Task This is the ninth report in a monograph series authorized by the Board of Trustees of the American Psychiatric Association to give wider dissemination to the findings of the Association's many commissions, committees, and task forces that are called upon from time to time to evaluate the state of the art in a problem area of current concern to the profession, to related disciplines, and to the public. Manifestly, the findings, opinions, and conclusions of Task Force Reports do not necessarily represent the views of the officers, trustees, or all members of the Association. Each report, however, does represent the thoughtful judgment and consensus of the task force of experts who formulated it. These reports are considered a substantive contribution to the ongoing analysis and evaluation of problems, programs, issues, and practices in a given area of concern. Judd Marmor, M.D. June, 1975 Library of Congress Catalogue Card No. 75-5319 1700 18th Street, N.W., Washington, D.C. 20009 CONFIDENTIALITY AND A Report of the APA Task Force on Confidentiality as It Relates to Third Parties Maurice Grossman, M.D., Chairperson Jack D. Barchas, M.D. Richard G. Johnson, M.D. Joseph Satten, M.D. Approved for publication by the Council on Professions and Associations Lewis L. Robbins, M.D., Chairperson Ruth Barnard, M.D. Robert S. Garber, M.D. Norman Q. Brill, M.D. William R. Sorum, M.D. Martin Booth, M.D. (Observer-Consultant) Harry H. Brunt, Jr., M.D. (Assembly Liaison) Donald W. Hammersley, M.D. (Staff Coordinator) American Psychiatric Association CONTENTS Introduction: General Principles Governing Confidentiality of Definition of Purpose Recommendations Regarding Education Coordination Acknowledgements Appendices A. General Principles Governing Confidentiality B. Proposed Coding for Mental Disorders C. Position Statement on the Need for Preserving A 1 9 12 13 14 20 ... ..... 21 D. Position Statement on The Role of Confidentiality in F. Principles Governing Confidentiality and Disclosures to ..... G. Testimony (with Addenda) Submitted on Behalf of the H. Samples of Reports from Psychiatrists of Injuries to 23 27 36 ...... 53 INTRODUCTION GENERAL PRINCIPLES GOVERNING CONFIDENTIALITY OF THIRD PARTIES The constitutional right to be secure in home and person is the basis of the general right to privacy all citizens are entitled to. In medicine this extends to the right of the patient to be secure in the privacy of his communications with his physician. In psychiatry, where it is the very essence of the profession to deal with the most private corners of the patient's personal life, security from abuses of privacy form a condition without which it would be difficult to practice psychiatry and psychotherapy at all. Thus there is concensus in the medical world, the legal community and the general philosophy of our system of government that confidentiality of private communication is a right. In particular, psychiatric treatment requires a secure atmosphere of confidentiality in order to protect the patient's right to the pursuit of health and happiness. To create an affirmative and secure atmosphere of confidentiality will encourage individuals who need help to seek it without fear that there will be destructive disclosure to the rest of the community. In fact, the mere disclosure of the fact of psychiatric treatment is sometimes felt to be a hazard to the patient. Further, some diagnostic terms have discriminating social connotations and can cause injury to patients if made known to others. The patient himself bears some responsibility to protect his own rights. Our position as the patient's physician also makes us responsible for the preservation of confidentiality. This responsibility is even more crucial when the patient's ability to protect his confidentiality is impaired by temporary regression incident to the therapeutic process, by his psychological state of function, or when, under financial duress, the patient permits release of information the consequences of which he only dimly perceives. The unfettered ability to maintain absolute confidentiality in psychiatry seems desirable. However, problems are created when third parties have legitimate ethical rights to some information about a patient, his treatment process, or even certain specific elements of the treatment itself. Balancing these conflicting interests thus be iv |