In an earlier column, I defined ethics as thinking about reasons in terms of values. From this definition, a question arises: Where can the values relevant to the practice of psychology be found? First and foremost, the values are found in the Ethical Principles of Psychologists and Code of Conduct (APA, 1992), which states that our "Ethics Code provides a common set of values upon which psychologists build their professional and scientific work." The Code sets forth the values upon which the profession of psychology rests.
Most important among these values is "the welfare and protection of the individuals and groups with whom psychologists work." Examples of other important values in the Code are individual autonomy, which psychologists promote through informed consent to research and therapy; truth-telling, which psychologists promote through public statements that are accurate and do not mislead; and confidentiality, which psychologists promote by protecting from inappropriate scrutiny information learned in a professional relationship.
The Ethics Code in a larger context
How the Ethics Code addresses confidentiality reveals another set of values relevant to our profession: the values of the society in which we live and work. Standard 5.02 in the Ethics Code states that "psychologists have a primary obligation and take reasonable precautions to respect the confidentiality rights of those with whom they work or consult, recognizing that confidentiality may be established by law...." Note how Standard 5.02 acknowledges that 1) confidentiality is a value central to psychology; and 2) confidentiality must be placed in a larger context, that of the law and, by implication, society as a whole.
How does this larger context relate to a psychologist's ethical obligations? To ask the question another way, how do the values of our profession relate to the values of our society? Mandatory reporting laws provide an interesting and telling illustration.
Mandatory reporting laws require that psychologists (along with other professionals) report certain information to a designated state agency. This information usually concerns a member of a group that is considered especially vulnerable, such as children or the elderly.
When a psychologist has reasonable basis to believe that an individual belonging to such a group has been harmed, or is at risk of harm, a mandatory reporting law may require the psychologist to disclose otherwise confidential material. Why? Because society has made a value judgment: The value of confidentiality must give way to the value of protecting vulnerable individuals. Put another way, society places the value of protecting the vulnerable above the value of confidentiality.
Psychology and society: Balancing values
Two points about this balance are important. First, because most laws relevant to the practice of psychology are made by states, rather than by the federal government, each state is free to strike this balance as it sees fit. Thus, while there is universal consensus that child abuse mandates a report, states differ as to which other groups fall into this category. As examples, certain states mandate reporting when a psychologist learns of spouse abuse, of sexual involvement with a previous therapist, or of a threat of physical harm to a third party, while other states do not. To put the matter in the language of values, individual states weigh confidentiality against competing values differently.
Second, because psychologists are members of society, many will fully agree with how the law balances confidentiality against other values. At times, however, psychologists may disagree with how this balance is struck. Consider a psychologist who receives an order from the court to disclose confidential information, perhaps for the purposes of litigation. The psychologist may feel strongly that disclosing the information will be detrimental to the patient's welfare.
Thus, the psychologist may acutely feel the tension between the value of confidentiality, fundamental to our profession, and the value of seeking truth, central to our system of justice. The psychologist will have to decide which value to give priority.
It is important to be clear that the Ethics Code allows the psychologist to follow the court order--indeed, the Code does not impose an ethical obligation to violate the law. If a psychologist nevertheless chooses to violate the law in order to protect confidentiality, the psychologist engages in civil disobedience, and may be exposed to penalties imposed by the law.
The choice the psychologist makes is a value choice, and the consequences arise because we practice our profession in the context of a larger society, a society whose values are often, but not always, the same as those psychology holds dear and seeks to protect.