318: Professional Ethics
Outline of Bok: The Limits of Confidentiality
Confidentiality is fundamentally an issue of the legitimacy of secrecy.
Proposal: The PRIMA FACIE DUTY of confidentiality for professionals is really a privilege, and requires justification, which will show that it has limits.
Premise 1: Individuals who possess autonomy retain control of their own lives only if their secrets, when voluntarily shared, are protected.
Premise 2: Human personal relationships involve some degree of intimacy and loyalty that does not extend beyond the relationship. These relationships should be respected. When secrets are shared with professionals, they must respect relationships already in place.
Premise 3: Professional confidentiality is based on a pledge (often explicit!) and a promise (often implicit). Where there is no wrong in making the promise in the first place, it should be upheld, so confidentiality should be upheld.
TOGETHER, these create a professional’s prima facie duty.
Premise 4 is very different: There is enormous social
utility in letting individuals seek help
confidentiality, where public knowledge of their problem would be a
reason for them to keep the problem secret, endangering others. There is
some harm in preserving confidentiality here, but the benefits to
society are enormous. Medicine and law are the obvious examples.
Confidentiality and minors
Solution: encourage minors to share information with
family/guardians, but do not mandate it.
3rd party harm
Solution: Confidentiality cannot be justified under any of premises 1 – 3.
1. It’s not about themselves, therefore autonomy is not sufficient.
2. To expect secrecy is to expect complicity, and thus intimacy, that is not appropriate to professional relationships.
3. No one has the right to promise to help harm a 3rd party.
The fourth premise, utility, is not obviously preserved, so an exception to confidentiality is allowable.
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Summary: Plans or high risk of 3rd party harm FORFEIT the client’s right. The duty of the professional is waived, BUT ONLY to the minimum extent required to prevent harm.
NO PROMISES OF CONFIDENTIALITY CAN EXTEND TO SECRETS ABOUT 3RD PARTY HARM
DOWNSIDE OF CONFIDENTIALITY:
It allows professionals to hide their own errors, negligence, and harm to the public. (Exorcism case)
Confidentiality should only extend to CLIENT INFORMATION, not professional behavior. (The client’s secrets should not translate into a hospital’s secrets about its failure rate.)
Government confidentiality is particularly troubling.
Bok then assumes that “internal memoranda and personnel files” deserve prima facie confidentiality. But why?
Last updated May 26, 2014