Running head: ETHICS AND CONFIDENTIALITY

Ethics and Confidentiality: When to Disclose

Melissa Martin
University of Calgary

ETHICS AND CONFIDENTIALITY

Confidentialityisthefoundationofthepsychologistandclientrelationship.
Schulz,Sheppard,Lehr,andShepard(2006)explainthatconfidentialityprovides
assuranceoftrustorconfidenceinthepersonwithwhomprivatemattersareshared.It
impliesanexplicitcontractorpromisenottorevealanythingaboutaclient,except
undercircumstancesagreedtobybothsourceandsubject(Cram&Dobson,1993).Itis
importantfortheclienttoestablishtrustintheirtherapistinordertoensureeffective
communicationandtreatmentinthetherapeuticprocess.Althoughpsychologistclient
confidentialityisofutmostimportance,therearecertaincircumstancesthatcreate
limitationstothispledge.
TheCanadianCodeofEthicsforPsychologistswasdevelopedtoguide
psychologiststoactandengageinbehaviorsinanethicalmannerbasedonfourethical
principles(Sinclair&Pettifor,2001).Whenengaginginethicaldecisionmaking,these
fourprinciplesarealltakenintoaccountandbalanced,exceptincircumstancesof
conflict.Whenconflictarises,thefourprinciplesareorderedaccordingtotheweight
eachshouldbegivenwhentheyconflict(Sinclair&Pettifor,2001).Theprinciplesareas
follows:PrincipleI,RespectfortheDignityofPersons,PrincipleII,ResponsibleCaring,
PrincipleIII,IntegrityinRelationships,andPrincipleIV,ResponsibilitytoSociety.In
applyingtheseethicalprinciplestotheissueofconfidentialityandwhetherornota
psychologistshouldreportcircumstancesofharmtooneselforothers,anumberof
conflictsbetweentheprinciplesarise.Byassessingandevaluatingeachprinciple,amore
thoroughunderstandingwillbeestablishedinregardstotheconflictsthisdilemma
createsaswellashowonewouldstillattempttoupholdtheiractionsinanethicalway.
ThevalueofconfidentialityisdescribedinPrincipleI:RespectfortheDignityof

ETHICS AND CONFIDENTIALITY

Persons:I.45Shareconfidentialinformationwithothersonlywiththeinformedconsent
ofthoseinvolved,orinamannerthatthepersonsinvolvedcannotbeidentified,exceptas
requiredorjustifiedbylaw,orincircumstancesofactualorpossibleseriousphysical
harmordeath(CanadianCodeofEthics,2000).PrincipleIshouldgenerallybegiven
thehighestweightintheethicaldecisionprocess,exceptwhenthereisaclearand
imminentdangertothephysicalsafetyofanyknownandunknownindividual(Sinclair
&Pettifor,2001).
UnderPrincipleII:ResponsibleCaring,itstates,II.39Doeverythingreasonably
possibletostoporoffsettheconsequencesofactionsbyotherswhentheseactionsare
likelytocauseseriousphysicalharmordeath.Thismayincludereportingtoappropriate
authorities(e.g.thepolice),anintendedvictim,orafamilymemberorothersupport
personwhocanintervene,andwouldbedoneevenwhenaconfidentialrelationshipis
involved(CanadianCodeofEthics,2000).Thisvalueofoffsetting/correctingharm
emphasizestheimportanceofbreachingconfidentialityincasesofathreattophysical
safety.AccordingtoSchulzetal.(2006),imminentdangermeansthecounselor
determinesathreattoathirdpartyorselfinthenearorforeseeablefuture.This
responsibilitytoreportisgreaterthanthatofconfidentiality,andifignored,canresultin
direconsequencessuchasdeath.
Inupholdingthesafetyofanindividualinharmswayandbreachingthe
confidentialitybetweencounselorandclient,PrincipleIII,IntegrityinRelationships,
wouldbeviolated.AsPrincipleIIImaintains,psychologistsareexpectedto
demonstratethehighestintegrityinalloftheirrelationships(Sinclair&Pettifor,2001).
Bybreakingconfidenceduetoareportingobligation,acounselorisdirectlyviolatingthe

ETHICS AND CONFIDENTIALITY

integrityintheirrelationshipwiththeirclient.Whileitisparamounttothepsychologist
clientrelationshiptomaintainthistrustandhonesty,itisalsoofoverridingimportanceto
notifythoseinharmsway.Inordertoensurethatbreachingconfidentialityisdoneinthe
mostethicalmannerpossible,psychologistsmustabidebythevaluetohonorall
promisesandcommitmentsunlessseriouscircumstancesintervene(Sinclair&Pettifor,
2001).Ifinterveningcircumstancesoccur,thepsychologistmustmakeafullandhonest
explanationtoallofthepartiesinvolved(Sinclair&Pettifor,2001).Thepsychologist
mustexplaininfulltheirchosencourseofactionandanypotentialoutcomestothose
whoareaffectedbythisdecision(Sinclair&Pettifor,2001).Psychologistsmustalso
limitdisclosuretoonlyinformationthatisrelevantandconsistentwiththeprinciplesand
standardsinthecode(CollegeofAlbertaPsychologists,1999).Indoingso,whilestillin
violationoftherighttoconfidentiality,thepsychologistswouldbeconducting
themselvesinanethicalmannerupholdingthedignityandrespectoftheirclient.The
psychologistwouldalsobemaintainingtheintegrityintheirrelationship,becausethey
wouldbestraightforwardandhonestwithhowtheyaregoingtousethisinformation
disclosedtothem.
InPrincipleIV:ResponsibilitytoSociety,respectforsocietyishighlightedby
declaring,IV.17Familiarizethemselveswiththelawsandregulationsofthesocietiesin
whichtheywork,especiallythosethatarerelatedtotheiractivitiesaspsychologists,and
abidebythem.Ifthoselawsorregulationsseriouslyconflictwiththeethicalprinciples
containedherein,psychologistswoulddowhatevertheycouldtoupholdtheethical
principles.Ifupholdingtheethicalprinciplescouldresultinseriouspersonal
consequences(e.g.jailorphysicalharm),decisionforafinalactionwouldbeconsidered

ETHICS AND CONFIDENTIALITY

amatterofpersonalconscience(CanadianCodeofEthics,2000).Thisvalueclearly
indicatesthatitisofthepsychologistsdiscretiontochoosethemostethicalcourseof
action.Thepsychologistmustalsobeawarethatchoosingtorevealinformationthata
clientdisclosestothemforthebettermentofsocietywoulddirectlyconflictwith
respectingthedignityoftheirclient.However,PrincipleIV.18statesintheCode(2000),
Consultwithcolleagues,iffacedwithanapparentconflictbetweenabidingbyalawor
regulationandfollowinganethicalprinciple,unlessinanemergency,andseekconsensus
astothemostethicalcourseofactionandthemostresponsible,knowledgeable,
effective,andrespectfulwaytocarryitout.Thisvaluegivespsychologiststheoptionto
breakconfidentialitybyseekingprofessionalconsultationincaseswheretheymayneed
guidanceinmakingadecision.Althoughconfidentialityisofimportance,ifsomeoneis
tobeharmed,psychologistsshouldmaintaintheirresponsibilitytosocietybyabidingthe
lawanddisclosingonlytheinformationthatispertinenttodealwiththedilemma.
Thoughpsychologistsmustchoosethemostethical,dignified,effective,andrespectful
waytocarryoutdisclosure,theirresponsibilityistothatpersoninharmsway(Sinclair&
Pettifor,2001).
Alegalcasethatdemonstratedtheimportanceofwhentodiscloseconfidential
informationwastheTarasoffv.RegentsoftheUniversityofCalifornia(1976).Prosenjit
ProddarwasagraduatestudentattheUniversityofCalifornia,Berkley.Hewasseeinga
psychologistattheUniversityHealthClinicbecauseagirlheliked,TatianaTarasoff,
rejectedhim(Schulzet.al,2006).ThepsychologisttendingtoProddarfoundhimtobe
dangerousbecauseofhispathologicalaffectionsforTarasoffandthefactthathe
purchasedaguntoharmTarasoff(Cohen,1978).Thepsychologistgaveverbaland

ETHICS AND CONFIDENTIALITY

writtennotificationtothepolice,wheretheybroughtProddarinforquestioningand
subsequentlyfoundhimtoberational(Schulzetal.,2006).Thisdecisionledthepolice
toreleaseProddarbysimplystatingthathemustpromisetostayawayfromTarasoff
(Schulzetal.,2006).PoddarthenkilledTarasofftwomonthslater(Schulzetal.,2006).
Aftertheirdaughtersdeath,theparentsofTarasoffattemptedtosuethe
UniversitysHealthClinicstaffmembersandpolice,butthecasewasdismissedincourts
(Cohen,1978).Theparentsappealedthisrulingandthecourtsdeterminedthattherapists
havealegaldutytousereasonablecaretoprotectthirdpartiesfromdangerspresentedby
patients(Schulzetal.,2006).TheSupremeCourtofCaliforniaimposedanaffirmative
dutythattherapistsmustwarnknownandunknownindividualsoftheintentionsoftheir
clientstoharmthesepeople(Schulzetal.,2006).Asthecourtstated,therightto
confidentialityendswhenthepublicperilbegins(Schulzetal.,2006).Thecourtalso
explainedtherapistshaveadutytoprotect,notjustadutytowarnandthusmustmakea
numberofstepstoprotectthevictim(Greene,2006).Ifnecessarythetherapistmust
warntheintendedvictim,thentonotifythepolice,ortakewhateverothernecessarysteps
toensurethevictimisprotected(Greene,2006).Thiscasewasthefirstofitskindwhere
itprovidedtherapistswithaframeworkofhowtodealwithsimilarcircumstances,should
theyarise.Althoughnotallcasesareasextreme,counselorsnowhaveaguideline
demonstratingthedireconsequencesthatmayoccurwhentheydonotreportathreat.
Tarasoffv.RegentsoftheUniversityofCalifornia(1976)couldbeconsidereda
legalembodimentoftherapistsethicalconvictions(Rosenhan,Teitelbaum,Teitelbaum,
&Davidson,1993).Rosenhanetal.(1993)discussedtherepercussionsfromthe
Tarasoffcaseandreflectedonfivemajorfactorsthatthecourtacknowledgedindeciding

ETHICS AND CONFIDENTIALITY

whetherornottorecognizeadutyofcare.Thefirstfactoridentifiedthespecial
relationshipbetweenthetherapistandclient.Thereisadutytoprotectathirdparty(i.e.
avictimorintendedtarget)whenthetherapisthasaspecialrelationshiptotheclientor
thirdparty.Tarasoffthusimposesupontherapistsanobligationtoprotectcertainthird
parties,inpart,byvirtueofthespecialrelationshipwhichexistsbetweentherapistsand
theirpatients.(Rosenhanetal.,1993).Inadditiontotheexistenceofaspecial
relationship,thesecondfactoracknowledgedtheforeseeabilityofthepotentialvictim.
Tarasoffrequiresthepresenceofcertainelementsofforeseeabilityinordertoimposea
dutytoprotect.Adoptingthelanguageofpriorcases,themajoritywrotethat,the
defendantowesadutyofcaretoallpersonswhoareforeseeablyendangeredbyhis
conductUnderTarasoff,thevictimmustbeforeseeable(Rosenhanetal.,1993).
Alongwiththeexistenceofaspecialrelationshipandaforeseeablevictim,theclient
mustposeaseriousthreatofharmtowardsapotentialvictim.Thisriskwillalertthe
professionaltofulfilltheirdutytoprotect.Itcanbeunclearastowhatconstitutesa
seriousthreatofharm.Thecourtsreasonthatatherapistsdutyofcareariseswhen
thereisaforeseeableriskofdangertoaforeseeablevictim.Thethreatsmadeagainsta
potentialvictimmustbeseriousenoughtoconstitutethisforeseeabledanger.(Rosenhan
etal.,1993).Inrelationtothesubjectofaseriousthreat,thefourthfactorexaminesthe
typeofthreatthattheclienthasexpressed.ThecourtinBellahv.Greensoninterpreted
Tarasoffasapplyingtothreatsofpersonalinjurydirectedagainstthirdparties.The
BellahcourtexplainedthatTarasoffisfoundeduponthepublicpolicyofprotecting
potentialvictimsfromviolentassault(Rosenhanetal.,1993).Therefore,athreatof
physicalinjurywouldbeconsideredthetypeofharmwhereadutytowarnaforeseeable

ETHICS AND CONFIDENTIALITY

victimwouldhavetooccur.Thefifthfactorintherecognitionofdutyofcareinthe
Tarasoffcaseisidentifyingtowhomthedecisionofbreakingconfidentialityappliesto.
Therearemanydifferenttypesofmentalhealthprofessionalswhomaybeinvolvedinthe
caseofoneclient,suchascounselors,socialworkers,occupationaltherapists,etc.The
Tarasoffcaseinvolvedtwopsychiatristsandapsychologist.Duetodifferingcodesof
ethicsandconfusionoverwhoisresponsiblefortheprimarycareoftheclient,itcanbe
difficultinestablishingwhichprofessionalhasthedutytoprotect.
Based upon the review of the Tarasoff case, I will provide a case study example
on a similar ethical dilemma as cited in Sinclair & Pettifor (2001):
You are employed in a young offender facility. You see individual adolescents in
therapy. During a session, an adolescent confides that some other adolescents on
the unit are planning to assault their staff at an opportune moment and try to
escape. They have obtained and hidden some tools to serve as weapons. It has
taken several months for a trusting relationship to develop between you and this
adolescent, and you believe that the sharing of information is a result of the
development of trust. Although you are worried about the potential consequences
of an escape attempt, you also are concerned that reporting the plans will
jeopardize the relationship that you have established with the adolescent, and
possibly result in retaliation toward the adolescent by other young offenders on
the unit. (p. 158)
Based on an initial review of this case, I feel that it is my responsibility to report
this potential danger to the appropriate authorities. I do not want to jeopardize the
relationship I have established with my client. However, I am even more concerned for
the safety of the staff members and others who may be at risk for harm. I do have to

ETHICS AND CONFIDENTIALITY

recognize the potential hazards involved with reporting this information. My client could
be harmed due to retaliation from the other young offenders in the unit and there could be
increased hostility between the staff members and the young offenders. My client and
other young offenders who I work with may also feel that they can no longer trust me
with confidential information, therefore compromising my position as a psychologist at
this young offender facility.
Step 1. Identification of the Individuals and Groups Potentially Affected by the
Decision
The primary individuals that appear to be affected are my client, the staff
members who may be assaulted, and the young offenders who are planning the assault
and escape. The secondary individuals who may be involved are the young offenders
who are not part of the escape plan, myself, and other staff members who work in the unit
but are not targeted for assault.
Step 2. Identification of Ethically Relevant Issues and Practices, Including the
Interests, Rights, and Any Relevant Characteristics of the Individuals and Groups
Involved and of the System or Circumstances in Which the Ethical Problem Arose
Using the chart that outlines the Code (The Four Ethical Principles with their
Respective Values and Standards), I can identify sixteen ethical values that I think are
key to my current dilemma: seven under Respect for the Dignity of Persons, four under
Responsible Caring, three under Integrity in Relationships, and two under Responsibility
to Society.
The Four Ethical Principles with their Respective Values and Standards
I. Respect for
the Dignity of
Persons
1. General

II. Responsible
Caring

III. Integrity in Relationships

1. General

1. Accuracy/Honesty

IV.
Responsibility
to Society
1.

ETHICS AND CONFIDENTIALITY

10

Respect
(I.1-I.4)

Caring
(II.1-II.5)

(III.1-III.9)

2. General
Rights (I.5-I.8)

2. Competence
and Self
Knowledge
(II.6-II.12)
3. Risk/Benefit
Analysis
(II.13-II.17)

2. Objectivity/Lack of Bias
(III.10-III.13)
3.
Straightforwardness/Openness
(III.14-III.22)

3. Respect for
Society
(IV.15-IV.18)

4. Maximize
Benefit
(II.18-II.26)

4. Avoidance of Incomplete
Disclosure (III.23-III.30)

5. Minimize
Harm
(II.27-II.36)
6.
Offset/Correct
Harm
(II.37-II.44)
7. Care of
Animals (II.45II.48)

5. Avoidance of Conflict of
Interest (III.31-III.35)

4.
Development
of Society
(IV.19-IV.29)
5. Extended
Responsibility
(IV.30-IV.31)

3. Nondiscrimination
(I.9-I.11)
4. Fair
Treatment/Due
Process
(I.12-I.15)
5. Informed
Consent
(I.16-I.26)
6. Freedom of
Consent
(I.27-I.30)
7. Protection for
Vulnerable
Persons
(I.31-I.36)
8. Privacy
(I.37-I.42)

Development
of Knowledge
(IV.1-IV.3)
2. Beneficial
Activities
(IV.4-IV.14)

6. Reliance on the Discipline

(III.36-III.38)
7. Extended Responsibility
(III.39-III.40)

8. Extended
Responsibility
(II.49-II.50)

9.
Confidentiality
(I.43-I.45)
10. Extended
Responsibility
(I.46-I.47)
Principle/Value
PRINCIPLE I: RESPECT FOR THE
DIGNITY OF PERSONS

My Thoughts

Value: General Respect

I.3 Strive to use language that conveys
respect for the dignity of persons as much
as possible in all written or oral
communication

Whatever I decide to do, I need to convey

respect for my client, the other young
offenders, and the staff members of the
young offender facility. This is especially
important if I communicate to my client

ETHICS AND CONFIDENTIALITY

11
and/or the authorities about any potential
decisions I make in regards to the clients
comments.

Value: General Rights

I.8 Respect the right of clients, employees,
and others to safeguard their own dignity

I need to make sure that I do not disrespect

my client, the other young offenders, and
the staff in my decision-making process. It
is important for me to explain my course of
action that emphasizes what is best for the
client and the others in the facility.

Value: Non-discrimination
I.9 Not practice, condone, facilitate, or
collaborate with any form of unjust
discrimination

If I decide to inform the authorities of the

planned escape, I need to ensure that the
other young offenders are not discriminated
against due to their planned actions. I also
need to ensure that other young offenders
do not target my client because he/she
confided in me.

Value: Fair Treatment/Due Process

I.12 Work and act in a spirit of fair
treatment to others

I need to remember to treat my client fairly

in relation to the other young offenders,
even after hearing about this possible plan
of escape.

Value: Informed Consent

I.16 Seek as full and active participation as
possible from others in decisions that affect
them, respecting and integrating as much as
possible their opinions and wishes

I need to be open with my client about the

resulting action that needs to take place
after he/she disclosed that information to
me. I also need to let him/her know that I
will have to inform others about the plan
for the safety of those in the facility. I also
have to let him/her know about the
potential risks involved.

Value: Confidentiality
I.45 Share confidential information with
others only with the informed consent of
those involved, or in a manner that the
persons involved cannot be identified,
except as required or justified by law, or in
circumstances of actual or possible serious
physical harm or death

If this is a serious threat to the safety of the

staff and other offenders, then I must break
confidentiality with my client since there is
a potential for serious physical harm and
death. I need to be aware of the possible
risks of my clients safety among other
young offenders in the facility if I disclose

ETHICS AND CONFIDENTIALITY

12
this information to the authorities. I also
need to be aware of my client and other
youth feeling resentment towards me if
they become aware of my disclosure of this
information.

PRINCIPLE II: RESPONSIBLE CARING

Value: General Caring
II.1 Protect and promote the welfare of
clients, employees, supervisees, and others.

It is my primary responsibility to protect

the clients I work with as well as my
colleagues. If this is a legitimate threat of
violence, then it is my responsibility to
protect those who are being targeted by
disclosing this information. In the
aftermath of this decision, how can I best
protect my client and/or myself from other
young offenders who may wish to harm
those responsible for informing the
authorities? How can I protect my other
clients who were not part of the escape plan
from being unfairly discriminated against
by staff members who may feel distrust
towards the young offenders as a result?

II.2 Avoid doing harm to clients,

employees, and others

If I decide to report the plan to authorities, I

am sharing information that my client told
me in confidence. I would have to disclose
this information if I feel there is a threat of
serious harm or death. I may also be
jeopardizing the safety of my client, others,
or potentially myself by breaking
confidentiality. However, if I choose to not
report this information, I am putting the
lives of targeted staff members at risk. I
may also be held liable if the assault and
escape plan is implemented and it is found
out that I knew about it beforehand.

II.3 Accept responsibility for the

consequences of their actions

If I decide to report this threat, then I need

to be aware of the potential consequences.
My client or the other young offenders I am
treating may not trust me. The young
offenders may decide to retaliate by
attacking my client and/or myself. There
may be feelings of distrust and alienation
between staff members and young
offenders. I must accept responsibility for
these potential outcomes.

ETHICS AND CONFIDENTIALITY

13

Value: Risk/Benefit Analysis

II.14 Be sufficiently sensitive to and
knowledgeable about individual, group,
community, and cultural differences and
vulnerabilities to discern what will benefit
and not harm persons involved in their
activities.

I need to be aware of the differences in

these young offenders to try and discern
whether or not they may be capable of
harming others. I also need to be aware of
their vulnerability in this young offenders
facility. I also need to be aware of the risk
I am placing my client under by disclosing
his/her information to the authorities.
However, I need to be aware of the
potential vulnerability of the staff members
that may be harmed by the youth involved
in planning the assault and escape.

Value: Minimize Harm

II.29 Be careful not to engage in activities
in a way that could place incidentally
involved persons at risk.

My actions of disclosing this information

will put my clients safety at risk. It is
important that I inform the authorities in a
private, professional manner that can
minimize the possibility of other offenders
discovering the truth and threatening my
client. I also need to ensure that my
disclosure does not put other offenders or
staff members lives at risk.

Value: Offset/Correct Harm

II. 39 Do everything reasonably possible to
stop or offset the consequences of actions
by others when these actions are likely to
cause serious physical harm or death. This
may include reporting to appropriate
authorities (e.g., the police), an intended
victim, or a family member or other
support person who can intervene, and
would be done even when a confidential
relationship is involved.

This part of the code states that it is my

responsibility to report the actions of others
if there is a potential for serious physical
harm or death. Even though my client told
me this information in confidence, I must
break that confidentiality agreement and
inform the appropriate authorities. It is up
to me to determine whether or not the
young offenders involved are capable of
serious harm against the staff members.

PRINCIPLE III: INTEGRITY IN

RELATIONSHIPS
Value: Objectivity/Lack of Bias
III.10 Evaluate how their personal
experiences, attitudes, values, social
context, individual differences, stresses,
and specific training influence their
activities and thinking, integrating their

I must recognize that my client and other

young offenders in the facility come from
different backgrounds and have had
different life experiences than myself. It is
important for me to not have biased
opinions of my client, the young offenders,

ETHICS AND CONFIDENTIALITY

awareness into all attempts to be objective
and unbiased in their research, services,
and other activities

14
and the staff members. I must be objective
in my interpretation and actions in regards
to the information that my client has
shared.

Value: Straightforwardness/Openness
III.14 Be clear and straightforward about
all information needed to establish
informed consent or any other valid written
or unwritten agreement

When obtaining informed consent from my

clients before working with them, it is
important that they understand all aspects
of the treatment process, my role as a
psychologist, and all the guidelines of
informed consent. Before working with
my client, I must inform him/her that it is
my ethical responsibility as a psychologist
to disclose confidential information if it
indicates a potential harm to that individual
and/or others. That way, the client is aware
of this before informing me of possible
danger in the facility.

Value: Avoidance of Conflict of Interest

III.33 Avoid dual or multiple relationships
(e.g. with clients, research participants,
employees, supervisees, students, or
trainees) and other situations that might
present a conflict of interest or that might
reduce their ability to be objective and
unbiased in their determinations of what
might be in the best interests of others.

It is my responsibility to protect the health

and well being of my client. It is also
important that I maintain my clients trust.
However, I cannot let my concern over our
relationship as well as his/her safety
jeopardize the security of the staff
members. I must inform the authorities and
do whatever I can to ensure the safety of
my client.

PRINCIPLE IV: RESPONSIBILITY TO

SOCIETY
Value: Respect for Society
IV.17 Familiarize themselves with the laws
and regulations of the societies in which
they work, especially those that are related
to their activities as psychologists, and
abide by them. If those laws or regulations
seriously conflict with the ethical principles
contained herein, psychologists would do
whatever they could to uphold the ethical
principles. If upholding the ethical
principles could result in serious personal
consequences (e.g. jail or physical harm),
decision for final action would be

It is important that I am familiar with the

laws and regulations of my workplace in
the young offender facility. I need to make
sure that I abide by these regulations in my
decision-making process. However, I also
need to follow the ethical principles as a
psychologist. It is important that I make
sure these do not conflict with each other in
this matter. The regulations of the facility
would support my decision to come
forward with the information to protect
their staff. However, it is important that I

ETHICS AND CONFIDENTIALITY

considered a matter of personal conscience.

15
follow the code to try to safeguard my
client.

Value: Development of Society

IV.26 Exercise particular care when
reporting the results of any work regarding
vulnerable groups, ensuring that results are
not likely to be misinterpreted or misused
in the development of social policy,
attitudes, and practices (e.g. encouraging
manipulation of vulnerable person or
reinforcing discrimination against any
specific population).

I need to be aware of the possible

repercussions of reporting this information
to authorities. The aftermath could result
in possible tension between the young
offenders and staff members. The young
offenders, including those who were not
part of the escape plans, may be unfairly
discriminated against. This could damage
the relationships and interactions between
staff members and the youth.

Step 3. Consideration of How Personal Biases, Stresses, or Self-Interest Might

Influence the Development of or Choice Between Courses of Action
My initial reaction is concern for the safety of the correctional staff members. I
am also worried about the safety and trust of my client for confiding me with this
information. I do not want to cause any harm to my client or have him/her to feel
resentful towards me for deciding to break confidentiality by reporting this information. I
have to assess the seriousness of this escape plan to determine if it is a legitimate threat to
the facility.
If I decide to report this information, I need to be aware of the possible outcomes
due to this action. If the young offenders discover that my client revealed the escape
plan, they may attack him/her. The youth that are involved with the plan may have to be
punished by staff members. This could lead to increased hostility and distrust between the
young offenders and correctional workers. My personal biases towards my clients
welfare may be inhibiting me from reporting this to the authorities. I do not want my
client and other young offenders to lose trust in me if they find out that I reported the
information. This would lead to feelings of guilt over deciding to break my
confidentiality agreement with my client and putting his/her life in possible danger. I

ETHICS AND CONFIDENTIALITY

16

would also feel guilty for the increased tension between the staff workers and young
offenders. I need to obtain more information before I make a decision.
Step 4. Development of Alternative Courses of Action
My analysis of this dilemma has led me to rule out several courses of action: a)
Continue counseling the youth without reporting the escape plan to the authorities. If this
threat of violence were found to be legitimate, I could be held liable for not reporting it
when I was informed of the situation, which would be in violation of the Ethics Code;
and b) Approach the young offenders who are involved and discourage them from
carrying out their escape plan. This could motivate the young offenders to retaliate
against myself, my client for confiding in a staff member, and possibly other correctional
workers if they still decide to carry out their plan. I would not want to create a risk for
violence in the correctional facility and this option may pose a greater threat for hostility
and aggression.
The following two courses of action seem reasonable in my opinion and I think I
should consider them further:
Alternative 1
My client has confided information that I would consider to be a threat of
violence that is potentially life threatening. I should report this to the appropriate
authorities and do whatever I can to protect my client from harm. I do not want to
jeopardize the relationship I have with my client, but the safety of the staff members and
other young offenders is of the upmost importance. I will have to remind my client the
guidelines of confidentiality from the informed consent procedure to help him/her
understand why it is my duty to disclose this information.
Alternative 2

ETHICS AND CONFIDENTIALITY

17

I am concerned that reporting this escape plan would lead to a risk of safety for
my client. Before disclosing this information, I would consult privately with other
professionals to help guide my decision-making process. I would protect the
confidentiality of my client and create a list of benefits and potential harms based on the
feedback I would receive. Then I would decide an appropriate course of action based on
the advice I have received from others.
Step5.AnalysisofLikelyShortterm,OngoingandLongtermRisksandBenefits
ofEachCourseofActionontheIndividual(s)/group(s)InvolvedorLikelytobe
Affected(e.g.,Participants,Colleagues,theDiscipline,Society,Self)
Herearesomeofmyinitialthoughtsaboutpossibleconsequences:
Possible Positive Consequences

Possible Negative Consequences

Alternative 1
In the short-term, this will ensure the safety
of the staff members and possibly other
young offenders by preventing a violent
escape attempt.

My client may become resentful towards

me for disclosing this information. It may
impair our psychologist-client relationship
and may lead to feelings of distrust towards
me from my client and other young
offenders.

Thiscouldleadtochangesinpolicyaround The young offenders may attack my client

for revenge if they discover that he
thecorrectionalfacilitytotryandmakeit
confided in me. They could also
saferforthestaffandyouth.
potentially harm myself for telling on them.
There may also be increased hostility
between the staff workers and the young
offenders as a result.
Alternative 2
Consultingwithotherprofessionalsmay
helpeasemystressofthesituation,makea
moreinformeddecision,andbringup
alternativestrategiesthatInevereven
thoughtofpursuing.

Iwillalsoneedtoinformthemofthe
possiblerisksinvolvedwithmyclientifI
choosetodisclosethisinformation.
Consultingotherprofessionalswillalso
increasetheriskofanescapeattempt
becauseIdidnotnotifytheauthoritiesright
away.

ETHICS AND CONFIDENTIALITY

Consultingwithagroupofprofessionals
willoffermetheexpertadvicethatIwill
needinmakingmydecision.Myclients
safetywillalsobeprotectedsinceIwillnot
identifyhim/hertothoseIamconsulting
with.

18
If I do not keep the clients personal
information anonymous among the
professionals, this could be considered a
violation of client confidentiality. Also, if I
do not report this information and the
escape attempt does occur, I can be held
responsible since I knew about the plan
before it happened.

Step 6. Choice of Course of Action after Conscientious Application of Existing

Principles, Values, and Standards
In assessing the two alternative courses of actions, I believe that the first
alternative is more clearly in support of Principle I (Respect for the Dignity of Persons),
Principle II (Responsible Caring), and Principle IV Responsibility to Society. The ethical
values that best correspond with Alternative 1 are I.45, II.1, I.39, and IV.17 since they all
emphasize the right to protect others by breaking confidentiality when there is a serious
threat of harm. The second alternative does adhere to the first principle and the second
principle with ethical values I.8, and II.1. However, it corresponds more to Principle III
(Integrity in Relationships) since it respects the safety and confidentiality of the client.
AlthoughIbelieveeithercourseofactiontobereasonablyethical,itisinmy
professionalopinionthatthefirstalternativeismoreinlinewiththeCode.I believe the
first alternative is more supportive of this principle because itemphasizesPrinciplesI
moreheavilythanthesecondalternative.Alternativeoneisalsomoreinlinewith
PrincipleII,offeringresponsiblecaringfortheclientsrespectanddignity.Therationale
istoprovidethebestcarepossibleforthisclientaswellasprotectingthesafetyofothers
bydisclosingthisreportofthisthreatofharm.

ETHICS AND CONFIDENTIALITY

19

Step7.Action,withaCommitmenttoAssumeResponsibilityfortheConsequences
oftheAction
Icannotkeepdelayingtheresolutionofmydilemma.Regardlessofthecourseof
actionIchoose,ImustcarryoutwhatIbelieveisthebestoptionfortheclientandmyself
andassumeresponsibilityforthepotentialconsequencesthatmayarise.

Step8.EvaluationoftheResultsoftheCourseofAction
Duetothecomplexityofmycurrentdilemma,theevaluationoftheresultsofmy
courseofactionwillneedtobeongoing.ThenextstepthatIchoosetodowillbe
dependentuponthereactionoftheauthoritiesonceIreporttheinformation,thestaff
memberswhentheyareadvised,myclientwhenhe/shediscoversthatIreportedthe
information,andtheyoungoffenderswhentheybecomenotified.ThenIwillneedto
evaluatewhetherornotIbelievethatadesiredoutcomehasbeenachieved.Thatis,that
safetyhasbeenreestablishedinthecorrectionalfacilityandmyclientissafe.
Step9.AssumptionofResponsibilityfortheConsequencesofAction,Including
CorrectionofNegativeConsequences,IfAny,orReengagingintheDecision
makingProcessIfEthicalIssueIsNotResolved
Although,Ihaveputmybesteffortsforwardtomaximizepositiveoutcomesand
minimizenegativeconsequences,itisalwayspossiblethatIhavemisjudgedwhatis
likelytohappen.Forinstance,theramificationsofmydecisiontoreportthisescapeplan
couldresultinendangeringthesafetyofmyclient.Ifotheryoungoffendersdiscovered
thatInotifiedtheauthoritiesbasedontheinformationmyclienttoldme,theycould

ETHICS AND CONFIDENTIALITY

20

attackhiminretributionforwhathedid.Myclientmayalsolosehistrustinme,which
maypotentiallydamageourrelationshipaspsychologistandclient.Myactionscould
alsoalterrelationshipsbetweenthestaffmembersandyoungoffenders.Theremaybe
hostilityandanincreasedsenseofdistrustbetweenthetwogroups.OtherclientsthatI
counselmaynotfeelcomfortableconfidinginmeiftheydiscoverthatIreportedtothe
authorities.However,IneedtorememberthatIamdealingwithapotentiallylife
threateningsituationandmyimmediateconcernhastobeforthosewhoselivesareat
risk.
Step10.AppropriateAction,asWarrantedandFeasible,toPreventFuture
OccurrencesoftheDilemma(e.g.,CommunicationandProblemSolvingwith
Colleagues,ChangesinProceduresandPractices)
Inthefuture,Ineedtoensurethatmyclientsarefullyawareofalltheguidelines
ofinformedconsent.Ineedtocarefullyreviewtheprinciplesofconfidentialitywithmy
clientsandemphasizewhenapsychologistmustdiscloseinformationtoathirdparty.
Hopefullythiswillpreventaclientsmisunderstandingsofmyintentionsforbreaking
confidentiality.
ReflectingonthiscasestudyincomparisontotheTarasoffcase,itisimportant
forthepsychologisttoestablishwhetherornothe/shehasadutyofcareovertheclientas
wellasotherswhomaybeinvolved.Thefactorofaspecialrelationshipisevidentinthis
casestudy.Thepsychologisthasatrustingrelationshipwiththeyoungoffenderand
thereisanobligationforthatpsychologisttoprotecthis/hercoworkersinthecorrectional
facility.Thevictimsareforeseeableinthiscasesincetheclientdisclosedthattheyoung
offendersweregoingtoattackstaffmembersinanattempttoescapethefacility.Based

ETHICS AND CONFIDENTIALITY

21

ontheaccountprovidedbytheclient,itisconsideredtobeaseriousthreatsincethereis
foreseeabledangerandthevictimshavebeenidentified.Weaponshavealsobeenhidden
andthismakesitclearthatthetypeofharmtowardstostaffmemberswouldbephysical.
Sincetheyoungoffenderisinthecorrectionalfacility,itcanbeassumedthatthe
psychologististheprimarymentalhealthprofessional.Therefore,thepsychologististhe
primarymentalhealthproviderandisresponsibleforanydecisionsbasedupon
informationprovidedbythisclient.Sincethiscasestudymeetsthefivefactorsoutlined
byRosenhanetal.(1993),thepsychologisthasadutyofcaretowardstheclient.
Confidentialityisaprimaryobligationforpsychologists.However,ithasbeen
subjectedtolegalandprofessionalbalancingtests,inwhichtheneedforaconfidential
relationshipisbalancedandthengiveswaytoothersocietalorprofessionalneeds
(Donner,VandeCreek,Gonsiorek,&Fisher,2008).Except in situations that involve a
threat of serious physical harm or suspected child abuse, the clients right to
confidentiality takes precedence over our professional obligation to correct or offset
harm. (Truscott & Crook, 2004). For this reason, it is important for all psychologists to
provide comprehensive informed consent to clients where both parties fully understand
the guidelines of confidentiality in the Canadian Code of Ethics.

ETHICS AND CONFIDENTIALITY

22

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Greene,J.M.(2006).Psychiatristduties:Tarasoff.StanfordUniversityDepartmentof
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