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Privacy and Confidentiality in the Therapeutic Relationship

Section 12
Ethics and Confidentiality

Question 12 | Test | Table of Contents

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Now this is pretty clear cut.  The correct answer is D, and you might reference the NASW Code of Ethics, Section 1.07(R). A, B, and C are incorrect, because they assume that exceptions can be made to confidentiality protections after the person dies.

Section 12 involves the patient or client’s right to know, and it raises the ethical issue regarding confidentiality as to how much information should be shared with family members, and also regarding patient or client self-determination.

The basis of this Section... is a case study by Dr. Saladay, who writes regarding ethical problems:  How much information does the patient have a right to know about his own condition? 

Now, we’re talking about confidentiality related to telling the individual, rather than telling other people. So we’re ending the course on a little twist regarding the normal issues of confidentiality.  See what you think should be done here.

♦ Case Study Analysis: Alvin's Biopsy
86-year-old Alvin was hospitalized for a biopsy and skin lump removal.  After Alvin awoke from surgery, his physician told him that the tumor had been completely removed, and did not look malignant.  Alvin made a great recovery.  Later, it was learned that the tumor was malignant, but slow growing.  However, Alvin’s prognosis is still excellent.

So what's the problem? Alvin's son and daughter believe that if he finds out about the pathology report, he'll go into a tailspin because he thinks cancer is a death sentence.

Normally I believe in full disclosure to patients. But under the circumstances, what's the point of telling Alvin about the biopsy results? Ethical behavior involves what's fair and right. In this situation, you think that the right thing would be to protect Alvin by withholding information about the biopsy results. After all, isn't his peace of mind the most important thing?

Before deciding, let's consider the main reason Alvin's children don't want to inform him about his biopsy results: They believe the news will be too upsetting for him. But why do they think he can't handle this information, especially when the facts are overwhelmingly positive? Does he have a history of significant depression? Is he being treated for depression now? Is he still grieving for loved ones who died of cancer? Has he ever been suicidal? Consider also the consequences of withholding information about his prognosis. How can he participate in treatment decisions if he's ignorant about his condition?

If you suspect that he would "go into a tailspin," as his family believes, you need to address the key mental health issues before tackling this one. If not, let Alvin's physician take the lead. As advocates for the patient, the nursing staff can work with the physician and family to reconsider Alvin's right to know. Educate Alvin's children about his condition. Emphasize the importance of telling the truth to ensure that he gets appropriate follow-up treatment and to foster trust between Alvin and his caregivers.

Alvin also needs education about his condition, so he can continue his recovery with the understanding that cancer isn't an automatic death sentence.

- National Association of Social Workers. (2017). NASW Code of Ethics. Retrieved from
- Purtilo, R., PhD. (2001). Health Professional/Patient Interaction. Philadelphia: W.B. Sauders Company.
- Reamer, F. G. (2009). Social Work Ethics Casebook: Cases and Commentary. Washington, DC: NASW Press.

Peer-Reviewed Journal Article References:
Barnett, J. E. (2019). The ethical practice of psychotherapy: Clearly within our reach. Psychotherapy, 56(4), 431–440.

Erickson Cornish, J. A., Smith, R. D., Holmberg, J. R., Dunn, T. M., & Siderius, L. L. (2019). Psychotherapists in danger: The ethics of responding to client threats, stalking, and harassment. Psychotherapy, 56(4), 441–448.

Franeta, D. (2019). Taking ethics seriously: Toward comprehensive education in ethics and human rights for psychologists. European Psychologist, 24(2), 125–135.

Moss, L. S. (2017). Collaboration, confidentiality, and care. Psychological Services, 14(4), 443–450. 

Walsh, R. T. G. (2015). Introduction to ethics in psychology: Historical and philosophical grounding. Journal of Theoretical and Philosophical Psychology, 35(2), 69–77.

In question 12, there is no correct answer here, merely circle those that apply.
Circle the questions that you may have about the case study. More than one may be indicated.
a. Why were Alvin's son and daughter told first?
b. Were they his legal guardians?
c. Was a release of information signed by Alvin?
d. Does this fall under the area of protection regarding harm to self?
To select and enter your answer go to Test.

Remember, the purpose of this course is to stimulate your thinking about ethics and confidentiality.

As is brought out in this Home Study Course, confidentiality practices, long believed invulnerable to change, are now being questioned. The advent of computers, for example, is raising doubts about whether confidentiality, because of this sharing of information, is becoming more of an outdated concept.

Confidentiality has become a highly complex ethical and legal issue, needless to say. Those professionals unaware of its complexities generally function with a few simple guidelines such as, "don't talk about clients outside work" and "when a subpoena arrives, you have to answer it." Unfortunately, numerous sticky situations arise in daily practice, and clinicians, administrators, and those concerned with personnel matters often find the standard guidelines inadequate.

There may be no single, definitive answer to tell the confused practitioner what should be done. Various sources can be consulted for guidance, but in the end, the individual must often exercise professional discretion, consult his malpractice policy to determine the extent of coverage, and stick his ethical neck out and do what he thinks best under the circumstances. If the troublesome problem is researched intensively, conflicting guidelines and mandates often emerge.

In short, given the uncertainty that characterizes large areas of health professions policy and practice, health professionals necessarily must be risk-takers, innovators, and probability seekers.

Let's look back over the Home Study Course in summary:

In Section 2 devil's advocate position toward ethics was taken in "Who Needs Ethics anyway." Prejudice was examined in light of emotions versus what is right.
Section 3 gives a review of the Tarasoff Decision and the duty to warn. Here you are in the precarious position of assessing the severity of the threat and the likelihood of its being carried out versus breaking confidentiality with your client.
Section 4, child abuse poses an ever increasing confidentiality challenge, as parents, physicians, teachers, and community agencies become involved in your treatment.
Section 7, physician confidentiality gave insight into confidentiality issues of a patient who felt a physician should have told her that her husband-to-be was a homosexual and a second case concerned possible child abuse and violating confidentiality.
Section 8 looked at the ethical arguments regarding a burn victim's desire to die.
Section 10, E-care Technology, touched upon the tip of the iceberg regarding the increased use of computers and the resulting increased challenge it presents to you to maintain confidentiality.
And finally, Section 12 asked you to think about the confidentiality question regarding a client's right to know about his or her own condition and self-determination.

Remember the purpose of this course is to stimulate your thinking about ethics and confidentiality. This Home Study Course is one in our Ethics series. We thank you for selecting us to fulfill this continuing education requirement, and hope you will consider our other Ethics courses in this series as future CE's are required. We also offer audio Home Study Courses, usually 10 hours in length, in other areas as well. I look forward to talking to you again in your next Home Study Course sponsored by the Healthcare Training Institute.