The Limits of Confidentiality: Informed Consent and Psychotherapy

Abstract

Sound ethical decision making is essential to astute and compassionate clinical care. Wise practitioners readily identify and reflect on the ethical aspects of their work. They engage, often intuitively and without much fuss, in careful habits—in maintaining therapeutic boundaries; in seeking consultation from experts when caring for pa- tients who are difficult to treat or have especially complex conditions; in safeguarding against danger in high-risk situations; and in endeavoring to understand more about mental illnesses and their expression in the lives of pa- tients of all ages, in all places, and from all walks of life. These habits of thought and behavior are signs of pro- fessionalism and help ensure ethical rigor in clinical practice. Psychiatry is a specialty of medicine that, by its nature, touches on big moral questions. The conditions we treat often threaten the qualities that define human beings as individual, autonomous, responsible, developing, and ful- filled. Furthermore, these conditions often are charac- terized by great suffering, disability, and stigma, yet individuals with these conditions demonstrate tremendous adaptation and strength. If all work by physicians is ethi- cally important, then our work is especially so. As a service to Focus readers, this column provides ethics commentary on topics in clinical psychiatry. It also offers clinical ethics questions and expert answers to sharpen readers- decision- making skills and advance astute and compassionate clin- ical care in the field. –Laura