Ethics and Confidentiality

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 (see below). Confidentiality is a core part of the helping relationship, and a foundation for trust and good practice. Here are two examples of confidentiality statements.

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.

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Example Two

American Association of Marriage and Family Therapists
Confidentiality (Code of Ethics July 2001)

www.aamft.org/resources/lrm_plan/Ethics/ethicscode2001.asp

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

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Reflection and Discussion
In what ways are the above standards relevant to member care workers who provide more “informal” services, or those who do not have a “professional” certification, or for those who come from different countries?

• How is confidentiality applicable if a colleague asks you for a referral or for some “friendly advice over a cup of coffee as friends”?
• Confidentiality can sometimes lead to misunderstandings. For example confidentiality can be seen as being secretive and withholding important information from an organisation about its staff. How can this misunderstanding be minimised?
• How do confidentiality standards apply to children in your work—i.e. when and how should parents be informed about their children who are receiving help?
• In what ways do the specific standards from the AAMFT above apply to your member care work (e.g., written authorisations, keeping/safeguarding files, using client cases in writing/teaching)?

Member Care and Ethics

During the months of April and May, we will be looking at the important area of ethics in member care. One of the main sources that we will use is from the July 2006 article in EMQ, "Upgrading Member Care."

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Ethics involves a mindset (a way of thinking through issues) in light of recognized guidelines which promote responsible care and good practice. Such guidelines deal with areas like confidentiality, skill competencies, continuing growth, accountability, sensitivity to human diversity, and organizational responsibility for staff care.

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"Member care is a broad field with a wide range of practitioners. As this field continues to grow, it is important to offer guidelines to further clarify and shape good practice. Any guidelines must carefully consider the fact of the field’s international diversity, and blend together the best interests of both service receivers and service providers. They also need to be applicable to member care workers (MCWs) with different types of training and experience."

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Is this relevant for me? For sure! Here are three examples.

Example One. Competence.

An experienced consultant makes recommendations to a humanitarian service organization based in Asia. The consultant is addressing the care of their emergency staff working in a mass disaster area, rampant with cholera and malaria. The consultant is vaguely familiar with that cultural context and the organization itself. To what extent does the consultant need to inform the agency about limitations in his/her background? When is it OK to “stretch” beyond one’s areas of training and experience? What if no one else is readily available to offer advice? So is the consultant acting competently?

Example Two. Confidentiality.

A compassionate leader informally exchanges a few emails with a man in their organization who has marital struggles. The man tells the leader that he and his wife have frequent fights that can be overheard by African neighbors. Later, the leader prays with his own wife about the other couple's struggles. Is it OK for one’s spouse to know such things? Is the disclosure of “significant problems” protected information? Would asking the leader to not share be “secretive”? So what type of confidentiality is appropriate?

Example Three. Responsibility.

A reputable sending organization shortens a family's field preparation from three months to one month. The reason is so that the husband, a medical doctor, can cover a crucial and vacant position in a refugee hospital in the Middle East. To what extent does making such “adjustments” simply reflect the realities of mission/aid work? What if “lives”, or a large funding grant, are at stake? So to what extent is the organization acting responsibly towards the family and the refugee patients?

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Reflection and Discussion

• Recall a situation in member care where ethical practice was not adequately understood.
• How can a person further develop a "mindset" for ethical practice?
• What is the difference between ethical guidelines for good practice and personal morality?