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.

Confidentiality in psychological practice

Confidentiality has long been a cornerstone of trust in the professional relationship between psychologists and their clients. Developments in computer technology, litigation, insurance reimbursement schemes, and changing lifestyles are forcing psychologists to reconsider and refine their approach to respecting this important ethical principle. This article review basic concepts on the matter, and discusses these in light of evolving issues in practice, technology, and the law. Some contrasts in legal and ethical aspects of confidentiality between Australia and the United States are discussed. Recommendations for enhancing attention to confidentiality in one's practice are included.     

Protecting Privacy and Confidentiality

Summary

This article discusses the confidentiality of communications between therapist and patient and the scope of, and exceptions to, the privilege preventing such communications from being disclosed. Ethical principles, statutes, and case law will be explored.     

Confidentiality in the military

This article presents and analyzes options military physicians face regarding whether or not to respect gay servicepersons' confidentiality. This situation is considered to be generic to others that involve similar conflicts. Dilemmas arising before and after the emergence of HIV-related diseases are discussed. Recommendations regarding psychiatrists' ethical obligations when conducting forensic exams are compared with military physicians' obligations to respect servicepersons' confidentiality. It is suggested that military psychiatrists should violate servicepersons' confidentiality under some circumstances, but generally should warn them in advance that they will do so. Possible exceptions exist when warning servicepersons would increase the likelihood that justice would be violated or substantial harm would occur.     

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.     

Confidentiality in Professional Medical Ethics

Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin.     

Qualifying Confidentiality Obligations

Objectives : To test the range of beliefs regarding the ethics of testing, in resource poor settings, new therapies that are less efficacious but more affordable and feasible than the best current therapeutic standard.

Design : Using a web-based survey, we presented a hypothetical scenario proposing to test a therapy for HIV disease ("therapeutic inoculation") known to be less efficacious than highly active antiretroviral therapy (HAART). Respondents evaluated various trial designs as ethical or unethical.

Participants : 604 subscribers to two listservs for individuals interested in international health research ethics.

Main outcome measures : Proportion of respondents endorsing trials testing this "substandard" therapy, and proportion endorsing placebo-controlled trials.

Results : There were 215 respondents from 47 countries. Forty-five percent of respondents were from low or middle income countries; 96% devoted at least some time to research activities; and 75% had "some" or "considerable" research experience in developing countries. Of respondents, 97% (95% CI 94.7 to 99.4) endorsed testing therapeutic inoculation, without HAART, in patients with HIV disease; 86% (95% CI 81.4% to 90.7%) endorsed testing against placebo. Sixty-eight percent explicitly endorsed principles where the standard of care for subjects in clinical trials is determined by local, not universal, standards. There were no differences in responses based on respondent education-level or the income-level of their country of citizenship.

Conclusion : There was broad agreement that a therapy of potential local benefit may be tested, even when that therapy is known to be inferior to the standard of care in wealthy countries. Most agreed that a placebo control may be used in some circumstances.     

Confidentiality and the counsellor in general practice

The privacy of patients and their need for protection from harm are values respected by all professions. But words are open to interpretation. When counsellors join a multi-disciplinary Team, the variety of attitudes to confidentiality is often not made explicit, but is held within a broad corporate ideology. How then do counsellors protect the patient, and themselves, within the team approach to medical care? What are the consequences if they do not adhere to team norms? It is contended that corporate ideology is the main variable affecting the integration of a confidential counselling service within a medical setting.     

Confidentiality in College Counseling Centers

In a national survey of college counseling centers, 40 percent of the responding counseling center directors indicated that information about counselees was given out without the students' permission. Information was available to administrative heads for use in recommendations and disciplinary action, 21 percent; deans of students, 10 percent; faculty in general, 5 percent; and prospective employers, 2 percent. This practice is in violation of the ethical codes of APGA and APA except in those relatively rare instances where there is clear and imminent danger to society. In this paper some speculation about the cause of breakdown in confidentiality is discussed, and some suggestions for correcting the situation are offered.     

Confidentiality and privileged communication in group psychotherapy

The concept of confidentiality is fundamental to all forms of psychotherapy. The idea of protecting confidential material goes as far back as the Hippocratic Oath in ancient Greek history. Centuries later, authors continue to assert that "only by maintaining confidentiality can the essential groundwork of trust in treatment be developed" (Hough, 1992, p. 106). Others have even argued that without confidentiality, psychotherapy has no value (Epstein, Steingarten, Weinstein, & Nashel, 1977). Confidentiality in group psychotherapy is more complicated than in individual therapy because self-disclosure is at the core of group therapy and there are numerous people hearing the disclosures. Confidentiality in group therapy, once ignored in the literature on ethics, is gaining more attention as this modality becomes more widely practiced; so too is an acknowledgement that ethical dilemmas surrounding confidentiality in groups are commonplace. This article discusses the major considerations and dilemmas on confidentiality in group psychotherapy. We first review confidentiality broadly and discuss the ethical principles that are related to confidentiality. In the next section, we discuss the complexities of confidentiality in group psychotherapy. Finally, we review research on confidentiality in groups and describe common ethical dilemmas.     

Confidentiality in Nondyadic Counseling Situations

Professional ethical codes and writings addressing confidentiality issues tend to assume a dyadic counselor-client situation. In practice, however, much of the counselor's work is in nondyadic situations. This article explores the dimensions of confidentiality in five such situations. Guidelines are offered for practicing counselors regarding (1) counseling done as part of a multidisciplinary team; (2) coordination of services, referral, and placement; (3) mandated services; (4) supervision; and (5) client advocacy. Three common themes—inadequacy of conceptualizing counseling as a dyadic situation, sharing information on a need-to-know basis, and clearly informing clients about the limits of confidentiality—emerge in reference to these disparate situations.