Conflicting Conflicting LoyaltyLoyalty

Professional Professional Responsibility IIResponsibility II

Prosenjit Poddar killed Tatiana Tarasoff

October 27, 1969

• Poddar confided his intention to Dr. Moore, University Hospital psychologist, U.C. Berkeley, two months ago

• On Dr. Moore’s request, the campus police briefly detained Poddar, but released him, as he appeared rational, on his promise to stay away from Tatiana

• Dr. Powelson, Moore’s superior, asked the police to return Moore’s letter, directed that all copies of the letter and Moore’s notes be destroyed

• He further directed that no further action be taken to detain Poddar

• Tatiana returned to the university after the summer vacation, and Poddar killed her.

Tarasoff v. Regents of the Tarasoff v. Regents of the University of CaliforniaUniversity of California

• Allegation: the University should inform Tatiana’s parents upon knowing Poddar’s intention to murder Tatiana

• The University negligently permitted Poddar to be released from police custody without notifying Tatiana’s parents

Should the University Hospital Should the University Hospital inform the Tarasoffs?inform the Tarasoffs?

• No, should keep confidential patients’ information

• Yes, should breach confidentiality in special cases

Tatiana’s parents

Tatiana TarasoffDr. MooreDr. Moore

Dr. Powelson

University Police

Poddar

University Hospital

University of California

What is your view?What is your view?

• Keep confidentiality?

• Breach confidentiality?

Argument for maintaining Argument for maintaining confidentialityconfidentiality

• Encourages people to seek psychiatric help; if other people know it stigmatization

• The guarantee of confidentiality is essential in eliciting the full disclosure necessary for effective treatment

• Continued trust in his psychiatrist is needed for successful treatment

Argument for breaching Argument for breaching confidentialityconfidentiality

• A therapist’s dual obligations

• Duty to the patient and duty to the patient’s intended victim

• Should weigh these two duties

Absolute confidentialityAbsolute confidentiality-- further argument-- further argument

• Critical thinking – argument, counter-argument, rebuttal of counter-argument （破立兼備）

• Rebuttal of Counter-Argument from the perspective of society (“Consequentialism”) – breaching confidentiality can increase, rather than decrease, violence

Confidentiality not absoluteConfidentiality not absolute-- further argument-- further argument

• Breaching confidentiality only in exceptional circumstances, and only in a very limited way

• The social consequences will not be as serious as the opponents claim

• Critical thinking – disagreement over moral norms vs. over empirical facts

第二十三回

董承

曹操

吉平

吉平 : “操賊常患頭風，痛入骨髓；纔一舉發，便召某醫治。如早晚有召，只用一服毒藥，必然死矣，何必舉刀兵乎？”

“某雖醫人，未嘗忘漢”

A doctor has dual duties, which might come into conflict, and one has to choose the “weightier”duty.

Relevant facts 相關事實

Moral norms道德規範

Worldviews 世界觀

Critical ThinkingCritical Thinking• Which duty is “weightier” or more

important? (difference in moral values ；應然 )

• Which moral duty will produce better social consequences? (difference in non-moral judgement ；實然 )

Journalist Journalist • Obtains an in-side story from a

“source” and promises confidentiality• The “source” is involved with a

murder case• The police demands the journalist to

reveal the identity of the “source”• Should the journalist maintain or

breach confidentiality?

Social workerSocial worker• In the process of counseling a man,

the social worker discovers that he sexually abused his young daughter several times in the past

• The social worker tries to help him to correct himself

• Should the social worker inform the mother about the possible danger of re-occurrence?

BishopBishop• A priest confesses to the bishop that

he has sexually abused a boy • The bishop counsels him and tries to

help him repent and not to sin again• Should the bishop report this

sin/crime to the police?

Codes of ConductCodes of Conduct• Medicine• Nursing• Social work• Counselor • Psychiatry • Clergy

Codes of Medical EthicsCodes of Medical Ethics• Oath of Hippocrates• Declaration of Geneva• International Code of Medical Ethics• Principles of Medical Ethics, AMA• Medical Council, Hong Kong• Chinese Medical Council, Hong Kong

屈法伸情的絕對保密原則屈法伸情的絕對保密原則葉公語孔子曰︰「吾黨有直躬者︰

其父攘羊而子証之。」孔子曰︰「吾黨 之直者異於是︰父為子隱，子為父隱，直在其中矣。」 （論語 子路第十三 18 ）

Privacy Privacy • No access without

authorization• To enjoy privacy ≠

to have the right to privacy

• Examples?

ConfidentialityConfidentiality• is a subset of informational

privacy – it prevents redisclosure of information that was originally disclosed within a confidential relationship

• Patient doctor 3rd party

Privacy or confidentiality?Privacy or confidentiality?

私隱？

Rehearsal of argumentsRehearsal of arguments• Pro • Con

See lecture notes p.4

Considerations in disclosureConsiderations in disclosure• Harm to others – how

much, and how likely?• Is disclosure the only

means to prevent the harm?

• How wide-spread will the disclosure be?

To disclose vs. Not to discloseTo disclose vs. Not to disclose

• Harm to 3rd party is serious and very likely

• Last resort to prevent the harm

• Disclose only to those people who can prevent the harm from happening

• Harm to 3rd party is not serious and not likely

• Harm can be prevented by persuading the client

• Disclose to the public

To whom to disclose?To whom to disclose?• Harm not yet

occurred• The police?• The potential

victim’s “significant others”?

• Will it happen?

• Harm has occurred

• The police?• The potential victim’s

“significant others”?

• Will it happen again?

Patient privacy in the Patient privacy in the practice of TCMpractice of TCM

• Horror stories

•飛手把脈•十耳聽診，病案紀錄•垂簾聽症• Improvements needed?

Confidentiality in the Confidentiality in the practice of TCMpractice of TCM

• Is there such a commitment?

•Are such commitments observed?

•Incidents of violation?

•Improvements?

Future of TCM?Future of TCM?• Quality of service• Quality of care• Quality of therapeutic relationship