New Ethics Opinion Addresses Obligations Associated With Collateral Information

The opinion was written in response to the following scenario submitted to the committee:

“In cases of crisis or imminent threat to safety/wellbeing, the psychiatrist’s foremost ethical and clinical obligation is to the patient’s safety,” the Ethics Committee stated in the new opinion. “Safety concerns override concerns about conflicts in the patient’s relationships and concerns about the confidentiality of sources of collateral information. Collateral information sources are essential to psychiatrists’ clinical decision making, and collateral information should always be documented carefully in the medical record.”

The committee added that “if the source of collateral information is adamant about maintaining their confidentiality, the psychiatrist might not always need to include specific identifying information in the record, particularly if the psychiatrist knows that the patient may choose to review their medical record and the contents within at any point. While it is common clinical practice to document the source of collateral information in the electronic medical record, consideration should be made in specific situations when sensitive information is shared.”

In addition, the new opinion noted that when a psychiatrist obtains collateral information from a source, he or she should disclose the potential that the information could be shared with the patient. “Rather than guaranteeing confidentiality to collateral sources, the psychiatrist should explain directly during the initial conversation that they may not be able to protect confidentiality, that the psychiatrist has an ethical duty to be honest with their patients, and that the psychiatrist’s ultimate obligation is to the patient and the potential for imminent threat to safety/imminent harm.”

In an interview with Psychiatric News, Barber underscored that point. “We can do our best to prevent complications in family dynamics and prevent things from becoming more interpersonally fraught in the case of involuntary hospitalization,” he said. “But ultimately our foremost ethical obligations are to the patient, the patient’s safety, and to honesty with the patient.”

Ethics Committee Chair Philip Candilis, M.D., said that “guarantees” of any kind are almost never possible in medical care. “Fidelity to the patient is the guiding principle behind this opinion,” he said. “It’s about the openness and transparency that are critical to the physician-patient collaboration and that build the trust that patients must have when they are working with us.” ■