For Therapists: Is Breaking Confidentiality For Contact Tracing Ethically Reasonable?
One of your clients may be COVID-19 positive. The law may require you to release their name and personal information to the contact tracers. It is to identify all those who have come in contact with your client.
What do you do? All of this may feel very wrong. You have the responsibility to preserve their privacy and confidentiality. But, you may also have to disclose information to the government due to the public health crisis.
Contact tracing is one of the most successful tools to manage the COVID-19 pandemic. Identification, isolation, and quarantine of people who have come in contact with those infected help reduce the transmission of the virus. However, it raises a concern regarding privacy, confidentiality, and individual rights.
The AMA has released guidelines for therapists and other healthcare professionals in case of a pandemic. It allows you to balance both patient confidentiality and the protection of community health.
You may wonder if this is ethically reasonable. How can you respond to such a sensitive situation?
Disclose only the necessary information
With regards to contact tracing, the two most important aspects to consider is the confidentiality of your client and the privacy of the people who have come in contact with your client.
While the latter aspect is not in your control, the former certainly is. The best way to protect your client's confidentiality is by disclosing only that information which is absolutely necessary. Nothing more, nothing less.
For example, when talking to third parties regarding possible exposure, there is no need to reveal or confirm the name of the patient.
Privacy and confidentiality extend beyond the pandemic. Your clients' records and information must be stored in a password-protected computer or secured storage cabinets. Protocols must be in place to protect the client's privacy during phone calls, video calls, or in private rooms to prevent the conversations from being overheard. You can then delete and erase the data as per government guidelines.
It is a therapist's responsibility to protect the clients' confidentiality to the greatest extent possible.
If you have to release your client's information to the authorities, then it is better to get their consent. You could inform your client that you have to share their details with the public health department for contract tracing purposes.
Considering the current situation, you could discuss the same with your client at the beginning of the therapy session. Make them aware of the fact that, if they end up testing positive for COVID-19 at any point and if you come to know about the same, then you might have to share their identity with the authorities. A signed consent wouldn't make you ethically liable.
However, the client does have the right to refuse to sign the confidentiality waiver and seek therapy elsewhere.
In case of a public health emergency, you may not need a privacy disclosure agreement from your client to share their information with the public health department.
At the beginning of the COVID-19 pandemic, the U.S. Department of Health and Human Services (HHS) implemented its enforcement discretion.
It states that all healthcare providers can use and disclose protected health information (PHI) during the COVID-19 public health emergency.
It would grant freedom for those associated with HIPAA, including therapists and psychologists, to cooperate with CDC, state, and local health departments. It would allow sharing confidential information without consent from clients known to be COVID-19 positive or a carrier.
In-house Contact Tracer
For school or college counselors, some of your staff could train to become a contact tracer. An in-house staff member trained in contact tracing would be able to handle any cases among the staff or students and maintain confidentiality in schools.
It will eliminate the need for any social or student workers to have access to confidential information for contact tracing.
Consult your board
The rules differ depending on individual state and local health departments. Therapists could consult with their lawyers, licensing board, and malpractice insurance providers to ascertain the appropriate way to approach this situation.
However, therapists should address the issue of "breaking confidentiality for the greater good" with their clients. If they explicitly agree to consent and sign a document, then you wouldn't be held liable.
So, when can a therapist break confidentiality? The answer entirely depends on the circumstance.
Therapists or healthcare providers are often reluctant to release their clients' personal information to health departments. The breach of private information disclosed in confidence is unacceptable. But, these are dire circumstances where the public health and patient confidentiality, both are at risk.
It is the therapist's responsibility to find a balance between individual rights and public health policies while upholding the highest standards of professionalism.