainable, and helps to keep public debate rational, honest and accountable. Similarly the Church never tires of upholding the essential moral categories of right and wrong, without which hope could only wither, giving way to cold pragmatic calculations of utility which render the person little more than a pawn on some ideological chess-board.

    With regard to the educational forum, the diakonia of truth takes on a heightened significance in societies where secularist ideology drives a wedge between truth and faith. This division has led to a tendency to equate truth with knowledge and to adopt a positivistic mentality which, in rejecting metaphysics, denies the foundations of faith and rejects the need for a moral vision. Truth means more than knowledge: knowing the truth leads us to discover the good. Truth speaks to the individual in his or her entirety, inviting us to respond with our whole being.

    Spe Salvi , 2. With confidence, Christian educators can liberate the young from the limits of positivism and awaken receptivity to the truth, to God and his goodness. In this way you will also help to form their conscience which, enriched by faith, opens a sure path to inner peace and to respect for others. It comes as no surprise, then, that not just our own ecclesial communities but society in general has high expectations of Catholic educators.

    This places upon you a responsibility and offers an opportunity. More and more people — parents in particular — recognize the need for excellence in the human formation of their children. As Mater et Magistra, the Church shares their concern. The objectivity and perspective, which can only come through a recognition of the essential transcendent dimension of the human person, can be lost. Within such a relativistic horizon the goals of education are inevitably curtailed.

    Slowly, a lowering of standards occurs. We observe today a timidity in the face of the category of the good and an aimless pursuit of novelty parading as the realization of freedom. We witness an assumption that every experience is of equal worth and a reluctance to admit imperfection and mistakes. How might Christian educators respond? This aspect of charity calls the educator to recognize that the profound responsibility to lead the young to truth is nothing less than an act of love.

    Indeed, the dignity of education lies in fostering the true perfection and happiness of those to be educated.