Limits Of Confidentiality Research Articles

Viewpoint: Concerns about the limits of confidentiality in FDR

Current provisions of the Family Law Act provide confidentiality and inadmissibility only to joint sessions of Family Dispute Resolution (FDR). It is submitted that the entire process of FDR from the client’s first contact with the service to termination of FDR (save for a few exceptions) should be confidential and inadmissible. This article provides a practical contextual commentary from the view point of an FDR practitioner who is both a psychologist and lawyer.

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

BackgroundMany factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.MethodsA prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO2 insufflation at the 10 cm of water. TIR was evaluated at the 24th, 72nd, 120th and 168th hour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.ResultsMore pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24th and 72nd; p < 0.01 - 120th and p < 0.001 - 168th hrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.ConclusionsMIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO2 insufflation however, led to moderate inflammation and less adhesion formation.

Bioethics in a clinic for women with psychosis

Clinical ethics takes on a special cast in a rehabilitation clinic for psychosis where many patients come from severely disadvantaged backgrounds and many suffer from fluctuating decisional capacity. This paper...

Duty to Warn versus Duty to Protect Confidentiality: Ethical and Legal Considerations Relative to Individuals with AIDS/HIV

This article explores ethical dilemmas associated with rehabilitation counselor service provision to individuals with AIDS/HIV, emphasizing the conflict between the duty to protect confidentiality and the duty to warn and the ethical and legal considerations pertaining to this conflict. A discussion on the limits of confidentiality, the application of the six ethical principles, the specific guidelines provided in rehabilitation counselors' code of ethics, and the legal actions that address the issue of duty to warn are provided.

Teaching of Medical Ethics: Students' perception in different periods of the course

Medical ethics is structured to guide doctors towards a better professional practice. However, its teaching in medical schools seems to be neglected.To evaluate the perception of Federal University of Sergipe medical students about ethical conflicts during their academic practice, in two different periods of a medical course.A cross-sectional, analytic and observational study. Using a qualitative approach, analytic categories were identified using an open questionnaire answered by two groups of students, before and after attending the medical ethics course.In everyday practice, the participants referred embarrassment in front of patients. When considering the relationship with the professional/professor, they identified negligence and conflicts of interests in their practice. The students also detected bad infrastructure and professional relationship in public services, when compared to private ones. The conflicts experienced by the students in their own practice were insecurity, inability to cope with patients' problems and inadequate perception of medical confidentiality limits. According to the respondents, contribution of ethics teaching varied from adequate, when it was effective to orient their practice and provide confidence, to inadequate or absent because of an overall superficial approach.Major deficiencies related to the teaching of medical ethics were identified, pointing to the need to change current medical education model.

Teaching of medical ethics: students' perception in different periods of the course.

Medical ethics is structured to guide doctors towards a better professional practice. However, its teaching in medical schools seems to be neglected. To evaluate the perception of Federal University of Sergipe medical students about ethical conflicts during their academic practice, in two different periods of a medical course. A cross-sectional, analytic and observational study. Using a qualitative approach, analytic categories were identified using an open questionnaire answered by two groups of students, before and after attending the medical ethics course. In everyday practice, the participants referred embarrassment in front of patients. When considering the relationship with the professional/professor, they identified negligence and conflicts of interests in their practice. The students also detected bad infrastructure and professional relationship in public services, when compared to private ones. The conflicts experienced by the students in their own practice were insecurity, inability to cope with patients' problems and inadequate perception of medical confidentiality limits. According to the respondents, contribution of ethics teaching varied from adequate, when it was effective to orient their practice and provide confidence, to inadequate or absent because of an overall superficial approach. Major deficiencies related to the teaching of medical ethics were identified, pointing to the need to change current medical education model.

Entropía aproximada del efecto placebo en ensayos clínicos con antidepresivos de nueva generación

Recent research concluded that antidepressant drugs are ineffective in treating moderate or severe depression. Statistically, there are no differences between the results with active drugs or placebo. Some authors have attributed this fail to variability or irregularity of the placebo effect in depressed patients or artifacts induced by meta-analysis.This fact highlights the difficulties faced by the research of psychoactive drugs in depression and revives the debate about the usefulness of the employ of placebo in these studies. This study aimed to determine the variability of the placebo effect in antidepressant clinical trials in simple linear and nonlinear complex models. We performed a secondary analysis of data from 35 trials presented as evidence to the Food and Drug Administration (FDA) for approval of new generation antidepressants, all double-blind controlled with placebo in patients with unipolar mild or moderate depressive disorder, according to the criteria of "Diagnostic and Statistical Manual of Mental Disorders (DSM).Articles reviewed included 5133 patients . We have calculated the coefficient of variability, autocorrelation and approximate entropy of the placebo and treatment effects to determine whether the variability or regularity between different studies should be attributed to meta-analytical methods, placebo effect or ineffective treatment itself. The coefficient of variability in the placebo group was 26.49% and 18.81% in the treatment group. The placebo effect autocorrelation was within the confidential limits while the treatment group was outside showed cyclical variation. The approximate entropy value (ApEn N=35,m=2,R=2) in the placebo group was 0.5579 and 0.5744 in treatment group, leading to the conclusion that placebo effect is highly consistent and regular in complex non-linear models. The apparent variability of the placebo effect in depressed patients slould be due to artifacts induced by simple linear models analysis.

Developing Ethical Guidelines for Safeguarding Children during Social Research

A working party of academics from both professional safeguarding backgrounds and research backgrounds developed and wrote ethical guidelines on safeguarding children in research on behalf of their faculty research ethics committee. The working party encountered a lack of useful precedents while developing the guidelines leading to a lengthy process of debate and consideration of the issues. This paper explores the various issues and dilemmas arising during this process, particularly the tension between safeguarding children from abuse and maintaining research confidentiality. One of the main areas of discussion was how to establish the limits of confidentiality without compromising the research in hand. The role and responsibilities of researchers in supporting children's welfare, and the development of procedures for ensuring that safeguarding is effective are discussed as key elements. In addition, the issues researchers may face when determining thresholds for intervention are considered alongside the uncertainties created by considerations of the extent to which children can give informed consent in research contexts. The paper reflects the process of considering these issues and the conclusions the working party drew as to how best to support children's welfare during research. It also outlines the key elements of the guidelines and the structures developed to ensure researchers could get advice if suspected child abuse became an issue in their research. The paper includes a short version of the guidelines which were eventually approved across the Higher Education Institute.

Delivery of confidential care to adolescent males.

Primary care providers' (PCPs') provision of time alone with an adolescent without the parents present (henceforth referred to as "confidential care") has a significant impact on adolescents' disclosure of risk behavior. To inform the development of interventions to improve PCPs' delivery of confidential care, we obtained the perspectives of adolescent males and their mothers about the health care concerns of adolescent males and the provision of confidential care. This focus-group study (5 groups: 2 with adolescent males and 2 with mothers) used standard qualitative methods for analysis. We recruited mother/son dyads who had been seen at urban primary care practices. Adolescents' health concerns focused on pregnancy and sexually transmitted infections; mothers took a broader view. Many adolescents felt that PCPs often delivered safe sex counseling in a superficial, impersonal manner that did not add much value to what they already knew, and that their PCP's principal role was limited to performing sexually transmitted infection testing. Though adolescents cited a number of advantages of confidential care and disclosure, they expressed some general mistrust in PCPs and concerns about limits of confidentiality. Rapport and relationship building with their PCP are key elements to adolescents' comfort and increased disclosure. Overall, mothers viewed confidential care positively, especially in the context of continuity of care, but many felt excluded. To increase adolescents' perception of the relevance of primary care and to foster disclosure during health encounters, our participants described the critical nature of a strong doctor-patient relationship and positive physician demeanor and personalized messages, especially in the context of a continuity relationship. Regular, routine inclusion of confidential care time starting early in adolescence, as well as discussion of the purpose and limitations of confidentiality with parents and adolescents, could lead to greater parental comfort with confidential care and increased disclosure by the adolescent.

Safeguarding: the missing seat at the table

Safeguarding: the missing seat at the table

Confidentiality in Arbitration

Confidentiality has long been part of the mythology of Alternative dispute resolution (ADR). It one of the apparent virtues of ADR is that its processes have been viewed as confidential. This aspect of the mythology has come under more scrutiny in recent years, particularly in the Arbitration Context . Arbitration has become a permanent fixture of the landscape of civil justice. Arbitration is promoted as a “private” or “confidential” process, raising some moral and perhaps ethical obligations on the part of the profession to be candid with consumers as to the meaning and limitations of arbitration confidentiality. Such candor is important because courts have begun to receive challenges to arbitration confidentiality, and more can be expected in the future as both voluntary and mandatory arbitration continue to expand and become more institutionalized.

Limitations of confidentiality

How far should we go in keeping secret what our patients tell us and in what they want us to tell others? This potential moral dilemma is well illustrated in a new and revealing Channel 4 drama about Mo Mowlam, the former Northern Ireland secretary who suffered a brain tumour while she was in office. The story of how Mo Mowlam misled everybody, including the-then prime minister Tony Blair, is the subject of Neil McKay’s latest investigative film. The fascinating and pertinent point of the story for nurses is the fact that ‘honest Mo’, as she was known, refused to tell the truth about her condition to those who voted for her and trusted her in what was an important point of the Northern Ireland peace talks.

It’s Been a Privilege: Advising Patients of the Tarasoff Duty &amp; its Legal Consequences for the Federal Psychotherapist-Patient Privilege

State laws modeled on Tarasoff v. Regents of the University of California require psychotherapists to warn potential victims or law enforcement when treating dangerous patients who make serious threats of harm to another person. In practice, many psychotherapists advise their patients who make such threats about their duty under these Tarasoff-model laws. Although they are not required to make these advisories by law, psychotherapists generally assume that they also have a concomitant ethical duty to advise their patients that such threats will not be kept confidential, as their communications normally would be. This Note looks at how these advisories affect the status of privilege for subsequent threatening statements relayed to a psychotherapist. It explores the opposing views in the federal circuit courts regarding whether such an advisory precludes the existence of privilege for subsequent statements, or whether the advisory operates as a waiver to the privilege. This Note argues that threats communicated to a psychotherapist after an advisory about a psychotherapist's Tarasoff duty cannot be considered privileged if the patient intended for the threat to be passed on to a third party. Psychotherapists must now be aware of the possible legal consequences regarding the patients' diminished expectation of confidentiality and lack of privilege following such advisories. In order to act in their patients' best interest, psychotherapists should educate themselves about the scope of a Tarasoff duty in their applicable states and should consider alternative intervention techniques that could reduce dangerous patients' risk of harm. Psychotherapists should continue to follow professional ethical guidelines about advising patients of the limits of confidentiality, but implement techniques that evidence the patients' true intent about confidentiality, in order to bolster the patients' possible privilege claims later on and minimize harm to the treatment relationship.

Validation of a HeLa Mx2/Luc Reporter Cell Line for the Quantification of Human Type I Interferons

Although antiviral assays have been the most widely available biological assays for interferons (IFNs), they are less sensitive and provide considerable interassay variation. In this study, we demonstrate a new reporter cell line, which is based on HeLa cells transfected with a plasmid containing a human Mx2 promoter driving a luciferase (Luc) cDNA. To characterize the specific gene expression profiles induced by interferon alpha, we analyzed the microarray results of interferon response gene expression induced by IFN-α2a or IFN-α2b treatment with HeLa cells. We found that the Mx2 gene increased the most by treatment with both IFN-α2a and IFN-α2b. Based on this result, we designed a reporter cell line, HeLa-Mx2, suitable for determination of IFN-α. HeLa cells were stably transfected with the luciferase gene under the control of Mx2 promoter. The expression of luciferase can be easily measured for luminescence using a 96-well luminometer and has been correlated with the concentration of added IFN and cell density. In the validation results, our reporter cell line had specificity for type I IFN, but the significant effects of a number of other cytokines such as tumor necrosis factor-α, interleukin (IL)-1β, IL-2, IL-5, IL-6 and GM-CSF, or type II interferon (IFN-γ) were not observed. Moreover, the robustness of our cell line is demonstrated by the lack of an effect of the HeLa-Mx2 cell culture’s age on the performance of the reporter gene assay. The reporter gene assay demonstrated reproducible dose-response curves for IFN-α2a in the range of 1–10,000 IU/ml. The 95% confidential limit and total coefficient of variation estimates ranged between 96 and 116 and 10.51% in the reducible range mentioned above, respectively. In conclusion, we established a stable IFN-responsible HeLa-Mx2 cell line, which has advantages with regard to simplicity, selectivity, and reliability over conventional cytopathic effect reduction assays used to quantify IFN-α activity.

Clinical Management of Children's Incomplete Comprehension of Confidentiality Limits

ABSTRACT Children find themselves included in custody evaluations in a variety of ways, sometimes to their dissatisfaction and discomfort. Even when children wish to have a voice in custody matters, they may shy away from the transparent nature of the process. Forensic evaluators seek informed consent from adults and assent from children who participate in evaluations, and that process includes a description of the limits of confidentiality. Children may not fully comprehend their role in an evaluation, the purpose of the evaluation, or the limits of confidentiality. In this article, we offer a review of relevant developmental processes that explain children's incomplete comprehension or miscomprehension of the limits of confidentiality. We offer practical clinical forensic strategies for what to do when children do not fully appreciate the limits of confidentiality in custody evaluations, with specific emphasis on how to respond to children's requests to retract what they have just said.

Age of consent for sexual activity in Canada

To help protect youth from sexual predators and to fight child sexual exploitation, which has become increasingly prominent in the age of the Internet, the Government of Canada has passed new legislation increasing the age of consent for sexual activity. The new legislation came into effect on May 1, 2008, and aligns Canada’s age of consent with that of many other countries. From 1890 until recently, the age at which a youth could consent to nonexploitative sexual activity was 14 years (1). With the recent change to the criminal code of Canada, the age of consent for nonexploitative sexual activity is now 16 years. Nonexploitative activity is defined as sexual activity that does not involve prostitution or pornography, and where there is no relationship of trust, authority or dependency between the persons involved (1). A coach, spiritual leader, teacher, school principal, guidance counsellor or family member are all examples of persons in a position of trust or authority with youth. For exploitative sexual activity (prostitution or pornography, or where there is a relationship of trust, authority or dependency), the age of consent is 18 years. The spirit of the new legislation is not to regulate consensual teenage sexual activity. To this effect, there are a few notable exceptions to the law: Youth 12 or 13 years of age can consent to nonexploitative sexual activity with peers when the age difference is no more than two years. For example, a 12-year-old child is deemed capable of consenting to sexual activity with a 14-year-old, but not a 15-year-old. Youth 14 or 15 years of age can consent to nonexploitative sexual activity when the age difference is no more than five years. For example, a 15-year-old can consent to having sexual intercourse with a 20-year-old, but not with a 21-year-old. Children younger than 12 years of age can never consent to sexual activity with anyone, of any age, regardless of whether they say they do. As before, all nonconsensual sexual activity, regardless of age, constitutes a sexual assault. Exploitative sexual activity, sexual assault or sexual activity with anyone younger than 12 years of age or between 12 and 16 years of age, except as above, should raise child protection concerns. All Canadian provinces and territories have child protection legislation with mandatory reporting laws for suspected cases of child maltreatment. Because child protection is a provincial matter, each province has slightly different legislations with notable exceptions in the ages at which youth are no longer considered ‘children’. A ‘child’ is usually defined as anyone younger than 16 years of age to 19 years of age, depending on the province (2). It is important for physicians counselling sexually active youth to enquire about consent and the age of their partner. As always, as a means to safeguard the trust relationship that exists between physician and patient, it is advisable for physicians to discuss the limits of confidentiality with all their young patients before entering into such conversations. As the new legislation gets implemented, child welfare agency responses to such concerns may differ from province to province. Any physician experiencing doubt about whether a situation constitutes maltreatment or whether it is reportable to child welfare authorities, should err on the side of caution and contact their local child welfare agency to discuss the matter further.

Ethical Dilemmas for Mental Health Practitioners: Navigating Mandated Child Maltreatment Reporting Decisions

All states have legislation establishing child protection agencies and reporting procedures, supported by the Child Abuse Prevention and Treatment Act (Child Welfare Information Gateway, 2003), which links federal funding to the stipulation that states must enact mandatory child abuse reporting laws. Despite this legal mandate, mental health practitioners often fail to inform their clients of the limitations of confidentiality and many are not aware of their legal mandate to report child maltreatment. This paper examines ethical and legal parameters mental health practitioners must address when working with cases of suspected child abuse and offers recommendations for practice and policy to improve collaboration between mental health practitioners and child protection agencies, in the interests of protecting children and strengthening families.

Research Participants' Perceptions of the Certificate of Confidentiality's Assurances and Limitations

THE CERTIFICATE OF CONFIDENTIALITY (COC) provides additional protections to personal and sensitive research data. COC guarantees are not absolute and investigators are obligated to inform potential participants of COC limitations. The present study utilized qualitative and partnership methodology to examine participants' (N = 24) perceptions of COC assurances and limitations in the context of a hypothetical study on depression. Although some participants were comforted by COC assurances, a majority of participants had confidentiality/privacy concerns specifically with COC passages concerning federal audits and legal reporting requirements. As one respondent noted, "Why is it that you guys don't have to turn the records over to the court unless I say so . . . but you have to give them over to the government? . . . I don't know about what is goin' on." Our findings underscore the need for larger quantitative investigations to examine the negative and positive impact of COCs on research participation and response bias.

Privacidade e confidencialidade na assistência à saúde do adolescente: percepções e comportamentos de um grupo de 711 universitários

To understand the opinion and behavior of a group of college students about the degree of privacy considered appropriate in several clinical settings and in which situations breach of confidentiality is admitted. An anonymous questionnaire about confidentiality in clinical settings was answered by 711 college students. The study had a transversal, descriptive, qualitative-quantitative design. We studied recognition of the ethical criteria for confidentiality limitation, and in which situations, common in adolescent morbidity, disclosure of this information is accepted. Data analysis used Epi-Info 6.04 and Microsoft Excel, 1997. The research was approved by PUCRS' IRB. The ideal situation for disclosing information was considered by 82% of the adolescents as the previous granting of authorization, which differs from other forms of breaching confidentiality. In cases of non-authorized disclosure, most of them admitted that it in case of suicidal ideation (85%), violence (84.2%), sexual abuse (81.7%), nervous anorexia (81.3%) and risk of life to third parties (72.3%). Half of them agree to it in HIV/AIDS (57.9%), drug abuse (51.7%) and STD (44.7%) situations; less than one third accept it in situations of pregnancy (33.6%), homosexuality (20.7%) and sexual activity (15.6%). Participants assigned different grades to the value of confidentiality in their health care, accepting that information may be disclosed to others when the patient authorizes it. The higher the risk to their integrity, the easier it was for them to admit non-authorized disclosure of information, however in aspects related to their sexuality disclosure is practically denied.

Duty to Warn and Protect: Not in Texas

Contrary to the 1976 California Supreme Court decision in the renowned Tarasoff case, the Texas Supreme Court rendered a 1999 opinion (Thapar v. Zezulka) that mental health providers in Texas do not have a duty to warn and protect their clients’ known and intended victims. This decision reflected the intent of the Texas court not to violate existing state confidentiality statutes that permit, but do not require, disclosure of intent to harm to medical or law enforcement personnel only. Other than the reporting of positive HIV results or suspected child abuse, mental health providers in Texas should proceed with caution in revealing confidential information to anyone for any reason, even when the limits of confidentiality are reached.