Ethics Rounds

At some point in every psychologist's career, there comes an occasion to work with another professional in order to serve a mutual client. The range of professionals with whom psychologists work reveals the breadth of what we do; psychologists serve in schools, in courtrooms and in jails, in hospitals and in mental health centers, in law enforcement and in the military, and in corporations large and small. Working effectively in a particular setting often entails cooperating with other professionals.

Cooperating with other professionals speaks to a goal fundamental to psychology, found in the Preamble to the Ethics Code, which states that the code has as a primary goal "the welfare and protection of the individuals and groups with whom psychologists work." With this very general concept as a context, the General Principles section of the Ethics Code sets forth the values central to our profession, while the ethical standards apply those values to our day-to-day practice. The standards provide direction when our values conflict, or potentially conflict, with one another--that is to say, when psychologists encounter an ethical dilemma.

Cooperating with other professionals raises interesting and challenging ethical dilemmas. General Principle B, "Fidelity and Responsibility," states "Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work...." General Principle E, "Respect for People's Rights and Dignity," states "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination." A possible tension arises between these two general principles and their inherent values because cooperating with other professionals will sometimes entail gathering, and sharing, information of a highly personal and private nature.

Being mindful of the potential tension between these two goals--benefiting clients through cooperating with other professionals and respecting clients' dignity by protecting their confidential information--can be helpful when psychologists find themselves in the position of sharing or seeking out information from other professionals. To be overly restrictive in the information we share or receive can render ourselves or other professionals unable to be as helpful as we might otherwise be. To be overly disclosing can reveal information that unnecessarily exposes our clients. Each alternative implicates and potentially compromises a value. If too little information is shared, our effectiveness is diminished; if too much, clients are not shown the respect they are due.

An indication of whether we have found the right balance can sometimes be found in considering how we would feel were the client a close friend or family member of our own. Would our thinking be that too little information had been disclosed, leading to a sense of frustration that the appropriate information for effective treatment had not yet been made available? In the alternative, would our sense be that too much had been revealed, and that private information concerning someone we care about deeply had been needlessly given away?

The ethical standards reflect the values in general principles B and E, as well as the possible tension between them. Note that Standard 3.09--which, through its use of the phrase "when indicated and professionally appropriate" leaves ample room for professional judgment--makes reference to Ethical Standard 4.05, from Section Four of the Ethics Code titled "Privacy and Confidentiality":

3.09 COOPERATION WITH OTHER PROFESSIONALS

When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately. (See also Standard 4.05, Disclosures.)

When psychologists exercise professional judgment in determining when to disclose confidential information in order to cooperate with another professional, and identify what information should be shared, Ethical Standard 4.05 sets the parameters for the conditions under which the disclosure takes place:

4.05 DISCLOSURES

a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law.

(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/ patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements.)

Psychologists will recognize that, perhaps ironically, the tension between cooperating with other professionals and protecting private information can be especially felt in health-care settings. In health-care settings, information can be readily available to anyone involved in a treatment or assessment, regardless of how peripheral that involvement may be. The Ethics Code highlights an important distinction: that information can be obtained or shared is a question separate from whether it ought to be obtained or shared. Ethical Standard 4.04 states that the touchstone for disclosing confidential information is its relevance to the matter at hand and its connection to the individuals with whom the information will be provided:

4.04 MINIMIZING INTRUSIONS ON PRIVACY

(a) Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the communication is made.

(b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.

It is interesting to note that very similar concepts are found in certain laws. As an example, the Health Insurance Portability and Accountability Act (HIPAA) "minimum necessary" rule applies when protected health information is disclosed for non-treatment-related reasons and states "a covered entity must make reasonable efforts to limit protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request." Through its psychotherapy-notes exception, HIPAA gives heightened protection to disclosures of treatment-related information even to other health-care providers. (See HIPAA Privacy Rule, www.cms.hhs.gov/hipaa, sections 164.501 and 502.) We thus see that, like our Ethics Code, the law also negotiates the tension between sharing information and protecting privacy.

To use the information we obtain--at the right time, in the right way, toward the right end--is a challenge that lasts our entire professional lives. The ethical aspect of how we use that information involves values central to our work, values set forth in the General Principles section of our Ethics Code. These values, which the ethical standards bring to life in our daily work, are to promote our clients' welfare in a manner that respects and protects their human dignity.

Further Reading

APA's Ethics Code is at www.apa.org/ethics. Send questions or comments about this column or suggestions for future columns via e-mail. Readers may submit vignettes (without identifying information) for "Ethics Rounds" consideration.