The Limits of Confidentiality: Informed Consent and Psychotherapy

Abstract

Sound ethical decision making is essential to astute and compassionate clinical care. Wise practitioners readily identify and reflect on the ethical aspects of their work. They engage, often intuitively and without much fuss, in careful habits-in maintaining therapeutic boundaries; in seeking consultation from experts when caring for patients who are difficult to treat or have especially complex conditions; in safeguarding against danger in high-risk situations; and in endeavoring to understand more about mental illnesses and their expression in the lives of patients of all ages, in all places, and from all walks of life. These habits of thought and behavior are signs of professionalism and help ensure ethical rigor in clinical practice.Psychiatry is a specialty of medicine that, by its nature, touches on big moral questions. The conditions we treat often threaten the qualities that define human beings as individual, autonomous, responsible, developing, and fulfilled. Furthermore, these conditions often are characterized by great suffering, disability, and stigma, yet individuals with these conditions demonstrate tremendous adaptation and strength. If all work by physicians is ethically important, then our work is especially so. As a service to Focus readers, this column provides ethics commentary on topics in clinical psychiatry. It also offers clinical ethics questions and expert answers to sharpen readers-decisionmaking skills and advance astute and compassionate clinical care in the field.

From posts to protection: Ethical considerations regarding forensic psychiatrists and a duty to warn based on social media

“…considerations favoring one action against considerations opposing the action). The ranking and priority of opposing duties and principles is dependent on the particular role of the psychiatrist and specific contextual factors (i.e., a treatment role, a research role, or a forensic role) (Darby & Weinstock, 2018a, 2018bWeinstock, 2015).…”

“…When using dialectical principlism, one identifies the relevant ethic duties and principles, prioritizes them based on role (i.e., ranks their importance in that situation relative to one another), and balances them (i.e., weighs the ethics considerations favoring one action against considerations opposing the action). The ranking and priority of opposing duties and principles is dependent on the particular role of the psychiatrist and specific contextual factors (i.e., a treatment role, a research role, or a forensic role) (Darby & Weinstock, 2018a, 2018b; Weinstock, 2015). Importantly, this approach does not compete with other forensic ethics models but rather distinguishes itself by helping the practitioner establish a hierarchy of ethics considerations.…”

Measurement-Based Care in Youth: An Opportunity for Better Clinical Outcomes?

“…Moreover, and even when the informed consent form is signed by their legal guardians, it is of utmost importance to ask the child or adolescent if they want to participate. It is also important to clarify the limits of confidentiality [50].…”

Deontología y confidencialidad en psiquiatría y psicología clínica en España

“…Efectivamente, dichos facultativos se enfrentan a menudo a consideraciones contradictorias. En psicoterapia en particular pueden ser relevantes los conflictos acerca de admitir qué principio ético es más prioritario (3,10,(32)(33)(34). Por otra parte, el consentimiento válido otorgado previamente a iniciar los tratamientos médico-psiquiátrico o psicológico-clínico no garantiza que no se vayan a plantear después esos conflictos sobre preeminencias.…”