Confidentiality as an Ethical Dilemma - Article Example

Confidentiality as an Ethical Dilemma 21 March, 2007 Confidentiality as an Ethical Dilemma Studies have shown that the most frequently described dilemmas in the field of therapy involve confidentiality. Of these incidents, several revealed that decisions had to be made as to whether confidential information should be disclosed and, if so, to whom (Pope & Vetter, 1993). The conflict between honoring confidential agreements and using the information to help the client requires a psychologist to make a decision that could go either way, but the decision must be made regardless. Nature, Purpose, and Manner of Disclosures When sharing confidential information outside a treatment relationship, psychologists must consider the nature, purpose, and manner of the disclosure. According to Stephen Behnke, APA ethics director, (2005), "confidentiality is the core value of the profession," but when faced with an ethical dilemma, the APA Ethics Code can offer guidance in a difficult situation. The key facts that create an ethical dilemma when confidentiality must be breached are first, the nature of an ethical dilemma in which confidentiality is an issue. It is therefore necessary to clarify the term "confidentiality." It is treatment of information given in a relationship of trust with the understanding that the information will not be disclosed without permission (MedSearch). Another area to be addressed is the purpose of an infringement of confidentiality, and the third is the manner of the disclosure (Behnke, 2005). Below are selected case histories in which confidentiality created an ethical dilemma: Problem: A colleague withheld information about a client from the therapist to whom she transferred a case on grounds of maintaining client confidentiality. Both were employed in the same agency. Should this information have been shared for the benefit of the client (Pope & Vetter, 1992, Confidentiality). Resolution: It is possible that holding back information will do more harm than good for the client. It depends on what the information is and how important it is in the treatment of the patient. Under Ethics Code 4.07, the therapist can ask the patient's permission to pass on information to another therapist. Another option would be to follow Ethics Code 4.06 and determine the minimum amount of confidential information that would assist the patient and the therapist and share that even though the patient has not given permission. Problem: An executive director of a Mental Health Clinic used his position to obtain and review clinical patient files of clients who were members of his church. Is he correct in his premise that confidential information will help him in his clerical role and therefore his use of the information is ethical (Pope & Vetter, 1992: Confidentiality). Resolution: Even though the director considers his actions to be ethical, he is still using confidential information to assist members of his church who are not his individual clients. The question is whether he can counsel church members without this information, and if so, shouldn't that be the most ethical option After all, the director has access to confidential information, but the church members have not given him permission to use it in a church setting. In the cases noted above, what is the purpose of disclosing confidential material, whether sharing it with a colleague or using it in an entirely different setting not related to professional therapy In the first case, information was not shared, but the purpose for holding back the information was not noted or explained. Since the two therapists are members of the same agency, sharing information for the good of the client would seem logical. In the second case, the director of the hospital is using information as a means of helping a parishioner in need. His purpose is not really justified, and the secretive manner in which he uses the information is unethical. If a client has a personality disorder and a consultation with another expert would be beneficial, it is quite possible the client would refuse to release confidential information. The question becomes: what action would be in the best interest of the client and how can a psychologist justify going against the client's wishes in order to improve the client's well being It is in this area that the Code can be most helpful. Ethical Standard 4.06 offers a choice that might be considered ethical wherein only confidential information that would not identify the client/patient would be shared or information only to the extent necessary to achieve a successful consultation would be disclosed. Ethical standard 4.07 gives a choice of obtaining consent to divulge confidential information or to disguise it by using a different gender, age, or profession. The problem with disguising information, however, might be that such information could give the consultant a distorted picture of the problem being addressed (Behnke, 2005). According to Principle 3B of the Code of Ethics for the American Mental Health Counselors Association (2000), clients have the right to share all materials in the official record, and have the right to decide what information may be shared with anyone beyond the immediate provider of service. This would indicate that the director of a mental health hospital would not have the right to use confidential information in his counseling sessions at his church under any circumstances. Awareness of ethics codes is crucial but formal standards are not a substitute for an active, deliberative, and creative approach to fulfilling ethical responsibilities. There are two standards for determining an ethical approach to a dilemma-teleological and deontological. The first is a common-sense approach in which moral status is determined based on the consequences of specific actions, in other words, the results. The second is that actions are inherently right or wrong, e.g. lying, cheating, stealing. In theory, these two standards conflict, but in practice, they complement each other. In the challenge of identifying and resolving ethical dilemmas, each acts as a check on the limitations of the other (White, 1993). The present concerns over ethical dilemmas and confidentiality, especially in a highly technological world, with the Internet offering instant information, call for further exploration of a specialized program in which ethics consultations would be offered to therapists. Like any treatment or intervention, ethics consultation has to prove its value on the basis of universal ethical principles demanded of medicine itself, but as more and more dilemmas occur, especially in the area of confidentiality, focus on solutions becomes more necessary, and it is important for local groups to work together to make this service a reliable source of advice and assistance when difficult ethical decisions are necessary (Reiter, 2000, 202-203). References Behnke, Stephen. (2005). Disclosing confidential information in consultations and for didactic purposes: Ethical Standards 4.06 and 4.07. APA Online, Vol. 36, No. 4, April 2005. Retrieved March 20, 2007, from http://www.apa.org/monitor/apr05/ethics.html MedSearch Glossary. Department of Health and Human Services. Retrieved March 19, 2007, from http://www.gulflink.osd.mil/medsearch/glossary/glossary_c.shtml Pope, Kenneth S., and Vetter, Valerie A. (1992). Ethical Dilemmas Encountered by Members of the American Psychological Association: A National Survey. American Psychologist, Vol. 47, No. 3, 397-411. Retrieved March 20, 2007, from http://www.kspope.com/ethics/ethics2.php Principle 3-B. Code of Ethics (revised 2000). American Mental Health Counselors Association. Retrieved March 20, 2007, from http://www.amhca.org/code/#3. Reiter, Stella. (2000). Ethics consultation on demand: concepts, practical experiences and a case study. Journal of Medical Ethics, 2000; 26:198-203. Retrieved March 20, 2007, from http://jme.bmj.com/cgi/reprint/26/3/198.pdf White, Thomas I. (1993). Resolving an Ethical Dilemma. Adapted from Thomas White, "Ethics," Chapter 1, Business Ethics: A Philosophical Reader (New York: Macmillan Publishing, 1993). Retrieved March 20, 2007, from http://www.ethicsandbusiness.org/pdf/strategy.pdf Read More