Yorkville University

The Limits of Confidentiality: Informed Consent and Psychotherapy

From introductory section:

• A practitioner must make judgments in certain situations that will have grave consequences for both their patient and third parties.
• One method of resolving biomedical ethics dilemmas is dialectical principlism, an approach that balances conflicting ethics criteria to determine the most ethical course of action
• The model strives to achieve this goal by first prioritizing ethics considerations according to an individual’s specific professional role, with primary versus secondary duties.
• Next, the model uses the unique set of personal, cultural, and societal values, as well as the context of the situation, to assign weights to primary- and secondary-duty principles.

From Informed Consent section

• The informed consent process encompasses multiple facets: discussing the patient’s part in the decision-making process, the treatment’s indication, alternatives (including no treatment), inherent risks and benefits, and uncertainties, and then assessing the patient’s understanding of the provided information and subsequent articulation of a choice

From Informed Consent in the Psychotherapy Setting section

• One such relevant area of possible harm to patients undergoing psychotherapy treatment involves situations in which the psychiatrist breaches doctor-patient confidentiality because of mandated reporting or a serious risk of danger.
• Although patient autonomy is a high priority, in this article, we address whether psychiatrists should or should not provide full informed consent in certain situations when the safety of the patient or third parties may be put at risk by this action.

From Case Illustration 1 section

• the psychiatrist would best achieve the primary-duty principles of beneficence and nonmaleficence by protecting the patient from self-harm

From Conclusion section

• Beauchamp and Childress (5) laid out four biomedical ethics principles that should govern ethical decision making as it relates to the healer role.
• Three of these principles have a primary emphasis on doing what is best for the patient.
• However, the authors did not provide a method to analyze which principle is dominant when the principles conflict.
• Dialectical principlism addresses these problems by clarifying the competing factors and placing value on the principles on the basis of the context and specific narrative.
• It appears that Beauchamp and Childress (5) implicitly agreed with this, given their clarification that they do not believe autonomy should always trump other considerations.