*2.8.2 Medical secrecy and a regional fragment of a unified state information system in the field of healthcare*

Issues of disclosure of medical secrecy have been developed with the introduction of a regional fragment of a unified state information system in the field of health care due to its inconsistency with the norms of modern legislation of the Russian Federation (RMIS).

RMIS as an element of the national information system created to ensure effective information support for bodies and organizations of the health care system, as well as citizens in the framework of health care management processes and its direct receipt. The development of the system is governed by the Concept of creating a unified state information system in the health sector, approved by order of the Ministry of Health and Social Development of the Russian Federation No. 364

*Education, Human Rights and Peace in Sustainable Development*

a licensed medical institution.

persistent remission (recovery) [50].

to work related to driving a vehicle.

*2.8.1 Medical secrecy and concealment of the diagnosis*

**2.8 Medical secrecy**

10, 1995, medical inspection of candidates for vehicle drivers is mandatory [49]. The receipt, replacement, and restoration of driving licenses are performed only if there is a medical certificate, which is issued after passing a medical examination in

The presence of documented epilepsy is a medical contraindication to driving a vehicle. According to clause 1 of Article 23.1 of the Law "On Road Safety," medical contraindications to driving a vehicle are diseases (conditions), the presence of which impedes the ability to drive a vehicle. The "List of medical contraindications to driving a vehicle," approved by Resolution of the Government of the Russian Federation No. 1604 dated December 29, 2014, states that epilepsy is a disease of the nervous system, which is a contraindication to driving a vehicle. At the same time, this List does not indicate that epilepsy does not cease to be a medical contraindication to driving a vehicle even after termination of dispensary observation due to

In accordance with order of the Ministry of Health and Social Development of the Russian Federation No. 302-n dated April 12, 2011, diseases accompanied by disorders of consciousness (epilepsy and epileptic syndromes of various etiologies, syncopal syndromes of various etiologies, etc.) are contraindications for admission

In view of the above, a question arises about the consequences of concealing the

• By virtue of Article 92 of Federal Law No. 323-FZ dated 21.11.2011 "On the basis of health protection of citizens in the Russian Federation," personalized accounting for medical activities is the processing of personal data about persons receiving medical services. Information about persons, who receive medical services, is classified as restricted access information and is subject to protection in accordance with the legislation of the Russian Federation.

• In accordance with clauses 1 and 2 of Article 13 of Federal Law No. 323-FZ dated 21.11.2011 "On the basis of health protection of citizens in the Russian Federation" information about the fact that a citizen applied for medical care, his/her state of health and diagnosis, other information received at his/her medical inspection, and treatment constitute a medical secrecy. The disclosure of information constituting medical secrecy, including after the person's death, by persons to whom it became known during training, working, and perform-

• According to Article 9 of Law of the Russian Federation No. 3185–1 dated 02.07.1992 "On psychiatric care and guarantees of the rights of citizens when it is provided" [51] information about the fact that a citizen applied for psychiatric care, his/her mental health and the diagnosis of mental disorder, and other information received during the provision of psychiatric care constitute

Thus, the constituent elements of the above medical secrecy are the fact and date of application for medical care, diagnosis, treatment, status, history of the disease, information about associated diseases (sexually transmitted infections, HIV

diagnosis of epilepsy. The following should be answered in this regard:

ing professional, official, and other duties is not allowed.

medical secrecy protected by law.

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dated April 28, 2011 [54], as well as a number of guidelines and functional requirements for individual components of the system, which are annexes to the order.

According to Article 23 of the Constitution of the Russian Federation, everyone has the right to privacy, personal and family secrets, and protection of his/ her honor and good name. Everyone has the right to confidentiality of correspondence, telephone conversations, and postal, telegraph, and other communications. Under personal privacy, the Constitution of the Russian Federation and federal legislation imply noninterference in privacy, the inviolability of personal and family secrets (privacy secrets). Restriction of this right is allowed only on the basis of a court decision.

By virtue of Article 92 of Federal Law No. 323-FZ dated 21.11.2011 "On the Basics of Health Protection of the Citizens in the Russian Federation," personified accounting for medical activities is the processing of personal data about persons who receive medical services. Information about persons, who receive medical services, is classified as restricted access information and is subject to protection in accordance with the legislation of the Russian Federation.

According to Article 9 of Law of the Russian Federation No. 3185–1 dated 02.07.1992 "On psychiatric care and guarantees of the rights of citizens when it is provided," information about the fact that a citizen applies for psychiatric care, his/her mental health and the diagnosis of mental disorder, and other information obtained during the provision of psychiatric care constitute medical secrecy protected by law.

It should be noted that the above program does not provide the necessary conditions for the protection of the information it contains, which creates the prerequisites for violating the norms of current legislation. The RMIS program contains confidential information, namely: the fact and date of applying for assistance, diagnosis, treatment, mental status, history of the disease, information about associated diseases (sexually transmitted infections, HIV infection, infertility, other gynecological pathology, genetic abnormalities, etc.), and history of life (adultery, homosexual orientation, sexual perversions, abortion, the concealment of true paternity in legal marriage, suicide attempts, etc.). The disclosure of this information can not only degrade the honor and dignity of patients and contribute to their discrimination in society but also cause auto-aggressive and aggressive tendencies (including to medical staff). Similar consequences may occur due to disclosure of diagnoses, for example, oncological and neurological, in particular epilepsy.

Moreover, the information contained in the RMIS program is currently not adequately protected and can be changed, replaced, deleted, stolen, and also made public in the media, including the Internet. The presence of an electronic signature in the doctor's account does not eliminate the possibility of such violations. As practice shows, due to insufficient protection of confidential information in the RMIS program, patients repeatedly refused to be examined and withdrew consent to treatment and to the processing of personal data.

Such a discrepancy between the information system and legal requirements violates the constitutional rights of citizens to privacy, personal, and family secrets.

#### **3. Conclusions**

In terms of the implementation of social rights of citizens with a diagnosis of epilepsy, there are the following problems:

1.There are no clinical guidelines on the provision of medical care to patients with epilepsy, approved by the Ministry of Health of the Russian Federation,

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*Problems of Social Rights Enjoyment by Persons Diagnosed with Epilepsy: Legal Aspect*

which makes it difficult for patients with a diagnosis of epilepsy to have access

2.The current system of drug provision does not ensure the right of people suffering from epilepsy to free modern effective drugs and does not comply with the unconditional right of everyone to free medical care stated in the Constitution of

3.In employment relationships, citizens with long-term remission (drug or nondrug) fall under the same legal restrictions as people with an incurable form

To date, an employer may dismiss or may not hire an employee who has been diagnosed with epilepsy or syncope condition (due to inconsistency with the position held), suggesting to an employee (if possible) employment in an alternative position (which he/she corresponds to). At the same time, contraindications to work with a diagnosis of "epilepsy" according to the list of general medical contraindications for admission to work with harmful and (or) dangerous production factors, as well as to work, during which the preliminary and periodic medical inspections (examinations) of workers are required (state and municipal services, prosecutor's office employees, judges, etc.) are saved for life not only for patients with epilepsy and epileptic syndromes of various etiologies (G40.0–G40.9) but also

4.Since 2013, it is impossible for citizens with a diagnosis of epilepsy to get an education in the desired profession if it is included in the established list of

5.Military service (including using a weapon) is possible with a single epileptic seizure in history (more than 5 years) or the presence of epileptiform activity

detected by electroencephalography, without clinical manifestations.

It is also important that the military-medical examination for epilepsy does not include seizures, which are the clinical manifestation of the acute condition of G40.5 (for example, alcohol poisoning, drugs poisoning, febrile seizures, etc.).

6.The ban on driving a vehicle remains for life, regardless of the severity of the seizures, their number and etiology (G40.0–G40.9), prolonged remission due

7.Information insecurity in the regional fragment of the unified state information system (RMIS) violates the patients' rights to privacy and the rights of the

for patients with syncope syndromes of various etiology.

medical contraindications.

to drug therapy, or in its absence.

The authors declare no conflict of interest.

doctor to medical activities.

**Conflict of interest**

*DOI: http://dx.doi.org/10.5772/intechopen.89007*

to modern treatment.

the Russian Federation.

of epilepsy.

which makes it difficult for patients with a diagnosis of epilepsy to have access to modern treatment.


To date, an employer may dismiss or may not hire an employee who has been diagnosed with epilepsy or syncope condition (due to inconsistency with the position held), suggesting to an employee (if possible) employment in an alternative position (which he/she corresponds to). At the same time, contraindications to work with a diagnosis of "epilepsy" according to the list of general medical contraindications for admission to work with harmful and (or) dangerous production factors, as well as to work, during which the preliminary and periodic medical inspections (examinations) of workers are required (state and municipal services, prosecutor's office employees, judges, etc.) are saved for life not only for patients with epilepsy and epileptic syndromes of various etiologies (G40.0–G40.9) but also for patients with syncope syndromes of various etiology.


It is also important that the military-medical examination for epilepsy does not include seizures, which are the clinical manifestation of the acute condition of G40.5 (for example, alcohol poisoning, drugs poisoning, febrile seizures, etc.).

