Writing About Clients: Ethical Considerations and Options

Abstract

Today, the decision to prepare clinical case material for publication is a decision that cannot be taken lightly. The decision involves reviewing ethical considerations and choosing among various options to safeguard client privacy. Such options include seeking the client's permission, disguising case material, and developing composite case material. These considerations are discussed and options are described along with guidelines and a case example illustrating these points.

Case Studies and the Therapeutic Relationship

“…Among the many ethical considerations in publishing clinical cases are the following: (1) preserving confidentiality-that is, protecting the patient's right to privacy; (2) fulfilling the physician's pedagogical responsibilities; (3) adhering to the principle of nonmaleficence, which entails avoiding any action that may harm the patient; and (4) respecting the potential ownership rights of the patient to written material that pertains to his or her care [2].…”

“…On the one hand, information contained in the medical record belongs to the patient and, absent a subpoena or other compelling legal authorization, cannot be released to third parties who are not directly involved in the patient's care without the patient's explicit consent [2,3]. On the other hand, it is not clear that physicians are ethically required to subject written accounts of their own clinical experiences to a "prior restraint" process governed by the patient's preferences.…”

“…Indeed, any putative "right" of the patient to approve or edit such material creates potential barriers to the unfettered transmission of medical knowledge. Nonetheless, the principle of nonmaleficence may impose certain constraints on what the physician may publish, sometimes superseding the physician's pedagogical responsibilities and prerogatives [2,3].…”

Commentary: Critical Reflections on the Ethical and Professional Considerations in Writing About Clients

“…The potential value and harm of using clients' stories in public venues must be cautiously weighed. The articles by Duffy (2010) and Sperry and Pies (2010) offered comprehensive and insightful ethical discussions, accompanied by valuable recommendations for best practice. Shifting from the general to the specific, Kantrowitz (2010) narrowed her discussion to psychoanalytic case studies, aptly reviewing the advantages of and the hazards of disguising identities in this therapeutic context.…”

“…If one uses real student cases for teaching purposes, no identifying student data (e.g., student name, school, or school district name) should be reported. School personnel should consider Sperry and Pies's (2010) guidelines for seeking permission, disguising the client identities, and developing a composite case. However, the nonidentifying information (i.e., the student's narrative in behavioral terms) presented to the public must not be embellished, distorted, or invented.…”