Limits Of Confidentiality Research Articles

Silent boundaries: exploring the limits of legal confidentiality in Poland

ABSTRACT Legal confidentiality, an integral aspect of European legal culture and legal services, plays a pivotal role in safeguarding the trust and privacy of professional-client relationships. This study focuses on the multifaceted dimensions of legal secrecy, particularly within the context of commercial lawyers in the European legal services market, using Polish legal advisers as an exemplar. The research explores evolving attitudes, expectations, and perceptions of legal secrecy amidst dynamic legal changes and discrepancies in interpretations among lawyers, public authorities, and citizens. A comprehensive mixed-method approach was used, including surveys, structured in-depth interviews, content analysis, and desk research, to investigate the diverse facets of legal secrecy. Findings reveal that while legal secrecy remains highly esteemed, its interpretation varies significantly across national and EU laws and among stakeholders. There are a multitude of types of legal secrecy, creating confusion and opportunities for public authorities to breach confidentiality. The study underscores the critical need for standardisation and unification of legal secrecy across European countries to enhance cross-border legal services, streamline justice systems, and bolster citizen protection. It emphasises that despite legal and societal changes, the fundamental essence and importance of legal secrecy in upholding democracy, justice, and trust remain steadfast.

A Matter of Trust: Confidentiality in Therapeutic Relationships during Psychological and Medical Treatment in Children and Adolescents with Mental Disorders.

Background: Confidentiality is a crucial ethical principle in therapy, particularly for children and adolescents, yet their perception of it remains understudied. We aimed to explore minors' perspectives and attributions on confidentiality in psychological and medical treatment. Methods: We interviewed 11 pediatric patients aged 7 to 15 and used reflexive thematic analysis to analyze their responses. Results: Four main themes were extracted from the data: (1) confidentiality and uncertainty regarding what information will be shared with clinicians and parents; (2) consequences of breaching confidentiality, encompassing breaches of confidentiality in the past and their negative effects on interactions with parents and health professionals; (3) exceptions to confidentiality, including understanding the limits of confidentiality; and (4) autonomy and self-determination, reflecting the desire for involvement in medical decisions. Conclusions: Explanations about confidentiality rules and limits, especially with younger children, are crucial. This is particularly important because it is fundamental to promote children's development and self-determination through increasing autonomy, as well as to provide a sense of security and respect through transparent rules. A single educational session on confidentiality at the outset of therapy is insufficient; ongoing conversations are needed to reinforce understanding and promote autonomy.

Blockchain-based group signature for secure authentication of IoT systems in smart home environments

ABSTRACT Current solutions that rely on a single-server architecture have privacy, anonymity, integrity, and confidentiality limitations. Blockchain-based solutions can address some of these issues but face challenges regulating behaviour and protecting access policy privacy. This study proposes a new approach to securing a smart home environment to overcome these limitations.The proposed architecture is based on a group signature scheme, which allows multiple IoT devices to securely exchange keys and authenticate each other without needing a central authority. Our experimental results indicate the effectiveness and efficiency of the proposed architecture and provide insights into its security and privacy features compared to existing IoT authentication methods.

Silent Boundaries: Exploring the Limits of Legal Confidentiality in Poland

Silent Boundaries: Exploring the Limits of Legal Confidentiality in Poland

Ethical Considerations in Working with Roman Catholic Seminarians and Men and Women in Religious Formation

There are many ethical challenges when mental health professionals work clinically with Roman Catholic seminarians as well as with men and women in religious formation. This article highlights several of the most prominent ethical issues and challenges confronted by mental health professionals working with these clients. These topics include issues of competence in evaluating, treating, and consulting with seminarians, those in religious life, or those applying to enter religious life. Issues of informed consent must also be considered so that seminarians, religious life clients, applicants, and their religious superiors have clarity about the limits of confidentiality and who maintains the privilege of accessing client information. In addition, professional conflicts can arise when Church expectations may seem challenging to satisfy for professionals trained in a predominantly secular environment. Cultural understanding and appreciation are needed to work with clients from different ethnic and racial groups as well as different religious orders and branches within the Catholic Church. Finally, the role of mental health professionals in the determination of acceptance or rejection into religious life and for ordination is discussed.

Ethical Dilemmas in the Fieldwork Training of Social Work Students

ABSTRACT Undergraduate social work students are exposed to ethical and legal dilemmas during their fieldwork training. This article presents a study that examined these ethical dilemmas in an Israeli sample of undergraduate social work students. 117 students who participated in a course in ethics submitted 31 written presentations of ethical-dilemma analysis. Their oral presentations were recorded and transcribed. Using a qualitative analysis, three major themes emerged: 1. The tension between the duty to maintain client's confidentiality and its violation under certain conditions; 2. The students’ conflict of loyalty toward the client vs. the organization; 3. The question of the clients’ right to self-determination when, in the student's view, this is against their best interests. Our findings point to the vital role of an ethics course in the social work undergraduate curriculum that can enhance students’ knowledge of specific laws relevant to the limits of confidentiality in social work and their ability to analyze ethical dilemmas as future professionals. Furthermore, it is essential to raise awareness in educators and supervisors concerning moral distress that may afflict students coping with ethical dilemmas at this early professional developmental phase.

The Influence of the Rebound Hammer Test Location on the Estimation of Compressive Strength of a Historical Solid Clay Brick

This paper presents the study of a two-hundred-year-old, demolded solid clay brick using the rebound hammer test for the estimation of the compressive strength. During the test, the location and face type influence on the rebound values are monitored and recorded. In addition, the calculation of the average rebound value has been modified to encounter the influence of location and face types. Furthermore, the estimated compressive strength is compared with the normalized mean compressive strength to check the accuracy of the rebound hammer test if it is within the confidential limit of ±25%. The result shows that the location and surface types have influence on the rebound value, which in turn affected the compressive strength.

Immigrant/Acculturation Experience.

In this article, we provide an overview on how to approach matters of forging a therapeutic alliance, empathetic listening, addressing issues related to obtaining informed consent, and limits of confidentiality, with cultural humility and nonjudgmental curiosity while working with diverse immigrants groups. We also discuss the use of broaching to discuss culturally sensitive topics with immigrant children and families The clinical pearls can be applied to different clinical scenarios and a variety of cross-cultural encounters.

Ethical dilemmas of school counsellors: A vignette study

AbstractSchool counsellors often encounter ethically challenging situations due to contradictory values and roles. This qualitative research aimed to define school counsellors’ ethical dilemmas and their responses to such situations. Twenty-seven school counsellors in Turkey were asked to respond to 13 vignettes with ethical dilemmas. The most frequent ethical dilemmas involved the limits of confidentiality, confusion about counsellors’ professional roles in school settings, uncooperative behaviours among stakeholders, and suspected child sexual abuse. It was revealed that counsellors prioritise the students’ benefit and respect students’ privacy. They follow legal guidelines in risky situations and insist on working within their areas of competence; they are not willing to accept noncounselling tasks. The results and implications for counsellors, counsellor educators and researchers are discussed.

Pengamanan Internet of Things Berbasis NodeMCU Menggunakan Algoritma AES Pada Arsitektur Web Service REST

Data confidentiality and resource's limitation issues are challenges for the Internet of Things. To implement good security on IoT systems, cryptography can do it, but it needs an effective encryption algorithm that does not require a lot of resources. The purpose of this study is to secure an IoT system by implementing an algorithm that is successful in maintaining the confidentiality of data transmitted. This research uses an experimental approach, by creating an IoT system for agriculture and adding an encryption algorithm. The IoT system uses NodeMCU as a microcontroller. NodeMCU is a microcontroller with small resources so it needs an efficient algorithm to be implemented in it. One algorithm that has good performance in a desktop computing environment is the Advance Encryption Standard (AES) algorithm. The algorithm is tested in an IoT computing environment with a data exchange architecture using an REST (Representational State Transfer) web service, resulting in an IoT system for agriculture with cryptographic implementations in it. In the tests carried out, the encryption process of 128 and 256 bits of plain text took 266.31 and 274.31 microseconds, while the memory used was 16% and 17% of the total memory, respectively. This shows the encryption time is fast, and the memory usage is relatively small.

Ethical dilemmas encountered in suicide research and management: Experiences of young mental health professionals.

This study aimed to explore ethical dilemmas and challenges faced by young mental healthcare researchers and professionals working with survivors of suicide (hereinafter suicide survivors). Two focus group discussions (FGDs) Researcher FGD (with those engaged in suicide research) and Clinician FGD (with those providing treatment to suicide survivors) - consisting of open-ended questions and lasting for 70-90 minutes were conducted and analysed using Thematic Analysis. Five themes were identified: i) struggling with the incongruity of harm within benefit, ii) difficulty in delineating boundaries, iii) self-doubt in one's professional competence, iv) nature of suicide straining the limits of confidentiality, and v) working with structural limitations. The study helps to understand the obstacles and dilemmas encountered in adhering to ethical principles while working with vulnerable individuals.

146 Provision of Adolescent Confidential Care in a Tertiary Care Setting

Abstract Primary Subject area Adolescent Medicine Background Adolescents are more likely to seek care and disclose sensitive health information if confidentiality is assured. Several national societies endorse the need for confidential care at all health-related encounters with adolescents. Many adolescents have infrequent contact with the medical system other than unscheduled urgent care in pediatric hospitals. Little is known regarding the effectiveness and feasibility of providing confidential care to adolescents in a tertiary pediatric hospital setting. Objectives We sought to evaluate the frequency, quality and factors associated with the provision of confidential care to adolescent patients at a pediatric teaching hospital. Design/Methods We undertook a cross-sectional survey of adolescents presenting to an urban tertiary pediatric hospital from December 2019 to December 2020. Adolescents eligible for confidential care under Quebec legislation (aged 14-18) were recruited from a convenience sample either when presenting to the Emergency Department (ED) for low acuity visits (CTAS 3-5) or when hospitalized on the pediatric inpatient medical ward. Participants completed a standardized, self-administered electronic questionnaire regarding the confidential care provided at their initial ED or inpatient medical encounter. Multivariable logistic regression was used to identify factors associated with the provision of confidential care. Results A total of 406 adolescents completed the survey (335 ED; 71 inpatient). The majority of respondents identified as female (233, 57.4%), white/Caucasian (260, 64.0%) and presented to the hospital with a parent (367, 90.4%). Overall, confidential care was offered to 137 (33.7%) respondents, with 95 (69.3%) accepting confidential time alone with their doctor. Among participants receiving confidential care, 43.2% endorsed that the limits of confidentiality were not reviewed, 24.2% reported that their private issues were still discussed in front of family members and 15.8% had private information that they had wished to discuss but were not asked. When offered, there was no difference between hospitalized and ED patients declining confidential care (32/100 vs. 10/37; p=0.73). The most common reasons identified for declining private time were that it was deemed unnecessary (29/42, 69.0%), perceived risk of parental conflict (8/42, 19.0%), or concerns for violation of trust by the medical team (5/42, 11.9%). Multivariable analysis found inpatient location (aOR 2.28, 1.04-5.01), female gender (aOR 2.02, 1.21-3.38), age (aOR 1.67, 1.03-2.69), psychiatric diagnosis (aOR 8.10, 1.47-44.6), resident involvement (aOR 1.96, 1.09-3.53) and overnight assessment (aOR 0.23, 0.06-0.90) were all associated with the provision of confidential care, after adjusting for patient- and hospital-level covariates. Conclusion Survey results suggest inadequate provision of confidential care in an academic pediatric hospital. Adolescents receiving confidential care were not consistently explained to regarding the limits of confidentiality, and breaches were reported in a quarter of all cases. Confidentiality-specific education initiatives are necessary to improve the frequency and quality of confidential care for adolescents in tertiary care settings.

Exploring Adolescent Experiences with Disclosing Self-Injurious Thoughts and Behaviors Across Settings.

Disclosure of self-injurious thoughts and behaviors (SITBs) is critical to current treatment and prevention programs. Limited research has examined patterns of and barriers to SITB disclosure in adolescents. This work is critical given the limits of confidentiality in this population. Over 1,000 adolescents aged 13-17 with a history of mental health treatment and SITBs were recruited online. Participants reported their history with disclosing SITBs across a range of relationships, honesty in and barriers to disclosure to healthcare providers, and their experiences with breaches of confidentiality to parents/guardians. We examined relationships among these experiences and a range of outcomes, including perceived likelihood of future disclosure. Participants reported most frequent disclosure of all SITBs to friends, and more frequent disclosure of nonsuicidal self-injury compared to suicide ideation or attempts. Adolescents were most likely to disclose SITBs when directly asked by healthcare providers, though many participants reported continued SITB concealment. The most commonly endorsed barrier to disclosure was fear that the provider would tell a parent/guardian. Experiences with confidentiality breaches involving a non-collaborative breach were negatively associated with future disclosure, mental health symptoms, and adolescent-parent relationships. SITB disclosure is a cornerstone to their treatment and prevention. Better understanding of to whom and when, barriers, and the impact of disclosure experiences is critical. Our research suggests that most adolescents do not want their parents to know about their SITBs, and that fear of parent involvement prevents disclosure. Results have several implications for SITB assessment across physical and mental healthcare settings.

An Integrated Software for Computing Mechanical Properties of Crystalline Material by Means of XRD

An integrated software for calculating the major mechanical properties of materials was newly programmed. The material mechanical properties are determined from a peak position and the broadness of X-ray diffraction (XRD) line using profile function method, including Gaussian, Parabola, Half-width, and Centroid. The X-ray diffraction line in software is also corrected by the generalized X-ray absorption function. The results show that the precision coefficient (R2) of the dhkl-sin2 ψ linear regression depends on tested materials and the method of the 2θ determination. The Parabola and Gaussian methods show greater fitting accuracy in comparison to the other two methods in determining stress. The mechanical properties calculated using this software agreed well with the values determined from the conventional methods. In addition, this XRD software also allows computing the 95% confidential limits of the results from a single measurement without conducting repetitive measurements. Therefore, the new software allows widening the experimental scopes of an X-ray diffraction device in both laboratories and the industrial sector.

Compulsively Moral: OCD, Ethics, and the Law.

Compulsively Moral: OCD, Ethics, and the Law.

Forensic mental health professionals\u2019 perceptions of their dual loyalty conflict: findings from a qualitative study

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice.Methods31 MHPs working in court-mandated treatment settings were interviewed. The interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved.ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system.

Vulnerable victims in court: from childhood to senescence

Introduction The trial process is usually stressful for victims. Testifying in criminal court must cope potentially traumatising effects and implies recalling and evoking a crime. Such act tends to be a revictimization [1–3]. Several studies have shown that re-traumatization of victims in criminal justice process has serious problems [3].The article 271 of the Portuguese Code of Criminal Procedure allows the prosecutors and the inquiring judge to record the victim’s testimony and use it during the future trial. This procedure, called future memory statements, prevents the victim to be exposed months or years later to the memories of a traumatic event [2]. Even this procedure has a traumatic outcome due to the normal anxiety felt by victims. To minimise this it is necessary to inform and prepare the victims for this diligence, explaining the court procedures. Prepare the vulnerable victim for future memory statements aims to avoid an emotional trauma event towards the criminal justice system. The purpose of this paper is to demonstrate the work developed by the Victims Information and Assistance Office (GIAV), and its role as technical advisor to the Public Prosecutor's Office, specifically about victim’s attendance. Materials and methods GIAV was established in partnership with Egas Moniz Higher Education School and it is located at the Combat Unit against Domestic Violence, 7th Section of the Lisbon Public Prosecutor’s Office. Data was collected between March 2013 and May 2015 from future memory statements protocol that comprises three phases: Pre-inquiry stage (1 or 2 days before inquiry), inquiry stage (trial hearing) and post-inquiry stage (after trial hearing) [1,2]. A total of 144 statements for future memory were performed by GIAV. All ethical issues have been taken due to the sensitive nature of the involved data involved and the respective informed consentient, the confidentiality limits, and information about the ethics and technician’s impartiality. Results The type of crime of vulnerable victims is mostly child sexual abuse (n = 55, 39.5%), child abuse and neglect (n = 42, 29.9%) and domestic violence (n = 26, 18.8%). The other type of crime are sexual harassment (n = 7, 4.9%), intimate partner violence (n = 4, 2.1%), and exposure to violence (n = 2, 1.4%), rape (n = 2, 1.4%) and others (e.g. threats and sexual coercion, crimes against freedom). We evaluate 98 female victims and 42 male victims, aged between 4 and 79 years old (M = 14.06, SD = 11.32).The relationship between victims and defendants are: 55 sons and daughters, 49 others situations, mostly more than one defendant (like parent and stepfather, grandmother and uncle), 16 stepchild, 6 ex-girlfriend and others (neighbour, grandchild, unknow). Discussion and conclusions It can be seen that the statements for future memory diligence is properly present in the current reality, and it can be concluded that the use of a structured protocol allows to benefit the quantity and quality of information, promoting, within what is a particularly vulnerable victim experience, making it very effective. At the same time, it allows the articulation between law, criminal justice system and forensic psychology, allowing an effective management of the process, praising the superior interest of the victim as well as emotional stability. Victim’s statements are crucial to our criminal justice system and give us a better understand of the experience of testifying and how we can reduce re-traumatization and revictimization of victims.

Elder abuse: the hidden face of domestic violence

Introduction Violence against the elderly constitutes an undeniable and serious violation of human rights and affects the physical and psychological integrity of the victim. Is not a new phenomenon, is a worldwide problem that has become more pronounce in contemporary societies because of the ageing of the population. World Health Organization [1] defines elder violence as a single or repeated action, or the absence of an appropriate action, arising in the context of a relationship where there is an expectation of trust that causes suffering or harm to an elderly person. Occurs through several behaviours involving psychological, physical, sexual, financial violence, neglect and self-neglect [2]. The purpose of this paper is to demonstrate the work developed by the Victims Information and Assistance Office (GIAV) and by Forensic Psychology Office (GPF) at Egas Moniz Higher Education School about elder abuse. Materials and methods The sample (n = 14) is derived from the domestic violence risk assessments of GIAV and GPF. We assessed 6 victims: 2 women and 4 man, aged between 64 and 95 years old (M = 76.67, sd = 10.71); and 8 defendants: 6 women and 2 man, aged between 24 and 77 years old (M = 46.13, sd = 15.52). The relationship between victims and defendants are 13 sons/daughters and 1 tenant. Data were collected from lawsuits, semi-structured interviews of the victims and defendants, collateral information and criminal record. All ethical issues have been taken due to the sensitive nature of the involved data involved and the respective informed consentient which contained the purpose of the assesses, the confidentiality limits, and information about the ethics and technician’s impartiality was sign by all participants. Results The results demonstrated physical and psychological abuse (in all cases), followed by economical abuse (n = 13, 92.9%) and social abuse (n = 3, 21.4%). It is possible to identify several victims’ risk factors, namely gender (female victims – n = 11, 78.6%), physical problems/limitations (n = 11, 78.6%), age above 75 years old (n = 8, 57.1%) and previous abuse (n = 6, 42.9%). The most relevant offender’s risk factors are financial problems (n = 12, 85.7%), deficit in the coping skills (n = 12, 85.7%), others blame (n = 10, 71.4%), history of violence against others (n = 8, 57.1%), aggressiveness (n = 8, 57.1%), criminal history (n = 6, 42.9%), victim of domestic violence in the past (n = 8, 35.7%) and perpetrator of domestic violence in the past (n = 5, 35.7%). Finally external/relational factors are: offender’s dependence (n = 11, 78.6%), cohabitation (n = 11, 78.6%), history of conflicts between victim and offender (n = 10, 71.4%), poor emotional attachment or low family cohesion (n = 10, 71.4%), social isolation or lack of social support (n = 8, 57.1%), intergenerational transmission of violence (n = 7, 50%), inability in the performance of caregiver tasks (n = 5, 35.7%) and inexperience as caregiver (n = 5, 35.7%). Discussion and conclusions Portugal it’s one of the top five European Countries with higher percentage (39%) of elderly mistreated [3], however, elder abuse is still the hidden face of domestic violence. The data show several risk factors for elder abuse. These results demonstrated the urgency about elder abuse risk assessment in criminal justice system and the need of a good articulation between Forensic Psychology and Law in order to demystify the hidden face of elder abuse.

Editorial

With its origin in the Hippocrates Oath (5th-3rd Century BC), The Nuremberg Codes (1947), and The Declaration of Helsinki (1964), medical ethics set the rules of the professional conducts for the physicians and other medical specialists. It amounts to the deployment of bioethical concepts, values (Autonomy, Non-maleficence, Beneficence, and Justice) and methods within medical set up to suggest the day-to-day decision-making procedures by combining theory and practice. It is a multidisciplinary study as it seeks to develop a set of guidelines for moral decision-making utilizing the resources of not only medicine and biology, but also of law, philosophy, theology, and the social sciences. As the branch of Bioethics, it investigates the complex ethical problems which arise for human life and society from sophisticated medical-technological usages and biological practices. The problems specifically include the nature and distribution of treatment and medical resources, the informed consent and authority of the patient, the physician and others involved in the medical practices, the scope and limits of confidentiality, the limits of acceptable intervention and experimentation, and the propriety of research involving humans and their applications. It also deals with the questions of moral dimensions and professional responsibilities involving all forms of ‘life-related’ issues such as research involving foetal tissues, withdrawal of life-sustaining medical treatment, issues over death, prenatal diagnosis and abortion, the storage of frozen embryos. Medical ethics is intricately linked to the culture and glocal values. To emphasise such aspect, the following papers come together to enrich this volume.

MEDICAL CONFIDENTIALITY DISCLOSURE IN CONDITIONS OF EPIDEMIC THREATS

The aim: To establish public opinion on the limits of medical confidentiality in an epidemic and the widespread use of applications that contain personal data, including those regarding health, to understand the possibility of changing the paradigm of public policy to protect medical confidentiality in an exacerbation of the epidemic situation. Materials and methods: This research is based on regulatory acts, scientific articles, and opinions of both medical workers and ordinary citizens of Poland, Germany, and Ukraine, judicial practice, doctrinal ideas, and views on this issue. Such methods as dialectical, comparative, analytic, synthetic, comprehensive, statistical, and generalization. Results: the results of a survey of residents of Poland, Germany, and Ukraine showed that one of the pandemic consequences was that a significant number of respondents were willing to partially renounce the right to medical confidentiality in the face of exacerbating epidemic threats to reduce the number of infected. Conclusions: In the face of the SARS-Cov-2 virus, nations worldwide have faced the challenge of respecting the right to privacy, particularly in terms of medical confidentiality. Virtual methods of patient communication with healthcare professionals use mobile electronic services (applications), and other new technologies in the context of the COVID-19 pandemic have exacerbated the issue of understanding the boundaries of medical confidentiality and personal data protection. In order to maintain an effective balance between human rights and public health, the mass collection and storage of sensitive personal data must take place following the Regulation of the European Parliament and of the Council on the protection of natural persons with regard to the processing of personal data and on the free movement of such data. At the same time, it is expedient to recommend states to specify specific provisions of this Regulation in order to avoid an expanded interpretation of certain of its provisions.