Is a psychiatrist-patient confidentiality relationship subservient to a greater good?

Abstract

Before embarking in a fruitless exchange the title question must be unpacked:

– is the ‘psychiatrist-patient confidentiality relationship’ a subset of the general doctor-patient confidentiality relationship?

– if different, what causes the difference? Is it the nature of mental disorder, for example the fact that some mental disorders may impair ‘mental capacity’ in ways different from general medicine?

– given that in addition to psychiatrists, psychologists, nurses, and social workers also enter into ‘confidentiality relationship’ with patients, should all be considered as tokens of the same type or as different types? If the latter, should such differences be considered as intrinsic or extrinsic? Intrinsic differences refer to structural dissimilarities; extrinsic differences to dissimilarities created by the respective legal frames imposed by each profession to its practitioners.

– is ‘subservience to a greater good’ an acceptable good way to describe the metier upon which the ethical scrutiny will be applied? Given that it does describe a ‘consequence’ of the process then it would seem that it prematurely opts for utilitarianism, an ethical theory that many may feel is not adequate to the case.

The general question and the pre-formulated debating positions are setting up a pseudo-debate. A more useful question should be: “Given the strong political and economic pressures being currently brought to bear upon all confidentiality relationships (held by priests, medics, lawyers, bank workers, etc.), what ethical system may be more convenient to:

– justify blatant breaches in confidentiality relationships;

– placate our moral conscience?”

Disclosure of interest

The author has not supplied his/her declaration of competing interest.