Limits Of Confidentiality Research Articles

Sharing information in health care: the nature and limits of confidentiality

Sharing information in health care: the nature and limits of confidentiality

The Duty to Rescue and the Limits of Confidentiality

Kenneth Kipnis's “A Defense of Unqualified Medical Confidentiality” provides an excellent analysis to some of the most troubling questions concerning the extent to which a physician should protect ...

The protections and limits of confidentiality in mediation

Threats to mediation confidentiality come in four contexts. In the first of a two-part article, Stuart M. Widman, of Chicago, covers two of the areas that can infringe on mediation confidentiality privilege—where mediation communications are needed for a criminal proceeding, and where they are needed to prove fraud or coercion led to a mediated settlement

Barriers to healthcare as reported by rural and urban interprofessional providers

SummaryThe research literature is replete with reports of barriers to care perceived by rural patients seeking healthcare. Less often reported are barriers perceived by the rural healthcare providers themselves. The current study is an extensive survey of over 1,500 healthcare providers randomly selected from two US states with large rural populations, Alaska and New Mexico. Barriers consistently identified across rural and urban regions by all healthcare professionals were Patient Complexity, Resource Limitations, Service Access, Training Constraints, and Patient Avoidance of Care. Findings confirmed that rural areas, however, struggle more with healthcare barriers than urban and small urban areas, especially as related to Resource Limitations, Confidentiality Limitations, Overlapping Roles, Provider Travel, Service Access, and Training Constraints. Almost consistently, the smaller a provider's practice community, the greater the reports of barriers, with the most severe barriers reported in small rural communities.

More mediation confidentiality limits: What the court may allow in to establish a settlement agreement

In the second of two parts, Stuart M. Widman, of Chicago, discusses two more categories that may infringe on traditional expectations of mediation confidentiality: when mediation information is needed to establish a settlement agreement's existence or terms, and when there is a need to impose sanctions or discipline against an attorney in connection with an ADR proceeding

The Complexity of the IRB Process

Using a question-and-answer format, this section addresses questions and concerns about the role of institutional review boards (IRBs) in monitoring the treatment of human participants in evaluation. According to the American Evaluation Association’s Guiding Principles for Evaluators, “Evaluators should abide by current professional ethics, standards, and regulations regarding risks, harms, and burdens that might befall those participating in the evaluation; regarding informed consent for participation in evaluation; and regarding informing participants and clients about the scope and limits of confidentiality” (for the full text, see http://www.eval.org/Guiding%20Principles.htm). Focusing on IRBs is important because evaluators receive varying levels of training in the regulations guiding ethical practice. In addition, evaluators have had disparate experiences with IRBs, ranging from being told that their work is exempt from review to receiving the same level of scrutiny that medical research receives. As academic institutions face increased scrutiny about their adherence to regulatory guidelines, many are becoming more vigilant (and authoritarian) about the behavior of institutional members.

Conducting research with children: the limits of confidentiality and child protection protocols

This paper addresses the issue of child protection protocols within research conducted with children. Based partly on primary data this paper raises questions about the role of ethics committees in defining the limits of confidentiality in relation to child protection protocols within research, the perceptions of both children and parents about the meanings of confidentiality and notions of 'harm', and the role of the researcher in relation to legal and professional guidance about the protection of vulnerable people in society. We explore the concept of confidentiality within a research setting from a child protection perspective. In doing so we examine the legal and moral obligations of researchers to report child protection concerns, how children themselves perceive 'harm', and the need for much clearer guidance to researchers, as well as child participants and parents, about the limitations of confidentiality.

Ethical Challenges in the Face of a Targeted Threat

Back to table of contents Previous article Next article LettersFull AccessEthical Challenges in the Face of a Targeted ThreatKatherine A. Best, M.S.W., M.P.H., Julienne Giard, M.S.W., and Roger A. Boothroyd, Ph.D.Katherine A. BestSearch for more papers by this author, M.S.W., M.P.H., Julienne GiardSearch for more papers by this author, M.S.W., and Roger A. BoothroydSearch for more papers by this author, Ph.D.Published Online:1 Dec 2004https://doi.org/10.1176/appi.ps.55.12.1444AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In this letter we describe some of the ethical challenges that emerged during an evaluation of a health care plan to assess the implementation of a disease management program for depression. In the fall of 2002, focus groups were held with enrollees of the health plan who had a diagnosis of depression with the goal of examining their experiences as health care recipients. All research protocols had been approved by the institutional review board (IRB) of the affiliated university. Before the focus groups, participants received a letter explaining the nature of the evaluation. At the start of the focus groups, consent forms were discussed, including the limits of confidentiality, and each participant signed a form. All identifying information specific to the case described here has been altered.During one of the focus groups, a participant reported having unsuccessful surgeries, which led to complications and subsequent impairment. The participant stated during the group: "I've had times when I lay there and think about … buying a damn gun…. Just to hell with him [the doctor] …. What have I got to live for? I'm not going to prison." There was enough information to indicate that this person was at high risk of violence on the basis of motivation and other stressors. We responded to these challenges by obtaining additional consents for release of information from the participant after the conclusion of the focus group. We sought immediate clinical and legal consultation—first, for a psychiatric evaluation, and second, for information about legally permissible actions to prevent the threatened violence.The dilemma we faced was the ethical obligation for researchers to maintain confidentiality—duty to the participant—within certain boundaries (1) and the opposing duty to protect, which required notification of the identified third party because of the targeted threat (2). Other questions emerged: Do qualitative researchers establish a "special relationship" as clinicians do (3)? And what are the ethical obligations attached to that relationship? Appelbaum and Rosenbaum (3) suggested that through face-to-face interviews researchers cultivate a rapport with participants to facilitate the receipt of sensitive information. There is no case law establishing that a special relationship exists between the research participant and the researcher as a result of qualitative inquiry.We made an effort to protect the third party by calling the local mobile crisis team for an emergency psychiatric examination of the person who made the threat. The team determined that he was not a threat. We met our IRB and legal obligations by calling the crisis team, but was that enough? Also, what additional follow-up with the participant or his health plan would be overstepping the research boundaries?Furthermore, we found no guidance in the literature about how to handle a Tarasoff-related situation in a focus group. Should the focus group participants be debriefed? If so, at what point during the group should this be done, and how?This case raised compelling ethical and practical dilemmas that qualitative researchers may face. It is hoped that the case will serve as a reminder to investigators of the need to continually examine the adequacy of their research practices and protocols. In addition, we suggest that further study should be given to Tarasoff-related situations in focus groups.The authors are affiliated with the Florida Mental Health Institute at the University of South Florida in Tampa.

Patient Safety and the Limits of Confidentiality

Patient Safety and the Limits of Confidentiality

Sexual offending and treatment of sex offenders

The assessment of risk in sex offenders is closely linked with the identification of treatment needs, and the clarification of those factors that may either increase or decrease risk in individual cases. Risk factors can be classified into static (historical facts about an offender which cannot be changed through intervention), dynamic stable (psychological characteristics which change over time, but slowly), and dynamic acute (current circumstances and behaviours which may change rapidly). Static risk factors are good indicators of long-term risk, stable dynamic risk factors represent important treatment targets, while dynamic acute risk factors provide a framework within which supervision aimed at detecting more immediate risk can be structured. Psychiatric involvement in sex offender assessment and management can most helpfully be directed towards diagnosing associated conditions such as mental illness and personality disorders, and providing treatment where hypersexuality and sexual rumination are important features. Drugs such as anti-libidinal medication and selective serotonin reuptake inhibitors (SSRIs) may be of particular benefit in such cases, contributing to cognitive-behavioural programmes that are the staple of sex offender treatment programmes. Legislation enacted since the mid-1990s has contributed to the risk management of offenders. Agencies both within and outside the criminal justice system now interact more closely, particularly in respect of higher-risk offenders. Psychiatrists are expected to cooperate with these arrangements, which requires a good understanding of the limits of confidentiality.

Professional Disclosure Practices of Rehabilitation Counselors

This article reports the results of a survey conducted in order to determine the professional disclosure practices of rehabilitation counselors in both the public and the private sector. Counselors were surveyed regarding the content, the circumstances, the timing, and the format of their disclosure. They were also asked to share their opinions about the use of written forms and about professional disclosure in general. A descriptive analysis revealed that although some information is routinely disclosed, many kinds of information (e.g., treatment risks, limits of confidentiality) that are generally considered very important in the disclosure process are not disclosed to all clients and/or are not disclosed at the outset of the counseling relationship. Several differences in practice between counselors in the public and private sectors were identified. Implications for ethical practice and risk management related to professional disclosure were discussed.

Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”

Given the morbidity and difficulty of treating psychotic disorders, including schizophrenia, there has been a move toward identifying and treating adolescents and young adults who appear to be clinically at risk or “prodromal” to psychosis. The field now has greater specificity in identification, with rates of 40–50% conversion to frank psychosis within 1–2 years. There is further evidence that medications and other treatments may have some efficacy for “prodromal” patients, though with variable side effects. However, controversy remains about some of the inherent risks in prodromal research, such as medication exposure and stigma among false-positives. In this paper, we add to this discussion through an analysis of ethics in prodromal research from the more established field of predictive genetic testing. Issues are raised about the effects of information on patients, families, and institutions, as well as future insurability, the limits of confidentiality (as it relies on discretion of patients and families), the autonomy of minors with psychiatric symptoms, and even the risks for the true-positive patient.

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Confidential health care for adolescents: position paper of the Society for Adolescent Medicine

Ovicidal activity of two fungal pathogens (Hyphomycetes) againstTetranychus cinnabarinus (Acarina: Tetranichidae)

The carmine spider mite,Tetranychus cinnabarinus, is an economically important pest that devastates varieties of crops worldwide and develops significant resistance to common chemical pesticides, most of which lack ovicidal activity. In the present study, two isolates of entomopathogenic fungi,Beuaveria bassiana SG8702 andPaecilomyces fumosoroseus Pfr153, were bioassayed againstT. cinnabarinus eggs at 25 °C under a photophase of 12:12 (L:D). Infected eggs onVicia faba var.minor leaves failed to hatch due to distortion and shrinkage and had fungal outgrowths when maintained under moist conditions. Sprays ofB. bassiana conidia toT. cinnabarinus eggs (on leaves) at the concentrations of 58, 298 and 1306 conidia/mm2 (3 replicates per concentration and 35–65 fresh mite eggs per replicate) resulted in corrected egg mortalities of 20.4±4.2%, 36.0±7.6% and 64.6±12.5% (F=43.14,P <0.01), respectively; sprays ofP. fumosoroseus at 129, 402 and 2328 conidia/mm2 caused egg mortalities of 16.1±11.1%, 44.2±13.3%, and 63.4±11.7% (F= 15.37, P=0.01), respectively. In contrast, natural egg mortalities in blank controls were 7.8% and 10.3% only. Based on probit analysis, the estimates of LC50 with 95% confidential limits were 548 (393–858) conidia/mm2 forB. bassiana and 914 (625–1550) forP. fumosoroseus, respectively. Apparently, both fungal species were capable of infectingT. cinnabarinus eggs, but the ovicidal activity of theB. bassiana isolate was greater than that of theP. fumosoroseus isolate. This represents the first report on the ovicidal activity of the two entomopathogenic Hyphomycetes againstT. cinnabarinus.

Confidentiality in psychotherapy: Some of actual dilemmas

The article examines confidentiality principle from different perspectives: as the factor which plays a very important part in developing a productive therapist-client relationship, ethical and, in many countries, legal issue. Ways to maintain confidentiality in therapy are stated, as well as situations in which it is inevitably limited. Three dilemmas concerning confidentiality are explained and discussed. The first is when one should speak and when one should be silent and what we should do when we are in two minds. The second is whether the client should be informed about confidentiality limitations at the very beginning, or when the need arises during the treatment. The third is whether confidentiality limitation (when a client poses a threat to himself or to the society) should be legally regulated, as it is being done in many western countries.

Limits of confidentiality: Disclosure of HIV seropositivity.

You are providing long-term follow-up to an HIV-positive patient on whom you operated several monthsago.Thepatientisactivelyengagedinasexualrelation-ship with one of your colleagues. The patient admitsthat he has not disclosed his HIV status to his partner,and adamantly refuses to do so. Which of the followingis your appropriate response?

Privacy of patients' information in hospital lifts: observational study

Respect for the confidentiality of patients' information is a basic principle of ethical and effective medical practice. It ensures individual patients' privacy, and, more broadly, it upholds public perception of...

Types of Witnesses

Types of Witnesses

With rojas, the california legal community examines the limits of mediation confidentiality

Alternatives to the High Cost of LitigationVolume 21, Issue 6 p. 119-121 Court Decision With rojas, the california legal community examines the limits of mediation confidentiality First published: 10 July 2009 https://doi.org/10.1002/alt.3810210607AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume21, Issue6June 2003Pages 119-121 RelatedInformation

Psychiatrists Urged to Ask About Domestic Violence

Psychiatrists Urged to Ask About Domestic Violence