Thursday 27 August 2009

Member Care and the Hippocratic Oath, Part 8

Confidentiality as a Lifestyle
Diego Rivera, Women combing each others’ hair, 1957
Si fuese el fablar
de plata figurado,
debe ser el callar
de oro afinado.
Sem Tob, 14th century, Spain
If speech is silver
then silence is gold.
All that may come to my knowledge
in the exercise of my profession
or in daily commerce with men,
which ought not to be spread abroad,
I will keep secret and will never reveal.
Hippocratic Oath
Keeping confidences is not just a member care practice or a professional standard (e.g., confidentiality is a serious part of “the exercise of my profession” Hippocratic Oath). It is also part of our lifestyle and commitment to integrity in our relationships (e.g., confidentiality is also explicitly included in our “daily commerce with men” Hippocratic Oath).
Have you ever wondered when it is OK to share information with another person? Can you tell one friend what another friend told you privately? What if there was no explicit stipulation that you need to keep this information to yourself? Or what if your friend "would not mind" if you told someone else--or so you think/rationalise? Is it just a matter of your discretion to determine, in the terms of the Hippocratic oath “what ought not to be spread abroad?”
Likewise when is it OK for us to share private information with a “consultant” in order to get “input”. Who and what constitutes a person being a “consultant” anyway? When might such consultancy be or lapse into more of a thin veneer for a juicy round of gossip or for affecting some unidisclosed manipulative end?
The list of questions and situations involving private communications and disclosures is seemingly endless, both in our private lives as well as in our member care work. The adage “when in doubt, don’t” is not a bad place to begin. The counter to all of this however is not to create some culture of secrecy where simply sharing news with each other is somehow hindered or viewed with suspicion.
The following material can help give us all some more clarity as member care practitioners. It is from the 2009 article, “Ethics and Human Rights in Member Care: Developing Guidelines for Good Practice” by Kelly O’Donnell
When is information considered “confidential”?
The basic consensus among professional codes of ethics is that any information shared during the course of professional services is considered to be "privileged" information. This means that only the "client" (the person asking for help/receiving services) can determine when and how this information can be shared by the helper/member care worker. There are a few important exceptions however when there is a danger to self/others (see below).
Confidentiality is a core part of the helping relationship, and a foundation for trust and good practice. It is not just a matter of member care workers (MCWs) simply being “discrete”—which can be interpreted in many different ways—and relying on one’s own “good” judgment concerning disclosures. Rather the MCW abides by a strict standard that honours the client’s rights.
Here are three confidentiality examples to consider. The third one was added to this blog entry. It is a a short prosaic piece (indicting almost all of us I'm afraid) on the common practice of ‘indulging in idle talk and rumours about others, especially the private affairs of others, often while feigning noble motives for such improprietous disclosures.’
Example One: Member Care Associates
Confidentiality (from Service Agreement)
We want you to know that what you share with us is confidential. The only exception, in compliance with most laws (e.g., American and European), is when: a) you or someone's life may be in danger (e.g., child/elder abuse, suicidal/homicidal threat, gravely disabled); or b) explicit written permission by you has been given to waive confidentiality.
Other types of personal struggles can significantly interfere with one's work role and/or credibility of one/s organization (e.g., abusive leadership, addictions, major depression, moral failure, serious marital conflict.) In such cases we usually encourage you to inform a leader whom you trust within your organization(s). We see such struggles as being larger than the helping relationship, and thus usually best handled with the involvement and support of others.
Note for group or debriefing services: The material shared by others during the group/debriefing sessions will be kept strictly confidential by the participants.
Example Two: American Association for Marriage and Family Therapy (AAMFT)
Confidentiality (Code of Ethics, July 2001)
Marriage and family counselors/therapists often work with more than one person in a family. It is important to guard each client’s confidence but it can be challenging at times. The AAMFT has developed six points relating to confidentiality. The main ideas in each point are listed below. Be sure to see the full code at the
AAMFT site listed above.
1. Discuss the nature of confidentiality to clients and any others involved in the case
2. Do not disclose information without written authorization or when required by the law.
3. Confidentiality is protected when using examples for teaching, writing, research ,etc.
4. Clarity about how to safeguard and destroy records of clients
5. Clarity about how to deal with client records when closing a practice, moving, or dying
6. When/how to disclose information if one consults with colleagues about a case
Example Three: The Snake That Poisons Everybody
Author Unknown (1980s)
It topples governments, wrecks marriages, ruins careers, busts reputations, causes heartaches, nightmares, indigestion, spawns suspicion, generates grief, dispatches innocent people to cry in their pillows.

Even it's name hisses.
It's called gossip.

Office gossip. Shop gossip. Party gossip.
It makes headlines and headaches.

Before you repeat a story, ask yourself:
Is it true? Is if fair? Is it necessary?
If not, shut up!
Reflection and Discussion
1. In what ways are the above “standards” relevant to member care workers who provide more "informal" services, or who do not have a "professional" certification, or who are not therapists, or who come from different countries?
2. How thorough and how specific should such standards be, for different settings in which different types of member care are provided, including counselling, team meetings, or internet communications?
3. Confidentiality sometimes leads to misunderstandings. For example, it can be seen as being secretive and withholding important information from an organization about its staff. How can this be minimized?
4. Can you think of additional ways to put into personal practice the third example above, on “gossip”?
5. How might the above standards apply to protecting information in written and digital form?

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