Confidentiality and Case Reporting

Ethics Committee Newsletter Piece: Confidentiality and Case Reporting
For the IPA Ethics Committee
by Howard B. Levine, MD

Professional Ethics are a foundational principle of clinical practice and, according to the philosopher Levinas, of all human relations (Chetrit-Vatine 2014). In this short communication, we will focus on patient confidentiality and case reporting, a subject that has been of recent discussion in both the Ethics Committee and the IPA Board.


In Freud’s (1913) second essay on technique, “On Beginning the Treatment,” where he described the fundamental rule of psychoanalysis - say everything that comes to mind without exception (pp. 134-137) -, he made it clear that nothing was to be exempt from disclosure in the process of free association, noting that:


            “It is very remarkable how the whole task [of analysis] becomes    impossible if a reservation [to speak one’s thoughts freely and         completely] is allowed at any single place. But we have only to       reflect what would happen if the right of asylum existed at any one point in a town; how long would it be before all the riff-raff of             the town had collected there? I once treated a high official who             was bound by his oath of office not to communicate certain things        because they were state secrets, and the analysis came to grief as             a consequence of this restriction. Psychoanalytic treatment must          have no regard for any consideration [that would allow evasion of             the basic rule], because the neurosis and its resistances are             themselves without any such regard.” (pp. 135-136).


Although unstated in this essay, no doubt Freud, who was a physician and who had taken the Hippocratic Oath, assumed that the analyst had a reciprocal obligation. If the patient was required to tell all without regard for social conventions or personal comfort, then the analyst, like the priest in the confessional, was obliged to hold whatever was told or occurred in the privacy of the consulting room in the strictest of confidence.


Without this safeguard of absolute privacy protection of the patient’s disclosures, psychoanalytic treatment becomes impossible. This principle was upheld in US Federal Court in a famous case (Jaffe vs. Redmond), in which a police officer shot and killed a man who was committing an armed robbery. Although the police officer was found to be operating within the accepted stipulated principles involving the use of force by law enforcement officers, he was nevertheless sued by the deceased robber’s family for a civil rights violation.


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