Are We Really “Informants” ?

The Ethics of “Conditional” Confidentiality

   The book “The New Informants,” by Christopher Bollas (psychoanalyst) and David Sundelson (attorney) created quite a stir when it was published in 1995. Today, few people mention that book. But it is worth revisiting.  It contains important information we should all be aware of; it offers admonitions we should still consider; and it makes some claims we may now want to challenge.  In Virginia, mental health professionals are legally required to disclose confidential information without client consent more often than in other states.   Is it fair to call us “informants”?   If not, why not?  If so, is this a problem that has a solution?

OUTLINE

A. ETHICALLY IMPORTANT DEFINITIONS and DISTINCTIONS

Privacy vs. Confidentiality vs. Privilege
Voluntary vs. “Involuntary” Disclosures
Required Disclosures vs. Allowed Disclosures
            1. Ethically Required Disclosures (None)
            2. Ethically Allowed Disclosures
3. Legally Required Disclosures
4. Legally Allowed Disclosures

B.  WHAT DID BOLLAS CLAIM IN 1995?

C.  WHAT ARE THE REALITIES NOW?

D.  THE COMPLICATED ETHICS OF “CONDITIONAL” CONFIDENTIALITY

E.  COULD YOU REDUCE VOLUNTARY/INVOLUNTARY DISCLOSURES:
In Your Own Practice or Setting?
In Your Agency or Organization?
Among Your Colleagues ?
Within Your Profession’s  Stance or Guidelines?  

Educational Goals:
1. List some examples of circumstances in which you have disclosed without consent voluntarily.
2. List some examples of circumstances in which you have disclosed information “involuntarily.”
3. Describe the potential impact on patients or on you in those situations.
4. State how you might now handle a previous confidentiality situation differently.