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Ethical Dilemma Essay (1,500 words)
Confusion about three commonly used terms: privacy, confidentiality, and privilege, often complicates discussions of ethical problems in this arena. Figure 1 attempts to illustrate the breadth of coverage for each of the concepts (described below) using a Venn diagram. At least part of the confusion flows from the fact that in particular situations these terms may have narrow legal meanings quite distinct from the broader traditional meanings attached by mental health practitioners. Many difficulties link to a failure on the part of professionals to discriminate among the different terms and meanings. Still other dilemmas stem from the fact that legal obligations do not always align with ethical responsibilities.
Donna’s situation poses a more complex problem. Dr. Childs almost certainly would have lost the trust of her client had she chosen to violate Donna's confidence. At the same time, providing a value-free climate in psychotherapy may have the net result of unintentionally condoning Donna's sexual behavior (Baumrind, 1990). The parents may feel jealous of the trust and respect their daughter seems to have in the psychotherapist, while feeling angry and disappointed at her sexual activity and resulting infection. A conference per se does not seem inappropriate, but would probably best succeed as a family meeting with Donna present. Dr. Childs could attempt to retain a supportive and therapeutic stance in such a session without necessarily breaking confidence. The sort of information the parents expect seems unclear. A preventive step might have included a pretreatment family conference with a discussion of the psychotherapy relationship and any attendant limitations. An outright refusal to meet with the parents in this circumstance would not serve the interests of any of the parties. Many state laws do permit minors to obtain treatment for sexually transmitted diseases or birth control information without parental consent and in confidence. Dr. Childs' behavior does not seem unethical per se.
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