6-1 Discussion:

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Informed Consent and Confidentiality

All human beings have three lives: public, private, and secret.

—Gabriel Garcia Márquez

Flowchart titled “Informed Consent” and sub-titled “Will vary according to the nature of the decision, but involves three elements colon.” Three arrows point from the sub-title to three further sub-titles: the first is “Provide Adequate Information,” under which are four points: “Ideally ensure via dialogue and process of exchange semi colon,” “Explain rationale colon why is this information being given question mark,” “outline treatment alternatives semi colon what are the risks and benefits of each option question mark,” “likelihood of each occurring question mark implications for future choices.” The second arrow points to the heading, “Patient's decisional capacity.” The four points under it are: “Can they communicate clearly question mark,” “understand the information question mark,” “demonstrate ability to reason using the information question mark,” and “can they appreciate the implications of the decision for their own situation question mark.” The third arrow points to the heading, “Is the decision voluntary question mark.” The points under it are: “consider the patient's stage of development colon,” “do they understand right to choose question mark,” may the illness be influencing their ability to choose question mark,” “are there emotional or psychological issues question mark,” “are there religious or cultural pressures question mark,” and “are there situational pressures parenthesis open example finance parenthesis closed that are influencing their choice question mark.”

Figure 6.1 (http://med.uottawa.ca)

Informed consent and confidentiality are considered the most important cornerstones in the psychology profession. Informed consent involves both verbal and written communication given to a client, student, research participant, advisee, or any other person who receives psychological services or guidance. Informed consent covers all of the rules of engagement. In this communication we impart sufficient information to those we serve in order to help them make a decision about whether or not to move forward with accepting services. As the chart above indicates, we need to provide adequate information, determine if the decision is voluntary, and ascertain the client’s decisional capacity. All clients and others we serve in the field of psychology have a right to know all of the rules and the particulars that go with varying forms of service.

Confidentiality is our promise to those we serve that we will keep private all communications they share except those that are overruled by law. There are always at least three exceptions or limitations to confidentiality. These include when a person is suicidal with plan and intent; when a person is homicidal with plan or intent; and when there is a strong suspicion that child abuse has taken place. In addition to these law-based limits to confidentiality, there are other areas where those we serve may lose their confidentiality. When we bill insurance on behalf of a client, they have agreed, by nature of authorizing billing, that the insurance company can have access to their records. When a credit card is used to pay for services, there is a loss of complete confidentiality by nature of this type of financial transaction. Writing a check for therapy means that check will be deposited in the therapist’s bank account and some privacy is lost in these types of transactions. Confidentiality is more than knowing how to keep quiet about the people we serve. Module Six explores these important considerations and foundations.

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