Confidentiality, privacy, and the facilitating role of psychoanalytic organizations

Burgeoning external threats to confidentiality by claims to clinical information create unprecedented challenges for psychoanalysts. Internal threats arise from the use of clinical material for educational, scientific and historical purposes. Traditionally, confidentiality is considered a patient's right and an analyst's obligation; privacy is not usually stated as a professional requirement. Little consideration has been given to the impact of the confidentiality and privacy dilemmas that analysts encounter throughout their careers. There has been no systematic examination of the confidentiality policies of psychoanalytic organizations, nor has their role in facilitating maintenance of patient confidentiality and analysts' privacy been made explicit. The research reported here was undertaken to address these issues and to obtain baseline information about the current confidentiality policies and practices of psychoanalytic organizations in three English-speaking countries (Britain, Canada and the USA). The author discusses survey results in the light of the challenges which arise at each phase of the analytic career. She makes suggestions as to how psychoanalytic organizations can and should facilitate analysts' resolutions of contemporary confidentiality and privacy dilemmas.     

Navigating the Unknown: Towards a Positive Conception of Anonymity

Talk of anonymity floats freely and, in many contexts, rampantly in everyday, nonphilosophical discourse. But despite a surge of interest in anonymity—in anonymity protections, on the one hand, and anonymity harms and abuses, on the other—it is not at all clear what anonymity is. Is it simply a matter of being unknown? Or is anonymity something more, or less, than this? Unfortunately, existing analyses frame anonymity very generally as a phenomenon of unknowability and/or concealment. Consequently, they fail to capture what distinguishes anonymity and anonymity relations from, for example, privacy and privacy relations. In this paper, I explore a more precise way of articulating anonymity, developing what I call the “central anonymity paradigm,” which frames anonymity as the result of a specific exercise of control in which true pieces of information about a person are concealed from others with an effect of dissociability. I use this paradigm to show how anonymity is characteristically interpersonal and network‐relative, and deeply connected to issues of personal identity.     

Researching the effects of confidentiality law on patients' self-disclosures

We hypothesized that conflicting research findings on the effects that confidentiality laws have on patients' self-disclosure reflect the fact that privacy is important only to some patients in some circumstances. Instead of asking whether privacy is always important, we posed the following question: What factors determine whether privacy is important? With 42 outpatients we found that self-disclosures about sensitive issues (e.g., child abuse, drug abuse) during intake were determined partly by how legally informed patients were and partly by how relevant and consequential the law was to their cases.     

Grey Matter: Ambiguities and Complexities of Ethics in Research

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research.     

Public Bodies, Private Selves

ABSTRACT A patient whose case notes had been used, without her permission, during a disciplinary inquiry on the conduct of Wendy Savage (her obstetrician) complained that this was a breach of confidentiality. Her complaint cannot be understood as based on a concern about the possible adverse consequences of this use of the notes: rather, her concern was just with the fact that medical information about her had been made known to others.
My concern is with the meaning and status of the right to privacy, to which the Savage patient appealed. Such a right cannot be reduced to a property right, since this cannot capture what concerned the Savage patient. A proper understanding of what lies behind her complaint requires us to recognise the way in which facts about oneself—in this case facts about one's body—are intimately bound up with one's self, with one's identity, and thus with one's autonomy. What kinds of fact, and thus what conception of the self, are involved in such a conception of privacy need not everywhere be the same; the crucial point is that privacy and the self are concepts which, whatever their particular content, are internally related [1].     

Tarasoff v. confidentiality

The Tarasoff decision is discussed as a logical extension of evolving legal doctrine imposing a special duty on caretakers. The mental health professions are being held to a standard of negligence and perhaps even to a standard of strict liability. Tarasoff is viewed as a part of society's interest in using the information disclosed in confidential relationships as a means of social control. This in turn is seen as part of a disquieting trend to curtail First Amendment rights. The adversarial nature of the relationship between the 1974 Tarasoff decision and the constitutional rights of patients to privacy, confidentiality, and privilege is discussed. The author re-asserts: “As asepsis is to surgery, so is confidentiality to psychiatry” (Beigler, 1978, p. 255).     

Strict Confidentiality: An Alternative to Pre’s “Limited Confidentiality” Doctrine

In “Advisory Opinion on Confidentiality, Its Limits and Duties to Others” the Canadian Interagency Advisory Panel on Research Ethics (PRE) articulates a rationale for a priori limitations to research confidentiality, based largely on putative legal duties to violate confidentiality in certain circumstances. We argue that PRE promotes a “Law of the Land” doctrine of research ethics that is but one approach to resolving potential conflicts between law and research ethics. PRE emphasises risks that have never materialized, and ignores jurisprudence on challenges to research confidentiality. When we examine what the courts have actually done with research-based claims of privilege, we find they clearly recognize and affirm researchers’ ethical obligations to maintain strict confidentiality and protect research participants. Ironically, the one exception – where the court ordered that information be disclosed – occurred precisely because the researchers had limited confidentiality. The passive approach PRE espouses leaves vital questions about what protecting confidentiality to the “full extent possible in law” means, and leaves the impression that academics should accept whatever limitations the courts may impose without participating in the courtroom dialogue determining where those limits are drawn. In contrast, we believe confidentiality is so important to the protection of research participants and the integrity of the research enterprise that it is worth fighting for. The “ethics-first” doctrine of “strict confidentiality” we describe adheres to the social sciences’ and humanities’ longstanding commitment to research confidentiality and duty to the research participant.     

The attenuating effect of mortality salience on dishonest behavior

People are easily tempted to engage in dishonest behavior when an incentive is given and when full anonymity is provided. In the present work, we investigated existential threat as a motivational factor that might reduce dishonest behavior. Research based on terror management theory has found that mortality salience increases the motivation to fulfill salient values of one’s cultural worldview. Assuming the concept of honesty is important to human societies, we hypothesized that mortality salience will reduce dishonest behavior when the concept of honesty is salient. In two experiments, we assessed dishonesty under full anonymity by applying a die-under-the-cup paradigm with the expected value serving as a stochastic baseline for honest behavior. Both experiments provided support for our hypothesis. Given an incentive to cheat, when the concept of honesty was cognitively activated by a word-search puzzle (Study 1) or by the name of the dice game (i.e., “honest game”; Study 2), mortality salient participants showed not only less dishonest behavior but actually honest behavior.

     

Confidentiality Revisited

This article challenges the importance and necessity of confidentiality, which are often taken for granted, and questions whether the default promise of confidentiality to all participants, particularly in educational research, could in fact be an unnecessary concern. This article begins by reviewing the difference in the way confidentiality is handled in different fields and the applicability of some underlying assumptions. This is followed by an explanation of why confidentiality is investigated in the sense of anonymity in this article. Then the article draws on an empirical study where original researchers and their original participants were interviewed about their views on anonymity. Lastly, the contradiction between the promises of confidentiality and the recognition of a participant’s contribution is highlighted. The article concludes with a call for more empirical observation and investigation into the importance of confidentiality.

Eavesdropping on the 50-minute hour: managed mental health care and confidentiality

This article discusses managed care, recent case law developments, and the legal basis of confidentiality in the patient-therapist relationship. It discusses how managed care intrudes into the confidential treatment relationship with prospective and retrospective utilization reviews. Some of the areas adversely impacted include public policy, the patient-therapist relationship, and informed consent. In order to be a program in the interest of patients and not simply cost containment, managed care must accommodate patients' reasonable expectations of confidentiality. Suggestions are delineated for the protection of confidentiality by managed care, including expanding the duty of confidentiality to managed care, obligating managed care to secure patients' informational privacy, obtaining informed consent to disclose as little information as necessary, and involving the patient in the cost containment and quality assurance process.     

Information privacy in organizations: empowering creative and extrarole performance

This article examines the relationship of employee perceptions of information privacy in their work organizations and important psychological and behavioral outcomes. A model is presented in which information privacy predicts psychological empowerment, which in turn predicts discretionary behaviors on the job, including creative performance and organizational citizenship behavior (OCB). Results from 2 studies (Study 1: single organization, N=310; Study 2: multiple organizations, N=303) confirm that information privacy entails judgments of information gathering control, information handling control, and legitimacy. Moreover, a model linking information privacy to empowerment and empowerment to creative performance and OCBs was supported. Findings are discussed in light of organizational attempts to control employees through the gathering and handling of their personal information.     

Ethical and methodological aspects of medical computer data bases and knowledge bases

Ethical problems are related to computer data bases, containing data on individuals and groups of persons, as well as to computer knowledge bases, containing general rules and elements of expert systems.In the present essay the following conclusions are made regarding computer data bases: privacy, security, and confidentiality of medical computer data bases should be ensured. This duty should rest with physicians in hospitals. The principle of informed consent should be applied to gathering information which is to be stored and processed by computers. Information stored in computer data bases should not be used for purposes for which the subjects (patients as well as personnel) have not given their consent. In order to decrease the possibility of misuses of medical data bases containing information on individuals, these registers should not be linked to other central data bases.     

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.     

Privacy and the Human Genome Project

The Human Genome Project has raised many issues regarding the contributions of genetics to a variety of diseases and societal conditions. With genetic testing now easily conducted with lowered costs in nonmedical domains, a variety of privacy issues must be considered. Such testing will result in the loss of significant privacy rights for the individual. Society must now consider such issues as the ownership of genetic data, confidentiality rights to such information, limits placed on genetic screening, and legislation to control genetic testing and its applications. There is often a conflict between individual rights to privacy and the need for societal protection.     

Pharmacogenetics: ethical issues and policy options

Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: (1) regulatory oversight, (2) confidentiality and privacy, (3) informed consent, (4) availability of drugs, (5) access, and (6) clinicians' changing responsibilities in the era of pharmacogenetic medicine. We analyze each of these categories of ethical issues and provide policy approaches for addressing them.     

Detecting nonadherence without loss in efficiency: A simple extension of the crosswise model

In surveys concerning sensitive behavior or attitudes, respondents often do not answer truthfully, because of social desirability bias. To elicit more honest responding, the randomized-response (RR) technique aims at increasing perceived and actual anonymity by prompting respondents to answer with a randomly modified and thus uninformative response. In the crosswise model, as a particularly promising variant of the RR, this is achieved by adding a second, nonsensitive question and by prompting respondents to answer both questions jointly. Despite increased privacy protection and empirically higher prevalence estimates of socially undesirable behaviors, evidence also suggests that some respondents might still not adhere to the instructions, in turn leading to questionable results. Herein we propose an extension of the crosswise model (ECWM) that makes it possible to detect several types of response biases with adequate power in realistic sample sizes. Importantly, the ECWM allows for testing the validity of the model’s assumptions without any loss in statistical efficiency. Finally, we provide an empirical example supporting the usefulness of the ECWM.     

It is more than personal: Development and validation of a multidimensional privacy orientation scale

This study summarizes the development and validation of a multidimensional privacy orientation scale designed for measuring privacy attitudes of Social Network Site (SNS) users. Findings confirm the existence of four dimensions: (1) belief in the value of “privacy as a right”; (2) “other-contingent privacy”; (3) “concern about own informational privacy” and (4) “concern about privacy of others.” Moreover, a segmentation of SNS users based on these attitude scores reveals three types of users: (1) privacy advocates, who are concerned about both their own and other people’s privacy; (2) privacy individualists, who are concerned mostly about their own privacy, and (3) privacy indifferents, whose score on all dimensions are lower than other segments. The results indicate that the four privacy orientation dimensions and three user segments predict key differences in terms of privacy protective behavior, information disclosure, and viewing personal information of others.     

Tele-counselling for Problem Gambling: A Case Study

Innovative approaches to the treatment of pathological gambling are required since the number of individuals who seek treatment tend to be fewer than the prevalence studies would indicate. In this study, an innovative approach to the treatment of pathological gambling was used in order to address the common hindrances to treatment-seeking these patients face. One such approach is to offer the option of manual-guided tele-counselling. This case study reports on the progress of one individual who was treated using this modality. For reasons of privacy and anonymity, the individual in this case report preferred to address her problem gambling with the assistance of a therapist whom she never met. The client was provided with 10 weeks of tele-counselling treatment during which six treatment modules were delivered. Problems of access, privacy and anonymity were overcome with this method and the client was able to reduce their gambling behavior significantly with the therapeutic gains being maintained at the 6-month follow-up. The implications for the treatment of problem gambling using a non-traditional approach are discussed.     

Cybersecurity and Authentication: The Marketplace Role in Rethinking Anonymity – Before Regulators Intervene

Anonymous speech plays a fundamental role in America’s political history. However, that long tradition of anonymous communications faces an image problem in today’s age of spam, computer viruses, spyware, denial-of-service attacks on websites, and identity theft. The criminals and hackers who perpetrate these insults on the commercial Internet are, for the most part, anonymous; we simply do not know the identities of these bad guys. Yet, the promise of anonymous communications is vital to the preservation of political liberty across the globe. Therefore, how should we regard anonymity in a digital age? And how should we strike the right balance between security and anonymity online? To begin, we should not consider the outlawing of anonymous communications as the answer to today’s cybersecurity threats. Commercial sector “regulation” of anonymity, so to speak, can play a significant role in combating these problems. Increasingly, online authentication has become important to both personal security and to cybersecurity in general. Some recent proposals toward bolstering security have included greater authentication of the source of emails to deal with spam and the requirement that those who conduct transactions online reveal their identities – seeming violations of online culture. Policymakers also want a say in the matter, and as the process unfolds, they might feel increasingly tempted to intervene whenever issues impacting privacy and authentication emerge in debates over telecommunications, intellectual property, biometrics, cybersecurity, and more. Regardless, government should not strip us of our anonymity online. Cybersecurity concerns may instead call for the marketplace – not regulators – to deal with the fact that many threats stem from that very lack of authentication. The inclusion of greater authentication standards into online services by private vendors will lead to their working in concert in unprecedented ways that may draw attention from regulatory and antitrust authorities. But these private, experimental efforts have no implications for political liberty – nor are they anticompetitive. Private solutions are the only real hope we have for decreasing cybersecurity threats, given that previous government efforts to regulate the Internet – for example, outlawing spam in 2004 – have not lived up to expectations. Political anonymity and commercial anonymity are not the same thing, and the distinction requires better appreciation. Over the coming tumultuous period of dealing with online threats, policymakers should allow the experimentation necessary to cope with today’s lack of online authentication to proceed with minimal interference.     

Intelligent digital image firewall system for filtering privacy or sensitive images

As the commonest part of social networks, sharing images in social network not only provides more information, but also gives more intuitive view than text. However, images also can leak out information more easily than text, so the audit of image content is particularly essential. The disclosure of a tiny image, which involves sensitive information about individual, society even the state, may trigger a series of serious problems. In this paper, we design a kind of intelligent image firewall to detect and filter sensitive or privacy images. Two different approaches of the firewall are proposed. In the first approach, we propose an image firewall based on joint sparse representation, which can provide accurate and robust privacy prediction, and also can provide rich spatial relationship information. In the second approach, we propose a method based on the deep learning (Faster RCNN), which can predict the privacy relationships or actions (like kiss, hug and hand in hand) among the persons of an image. Experimental results show the effectiveness of the two kinds of approaches.