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Overview
Since the early 1950s, court interpretations and legislations have been sought to establish some form of privileged status regarding the psychotherapeutic communications and the medical records/data in general. Subsequently, in 1996, the Supreme Court of the United States ruled in Jaffee v Redmond HIPAA case that the psychotherapeutic communications should be privileged in any federal court.
Moreover, the medical privacy rule underlying the Health Insurance Portability and Accountability Act (HIPAA) allows the US Department of Health and Human Services to give both the patients’ medical records and psychotherapeutic notes the necessary confidentiality protections as outlined in the legislations (Mosher & Swire, 2002, p. 575).
Further, due to the underlying risk that different people may interpret these legislations in different ways or that these legislations may be in direct or indirect conflict with the existing Ethics Code for psychologists, this article seeks to discuss the ethical and legal implications of the Jaffee v Redmond HIPAA case.
Legal implications
In the early 1990s, many federal courts in almost 50 States sought to establish federal privilege regarding the psychotherapeutic communications except that they had not reached a decisive conclusion.
However, through the Jaffee v Redmond case, the US Supreme Court established an absolute privilege as opposed to a qualified privilege, which in this regard excludes case-by-case considerations seeking to factor in the impact of any evidence protected by the federal privilege in court proceedings.
As a result, the ruling implies that the privilege established in the psychotherapist-patient communications should be very reliable and unambiguous to maintain confidence and trust in the psychotherapist-patient relationship (Mosher & Swire, 2002, p. 576).
Furthermore, the Jaffee v Redmond case promotes confidential psychotherapy, which has been overlooked by the society for many years. Here, it is worth noting that many federal courts pursue certain truths in different cases by examining any possible piece of evidence that tends to overlook the need to maintain and protect confidential treatment relationships.
Therefore, this case is a first step toward expressing the paramount need for other legal considerations that compel psychotherapists and other health practitioners to disclose damaging information provided by patients to give way to the ideals of confidential psychotherapy as outlined in the Ethics Code (American Psychological Association, 2011).
On the other hand, the foregoing significance of the case notwithstanding, it is equally important to take note that the legal privilege in Jaffee v Redmond does not include psychotherapeutic communications made under private arrangements. For instance, with regard to insurance contracts, the psychotherapist can seek the patient’s consent to disclosure regardless of the underlying federal privilege (Mosher & Swire, 2002, p. 576).
Moreover, the federal privilege (HIPAA) rule in Jaffee v Redmond does have any direct legal implications in cases whereby the patient consents to the psychotherapist to present evidence (confidential information) to a federal court.
Here, the consent to disclosure is occasioned by instances where a third-party is involved in covering the medical expenses of the patient, in making applications for life insurance, or in cases whereby the patient may consider that the psychotherapist’s testimony will aid court proceedings.
Therefore, the patient’s consent or voluntary privilege waiver denies the psychotherapist any legal basis to withhold confidential information in many States except the District of Columbia whereby even in the existence of the consent, the action of disclosing the patient’s confidential data is still considered to be illegal (Mosher & Swire, 2002, p. 578).
Conversely, a disclosure may be sought without the patient’s consent in case the patient has a communicable disease, gunshot wounds, or the patient intends to pose an imminent harm to third parties.
However, the Jaffee v Redmond and other state privilege legislations provide a protective order that prevents third parties from using the information disclosed in court for any other purposes besides litigation (Mosher & Swire, 2002, p. 580).
Ethical implications
The Jaffee v Redmond and the HIPAA privilege rule reduce the conflict between law and ethics. Here, according to the Ethics Code, the psychiatrists and other medical professionals are under obligation to follow the law. However, these people do encounter cases whereby the law comes in direct conflict with ethical standards (American Psychological Association, 2011, p. 1 of 15).
Therefore, considering that the Jaffee v Redmond HIPAA case recognizes the significance of the APA ethical codes, the ruling seeks to support those psychiatric and medical professionals pursuing ethical considerations that will result in protection of the patient’s confidential information. Further, real-world experience presents psychiatric and medical practitioners with numerous conflicts, which may prove challenging to resolve.
For instance, it is the duty of the practitioner to explain the limits of confidentiality before treating the patient and developing a positive relationship (American Psychological Association, 2011). However, consider cases whereby the practitioner discloses to the patient that any information regarding child abuse, domestic violence, or crime will be reported to the authorities.
It is evident that the amount of information that the patient will be willing to give the practitioner will be limited to non-incriminating information only. It then follows that such an ethical obligation may lead to failure of some psychotherapeutic procedures such as psychoanalysis (Mosher & Swire, 2002, p. 576).
Taking the preceding conflict into perspective, the Jaffee v Redmond HIPAA case presents avenues through which practitioners can resolve disputes involving ethical codes and the law. Here, the ethical precepts withstanding, the practitioner should seek the patient’s consent or refer to provisions regarding cases whereby disclosure is paramount regardless of the patient’s wishes to resolve outstanding conflicts.
As noted earlier, when the patient decides to give a voluntary privilege waiver, it is the duty of the practitioner after consulting colleagues and legal advisors to ensure that disclosure of confidential information is in the best interest of the patient especially when the patient does not understand the extent and possible consequences of the disclosures (Mosher & Swire, 2002, p. 578).
On the other hand, both the state privilege statutes and the Jaffee v Redmond federal privilege protect patients against compelled disclosure of confidential information without consent, which may be deemed necessary to satisfy specific ethical duties.
Therefore, both the psychotherapist-patient and physician-patient privilege legislations safeguard patients against being coerced into providing the privilege waiver besides recognizing the ethical duty of practitioners to act in the patient’s behalf when the patient is incapable of making informed decisions.
Overall, the legal duty of the practitioners in protecting third parties against any imminent harm intended by the patient may not hold without first involving the patient in the act of protecting others rather ignoring the principles of confidentiality all together (Mosher & Swire, 2002, p. 583).
References
American Psychological Association. (2011). Ethical principles of psychologists and code of conduct, 2010 Amendments. Web.
Mosher, P. W. & Swire, P. P. (2002). The ethical and legal implications of Jaffee v Redmond and the HIPAA medical privacy rule for psychotherapy and general psychiatry. Psychiatric Clinics of North America, 25, 575-584. Web.
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