The shifting sands of confidentiality

Dr Danny Sullivan1

1Executive Director of Clinical Services, Forensicare

Confidentiality has long been sacrosanct in health care. In forensic practice, its status has been more equivocal, but still valuable. However there has been a recent, increasing and significant erosion of the prima facie value of confidentiality.

In this presentation I will explore the trend to limit a right to confidentiality. This is apparent in increased access to personal data provided through public transactions, and the insidious transformation of public space into a forum in which personal data can be obtained and used. Crime investigation and prevention can now draw on a broad range of public and private surveillance.

Recent legislative changes in Victoria have created several positive duties for clinicians to breach confidentiality, justified by ‘public interest’ or the rights of putative or prospective victims. Is it correct to claim confidentiality is implicit in the therapeutic relationship, or should clinicians be frank in disclosing the limits to confidentiality prior to engagement?

I will argue that clinicians should contemplate the unintended consequences of erosion of confidentiality, and engage in both public and therapeutic discourse about the value – or limits – of maintaining confidences.