A moral approach to electronic patient records.

This paper seeks to establish a morally appropriate balance between the various moral standards that are in tension in the field of Electronic Patient Records (EPRs). EPRs can facilitate doctorpatient relationships, however at the same time they can undermine trust and so harm the doctorpatient relationship. Patients are becoming increasingly reluctant to tell their own doctor everything that is relevant. A number of moral principles and the question of consent to release of records are considered here. There is also explicit mention of the principles for the treatment of the EPRs of the dead. A number of tensions between principles are explored, including that between privacy and promotion of welfare, both in an emergency and in more routine situations. The discussion also includes the tension between access and the right to not know about a condition that may undermine, for example, self-esteem; and the tensions between principles that arise when epidemiology, public health surveillance and healthcare evaluation are conducted. Suggestions are made about an appropriate balance between the principles. It is suggested that the patient's right to informed consent should be dominant.