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Privacy and Unique Health Identifiers

ABSTRACT: Privacy protections for medical records present a regulatory nightmare. Quick retrieval of medical information is critical to quality care since it gives a doctor a patient’s history in a short amount of time, but quick retrieval can also degrade privacy. In order to balance the two, the 104th Congress mandated that the Department of Health and Human Services develop and promulgate a standard for Unique Health Identifiers (UHIs). In this paper I examine the costs and benefits of unique health identifiers and conclude that forcing the adoption of such a standard at this time would have a negative impact on patient privacy and confidentiality.

Privacy protections for medical records present a regulatory nightmare. Medical records are critical to quality care since they give a doctor a patient’s history; they are key to preventing dangerous drug interactions, complications from allergies, and harmful drug side effects. Medical records also play a key role in medical and health system research. The information in a patient’s medical records, however, can be used for much more insidious purposes; denial of medical care, denial of employment, character assassination, and extortion are all consequences of medical information falling into the wrong hands. The difficulty of balancing these needs has resulted in a thin patchwork of regulatory protection of medical information; as one commentator has noted, federal law protects video rental records more thoroughly and completely than medical records. [1]

Some legislators and administrators have advocated the use of “unique health identifiers” (UHIs) in order to allow doctors and researchers to properly access medical records while preventing some forms of misuse. When Congress passed the Health Insurance Portability and Accountability Act in 1996, they specifically included a requirement for the Department of Health and Human Services to develop standards for UHIs by 1998.1 [2] The Clinton Administration, however, indefinitely postponed creating this standard, saying that further legislation protecting medical record privacy needed to be enacted before they would promote a UHI standard. [3] In this age of ubiquitous networks and nearly free-flowing information, UHIs tip the balance between privacy and accessibility too far to one side; unique health identifiers pose a unique threat to privacy.


Undeniably, UHIs offer several benefits to the medical community, particularly in the areas of patient care and research. Proponents of unique identification claim such a system would improve the quality of medical care by allowing doctors and other medical agencies to obtain a complete medical history quickly.

Human Cloning Debate and Life Issues

Human Cloning Debate and Life Issues

The use of cloning to produce “Dolly” the sheep has prompted a public debate about cloning humans. This issue has quickly become linked with the issues of abortion and embryo research.

What is cloning?

Cloning is a way of producing a genetic twin of an organism, without sexual reproduction. The method used to produce Dolly the sheep is called “somatic cell nuclear transfer”: the nucleus of a body cell (“somatic cell”) is transferred into an unfertilized egg whose nucleus has been removed or rendered inactive. A tiny electric pulse may then stimulate development of the resulting embryo, which is an almost exact genetic twin of the creature that supplied the nucleus. It may be technically possible to use this procedure to reproduce human beings.

What does cloning have to do with embryo research?

A great deal. Cloning a human being or other large organism begins by artificially producing an embryo of that species. To produce one live sheep, “Dolly,” scientists created 277 sheep embryos; 276 died or were discarded. Experiments in human cloning would involve the creation and destruction of human embryos on a massive scale.

Didn’t the National Bioethics Advisory Commission (NBAC) propose a ban on cloning?

Not really. It proposed a five-year moratorium on use of cloning to produce a “child,” meaning a live-born child. This would allow unlimited cloning to produce human embryos, so long as the embryos were then destroyed. Such experiments could be used to refine the procedure and test its likelihood of causing birth defects. After years of destructive experiments, the ban on allowing live birth could be reconsidered. So NBAC’s proposal is not a ban on cloning but a permission slip for experimenting on embryos and a mandate for destroying them. This approach is reflected in S. 1602, a bill introduced by Senators Kennedy and Feinstein to prohibit transferring a cloned human embryo to “a woman’s uterus.” Under S. 1602, researchers could clone embryos and experiment on them without limit; they would violate the law only if they failed to throw away the embryos afterwards.

What does human cloning have to do with abortion?

Quite a bit, because bills like S. 1602 would enforce a ban on “cloning a human being” by mandating the destruction of all cloned human embryos. This would mark the first time Congress has ever declared that human embryos are not humans and are worthy only of destruction.

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