The PANY Bulletin

Psychoanalytic Association of New York
Volume 43, #3 Fall 2005

Ethics In Sight

Confidentiality: Duty to Report
(Ethics Case Book pp. 25-27)

Dr. Johnson is a training analyst who hears from one of his candidate patients during an analytic session that a colleague, Dr. Duval is becoming demented. Apparently, Dr. John-son's candidate patient is a close personal friend of another candidate who is being analyzed by Dr. Duval. This friend told the patient that Dr. Duval tells the same joke over and over again, frequently falls asleep during sessions, and calls his patient by the wrong name. Dr. Johnson is deeply troubled by this news but has no other source of information about Dr. Duval's cognitive decline. Dr. Duval attends Education Committee meetings only infrequently and is usually silent during discussions.
Is it enough to hope that other colleagues or supervisees working with Dr. Duval would ultimately bring this to the attention of the appropriate committee or the director of the institute? Whose responsibility is this unpleasant duty?

Dr. Johnson is perplexed as to what action he should take. He knows that information he hears from the couch must be kept confidential. However, he is worried that candidates and other patients are being harmed by his inaction and by Dr. Duval's possible decline. He considers asking his candidate patient to encourage his friend who is in analysis with Dr. Duval to bring this to the attention of the director of the institute or the assistance or ethics committee of the institute. On the other hand, he is uncertain as to the accuracy of the information he is hearing and is equally concerned that pressuring his candidate patient in that way is not in the best interest of the analytic process. He also wonders about setting up a lunch appointment with Dr. Duval so that he could have a personal conversation with him and evaluate his cognitive functioning in that context. But he recognizes that even a lunch appointment such as that would be acting on information he heard from the couch. What should he do?

At this point we encourage you to consider this ethical issue before moving on to Dr. Clark’s discussion.

He is thinking ethically by recognizing that he should not use information obtained from the couch. The Tarasoff decision does not apply here because the harm to patients involved is not in the same category as homicidal threats that might legally require breaching of confidentiality. If he pressures his candidate patient to take action and speak with his friend, Dr. Johnson places both candidates in very difficult positions. He decides to continue analyzing his patient while observing any extra-analytic evidence of cognitive decline in Dr. Duval. He also decides to consult the Analyst Assistance Committee of his institute to alert them to his concerns without giving the specific information that he has heard from his patient.

It is essential to act in association with others to compare observations and decide on a course of action. It would be unlikely that the transference influenced patient would be able to handle the situation without outside help. The profession has a collective responsibility to safeguard the public and the profession, as well as to care for its own impaired members.

We encourage our readers to send their own discussions of this case to either Dr. Clark or the Editor.