While proponents of social (i.e., nonmedical) egg freezing argue that it is liberating for women, opponents contest that the technology provides an individualist solution to a social problem. This article comprises personal and academic reflections on the debate on social egg freezing from four young women studying reproductive technologies. We challenge the promotion of social egg freezing as an empowering option for women and question cultural assumptions about childbearing, the disclosure of risk, failures to consider sexual diversity and socioeconomic status, (...) and the expansion of the market in reproductive tissues. (shrink)

Recent events have revived questions about the circumstances that ought to trigger therapists' duty to warn or protect. There is extensive interstate variation in duty to warn or protect statutes enacted and rulings made in the wake of the California Tarasoff ruling. These duties may be codified in legislative statutes, established in common law through court rulings, or remain unspecified. Furthermore, the duty to warn or protect is not only variable between states but also has been dynamic across time. (...) In this article, we review the implications of this variability and dynamism, focusing on three sets of questions: first, what legal and ethics-related challenges do therapists in each of the three broad categories of states (states that mandate therapists to warn or protect, states that permit therapists to breach confidentiality for warnings but have no mandate, and states that give no guidance) face in handling threats of violence? Second, what training do therapists and other professionals involved in handling violent threats receive, and is this training adequate for the task that these professionals are charged with? Third, how have recent court cases changed the scope of the duty? We conclude by pointing to gaps in the empirical and conceptual scholarship surrounding the duty to warn or protect. (shrink)

After recent tragedies involving mass murders on a college campus in Virginia, an Army base in Texas, a congressional constituent event at a shopping center in Arizona, and a movie theater in Colorado, one might have assumed the public had become numb to horrendous and senseless acts of killing. If so, one would have been wrong. The public was not prepared for the brutal and cold-blooded murder of 20 first-grade school children and six teachers and staff at Sandy Hook Elementary (...) School in Newtown, Connecticut, on December 14, 2012.Following the all-too-familiar emotional stages of shock, grief, and anger, many members of the public and elected officials turned to the issue of how to prevent such tragedies in the future. Two main questions quickly became the focus of policy makers. (shrink)

This paper demonstrates how ubuntu relational philosophy may be used to ground beneficial coercive care without necessarily violating a patient’s dignity. Specifically, it argues that ubuntu philosophy is a useful theory for developing necessary conditions for determining a patient’s potential dangerousness; setting reasonable limits to the duty to protect; balancing the long-term good of providing unimpeded therapy for patients who need it with the short-term good of protecting at-risk parties; and advancing a framework for future case law and appropriate regulations (...) in the care of psychotherapy patients. Issues regarding the decision to breach medical confidentiality in psychotherapeutic care are ultimately reserved for the courts. Professional assessment might be an important first step in this process, and court rulings govern most aspects of this assessment. However, current case law, especially in the United States, places an unreasonable expectation on psychotherapists to protect all at-risk parties or foresee that a patient intends to follow through on said threats. It has largely failed to guarantee psychotherapy patients unlimited access to care, while potentially inhibiting future honest communication between patients and health professionals and endangering the safety of others. Of these decisions, the two most prominent are the 1976 Tarasoff decision and the 2016 Volk decision. This paper argues for the possibility of grounding good laws in ubuntu African philosophy in a way that protects others from harm and ensures unimpeded access to care without necessarily breaching medical confidentiality. (shrink)

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep (...) it confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)

Confidentiality of health information is increasingly relevant in the era of electronic medical records. We discuss the case of a hospitalized patient who requested a neurology consultation for an episode he described as an “LSD-like” (Lysergic acid diethylamide) flashback. The patient expressed concern that the episode was a residual effect of past drug use, but subsequently requested that his drug use not be documented. Involved in a custody battle, he feared that if his records were released to the court he (...) could lose custody of his children. Ethical concerns arose with regards to the physician’s competing obligations with a duty to record information accurately and honestly, respect patient autonomy, and maintain patient confidentiality. We discuss the decision of the team to document the patient’s drug use by arguing that the obligation to maintain confidentiality did not supersede the primary role of the medical record as a complete and accurate account, which cannot be altered at a patient’s behest. (shrink)

For counselors, the welfare of clients and the protection of the community are grounded in comprehension and implementation of ethical principles in practice. Counselors face increasing ethics complexity as organizational and political influences conflict with client’s self-interest. Two thought-experiments involving a Tarasoff-like dilemma were used to explore factors related to ethical decision-making by clinicians in definitive and ambiguous duty-to-warn situations. Outcomes demonstrated that legal, moral, and social factors influenced ethical decision-making in a non-probability sample of 221 U.S. counselors who (...) participated in the thought-experiment study. Increasing ethical uncertainty was related to a decrease in direct action, stronger influence of moral and social factors, and the stronger influence of ethical self-efficacy on decision-making. This study bridges the cognitive model of moral reasoning and social cognitive theory, extending the concept of agency into the ethical domain and suggesting refinements to moral reasoning models. Implications are discussed. (shrink)

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress. Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that (...) although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident. (shrink)

This chapters explores a variety of issues related to protecting privacy and confidentiality in research including the moral and legal basis for privacy and confidentiality; the relationship between trust and privacy and confidentiality; the difference between privacy and confidentiality; the Privacy Rule of the Health Information Portability and Accountability Act (HIPPA); the European General Data Protection Regulation; methods and strategies for protecting privacy and confidentiality; the conflict between sharing data and biospecimens and protecting privacy and confidentiality; data security, data use (...) agreements; the difference between identified and de-identified data and biospecimens; the Tarasoff case; privacy in genetic and genomic research involving family members; reporting of suspected abuse and neglect of children or vulnerable adults; and reasons for breaching privacy and confidentiality in some situations. The chapter also argues that recognizing the importance of trust in research can provide investigators with useful guidance and help solve some ethical dilemmas involving privacy and confidentiality. (shrink)

Bioethicists have virtually assumed that Tarasoff generated a duty to warn the sexual partners of an HIV‐positive man that they risked infection. Yet given the views of sex and of AIDS that have evolved in the gay community, in many cases the parallels to Tarasoff do not hold. Bioethicists should at the least attend to the community's views, and indeed should go beyond doing mere “professional ethics” to participate in the moral self‐exploration in which these views are located.

Mental health clinicians and evaluators of a person's mental health for legal purposes must address highly nuanced and possibly conflicting goals that arise in their work. Forensic Neuropsychiatric Ethics reviews real-life dilemmas facing practitioners who work in the field of mental health. The first two chapters ground the reader in the modern history and evolution of forensic ethics. Subsequent chapters provide practical direction on a range of important topics, including maintaining robust professionalism, writing an ethical report, testifying ethically, participating in (...) capital cases, managing bias and subjectivity, incorporating testing into one's opinion, and working in leadership roles. Other topics include providing informed consent; violating confidentiality; considering advance directives and physician assistance in dying; fulfilling the Tarasoff duty to protect; ethical considerations related to assisted outpatient treatment; the assessment and potential removal of firearms; the termination of pregnancy and decisional capacity; recognition of structural and implicit bias in violence risk assessments; and implications for the use of neuroscience and artificial intelligence in the courtroom. The book is written for all clinicians, forensic evaluators, educators, administrators, lawyers, and judges. (shrink)

Die ärztliche Schweigepflicht ist für die Vertrauensbeziehung zwischen Arzt und Patient von grundlegender Bedeutung. Von besonderer Brisanz sind Fälle, bei denen das Schweigegebot eine Gefährdung Dritter bewirkt. Ein aktuelles Urteil des Oberlandesgerichtes Frankfurt hat eine erhebliche medizinrechtliche und ethische Debatte ausgelöst: Eine Frau als Klägerin verlangte vom Hausarzt der Familie die Feststellung der Schadensersatzpflicht und ein hohes Schmerzensgeld aufgrund einer Pflichtverletzung, da der Arzt von der Aids-Erkrankung ihres uneinsichtigen Lebensgefährten wusste, die Patientin aber mit Verweis auf seine Schweigepflicht nicht über (...) die Gefahr informiert hatte. Problematisch ist die von den Richtern neben dem Offenbarungsrecht vertretene Rechtspflicht des Arztes zur Mitteilung des Sachverhaltes. Der Beitrag erörtert die ethischen und rechtlichen Implikationen dieses Urteils sowie die grundlegenden Regelungen des neuen Schuld- und Schadenersatzrechts in Bezug auf die ärztliche Schweigepflicht. Aus medizinethischer Perspektive ist bei der Güterabwägung für die höher rangigen Werte zu entscheiden (Prinzipien des Nichtschadens und der Benefizienz, "Tarasoff-Pflicht" zur Warnung), gleichwohl zeigen der genannte und andere Fälle Defizite in der Patient-Arzt-Beziehung in Bezug auf einen reflektierten Dialog und die Notwendigkeit von klaren Empfehlungen für den Alltag. Ein interdisziplinärer Ansatz kann medizinrechtliche und ethische Aspekte sinnvoll integrieren. (shrink)

An extended version of Gieryn's notion of ‘boundary-work’, supplemented with insights of Thomas Goodnight, is used to represent the central role of rhetoric in disputes on the boundary of science and the public. From a study of the Tarasoff-case it is shown that the rhetorical process of turning obstacles into resources works to move the boundary between a science and the law. It is concluded that rhetorical scholars can and must play a part in the resolution of boundary disputes (...) and that concrete case-studies of boundary-work may deepen criticism of argument. (shrink)

Machine generated contents note: CHAPTER 1 HEALTH CARE PROFESSIONALS AND HIV: The Duty To WarnI -- CHAPTER 2 EMERGENCY CARE AND HIV: Treatment Policy and -- Pracice17 -- CHAPTER 3 A REVOLUTIONARY POLICY? Mandatory Disclosure of HIV -- Serostaus29 -- CHAPTER 4 MINORS AND HEALTH CARE: The Limits of Consent and -- Confidentiality39 -- CHAPTER 5 THE RIGHTS TO REFUSE AND DEMAND MEDICAL -- TREATMENT: The Bounds ofAutonomy andFutli{y47 -- CHAPTER 6 RELIGIOUS FREEDOM AND THE RIGHT TO REFUSE CARE: -- (...) What Are The Limits?65 -- CHAPTER 7 ASSISTED REPRODUCTIVE TECHNOLOGY: The Business of -- Making Babies 89 -- CHAPTER 8 TWINS AND TRANSPLANTS: Choosing Who Lives 113 -- CHAPTER 9 FREE ABORTION SERVICES AND FETAL TISSUE RESEARCH: -- Freedom of Choice and Coercion123 -- CHAPTER 10 PROPERTY RIGHTS, BODY PARTS, AND REPRODUCTION: -- Who Owns the Human Body? - 139 -- CHAPTER 11 OUTBREAK IN AMERICA: The Policy of Public Verses Private -- Interests 153 -- APPENDIX A CONFIDENTIALITY OF HIV TEST RESULTS: California Health -- and Safety Code Sections 120975 Through 121020169 -- APPENDIX B HEALTH CARE PROFESSIONALS AND HIV: Texas Health and -- Safety Code Section 58.204 175 -- APPENDIX C TARASOFF v, THE REGENTS OF THE UNIVERSITY OF -- CALIFORNIA: Supreme Court of California177 -- APPENDIX D THE RIGHTS OF MINORS TO CONSENT TO HEALTH CARE: -- California Family Code Sections 6903 Through 6929183 -- APPENDIX E FEDERAL DRUG AND ALCOHOL ABUSE CONFIDENTIALITY -- REGULATIONS: Title 42 Code of Federal Regulations Part 2 187 -- APPENDIX F CHILD ABUSE REPORTING LAWS: Caitfornia Penal Code -- Sections 11164 Through 11166 193. (shrink)

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown (...) how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties. (shrink)

This chapter argues that employee and professional confidentiality rules coerce silence, generally for good purposes. Confidentiality is an arena of justified information privacy coercion. Keeping appropriate silences has been recognized as a challenging goal of personal virtue since Aristotle. When employees and professionals obtain knowledge of others in the course of their work, they incur ethical responsibility to comply with a complex set of civility rules, including those of confidentiality. Rules of silence are spelled out in ethical codes and are (...) enacted into law. The people who manage corporations are duty bound to maintain trade secrets and to not disclose information that may lead to trading on insider information. The laws of confidentiality for health care professionals are open to criticism but are generally popular. The laws that require confidentiality of lawyers are also open to criticism, and are somewhat less popular. Many people are ambivalent about the adversary system that enables lawyers to profit handsomely from keeping the secrets of despicable criminals. Financial incentives exist for voluntarily assuming difficult legal burdens of silence. Payment for secrecy is not the whole story of why confidentiality is justly coerced. The larger story involves dignity and respect for moral agency, moral autonomy and the welfare of citizens of liberal democracies. Laws that demand confidence-keeping of professionals (lawyers, doctors, corporate insiders) are generally popular -- that is, they are generally applauded by the public and embraced by practitioners in the field along with experts who study the field. (shrink)