To the Editors:
Imagine that the American College of Surgeons came out with an official statement regarding the ethical principles of their profession that read as follows: “Except as required by law, a surgeon should always use aseptic technique”. Should he be required by a court of law to refrain from using aseptic tecnhique, he should conduct himself responsibly toward his patient and should confine himself to use non-aseptic technique only as may be required by law.“
A tasteless joke? I agree; and yet Section #6 of the recently published “Principles of Ethics for Psychoanalysts,” approved by the Board on Professional Standards of the Executive Council of the American Psychoanalytic Association, enunciates exactly the same principle. Let me quote here from Section #6, entitled “Protection of Confidentiality”: “Except as required by law a psychoanalyst may not reveal the confidences entrusted to him in the course of his professional work, or the particularities that he may observe in the characters of patients. Should he be required by a court of law to give testimony relating to the confidences of his patient, he should conduct himself responsibly toward his patient and should disclose only such information as may be required by law.”
Since the law in most states allows courts to subpoena a psychoanalyst, and for that matter a psychiatrist or other mental health professional, to testify about his patient, even against his patient's expressed wishes, any of us are bound to find ourselves in an untenable position just as would a surgeon if he had to follow the fictitious ethical guidelines given above. According to the logic of such guidelines, a psychoanalyst who, following his conscience, refuses to testify against his patient's wishes would behave unethically.
Part of the difficulty with Section #6 seems to derive from a confusion about the way ethical principles are to be formulated. Ethical principles should refer to general basic ideas only, and not contain specific references to how people should behave. Therefore, reference to law and courts of law has no place in such a statement of ethics. Section #6 should simply indicate that an analyst is obligated to preserve his patients' confidences and that an analytic patient has the right to expect absolute protection of whatever he verbally or otherwise confides to his analyst.
It should also be noted that the violation of a patient's right to confidential communication is a violation of the Hippocratic oath. The issue, of course, transcends psychoanalysis and concerns all psychiatry. If patients could not trust their therapists, they should not reveal to them anything of importance and could never become sufficiently involved in the treatment process.
I have recently been accepted as a member of the American Psychoanalytic Association. But the fact that the guidelines quoted above have been approved by the membership of this Association raises disquieting questions in my mind as a neophyte. Am I to understand that it is agreed to by my Association that I should be ready, if required by outside pressures, to violate my patient's confidences?
Peter C. Novotny