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Ethical Dilemmas Of Psychiatry: Should Confidentiality Ever Be Breached?

I’ve been asked several ‘ethical dilemmas’ in the past few weeks.  I’m putting them up on Shrink Rap, but please don’t get hung up on the details.  These aren’t my patients, but the details of the stories are being distorted to disguise those involved.  The question, in both cases, boils down to: Should the mental health professional report the patient to his professional board?

In the first case, a psychiatrist is treating a nurse who is behaving badly.  The nurse is stealing controlled substances from the hospital and giving them to friends who ‘need’ them.  She doesn’t intend to stop, and her contact with the psychiatrist was only for an appointment or two before she ended treatment.  Should the psychiatrist contact the state’s nursing board?   Is he even allowed to?

In the second case, a psychotherapist  sees a patient who is also a psychotherapist (I will call the patient here the patient/therapist).  The patient tells the therapist he’s having a sexual relationship with one of his own patients (the patient/victim).  This is clearly unethical, but the patient/victim is an adult and the relationship is “consensual” in that it is not forced or violent.  There is no question that if a licensing board knew of this, the patient/therapist would lose his license.  Should the treating therapist report his patient for unethical behavior?  Ah, he asked a colleague on the Board and was told that he must report this, and if he doesn’t, his own license could now be at risk.  If he now reports it, as instructed, can the patient/therapist turn around and sue him for breaching his confidentiality?  After all, he was seeking help with his problem, he believed it was protected information, and now he will be sanctioned out of a livelihood.  Does it matter if the therapist is a physician (for example, a psychiatrist) as opposed to a psychologist or social worker or nurse practitioner?  I realize that all mental health professionals have confidentiality standards, but are the confidentiality laws that apply to physicians/clergy/attorneys the same as they are for other mental health professionals?

*This blog post was originally published at Shrink Rap*

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