Paternalistic Breaches of Confidentiality in Prison: Mental Health Professionals' Attitudes & Justifications
AIM:
This
manuscript presents mental health practitioners' (MHPs) practice, attitudes and
justifications for breaching confidentiality when imprisoned patients disclose
suicidal thoughts or abuse by others.
METHODS:
24 MHPs
working in Swiss prisons shared their experiences regarding confidentiality
practices. The data were analysed qualitatively and MHPs' attitudes and course
of action were identified.
RESULTS:
Analysis
revealed paternalistic breaches of confidentiality. When patients reported
suicidal thoughts and abuse, MHPs believed that forgoing confidentiality is
necessary to protect patients, providing several justifications for it.
Patients were informed that such information will be transmitted without their
consent to medical and non-medical prison personnel. With reference to suicidal
attempts, MHPs resorted to methods that may reduce suicidal attempts such as
transfer to hospital or internal changes in living arrangements, which would
require provision of certain information to prison guards. In cases of abuse,
some MHPs convinced patients to accept intervention or sometimes overrode
competent patients' refusals to report. Also in the case of abuse, provision of
limited information to other prison personnel was seen as an acceptable method
to protect patients from further harm.
DISCUSSION:
Breaches
of confidentiality, whether limited or full, remain unethical, when used for
competent patients based solely on paternalistic justifications.
Institutionalising ethical and legal procedures to address suicidal and abuse
situations would be helpful. Education and training to help both medical and
prison personnel to respond to such situations in an appropriate manner that
ensures confidentiality and protects patients from suicide and abuse are
necessary.
- 1Institute for Biomedical Ethics, University of Basel, Basel, Switzerland Center for Legal Medicine, University of Geneva, Geneva, Switzerland.
- 2Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- J Med Ethics. 2015 Jun;41(6):496-500. doi: 10.1136/medethics-2013-101981. Epub 2015 Jan 13.
No comments:
Post a Comment