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What are a psychiatrist’s ethical obligations regarding confidentiality of sources of collateral information obtained in the involuntary hospitalization of a patient?
In a new opinion added to “The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry,” the APA Ethics Committee underscored that a psychiatrist’s overriding ethical obligation is to the safety of the patient, and that there can be no guarantee of confidentiality to family members or other sources who provide information that is used during involuntary hospitalization.
“Psychiatrists deal with collateral information in clinical practice routinely,” said Ethics Committee member Gregory Barber, M.D. “It’s a standard part of the job to collect collateral information in cases where a patient is hospitalized, especially involuntarily, and there can be a lot of complicated interpersonal dynamics that come up when family members provide that information.
“We obtain collateral information from people who know a patient well as a way to ensure we have a full clinical picture regarding the patient’s situation,” Barber said. “But our ethical obligations are to the patient and the patient’s safety. Psychiatrists do not have an established doctor-patient relationship with the source of collateral information and do not have obligations to keep the source hidden from patients. And we should not make guarantees that the information will remain confidential.”
Here are some thoughts:
Psychiatrists' ethical obligations regarding confidentiality of collateral information in involuntary hospitalization prioritize patient safety. While they should strive to protect sources' privacy, this may be secondary to ensuring the patient's well-being. Transparency and open communication with both the patient and the collateral source are essential for building trust and preventing conflicts.
