Summery of two articles

PROFESSIONAL ETHICS, VOL. 3, NO.1

Confidentiality: A Comparison across the Professions of Medicine, Engineering and Accounting

Mary Beth Armstrong

Introduction

Professions are organizations of people sharing a certain expertise (e.g., knowledge of medicine, law, accounting). The expertise is typically of a theoretical nature and requires extensive education and training. Thus, society restricts practice of the expertise to licensed individuals. But monopoly and special knowledge lead to power; and power in the hands of a few can result in harm to the many. Thus, at the heart of every pro- fession is a service ideal, or promise to use the special knowledge and monopoly to benefit, not harm society. All professions, by their very nature, must be concerned with and must strive to advance the public interest.

Keeping professional secrets or confidences has long been considered to be in the public interest. Arguments defending professional confiden- tiality are both deontological and utilitarian. Deontological justifications for confidentiality are based on the notions of privacy, autonomy, promise keeping and loyalty, while utilitarian arguments stress the positive benefits to society when professionals can be trusted to keep confidences. As one court stated (1965, Hammonds v. Aetna):

Since the layman is unfamiliar with the road to recovery, he cannot sift through the circumstances of his life, and habits to determine what is information pertinent to his health. As a

© Mary Beth Armstrong 1994

72 Professional Ethics

consequence, he must disclose all information in his con- sultations with his doctor-even that which is embarrassing, disgraceful, or incriminating. To promote full disclosure, the medical profession extends the promise of secrecy.

Deontological arguments are summarized well by Sissela Bok (1982). According to Bok (pp. 119-124), justification for confidentiality rests on four premises: individual autonomy over personal information, respect for relationships among human beings and for intimacy, the obligation created by a pledge of silence, and utility to persons and society. While these four premises are strong, creating the prima facie importance of the principle ot confidentiality, they are not absolute, nor is the principle. "The premises supporting confidentiality are strong, but they cannot support practices of secrecy-whether by individual clients, institutions, or professionals themselves-that undermine and contradict the very respect for persons and for human bonds that confidentiality was meant to protect" (Bok, 1982, p. 135).

Since professional confidentiality is recognized as a prima facie duty, it therefore follows that it is morally binding on professionals unless it is in conflict with equal or stronger duties. Ross (1930), for example, would argue that in any particular situation a professional's actual duty in the situation is determined by an examination of the weight of all the competing prima facie duties. Furthermore, Beauchamp and Childress (1989, p. 53) assert four requirements for justified infringe- ments of a prima facie principle or rule:

(1) The moral objective justifying the infringement must have a realistic prospect of achievement.

(2) Infringement of a prima facie principle must be necessary in the circumstances, in the sense that there are no morally preferable alternative actions that could be substituted.

(3) The form of infringement selected must constitute the least infringement possible, commensurate with achieving the primary goal of the action.

(4) The agent must seek to minimize the effects of the in- fringement.

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When individual decision makers or public policy formulators advocate the breaking of professional confidences, the principles most often evoked are those of "not causing harm" or "preventing harm." Thus, the interests of the client or patient, to whom the professional owes the prima Jacie duty of confidentiality, is pitted against the interests of others in society (or even society itself) who may be harmed if con- fidentiality is kept.

Not all duties, however, are of equal weight nor do they all impose an equal burden on the professional. Ruland and Lindblom (1992) point out in their discussion of authors who distinguish between positive and negative duties [see for example Foot (1967), Trammell (1975), Blumfield (1981), Abelson (1982)], that the distinction may be beneficial in attempting to order duties related to confidentiality issues. Neverthe- less, a few scholars argue against the significance of the distinction [see for example Bennet (1966), Tooley (1972), Rachels (1975)]. In general, positive duties are obligations to bring about good or be meritorious and generally require some action on the part of the professional. Negative duties, on the other hand, are duties to not harm or not do bad, and most often require inaction or compliance with rules defining ones role. Negative duties are seen as more obligatory than positive duties. Thus, keeping a professional confidence, a negative duty, would be a stronger duty than the positive duty to take action to prevent harm, assuming the magnitude of the potential harm to society is equal to the magnitude of the potential harm done to the client/patient by revealing the confidence.

Ruland and Lindblom argue that the positive/negative duty distinc- .tion serves as the basis for a strict ordering of duties. They describe four criteria for policy makers to utilize to determine when professionals should be bound by the negative duty to maintain confidentiality and when they should reveal the confidences to prevent an impending harm: relentlessness, the uncertainty of outcomes, the nature of responsibilities and the magnitude of the consequences.

Relentlessness refers to the dischargability of a duty. Since all positive acts of beneficence cannot be performed, some ethicists see positive duties as relentless and thus never obligatory. However, Ruland and Lindblom would find positive duties obligatory in "circumstances that can be defined as less than relentless" (p. 265). Thus, for example, even

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though accountants cannot be held to a duty to disclose all information of benefit to the public, they may have a duty to disclose certain limited sets of information.

The uncertainty of outcomes criteria refers to the fact that "the strictness of a positive duty is related to the probability that something bad will occur or that something good will not occur if the duty is not fulfilled" (p. 265). Usually, if a negative duty is violated some bad end will occur. When a positive duty is violated, however, the bad end can be avoided by other means. "There are circumstances, however, in which failure to act on a positive duty will have an almost certain outcome . . . . When the circumstances do occur they could . . . change the relative strictness of a positive duty to act" (p. 265).

The nature of the responsibility for positive duties refers to changing levels of responsibility because of circumstances that create special duties for particular persons. Ruland and Lindblom illustrate the concept by reference to several scenarios involving a drowning person and an individual observing the drowning. The individual's responsibility to save (positive duty) the drowning victim depends on circumstances. Can the rescuer swim? Is s/he a lifeguard? Are others present who could also do the saving? Does the rescuer have other, conflicting duties, such as child care? Thus the strength of a positive duty is affected by who else might share the responsibility and by the nature of the shared duty.

The magnitude of the consequences is self explanatory. As the magnitude of the consequences increases (for a positive duty) and the magnitude decreases (for a negative duty), the positive duty can be seen to outweigh the negative duty.

Beauchamp and Childress (1989, p. 337) employ a similar notion when they state that "it is necessary to consider both the probability and the magnitude of harm and to balance both against the rule of con- fidentiality" :

Probability of Harm

High Low

Magnitude of Harm Major Minor

1 3

2 4

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"As the health professionals' assessment of the situation approaches 1 in the above chart ... the weight of the obligation to breach confidentiality increases. As the situation approaches 4, the weight decreases." Cases 2 and 3 are more difficult to resolve. However, Beauchamp and Childress see no moral obligation to breach confidentiality in case 2 (high probability of a minor harm) and conclude that, in case 3, some form of risklbenefit analysis is called for, since judgement about probabilities lL'1d magnitudes are required. They also imply (p. 338) that reasonable doubts ought to be settled in favor of preserving confidentiality.

Unfortunately, Beauchamp and Childress do not give guidance to their readers to help them assess the probability of the risk of harm or its magnitude. Nor do they distinguish between types of harm (e.g., bodily harm, loss of wealth, damage to reputation). Ought all "harms" be treated equally? Presumably these distinctions and difficult assessments are to be made by individual professional practitioners in concrete situations, based upon guidelines by her/his professional organization. Such guidance, presumably, would include rules to be followed in typical and commonly encountered situations within the particular profession. Ideally, these rules would be well conceived and based upon the same concepts described herein.

One special form of confidence breaking, termed "whistleblowing," requires additional analysis. Whistleblowing can be internal, in the sense that one "goes over the head" of an immediate manager, perhaps even to the board of directors, or, as more commonly understood, one goes outside the organization in an act of external whistleblowing. Just as whistleblowing can be internal or external, professionals can be classified as internal or external. For example, doctors, attorneys, engineers and accountants often practice their professions in the context of professional firms offering services to a variety of patients/clients. These profes- sionals are "external" to their patients/clients. Yet a significant number of professionals are employed directly by corporate employers. This latter group, "internal" professionals, have dual responsibilities of em- ployee loyalty to their employer corporations and the requirements shared by all professionals to adhere to their profession's promulgated standards.

According to Peter Drucker (1981, p. 33) whistleblowing is just another name for informing and "the only societies in Western history

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that encouraged informers were bloody and infamous tyrannies." In Drucker's view, "under whistleblowing, under the regime of the infor- mer, no mutual trust, no interdependencies, and no ethics are possible. "

Bok, in describing the nature of whistieblowing, paints an equally dismal picture (1982, p. 214): "Three elements, each jarring, and triply jarring when conjoined, lend acts of whistleblowing special urgency and bitterness: dissent, breach of loyalty, and accusation."

The dissent is the act of alerting the public to a risk perceived by the whistleblower but denied by those in authority over the whistleblower.

The breach of loyalty is perceived because the whistleblower comes from within. Thus, the whistleblower's act is perceived as different from the muckraker's or other forms of exposure from without.

Accusation points the finger of responsibility to certain persons or groups within the organization. Thus, the collapse of a building or bridge is not bad luck, or an act of God, but is brought about by negligence or greed of specific individuals. The accusation concerns a present or imminent threat.

All three of the elements described above impose requirements on the whistleblower (p. 219): "of judgement and accuracy in dissent, of exploring alternative ways to cope with improprieties that minimize the breach of loyalty, and of fairness in accusation."

Thus Bok sees whistleblowing as a valid means of last resort to dis- charge a duty to protect the public from harm if I) the threat is imminent and serious, 2) existing avenues for change within the organization have been exhausted, and 3) the whistleblower makes his/her accusations openly, so those criticized have the opportunity to defend themselves. This last requirement is particularly troublesome, since fairness to the accused may result in unfairness to the whistleblower. Some states and organizations, as well as the federal government, recognize this im- balance of power, and have enacted whistleblowers protection acts to safeguard the rights of whistleblowers.

De George (1981) enumerates similar criteria. For him, engineers in large corporations are permitted to go public about information regarding the safety of a product if (p. 7):

1) [T]he harm that will be done by the product to the public is serious and considerable.

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2) [T]hey make their concerns known to their superiors, and

3) [I]f, getting no satisfaction from their immediate su- periors, they exhaust the channels available within the corporation, including going to the board of directors.

For an engineer to have a moral obligation to bring his case for safety to the public, additional requirements are (p. 7):

4) He (sic) must have documented evidence that would convince a reasonable, impartial observer that his view of the situation is correct and the company policy wrong.

5) There must be strong evidence that making the in- formation public will in fact prevent the threatened serious harm.

Martin (1992), on the other hand, argues that under certain cir- cumstances, similar to those listed by Bok and De George, an engineer may have a strong prima jacia obligation to whistleblow, but that obli- gation may be overridden by family and other personal obligations.

Dunfee and Maurer (1992), in discussing corporate attorney whistle- blowing, argue for a standard of broad permissibility (as opposed to a narrow standard now imposed by the American Bar Association's Model Rules) and offer a consequentialistic analysis to aid corporate attorneys in their decision making.

In summary, confidentiality is a prima jacie obligation, but not an absolute obligation. Ethicists may argue about when and under what cir- cumstances confidentiality should yield to other duties, especially duties to protect the public from harm, but few ethicists, if any, would see pro- fessional confidentiality as an absolute duty. Whistleblowing, a special form of confidence breaking, is especially troublesome for professionals (as opposed to managers) in a corporate/employee relationship (as opposed to an external/consultant relationship). The remainder of this paper explores the extent to which three professions (medicine, en- gineering, and accounting) have attempted to give guidance to their

. members concerning when, and under what circumstances, to breach confidentiality.

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The Medical Proression

Confidentiality in the medical profession dates back to the fourth century B.C. and the Hippocratic Oath. "Whatsoever things I see or hear concerning the life of a man, in any attendance on the sick or even apart therefrom, which ought not to be noised about, I will keep silent thereon, counting such things to be holy secrets."

In 1803, Thomas Percival published his Code of Medical Ethics, which was the basis for the American Medical Association's (AMA) code, first promulgated in 1847. Over the next century several major revisions were made to the AMA code, the most dramatic coming in 1957. That year's Principles of Medical Ethics stated the following (section nine):

A physician may not reveal the confidence entrusted to him in the course of medical attendance . . . unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or the community.

The 1980 revision to the AMA's Principles of Medical Ethics (preamble, section IV) states:

A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law.

Another section ("5.05 Confidentiality") states:

The obligation to safeguard patient confidences is subject to certain exceptions which are ethically and legally justified because of overriding social considerations. Where a patient threatens to inflict serious bodily harm to another person and there is reasonable probability that the patient may carry out the threat, the physician should take reasonable precautions for the protection of the intended victim, including notification of law enforcement authorities. Also, communicable diseases, gun shot and knife wounds, should be reported as required by applicable statutes or ordinances.

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The change in language between the 1957 Code and the 1980 Code reflects a watershed event in the history of medical confidentiality; the Tarasoffcase [Tarasoffv. Regents o/the University o/California]. This case involved one Prosenjit Poddar, a man obsessed with a student he met at a dance, Tatiana Tarasoff. Poddar revealed to Dr. Moore, the staff psychologist at the University of California, Berkeley student health services, that he thought of harming and maybe killing Tarasoff. When Poddar purchased a gun and discontinued therapy, Dr. Moore notified the campus police, who questioned and then released Poddar. Two months later Poddar killed Tarasoff.

In 1974 the California Supreme Court ruled that Dr. Moore had a duty to warn Tarasoff. In 1976 the same court reheard the case and changed the ruling from the duty to warn, to the duty to protect, the potential victim. Presumably, one could protect an intended victim through a variety of means, including warning.

Shortly after the Tarasoff case, a series of cases followed both within and outside of California. For example, in 1980 in Lipari v. Sears, Robuck & Co. the court extended the class of potential victims beyond those identifiable to the therapist to include the general public, since the harm was foreseeable. Also, state legislators have been busy redefining the law as it relates to medical confidentiality. In 1985 the state of California enacted a statute requiring psychotherapists to use rea- sonable care to protect the identified victim from a potentially dangerous patient by notifying the victim (or by notifying the police if the victim is unknown).

The end is not in sight. The AIDS epidemic is a particularly ripe arena for controversy regarding confidentiality. Some analysts may use a Tarasoff-type approach and argue that doctors have a duty to protect potential victims (including the general public) from the harm inflicted by this deadly disease. Others believe that, since the repercussions of dis- closure of AIDS on the patient are so adverse, they outweigh even the potential contraction of the disease by a third party. AIDS patients are often ostracized from society and left to die.

Increasingly creative forms of medical practices in recent years have resulted in additional complexities in doctor-patient relationships. As more and more physicians become employees of HMOs, hospital

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corporations, and other groups, the previously-described distinction be- tween external professionals (those with professional/client relationships) and internal professionals (those with professional/employer relationships) becomes blurred. Additional conflicts may arise between loyalties to the group/employer and confidentiality commitments to individual patients.

To date the AMA has, in effect, offered the following guidance to physicians relative to appropriate breaches of confidentiality: protect threatened victims and the general public, when required to do so by law. Since courts and legislatures are still busy deciding when a physician should or should not maintain patient confidences, doctors almost need to be lawyers to keep abreast of their professional responsibilities, as delineated by the AMA. Apparently, officials within the medical profes- sion who are charged with the responsibility of making policy for its members have decided that courts and legislatures, rather than them- selves, should grapple with issues such as resolving conflicts among prima facie duties, prioritizing duties (i.e., positive/negative), defining harm, assessing risks of harm, assessing strengths of loyalties, etc. As Beauchamp and Childress (1989, p. 341) conclude: "rules of medical confidentiality are not at present well delineated and would profit from a thorough restructuring." The medical profession is not unique in its struggle with confidentiality. The next two sections of this paper will discuss the issues from the prospective of engineers, who have tradi- tionally been professional employees (or internal professionals), and accountants, who are more equally divided between internal and external professionals.

The Engineering Profession

Engineers comprise a large and diverse profession with dozens of pro- fessional societies and over 500,000 members. One of the first sources of official ethical guidance for engineers was the 1912 Code of Ethics of American Institute of Electrical Engineers. In that code an engineer was told that he should consider "the protection of a client's or employer's interests his first professional obligation." (Peterson and Farrell, 1986, p. 8). In 1947 the Engineers' Council for Professional Development [ECPD], a model for many engineers' codes, called for the engineer to "discharge his duties with fidelity to the public, his employers and

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clients, and with fairness and impartiality to all. It is his duty to interest himself in public welfare and to be ready to apply his special knowledge for the benefit of mankind." (peterson and Farrell, 1986, p. 8).

The 1974 revision of the ECPD Canons of Ethics stated that "Engineers shall hold paramount the safety, health, and welfare of the public in the performance of their professional duties." (peterson and Farrell, 1986, p. 8). Thus, in 62 years the engineers' thinking on the issues had evolved from a primary duty to clients and employers to simultaneous (and presumably equal, and sometimes conflicting) duties to clients, employers and public, to a primary duty to the general public.

Currently, the American Society of Civil Engineers, the America Society of Mechanical Engineers, the Institute of Industrial Engineers, and Tau Beta Phi have adopted language similar to the 1974 ECPD Canons. The American Association of Engineering Societies [AAES], an umbrella organization comprised of 22 engineering societies, uses even stronger language: "Engineers perceiving a consequence of their professional duties to adversely· affect the present or future public health and safety shall formally advise their employers or clients and, if war- ranted, consider further disclosure." (Gorlin, 1990, p. 64).

In 1989 the AAES issued "Public Policy Perspectives: Ethical Stan- dards," which stated the following policy, intended to aid engineers who feel they have no choice but to blow the whistle (Gorlin, 1990, p. 65):

Engineers, in their contributions to technological endeavors, must continually balance creativity and the end effects of their work upon the public welfare. Their contributions may be affected by management and financial decisions which are in conflict with their own ethical standards.

AAES urges that these conflicts be disclosed and resolved with appropriate mechanisms to protect the public safety, and adequate protection for the engineer who jeopardizes his or her career, reputation, and well-being by making such disclosures in the public interest. To this end, AAES is cooperating with various organizations in examining these points and developing measures to enhance ethical approaches wherever technology is present.

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Action Agenda

Encourage disclosure necessary to protect the public safety. Establish active society support of individuals who make dis- closures.

The BART case is a good example of engineering "society support of individuals who make disclosures." It involved the faulty design of the automatic train control system of the Bay Area Rapid Transit (BART) system that runs through three counties in northern California. Three engineers became concerned over a period of years with the way the system was being developed. All three expressed concerns to their respective managements, and all three received no significant response. Toward the end of 1971 the three engineers decided that the public safety could be in jeopardy if the system were implemented, so they decided to go over their managers' heads and take their concerns to the BART Board of Directors. The Board ruled in favor of management, who traced the complaints back to the three engineers and fired them.

One of the fired engineers enlisted the support of the California Society of Professional Engineers (CSPE), which began a study of the situation. The study brought to light many engineering and management problems which confirmed the claims of the three engineers. Actual malfunctions, such as an October 1972 incident where the system gave a command to a train to speed up when it should have a slowed down (causing the train to jump the tracks and injure several people), also confirmed the engineers' complaints. Thus, with the help of the CSPE, the three engineers were publicly vindicated, but were still out of work and experiencing difficulty getting hired by any company. However, although filing an amicus curiae brief may have been a step in the right direction, helping the unemployed engineers secure new employment would have sent an even stronger message to other engineers facing similar circumstances.

Further protection of engineers who follow the ethical guidance noted above will probably have to come in the form of legislation. In 1981 Michigan became the first state to enact a "Whistleblowers Protection Act" covering corporate employees. It allows courts to grant back pay, reinstatement in the job, and costs of litigation to employees who can demonstrate improper treatment. [Bok, 1982, p. 227].

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Other states, even the federal government, will have to follow Michigan's example if many engineers are to be expected to "hold paramount the safety, health, and welfare of the public" and prevent such well-known disasters as Ford's Pinto, McDonnell Douglas' DC-10, General Motors' Corvair, B.F. Goodrich's aircraft brakes, the Challen- ger's O-rings, etc.

A comparison of the AAES guidelines with those of the AMA reveals an interesting difference: the engineers appear more willing to break professional confidences in the absence of laws requiring them to do so. Indeed, the engineers are in the process of providing structures to encourage necessary disclosures among their ranks and to protect their members from resulting repercussions. This difference may, in part, be due to the catastrophic nature of engineering disasters, (magnitude of the harm) but medical epidemics can be equally devastating.

In grappling with the confidentiality problem, engineers have con- cluded that the duty to the public's safety, health and welfare is a higher duty than other, conflicting, primajacie duties. Although this conclusion does not satisfy the needed analysis nor does it give much guidance relative to risk assessment, definitions of harm, and the myriad other related questions, it is a foundation upon which to build.

The Accounting Proression

Accountants, like engineers, work for a variety of organizations and perform a variety of functions. This paper, however, will examine pro- fessional guidance from only two sources: the American Institute of Certified Public Accountants (AICPA), and the Institute of Management Accountants (lMA). AICPA members are licensed by the state (similar to physicians), while IMA members are not (similar to many engineers). The presence of a licensing requirement, or state certification, presum- ably gives stronger authority to confidentiality rules that are embedded in state business and professional codes than to similar rules promulgated by professional societies. I will return to this point later in this section.

The AICPA membership is almost evenly divided between external, independent accountants who work for CPA firms, and internal account- ants who work for large corporations or government as management (internal) accountants or internal auditors. Those CPAs who work as

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independent, external accountants are almost evenly divided between auditors and tax advisors/management consultants. Originally the AICPA Code of Professional Conduct was applicable only to CPAs performing the audit function as external, independent auditors. In 1988 the Code of Conduct was expanded to include all AICPA members, external and internal, no matter what their function.

The AICPA Code of Professional Conduct is divided into two main sections, Principles and Rules. The former are aspirational in nature, while the latter are mandatory and violators are subject to disciplinary ac- tion. In Ruland and Lindblom's terms, the principles are positive duties (unless they suggest refrainment) while the rules are negative duties, and will usually (but not always) trump the positive duties if the two are in conflict.

The Principle entitled "The Public Interest" states: "In discharging their professional responsibilities, members may encounter conflicting pressures from among each of [several] groups [clients, credit grantors, governments, employers, investors, the business and financial com- munity, and others]. In resolving those conflicts, members should act with integrity, guided by the precept that when members fulfill their re- sponsibility to the public, clients' and employers' interests are best served." Thus, the Principles section of the Code seems to establish a positive duty to place the public interest above other interests when there is a conflict.

Rule 301 states "A member in public practice shall not disclose any confidential client information without the specific consent of the client. " It goes on to explain: "This rule shall not be construed (1) to relieve a member of his or her professional obligations under rules 202 and 203 [i.e., to follow appropriately established accounting rules]; (2) to affect in any way the member's obligation to comply with a validly issued and enforceable subpoena or summons; (3) to prohibit review of a member's professional practice under AICPA or state CPA society authoriza- tion; or (4) to preclude a member from initiating a complaint with or responding to any inquiry made by a recognized investigative or disci- plinary body."

The negative duty to maintain client confidentiality does not allow for exceptions other than the following which are explicitly stated: Members have to disclose information if the promulgated accounting

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rules require it, if the information is subpoenaed, if it is part of a peer or quality review of the CPA firm, or is part of an AICPA or State investigation of the CPA's adherence to professional standards. Notably absent are exceptions for the public interest (e.g., the Savings and Loan crisis, where appropriate accounting rules may have been followed, but they did not tell an accurate story) and exceptions for compliance with the law (as the AMA code provides).

Case law relative to accounting confidentiality has been expanding rapidly, though not as rapidly as in the medical profession. In Fund of Funds, Ltd. v. Arthur Andersen &: Co. (1982), the auditors were held liable when they did not reveal to one client that it was being defrauded by another client. Since the CPA firm audited both clients, it knew (or should have known) that one client was defrauding the other, and the courts held that it had a duty to warn the defrauded client. In a New York case, White v. Guarente, the auditor was held liable for not revealing to limited partners that they were being defrauded by a general partner (Causey, 1988, p. 30). Liability may even exist where newly discovered information reveals fraudulent client activity after the financial statements are issued (for additional discussion of recent case law, see Causey, 1988). Thus the courts do not appear to be persuaded by the argument that CPAs (or medical doctors) who adhere to confidentiality rules promulgated by state business and professional codes are "obeying the law," and the practical effect of such rules may be that they carry no more authority than do similar rules promulgated by professional societies.

Although management (internal) accountants who are members of the AICPA are included in the AI CPA Code of Professional Conduct (except where explicitly excluded), the code was, for years, directed toward CPAs in public practice engaged in the auditing function. The Standards of Ethical Conduct for Management Accountants, promulgated by the IMA, explicitly address the concerns of internal accountants. The IMA Standards state: "Management accountants have a responsibility to refrain from disclosing confidential information acquired in the course of their work except when authorized, unless legally obligated to do so." The Standards also discuss actions to be taken by management accoun- tants who encounter unethical behavior within their organization:

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If the ethical conflict still exists after exhausting all levels of internal review, the management [Le. internal] accountant may have no other recourse on significant matters than to resign from the organization and to submit an informative memoran- dum to an appropriate representative of the organization. Except where legally prescribed, communication of such prob- lems to authorities or individuals not employed or engaged by the organization is not considered appropriate.

Thus, the official organization of management accountants, unlike organizations of engineers, do not allow for whistleblowing as an act of last recourse. Rather, management accountants are expected to resign and walk away. Some might argue that the threat to public safety ex- posed by an engineer is serious enough to warrant such drastic action as whistleblowing, while mere financial loss, the domain of the accountant, does not. In light of the dramatic losses incurred by the Savings and Loan industry, however, that distinction may no longer be appropriate.

Conclusion

The introduction to this paper described a social contract between pro- fessions and the larger society. At the heart of the contract is the profession's service ideal, or promise to act in the public's interest. Historically, professional confidentiality was deemed to be in the public interest and took on an almost sacred aura. In recent years, however, society, through its courts and legislators, has denied that confidentiality is always in the public interest. Professions, especially in the form of official guidance, have been slow to respond to society's new expec- tations relative to confidentiality, although some professions are moving faster than others.

The American Medical Association basically exhorts physicians to maintain confidentiality unless the law tells them to do otherwise. Medi- cal ethicists, on the other hand, are calling for a complete reexamination of the confidentiality issue. Professional engineering societies, in their umbrella organization (AAES), have recently pledged to encourage dis- closure necessary to protect public safety and to establish active society support of individuals who make disclosures. To date, however, their practical assistance to whistleblowers who have been blackballed is

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limited. The accounting profession, the author's own profession, is the slowest of the three professions examined to advocate change in its con- fidentiality rules. Accountants are traditionally conservative. But in their zeal to maintain client/employer confidences, accountants cannot lose sight of their pledge to fulfill their responsibilities to the public interest. The public no longer believes that absolute confidentiality is in their interest. It is time, therefore, for accountants, medical professionals, en- gineers, indeed all professionals, to work together and with ethical theorists to rethink and reformulate confidentiality guidance, from the ground floor up.

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Lipari v. Sears, Roebuck &: Co., 497 F. Supp. 185 (D. Neb. 1980). Tarasoffv. Regents of University of California. 17C. 3d 425; 131 Cal.

Rpt. 14,551 p. 2d 334 (1976).