When is research on patient records without consent ethical?

Current regulations do not allow most low-risk research using patient records without patient consent. One of the main reasons adduced for this is that such research constitutes an unacceptable breach of confidentiality. By contrast, it is argued in this paper that it may, on occasion, be acceptable for confidentiality to be breached according to all three of the major ethical justifications for respecting patient confidentiality. In practice, the arguments against allowing research using patient records are usually grounded in claims about the link between confidentiality and respect for patient autonomy rather than legitimate patient expectations. Patients may have good reason to expect, or come to expect, that their records will be used without their consent for low-risk research, under certain conditions. Where this is the case, such expectations provide reasonable grounds for considering such research to be ethical.