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Make or break client confidentiality?

You run the only substance abuse clinic in your region. One day a new client arrives. He’s your wife’s boss, whose erratic ways have been making her life so miserable that she’s decided to quit her job at the end of the month. Is this a case for breaking client confidentiality?

By Ruth McQuirter Scott and Ken Gallinger

Author's photo
Ruth McQuirter Scott is an educator and member of Port Nelson United in Burlington, Ont.

It would be lovely if I could pick and choose when to be ethical. I could decide to respect client confidentiality just as long as it didn’t negatively affect my own life. Then I would take my wife aside and tell her, in strict confidence, to hang in there — help is on its way. I’d assure her that once we’ve treated her boss, he will return a new man, life at the office will settle down and all will be well.

This scenario, of course, is ludicrous, albeit tempting. I have no more right to betray this client’s confidence than that of a stranger arriving at the clinic.

My experience in running the clinic has shown me how much courage it takes for an addict to admit to having a problem and then to take action. How devastating it would be for him to discover that his substance abuse had been revealed to one of his employees, especially when the leak came from the head of the very clinic where he had sought help. My wife may agree to keeping the information secret, but what would prevent her from using the same logic I did and revealing her boss’s addiction to a co-worker who was also suffering from his erratic behaviour?

As the director of the clinic, I have to model the highest of ethical standards. If it’s all right for me to break client confidentiality, how can I expect others to adhere to this fundamental principle? Before long, the reputation and security of the only substance abuse clinic in the region could be compromised.

I will support my wife as I always have and let her make her decision about resigning based on the information she has available. If possible, I will remove myself from direct treatment of the boss, declaring a conflict of interest. If we must interact, I will let him know of my connection to his work and guarantee his right to confidentiality.

From a purely ethical standpoint, the answer is obvious: of course it’s not a case for breaking confidentiality. Confidence is a relationship of trust, and such relationships depend on being worthy of such trust. So, in the rarefied air of pure ethics, the answer, simply, is no.

But I don’t live in such a pure world. I genuinely care about my client, but I care about my wife more. Our relationship of trust goes back a long way before either of us even met her boss, whose “erratic” behaviour is now making her life hell.

So I’d say to my wife, “You know I can’t talk about my clients. But I can tell you that the behaviour you’re seeing at work is sometimes related to substance abuse. And sometimes, if people like your boss get help from a clinic like ours, they can conquer their addictions and learn to act differently. So you might want to wait a bit before resigning, in case things improve.”

I might even wink when I said it.

Yes, I know — that’s treading perilously close to an outright breach of confidence. But I’m prepared to risk walking that close because I care more for my wife than for her boss.

Maybe she’ll resign anyway; maybe this guy is just a jerk, and his behaviour has nothing to do with addiction. All addicts aren’t nasty, and all nasty people aren’t substance abusers. She needs to make that decision for herself.

One more thought: the boss knows I’m his employee’s husband. Yes, we’re the only clinic in town, but there are other towns and other clinics. I wonder if he chose to come to me in the hope that I’d say something at home, and by doing so, help a valued employee understand her boss’s behaviour.

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