Social workers in health and social care are bound by a duty of confidentiality. This means that, outside a number of established situations, information may not be shared with others. Nevertheless, in practice it can happen that a need arises to share information and thus break the duty of confidentiality. We call this a conflict of duties. In such a situation, careful and documented balancing of interests is essential.
The duty of confidentiality within health and social care is a great thing. The profession stands for confidentiality which contributes to the approachability of care. People should be able to speak freely and share personal information with the caregiver.
In addition, the duty of confidentiality has a legal basis. Sector laws such as the Social Support Act 2015 (WMO), the Youth Act and the Long-Term Care Act explicitly describe confidentiality towards clients.
In some cases, information may be shared:
With parents of children up to 16 years of age, unless contrary to good counseling;
With directly involved colleagues for the benefit of the client and for the purpose of proper treatment;
If the provision of the information is in the law;
If the individual has given consent.
In all cases, the confidential relationship should be violated as little as possible.
There are conceivable situations where a need arises to share information without any of the above being applicable. It may be that you want to report to a doctor or the police at the moment that someone poses a serious danger to themselves or others. For example, if a client indicates an intention to harm another person. We call this a 'Conflict of Duty'. In order to determine whether the need to share information outweighs the breach of confidentiality, careful consideration is required. Consider the following:
What legitimate purpose do I want to achieve by breaking confidentiality?
Can this goal also be achieved without breaking confidentiality?
Given the situation, is it possible and desirable for me to seek consent from the client, and if so have I done everything possible to obtain consent?
Is the situation in which the client or a third party finds themselves so serious as to outweigh the client's interests in confidentiality?
If it is possible to obtain consent, the goal can be achieved without violating confidentiality, or the seriousness of the situation does not outweigh violating confidentiality to the client, do not violate confidentiality.
If you conclude that the need to provide information outweighs the duty of confidentiality to the client (proportionality) and there is no other effective means of achieving the goal (subsidiarity), a decision can be made to share information with a third party.
If so, describe the considerations made in arriving at this choice as specifically as possible. Also record which information is shared with which party. As a healthcare organization, it is wise to draw up a protocol for such a situation. In it you lay down in advance what will be included in a written balancing of interests. It also specifies which persons within the organization will be involved. After all, you never make a decision to break confidentiality alone. You need several points of view to make a good assessment. If in doubt, you can also seek external advice. Or initially present the case anonymously to the third party. Who knows, you may come to a solution together that does not require a breach of confidentiality.
But if the conclusion falls on the side of reporting rather than silence, it can be very valuable to do so. By recording the consideration in the file, if necessary, it can be explained afterwards why this choice was made. With careful and documented consideration of interests, it is not just a gut feeling that something should be reported, but is a substantiated decision that the organization stands behind.
