A Defense of Unqualified Medical Confidentiality

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties.     

Mothers', fathers' and children's perceptions of parents' expectations about children's family obligations in nine countries

Children's family obligations involve assistance and respect that children are expected to provide to immediate and extended family members and reflect beliefs related to family life that may differ across cultural groups. Mothers, fathers and children (N = 1432 families) in 13 cultural groups in 9 countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand and United States) reported on their expectations regarding children's family obligations and parenting attitudes and behaviours. Within families, mothers and fathers had more concordant expectations regarding children's family obligations than did parents and children. Parenting behaviours that were warmer, less neglectful and more controlling as well as parenting attitudes that were more authoritarian were related to higher expectations regarding children's family obligations between families within cultures as well as between cultures. These international findings advance understanding of children's family obligations by contextualising them both within families and across a number of diverse cultural groups in 9 countries.     

A defense of unqualified medical confidentiality

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties.     

Expectations and preferences regarding confidentiality in the psychologist-client relationship

Two hundred and fifty-six members of the Australian public were surveyed regarding situations in which a psychologist might breach confidentiality and third parties to whom information might be disclosed. There was strong agreement between respondents' expectations about the way in which psychologists would act, and their preferences regarding how psychologists should act. While respondents supported confidentiality within the psychotherapeutic relationship, they clearly distinguished situations in which, and third parties to whom, disclosure could appropriately occur. Disclosure was expected and preferred when a client revealed a murder (planned or confessed), suicide plans, child abuse, or treason, and where the recipients of the information were colleagues of the psychologist or parents of a client younger than 13 years. Compared to nonparents, parents more strongly supported disclosure regarding illegal drug use and child abuse, and believed that parents should have access to a child's records. In general, respondents' view of the way in which psychologists should treat confidentiality issues were consistent with the guidelines prescribed by the Australian Psychological Society in the Code of Professional Conduct (1986).     

Issues Regarding Confidentiality for Military Psychologists

Federal statutes and military service regulations govern the functioning of military psychologists. Effective July 18, 1988, military psychologists were required to maintain an active state license. The licensing laws of all 50 states cite adherence to the Ethical Principles of the American Psychological Association (APA, 1981a). Potential conflicts exist between federal statutes, service regulations, and ethical principles of the APA. The principal area of conflict may be with confidentiality of information obtained by psychologists from consumers. Thirty active duty Army Medical Department (AMEDD) psychologists were surveyed on current practices regarding confidentality. Twenty-four (80%) responded. Results suggest that most AMEDD psychol- ogists (21 respondents or 87.5%) do not document in writing that they have informed consumers of the limits of confidentiality of psychological infor- mation. Nor do they obtain written permission before releasing information on consumers when requested by unit commanders. Military psychologists are encouraged to advise consumers in writing of the limits of confidentiality of psychological information prior to initiating any professional relationship with a patient.     

Patient choices, family interests, and physician obligations

Recent articles in biomedical ethics have begun to explore both the relevance of family interests in treatment decisions and the resultant ramifications for physicians' obligations to patients. This article addresses two important questions regarding physicians' obligations vis-a-vis family interests: (1) What should a physician do when the exercise of patient autonomy threatens to negate the patient's moral obligations to other family members? (2) Does respect for patient autonomy typically require efforts on the part of physicians to keep patients' treatment decisions from being influenced by family considerations? A series of clarifications about the concept of autonomy is also presented.     

Medical practitioners' competence and confidentiality decisions with a minor: An anorexia nervosa case study

Minors (i.e., those under 18 years of age) hold a tenuous legal position in medical settings. While recent legal authority in numerous jurisdictions affords competent minors the right to consent to medical treatment, the guidelines for assessing competence are often vague or non-existent. In addition, these changes have not adequately addressed the issue of confidentiality, and it is unclear whether general practitioners (GPs) owe a duty of confidentiality to competent minors. As medical practitioners are the first point of contact in medical settings, the present study explored GPs' competence and confidentiality determinations regarding a 16-year-old female patient who presented with symptoms of an eating disorder. Questionnaires and hypothetical scenarios were sent to a sample of 1000 GPs, of which 305 responded. Results indicated that 62% of respondents would have found the patient competent, while 82% would have maintained her confidentiality. However, analysis of the rationales provided for these decisions revealed a wide discrepancy in GPs' understanding and implementation of current legal principles. This research highlights the necessity of providing GPs with clear guidelines regarding competence and confidentiality determinations when dealing with minors.     

Why Keep a Dog and Bark Yourself? Making Choices for Non‐Human Animals

Animals are usually considered to lack the status of autonomous agents. Nevertheless, they do appear to make ostensible choices. This article considers whether, and how, I should respect animals' choices. I propose a concept of volitionality which can be respected if, and insofar as, doing so is in the best interests of the animal. Applying that concept, I (we) will argue that an animals' choices be respected when the relevant human decision maker's capacities to decide are potentially challenged or compromised. For example, it will be best to respect the animals' choice when the human decision maker: (1) lacks accurate knowledge of the animal's subjective experiences; (2) does not know what will lead to desirable experiences or allow for the avoidance of undesirable ones; (3) is biased; (4) is less aware of the animal's specific situation; (5) cannot appreciate all elements comprehensively, including considering any (content‐neutral) value to the animal being allowed to make and implement a choice, such as where a lack of control or liberty would be unpleasant or where an animal would usefully learn from the process of choice‐making; and (6) when the animal's choice is achievable. This additionally suggests that we may often beneficially choose to set up situations that empower animals to make better choices.     

An analysis of the law of confidentiality with special reference to the counselling of minors

Although professional counsellors would be aware of the need to maintain confidentiality in their work with clients, the basis and scope of this obligation is generally less well understood. This article examines the issue of counsellor-client confidentiality from a legal perspective, and considers the potential bases of legal liability which counsellors may have with respect to the maintenance of client confidentiality as well as the circumstances under which disclosure of this information will be required or may be permitted. It is contended that the general issue of counsellor-client confidentiality presently poses particular difficulties for counsellors who work primarily with children and adolescents, especially when clinical services are provided directly to adolescents. In such instances, counsellors may be confronted by competing and even conflicting interests, and may be required to exercise judgement in relation to the disclosure of confidential information which has been provided by a minor. Although there is no clear law which directly relates to this area, it is argued that counsellors may presently have a primary obligation to respect the wishes which are expressed by a "mature minor" in relation to the provision of counselling services. It is further argued that awareness of general legal principles which are of relevance to areas of professional practice can provide much assistance to practitioners who could be required to make decisions in the course of their work which may later be examined in the context of legal proceedings.     

Nationality, Distributive Justice and the Use of Force

To whom do we owe obligations of distributive justice? In the last decade a number of distinguished political theorists — such as David Miller and Yael Tamir — have defended a nationalist account of our distributive obligations. This paper examines their account of distributive justice. In particular, it analyses their contention (a) that individuals owe special obligations to fellow-nationals, (b) that these obligations are obligations of distributive justice and (c) that these obligations are enforceable. Miller and Tamir's justifications, I argue, do not support these claims. Moreover, I argue, (a) and (c) should only be accepted in a greatly qualified form and (b) should be rejected altogether. The paper thus concludes that the nationalists' preferred account of distributive justice is untenable.     

Guilt feelings and the intelligibility of moral duties

G.E.M. Anscombe argued that we should dispense with deontic concepts when doing ethics, if it is psychologically possible to do so. In response, I contend that deontic concepts are constitutive of the common moral experience of guilt. This has two consequences for Anscombe's position. First, seeing that guilt is a deontic emotion, we should recognize that Anscombe's qualification on her thesis applies: psychologically, we need deontology to understand our obligations and hence whether our guilt is warranted. Second, the fact that guilt is a deontic moral emotion debunks Anscombe's claim that deontic concepts are a relic of the Western, religious past: guilt feelings–hence the idea of moral duty as well–can be found in cultures without an ethics of divine command. Modern moral philosophers' interest in oughts and obligations is not an academic hobbyhorse, but a vital concern arising out of a primeval human emotion.     

Balancing Confidentiality and Collaboration Within Multidisciplinary Health Care Teams

As multidisciplinary perspectives are increasingly integrated into the treatment of health problems, opportunities for clinical psychologists in medical settings are expanding. Although cross-discipline collaboration is at the core of multidisciplinary treatment models, psychologists must be particularly cautious about information sharing due to their profession??s ethical standards regarding patient confidentiality. Psychologists?? ethical obligations require them to achieve a delicate balance between contributing to the treatment team and protecting patient confidentiality. In the current review, relevant ethical standards and federal guidelines are applied to everyday practices of clinical psychologists in medical settings. Additionally, recommendations for individual psychologists, health care organizations, and graduate training programs are presented.     

Confidentiality in psychological practice: a decrepit concept?

Although the principle of confidentiality in the relationship between psychologists and client has been vaunted, and is emphasised in the Australian Psychological Society's Code of Professional Conduct (the APS code; 1994), the confidentiality of this relationship is circumscribed by the absence of legal protections, the ethical beliefs of psychologists, institutional practices, and the provisions of the APS code itself. Lack of privilege in judicial proceedings, and statutory obligations to report certain types of behaviour, mandate breaches of confidentiality in some circumstances. Ethical beliefs of psychologists may support disclosure, especially where it is believed that there is danger of serious physical harm to the client or others. Multidisciplinary teams and institutional settings require the exchange of information for optimal delivery of services. Recent amendments to the APS code may require disclosure without the client's consent when a client is believed to be suicidal. Such developments, when considered at all, are typically regarded as exceptions to a general obligation of confidentiality. However, discussion of exceptions presupposes agreement on fundamental principle: the significance of, and rationale for, confidentiality in the psychologist-client relationship. It is argued in this paper that the obligation of confidentiality has been assumed rather than vigorously analysed and empirically explored. A critical examination of this obligation is the most appropriate starting point for the rehabilitation of contemporary principles of confidentiality in the psychologist-client relationship.     

Confidentiality issues in psychological research

There has been increased attention in recent years to the importance of individual privacy and professional confidentiality both in Australia and overseas. At the same time, psychologists' growing research interests in areas such as AIDS, child sexual abuse, and domestic violence have led to new ethical dilemmas over the contract of confidentiality between researchers and their research participants. The present paper discusses a number of issues regarding the ethics of confidentiality in psychological research. Following Bok (1989), the issues are highlighted within the context of four ethical principles that underlie researchers' obligations to preserve confidentiality. These principles are derived from considerations of privacy, loyalty, the pledge of silence, and professional codes of ethical standards. Each of these principles is illustrated with examples taken from recent research. We devote special attention to instances that appear to provide a clash between moral principles.     

Breaching Confidentiality to Protect the Public: Evolving Standards of Medical Confidentiality for Military Detainees

Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health.     

Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

Hey,How did I become a Role Model? Privacy and the Extent of Role‐Model Obligations

Much of the public criticism of many public figures, such as that of Michael Phelps, Lindsay Lohan, and Bill Clinton, accuses those persons of failing as role models. The criticism often ascribes to public figures role‐model status in a general sense that encompasses their behaviour in aspects of life beyond the fields for which they are known. I argue that, because of privacy considerations, we are unjustified in ascribing broadly to public figures role‐model status in the general sense. Unless public figures hold themselves out to be role models regarding other aspects of life, we are justified in demanding only that they be good role models with respect to their behaviour in their particular fields. To make my arguments, I demonstrate that: 1) we are justified in ascribing role‐model status to individuals far less often than most believe; 2) legitimate role‐model obligations typically do not extend as far into role models' lives as most believe; and, 3) those who try to convince public figures to be better role models should redirect their efforts toward educating young people about who are proper role models and about what aspects of role‐models' lives young people should imitate.     

Limits to Confidentiality in U.S. Army Treatment Settings

A number of reports detail ethical concerns of behavioral health providers in the U.S. Military regarding limited confidentiality. This article provides a review of limits to confidentiality in behavioral health settings as outlined by U.S. Army regulations and Department of Defense directives. Specific limits are discussed under seven categories, including: medical treatment and oversight, command notification, threats to safety, public health purposes, judicial or administrative proceedings, law enforcement investigation, and specialized personnel programs. Specific attention is given to war crimes reporting, special duty, and command involvement. Lessons learned for best practice across service branches are provided as a collaborative model for resolving perceived conflict between the APA Ethics Code and military regulations.     

Civil Ethics and the Validity of Law

This paper aims to clarify the nature and contents of 'civil ethics' and the source of the binding force of its obligations. This ethics should provide the criteria for evaluating the moral validity of social, legal and morally valid law. The article starts with observing that in morally pluralist Western societies civil ethics already exists, and has gradually started to play the role of guiding the law. It is argued that civil ethics should not be conceived as 'civic morals' which is in fact rather 'state ethics', nor as 'public ethics' which is said to reach its perfection when it becomes law, nor as ethics applicable primarily to the basic structure of a society (political liberalism), but instead as a citizens' ethics. Subsequently the paper attempts to show what the contents of this ethics are, and which ethical theory would be able to ground its obligations.     

Academic Deans,Codes of Ethics,and……Fiduciary Duties?

College and university academic deans must comply with two sets of professional regulations. As faculty members, they must adhere to their institution's internally generated code of ethics. As administrators and agents of their institution, they must meet the fiduciary duties of diligence and loyalty. Both sets of regulations are similar in the obligations they impose on a dean, the degree of care they demand of a dean in the execution of those obligations, the nature of a breach of those obligations by a dean, the procedures by which the breach of an obligation is addressed, and the remedies available to the institution against a dean following a breach. Colleges and universities should develop and publish both an ethics code and a fiduciary code. Both sets of regulations, however, should avoid common shortcomings. Ethics codes should not be too specific or too general, overly simplistic or highly complex, or outstripped by the rapidly changing world of academia. A codification of fiduciary duties should avoid the problems of poor definition or ambiguity. Developing an institutional code of professional responsibility that incorporates both ethical and fiduciary responsibilities would provide an academic dean with a more comprehensive benchmark for professional expectations and responsibilities. The interplay between the two sets of complementary regulations would further clarify the professional expectation of an academic dean and may also ameliorate some of the shortcomings inherent in an ethics code.