The Ethics of Confidentiality: Professional Duties and the Uncooperative HIV-Infected Client

Abstract

The purpose of this paper is to discuss the ethics of confidentiality in the professions. Each profession has its own policy regarding confidential communications outlined in its ethical code. Such rules are in place to guide the actions of the members of a given profession. Most professions currently adhere to a general rule of confidentiality but allow exceptions in certain circumstances. For example, the American Psychiatric Association's code of conduct includes a rule that allows a psychiatrist to breach her client's confidence whenever that client poses a significant threat of harm to himself or an innocent third party. One encounters similar exceptions to confidentiality in other professional codes of ethics. These exceptions seem to suggest that a client's 'right to privacy' sometimes conflicts with the basic rights of others, such as the rights to life and bodily integrity. However, I shall argue that this conflict does not seem to provide a sufficient reason to break a client's confidence. I will begin by outlining one dilemma faced by professionals in regards to confidentiality, namely, that of choosing between maintaining a client's confidence or violating it in order to protect a third party at risk of harm. Of particular interest to me is the professional confronted by an uncooperative HIV-infected client someone who presents a significant threat of harm to a third party, yet refuses to warn that person of the danger. The harm mentioned in this particular case, of course, is the transmission of HIV from the infected client to an unsuspecting third party. I will lay out this dilemma in concrete form in the second section. Next, I will establish a justification for the importance of confidentiality in the professional setting. Although the duty of confidentiality is considered by most to be a crucial fixture in