Despite these and other exceptional waivers of privacy as part of military service, military personnel are entitled to some expectation of basic levels of accuracy, privacy, confidentiality, and security in the keeping of records of their exposures to radiation. To clarify these expectations, accuracy, privacy, confidentiality, and security in these contexts require definition. The accuracy of records means that the data that are collected should be complete, material, current, and correct. Health information privacy may be defined as an individual's claim to control the circumstances in which personally identifiable (versus anonymous or linkable) information is collected, used, stored, or transmitted. Confidentiality refers to privacy interests arising out of a specific relationship with the person about which information is gathered. In this context, a soldier may expect that a military physician whom he or she has seen for a medical condition will keep that information confidential, despite the dual fiduciary relationship of the physician to the patient and the physician's commanding officer. Security denotes the technological, organizational, or administrative processes designed to protect data systems from unauthorized access or unwarranted disclosures, modification, or destruction (Gostin, 1995, 1997; Gostin et al., 1996).

Consistent with these definitions, even the most secure system of military medical record management cannot maintain the privacy of records because no collection of information is free from unauthorized access. Although privacy expectations arise, in part, from the ethical principle of autonomy, they are not in any sense absolute. Medical records, by their nature, are created to be shared with others. Health information is lawfully exchanged among numerous parties, regardless of an individual's claim to control the circumstances in which it is transmitted.9 In the military individual interests in health information privacy must be balanced against the individual's own interests in comprehensive and accurate recordkeeping, as well as the competing interests of the military and clinicians in information concerning radiation exposure. The result in military settings is a privacy trade-off between the privacy of the medical records of military personnel and the communal defense-oriented interests of the military.

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For example, state reporting requirements mandate the reporting of instances of multiple diseases to state authorities, regardless of whether an individual diagnosed with the condition consents.



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