Essay Sample on Confidentiality in Psychiatry: Respect, Value & Exceptions

Introduction

The issue of confidentiality in health information has accompanied the practice of medicine since its inception. For psychiatry, its application, restrictions and its exceptions constitute a core part of its existence as a medical specialty. The patient assists the psychiatrist with a priori conviction that they will share relevant and intimate information with a person trained to receive it empathetically, who will respect the value and socio-cultural aspects and who will issue an opinion about mental and behavioral symptoms proposing a treatment scheme. However, as time has passed, the complexity of medicine and the tendency to interdisciplinary work within health institutions has caused erosions and changes in the application of confidentiality.

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The legal aspects and the influence of health administrators, the different types of information recording together with the implementation of electronic files have required the construction of new foundations on the concept of confidentiality. Maintaining high ethical standards in the application of medical practice should be inseparably linked to the study of bioethics from the initial training of doctors.

Annotated Bibliography

Koocher, G. P., & Keith-Spiegel, P. (2018). Necessary Secrets: Ethical Dilemmas Involving Confidentiality. Continuing Education Courses.

This article addresses the balance between confidentiality and public protection in respect to individual medical data, with the focus on ethical dilemmas that exist, for instance, public interest versus individual privacy rights in the event of the patient posing a risk to other members of the society. The authors noted that confidentiality is the cornerstone of the doctor-patient relationship in psychiatry and that it acquires a very high weight for the confidential information, often endowed with shame and scruples that patients provide to their handlers. At other times, any disclosure of specific pathologies or some aspects of them painfully erodes the dignity of patients, due to the prejudiced view that societies exercise about many psychiatric pathologies.

As a principle, the reservation of the information contained in the clinical record, the information that arises, both from the clinical record and from the studies and other documents that record procedures and treatments to which people are subjected must be considered as sensitive data. By analyzing the ethical dilemmas surrounding confidentiality, the article provides essential aspects that determine the significance of keeping mental health records private as a way of protecting patient rights and dignity.

Abdekhoda, M., Dehnad, A., & Khezri, H. (2019). The effect of confidentiality and privacy concerns on adoption of personal health record from patient's perspective. Health and Technology, 9(4), 463-469.

This paper approaches the issue of data confidentiality from the perspective of the patient. The authors observed that ethics in psychiatric practice, in addition to being a governing entity of our functioning, is involved in most clinical decisions. Many of the patients who consult the psychiatrist resist for years seeking help. They must previously overcome social obstacles and the gravitating weight of stigmatization. In this way, psychiatrists, in addition to the usual clinical work, must keep these aspects in mind to be tributaries of the patient's confidence. Every time this initial complexity is overcome, the foundations are laid for the beginning of the therapeutic alliance.

The paper provides reliable insights as to the position of the patient not only concerning their understanding of their disease, but also their ability to establish a lasting working alliance with the therapist based on treatment. Developing the therapeutic link is therefore founded on the trust and confidentiality assumed between the mental health professional and the patient, failure to which a series of relevant ethical issues begin to gravitate.

Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus, 16(4), 395-401.

This paper explores the issue of confidentiality and its exceptions in special clinical situations in psychiatry. As the authors observe, the idea of the concept of confidentiality is implicit a priori in patients, even without necessarily reflecting extensively on its meaning. It is difficult for psychotherapy or a psychiatric medical intervention to make any sense without the patient feeling with the most considerable freedom to vent private information. In psychiatry, data and sensitive information of people are managed, which they consult in a period of fragility and vulnerability. On many occasions, the monitoring and control of these patients last for an extended time, even years. The management of all this information and its interpretation is part of the medical act, that is its only possible purpose, and its use is for the direct benefit of the patient. Failure to safeguard this data exposes patients to many risks, including their unfortunate dissemination. This taints the dignity of people and contributes to stigmatization in the case of psychiatric patients. The paper, therefore, contributes to the discussion on the confidentiality between the psychiatrist and the patient, paying attention to the margins of negotiation and the limits of disclosure.

Askitopoulou, H., & Vgontzas, A. N. (2018). The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times. European Spine Journal, 27(7), 1481-1490.

This journal evaluates the Hippocratic Oath, which is the ethical framework for morality and confidentiality in medical practice. As the authors describe, the first approaches to privacy in the doctor-patient relationship can be identified in fragments of the Hippocratic Oath, between the 6th and 3rd centuries BC: "What in the treatment, or even outside it, they see or hears about the life of men, that which should never be disclosed, I will keep it secret". Many of the Hippocratic approaches derive from the Pythagorean circles, a community that professed certain precepts, obligatory for all its members and that many times had to be kept in the deepest secret. The authors also observe that the oath advocates non-disclosure, but does not define what is prohibited, leaving this decision at the discretion of the doctors inserted in the specific social and professional contexts. The journal, therefore, offers crucial insights as to which circumstances should determine when and not to make medical records private in congruence with the Hippocratic Oath and ethical practice.

Lewis, O., & Callard, F. (2017). The World Psychiatric Association's "Bill of Rights": A curious contribution to human rights. International Journal of Mental Health, 46(3), 157-167.

This journal explores the international medical practice regulations that define appropriate conduct among health professionals dealing with mental health. Historically, different views have been recorded concerning the place of medical secrecy. In 1948 the World Medical Association gave rise to the Geneva Declaration and in 1949 to the International Code of Medical Ethics. The Geneva Declaration states: "I will respect the secrets that are entrusted to me", further elaborating: "A doctor owes their patient the absolute secret about everything that has been entrusted to them or that they know due to the confidence deposited in them. On the other hand, the World Psychiatric Association in 1977, through the so-called Declaration of Hawaii, gave rise to the first code of ethics aimed at psychiatrists.

Although most legal frameworks such as those previously exposed speak of civic sophistication and a legal system that protects the individual and their privacy, it is necessary to be cautious in relation to the limits of the laws since they cannot cover all the events that could occur in the field of confidential data in psychiatry. In the daily practice of this specialty, the approach to the problems related to confidentiality have a more inclined aspect towards bioethics than towards the laws in force. There are clinical situations that generate important ethical conflicts in psychiatry.

References

Abdekhoda, M., Dehnad, A., & Khezri, H. (2019). The effect of confidentiality and privacy concerns on adoption of personal health record from patient's perspective. Health and Technology, 9(4), 463-469.

Askitopoulou, H., & Vgontzas, A. N. (2018). The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: The Hippocratic Oath from antiquity to modern times. European Spine Journal, 27(7), 1481-1490.

Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and Psychotherapy. Focus, 16(4), 395-401.

Koocher, G. P., & Keith-Spiegel, P. (2018). Necessary Secrets: Ethical Dilemmas Involving Confidentiality. Continuing Education Courses.

Lewis, O., & Callard, F. (2017). The World Psychiatric Association's "Bill of Rights": A curious contribution to human rights. International Journal of Mental Health, 46(3), 157-167.