42. CASE: “Oops, Did I Say Too Much?” The Ethics of Confidentiality

You work with a variety of patients and families, and often see firsthand both the joys and disappointments that can come with trying to manage mental health issues. Over time, you have developed some special expertise in working with patients with schizophrenia and often are asked by family doctors for assessments and/or support with treatment plans.

While there have been some real successes, you have also been involved in a number of situations where patients have gone off of their medication(s) with varying outcomes. Some patients have had run-ins with the law while others have retreated from the world and live on the “fringes”, while still others, unfortunately, have committed suicide.

At a party yesterday, you had a chance to catch up with your goddaughter, Sherrie. She is twenty two, has an active social life and has just started dating someone seriously. As Sherrie talks about her new boyfriend, Jonas, she mentions that he has had some issues with his medications – “which you would understand all about being that you work in mental health” – and has stopped taking them completely.  More details about Jonas and his interests are shared as the conversation continues, and you start to get a bad feeling.

You believe that Jonas is a patient you were asked to assess a few years ago. If you’re right and this is the same person, Jonas has paranoid schizophrenia and a tendency to get very aggressive and potentially quite violent when he is not taking his meds. You feel as if you would never forgive yourself if you let something happen to your goddaughter, so should you tell Sherrie what you know?

  • What are your options for action in this situation?
  • What process would you use to decide what to do?
  • What are the competing values you would weigh?
  • Should Sherrie’s safety or Jonas’ privacy take precedence?

Some Values and Ethics Issues to Consider

  • Patient- family relationships
  • Compliance with policies and procedures
  • Respect for privacy and confidentiality
  • Overlapping roles and responsibilities
  • Professional boundaries
  • Honesty, trust and truth-telling
  • Community relationships

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