Intimacy and confidentiality in psychotherapeutic relationships

This article explores the relations among and between intimacy, psychotherapeutic relationships and moral advice. The article concludes that a psychotherapeutic relationship is not usefully explained in terms of intimacy. Instead, a psychiatric relationship is a form of moral advice, and it is this dimension of a psychotherapeutic relationship as a form of moral advice that poses a natural limit to the confidentiality necessary for engaging in psychotherapy.     

Revisiting confidentiality: observations from family therapy practice

Confidentiality has long been recognized as a critical legal and ethical principle for the committed, value‐based practitioner. Vital principles (such as confidentiality) become manifest in material practices and in the language of professional and societal narratives. This articulation into specific practices and performances requires a pragmatic process that transforms the abstract into real‐world activities. This imperfect process has the potential of including the derived practices that in certain ways may extend the principle in unintended or unwanted directions. In the case of confidentiality, the actual practices of confidentiality may be both emancipating and inhibiting – they may protect as well as isolate. Our purpose is to revisit the idea of confidentiality and to deconstruct the way it functions in both positive and negative manners in clinical work.     

Role of HIV serostatus,relationship status of the patient,homophobia, and social desirability of the psychologist on decisions regarding confidentiality

Abstract

What factors influence a psychologist's decision to maintain or break confidentiality of an HIV-positive patient? Dangerousness (serostatus), identifiability (relationship status of patient and third party), homophobia, and impression management were the major factors examined. The sample was composed of 236 psychologists and psychologists in training attending the 1994 American Psychological Association (APA) convention in Los Angeles, California. They were given 16 scenarios depicting four different situations with patients at various HIV risk levels, and measures determining levels of impression management and homophobia. A majority (51% to 92.2%, depending on the scenario) of the respondents chose to maintain confidentiality in all scenarios. Participants were least likely to maintain confidentiality in scenarios describing a high level of dangerousness and identifiability.     

HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient.     

Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

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.     

Predictors of perceived road collision/incident risk among horse users: A survey study from Norway

Although horse users in traffic are a vulnerable road user group, traffic safety problems among them are scantly examined by previous research. The main aim of the present study was to examine the role of some demographic variables, traffic safety attitudes, and level of knowledge about rules and regulations applying to horse use in traffic for predicting perceived road collision/incident risk in a sample of horse users in Norway. An online survey was conducted to collect data from a total of 1733 horse users including horse riders and drivers of horse-drawn sulky, wagon or sled. The respondents accessed the survey via a link put to the website of the Norwegian Horse Centre, which is in contact with many different horse user environments in Norway. The majority of the respondents were female and between the ages of 18–30. A multiple regression analysis was conducted to examine the predictors of the perceived collision/incident risk involving other motor vehicles. Results showed that traffic safety attitudes among horse users were the strongest predictor of the perceived collision/incident risk. In particular, horse users reported a negative attitude towards the other road users (e.g. drivers) indicating that they perceive the other road users’ actions and approaches as the biggest source of risk in road traffic. The level of knowledge about the rules and regulations applying to horse use, especially in walking and cycling lane, was relatively low among the respondents. However, knowledge about rules and regulations did not appear as a strong predictor of the perceived collision/incident risk. Results indicate the need to increase road users, especially drivers’, awareness about the problems and needs of horse users in traffic.     

A domain‐specific risk‐attitude scale: measuring risk perceptions and risk behaviors

We present a psychometric scale that assesses risk taking in five content domains: financial decisions (separately for investing versus gambling), health/safety, recreational, ethical, and social decisions. Respondents rate the likelihood that they would engage in domain‐specific risky activities (Part I). An optional Part II assesses respondents' perceptions of the magnitude of the risks and expected benefits of the activities judged in Part I. The scale's construct validity and consistency is evaluated for a sample of American undergraduate students. As expected, respondents' degree of risk taking was highly domain‐specific, i.e. not consistently risk‐averse or consistently risk‐seeking across all content domains. Women appeared to be more risk‐averse in all domains except social risk. A regression of risk taking (likelihood of engaging in the risky activity) on expected benefits and perceived risks suggests that gender and content domain differences in apparent risk taking are associated with differences in the perception of the activities' benefits and risk, rather than with differences in attitude towards perceived risk. Copyright © 2002 John Wiley & Sons, Ltd.     

A Holistically Deweyan Feminism

The argument that a holistic analysis of Dewey's work, drawing not only on the major portions subject to extensive commentary (such as Experience and Nature ) but also on his aesthetics, provides fuel for feminist theorizing is sustained by advertence to the standard commentary and also to new work in aesthetic feminism itself. Sleeper, Rorty, Hickman and Russell are cited, and the recent resurgence of interest in developing the intersection between analytic aesthetics and feminist aesthetics is alluded to. It is concluded that the enterprising feminist theorist may suffer from an embarrassment of riches in attempting to approach Dewey but that such an approach is well worth the effort.     

A Synthetic Approach to Bioethical Inquiry

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated.     

Violating confidentiality to warn of a risk of HIV infection: Ethical work in progress

The old literature on whether medical confidentiality may be breached to warn a spouse of a risk of contracting syphilis from his/her partner — a deep and rich literature — has become relevant once again in the context of HIV infection and AIDS. This paper examines the reasoning and method employed in: the Catholic approach centered around the patient's (property) right to the secret; a (generic) model of justice, utilizing minimal principles of non-aggression and restitution; and an approach involving the elimination of unstable alternatives: the view that public health officials, but not the spouse, may/must be notified; and, that maintaining that the physician is at liberty to disclose but is not obliged to do so. The theory and method behind confidentiality turns out to be deeper than you might have anticipated.     

心理咨询保密豁免规则的立法构建

《中华人民共和国精神卫生法》首次对心理咨询人员的保密义务做出原则性规定,与《中华人民共和国民法典》等法律规范形成了框架,但实践要求下保密豁免情形尚未形成系统性规则。基于隐私权保护和专业信任关系,探讨心理咨询保密义务的来源,提出遵循来访者对隐私的自我决定和“权益位阶理论”下保密豁免的正当性。明确心理咨询人员在涉及公共安全等利益时负有配合调查义务,面临自然人生命健康可能遭受非法侵害时的预警和保护义务以及针对未成年人和成年心智障碍者的强制报告义务,以期促进保障隐私权益和周全更优位利益的平衡。

     

A NEOPRAGMATIST PERSPECTIVE ON RELIGION AND SCIENCE

Abstract. Pragmatists, most notably John Dewey and Richard Rorty, propose overcoming the modern split between science and values with a new image of ourselves as language users. In this new self-understanding, both our scientific and evaluative vocabularies are integral parts of self-reliant human problem solving and coping with the larger natural environment. Our language is not the medium of any higher power from which it derives its legitimacy. On this view, the principal matter at issue between pragmatists and realists so far as interaction between religion and science is concerned is the moral one of human self-reliance.     

To be or not to be at risk: Spontaneous reactions to risk information

Rheumatoid arthritis (RA) is a chronic disease, which can lead to considerable psychological distress. The present study evaluated anxiety and depression symptoms for this chronic and painful illness within the framework of the conservation of resources (COR) theory. Coping strategies, coping self-efficacy, religiousness and social support are very important personal resources, which have been found to protect individuals from psychological distress. The aim of the present study was to examine the predictive values of socio-demographic and illness-related variables, perceived social support, ways of coping, religiousness, arthritis self-efficacy and resource loss for psychological distress in a sample of 117 RA patients from Turkey, a secular, Islamic, non-western developing country. The results revealed that RA patients experience considerable anxiety and depressive symptoms. The results of the regression analysis showed that gender, helplessness coping and resource loss are significant predictors of anxiety, whereas arthritis self-efficacy and resource loss are significant predictors of depression. Resource loss appeared as an important predictor for both anxiety and depression. This finding was consistent with the COR theory. The clinical implications of these findings are discussed.     

A Mere Idea

In response to Khin Zaw's pragmatic model of reason, I argue for a normative,Kantian account in which reason actively impels thought andunderstanding towards transcendental ideals. Reason is neither constructedout of what is ready to hand, nor imposes moral laws from a transhistorical content. Reason's role is to provide the formof our ideas of the good in accordance with which we may shape thecontent in any particular culture. I argue that the well-rehearseddebate between nature and culture cannot be advanced without recourseto metaphysics. Since metaphysics in transcendental, not transcendent,what emerges from metaphysics must be revealed, interrogated andcriticised, never assumed.     

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.     

Confidentiality of Adolescent Risk-Taking Behaviors: A Survey of Turkish School Counselors

The present study investigated school counselors’ ratings of the importance of factors in deciding to report adolescent risk-taking behaviors to parents. Turkish school counselors (N = 346) were surveyed. Differences based on gender, years of experience, level of education, attendance of a counseling ethics course, and geographic region were investigated. Mann-Whitney U and Kruskal Wallis tests were used in data analysis. Protecting the student was the highest rated factor. Women and those who took an ethics course rated protecting the student higher than others. Implications for counseling ethics training are discussed, and recommendations for future research are outlined.     

On A Reductionist Analysis of William James's Philosophy of Religion

William James undertook to steer his way between a rationalistic systemthat was not empirical enough and an empirical system so materialistic that it could not account for the value commitments on which it rested. In arguing against both the absolutists (gnostics) and the empiricists (agnostics), he defined a position of pluralistic moralism that seemed equally distant from both, leaving himself vulnerable to the criticism that he had rescued morality from scientism only by reducing religion to morals. Such criticism, however, ignores distinctions James made between religion and theology and between monistic theology and dualistic theology. When these distinctions are taken into account, it becomes evident that James can be criticized for reducing religion to morality only from the point of view of either absolute monism or religious humanism and that radical empiricism not only embraces a significant number ofnonmoral religious experiences but also leaves open the possibility of belief in the particular historical God of traditional Christianity.     

Huntington disease: A case study describing the complexities and nuances of predictive testing of monozygotic twins

When a candidate for predictive testing for the Huntington disease gene is a monozygotic twin, confidentiality of the co-twin's diagnosis and autonomy of participation are among the critical genetic counseling issues. Predictive testing can proceed when twins voluntarily and simultaneously request counseling and evaluation in an HD testing program. This case describes a young man referred for predictive testing to an HD testing site on the East Coast of the United States. Family history revealed a twin brother of unknown zygosity who resided on the West Coast of the United States. The genetic counselors on opposite coasts collaborated to provide genetic counseling and evaluation for voluntary, informed predictive testing of the twins, protecting their rights while observing national protocol guidelines.     

Pragmatism, Science, And Society: A Review Of Richard Rorty's Objectivity, Relativism, and Truth: Philosophical Papers, Volume 1

Richard Rorty's Objectivity, Relativism, and Truth: Philosophical Papers, Volume 1 is a collection of papers that explores the implications of philosophical pragmatism in several areas, including natural science, mind—body issues in philosophy, and perspectives on liberal democracy and social change. Similarities between Rorty's pragmatism and Skinner's radical behaviorism are explored in each of these three areas. Although some important and interesting differences are found regarding the role of science in social change, most areas show remarkable similarities between the two systematic perspectives.