Keeping Secrets

Ethics Checklists for Protecting Confidentiality Rights

The topic of confidentiality has become very complex, so this workshop uses a series of checklists based on the presenter’s six-step Ethical Practice Model to help clinicians maintain an ethical focus even when faced with clinical complications and legal demands for disclosure of confidential information.

I. How Did “Confidentiality Ethics” Become so Complicated?

A. Confidentiality “Then” = “Everything you tell me stays in this room”
B. Confidentiality “Now” = We Have Only Two Ethical Options

— Protect confidentiality absolutely and face the legal, financial, and clinical consequences.
— Provide “conditional” confidentiality; inform prospective patients what the “conditions” will be.

II. Defining Terms & Clarifying Concepts Used in this Workshop

A. Privacy ? Confidentiality ? Privilege ?
B. Ethical Focus vs. Legal Focus vs. Risk Management Focus
C. Voluntary Disclosures vs. “Involuntary” Disclosures

— Legally Required Disclosures: Considered “involuntary” because disclosure may be required whether or not patient gives consent, and therapists may not have legal ability to refuse.

— Legally Allowed Disclosures: Considered “voluntary” because patients are legally free to withhold consent and therapists are legally free not to disclose.

D. Ethical “Doors” to Disclosure

— Client Gave Consent for this Disclosure
— Disclosure is Legally Required
— (Disclosure is Legally Allowed)

E. Informed Consent

— Avoiding “UNinformed” Consent
— Protecting Client’s Right to Give “Informed Refusal”

III. Clarifying Personal Ethics:  Supererogatory Position(s) Anyone?

A. Contesting Legal Demands: Protecting Confidentiality to the Extent Allowed By Law
B. Avoiding “Figure-Ground Confusion” About Confidentiality (Beck, 1990)

IV. Reviewing 6-Step Ethical Practice Model and its Checklists

A. Origins of the Model
B. Details & Uses of the Model
C. Why Use “Checklists”?

V. Applying the Model and its Checklists in Your Own Practice

Learning Goals:
1. Outline the preparation necessary for protecting patients’ confidentiality rights.
2. Describe the components necessary for obtaining “truly informed” consent about confidentiality
3. Explain the ethical difference between “voluntary” disclosures and legally-required (“involuntary”) disclosures.
4. List five ways to avoid some of the “preventable” disclosures of confidential information.

[This CE Workshop was first presented at the Annual Convention of the
American Psychological Association (APA), Denver, Colorado, August 5, 2016]