What is confidentiality?

Introduction

Confidentiality is important to psychologists in both its legal meaning and its ethical meaning. The legal meaning covers relevant federal, state, and local laws that may affect how much confidentiality can or must be maintained by a mental health practitioner. Ethics refers to moral principles or values; ethically, psychologists may choose to disclose or refuse to disclose information. Such values may be in conflict with the law but in the best interest of the individual research participant, therapeutic client, consultant client, or other party whose information, data, or relationships to the psychologist are being protected.

When individuals enter into a professional relationship with a psychologist, the psychologist provides information to the individuals, informing them of the limits of confidentiality pertaining to their relationship. In research projects, this takes place during the consent process, when participants give permission and agree to participate in the project proposed. Typically, the consent process is overseen by an institutional review board, a group of individuals who ensure that the rights of participants are properly addressed and protected. In therapy, this takes place during the intake process, before treatment begins. In any case, an individual may always disclose personal information as he or she wishes.

Legally, professionals such as psychologists are not allowed to disclose protected information unless given permission to do so by the client. However, some exceptions to this general rule exist. One exception is when clients admit that they may commit harm to themselves. In this situation, the psychologist takes appropriate action to prevent any harm coming to the individuals. The obligation to do so is known as a duty to protect. A second exception is when clients admit that they may commit harm to another person. In this situation, the psychologist takes appropriate action to prevent harm coming to the individual identified as the target of harm. Typically this activity by the psychologist is understood as a duty to warn. It should be noted though that even with these duties, the information shared is only that necessary to achieve the duties to protect or warn. In either situation, what is imperative is that the individuals entering into any agreements with the psychologist be competent. Competency
refers to the legal fitness of the individual to make such a decision. This means the individual is mentally able to understand the consequences of the decision, can make a free choice in the decision, and is choosing to enact the decision.

Importance

Confidentiality is an important protection for a number of reasons. First, confidentiality is important because it protects therapeutic clients, research participants, their private information, and their interests. Second, such protection allows free participation in therapeutic activities, research, and other programs without fear of having private information disclosed without permission. This encourages honesty and trust. Particularly for research endeavors, confidentiality maintains the integrity of the scientific work at hand by dissuading participants from altering their information so as to protect themselves, which could inadvertently damage the research.

Such concerns about confidentiality in research have led to the development of special certificates of confidentiality for government-funded research projects, such as those sponsored by the National Institutes of Health. With a federal certificate of confidentiality, data collected from an individual for the purpose of research are given special protection from forced disclosure (such as with a subpoena). The certificate allows study investigators and their research institutions to refuse to disclose identifying information about participants that could have adverse consequences for the participant if it were disclosed. Information protected could include name, address, identifying numbers such as a Social Security number, criminal history, fingerprints, voiceprints, photographs, history of mental health problems, alcohol or drug use history, human immunodeficiency virus (HIV) status, pregnancy termination, or other sensitive medical data, such as bodily tissues or genetic information. These protections allow participants to avoid potential consequences such as problems related to reputation, employability, financial standing, and insurability, among others. This protection extends to any type of proceeding (civil, legislative, administrative, or criminal), whether at the federal, state, or local level of government.

Context

In the United States, the Fourth Amendment to the Constitution asserts that people have a right to be secure in their persons, houses, papers, and effects and to be protected against searches and seizures that are unreasonable or not founded in probable cause. With events such as the terrorist attacks of September 11, 2001, in the United States, concerns over confidentiality and the protection of private information were heightened. Debate raged over the need to balance individual desire for privacy with a strong need for information to protect national security.

In this same context, there are increasing requests for information from marketing companies, health care management organizations, and even the government for the purpose of federally funded research. At the same time, technology is increasing to the point that information shared by one individual could affect that person’s entire family across generations. For instance, one person providing genetic information about family history of illness could affect the ability of that individual’s family members to be insured or to be eligible for certain benefits. Confidentiality therefore is likely to develop as a more complex legal and ethical issue over time, as its relevance to whole systems of people, not just individuals, is recognized.

Bibliography

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