Social Work Ethics: Understanding Confidentiality

What happens if a client dies?

Social workers and MFTs frequently ask me legal and ethical questions related to their private practice or licensing prep. One question that I get asked about a lot is the limits to confidentiality, and when we can, or cannot release information. It’s really tricky because there are a lot of different factors that go into this. As practitioners we have a responsibility to our clients and legal responsibilities as well. Let’s take a closer look at this with a sample question:

Clinical Scenario:

A therapist in a private practice has been working with a 19-year-old male for three years when the client commits suicide.  The client's mother, who had previous contact with the therapist when the client was a minor, calls the therapist crying and asks if she can have access to her son’s records as a way to, “understand what he was going through.”  How should the therapist respond to this request?

A. Explain that her son had not signed a release of information for this disclosure.

B. Maintain the client's confidentiality according to professional standards.

C. Release limited records from the time period that the mother had contact with the therapist.

D. Empathize with the mother's request and release the full record to the mother.

When working with client’s who are living adults, it’s much more clear what the limits of confidentiality are. You want to maintain the client's confidentiality unless there is a "compelling professional reason" for disclosure, which includes the prevention of "serious, foreseeable, and imminent harm to a client or another identifiable person, or laws or regulations that require the disclosure without the client's consent," (NASW Code of Ethics, 2008).  

But what do we do when a client dies? Do they lose their right to confidentiality?  What about in the situation above, where the parent at one time DID have potential rights to access the information?

According to the NASW Code of Ethics, social workers should continue to protect the confidentiality of clients, even after the client has passed away. As practitioners, we can’t disclose confidential information unless we have received the proper legal authorization to do so (such as a subpoena from a judge). When a disclosure of confidential information has been properly authorized, the least amount of information should be given in order to fulfill the purpose of the disclosure (Reamer, 2010).

Please visit this website for a digital copy of the NASW Code of Ethics: http://www.naswdc.org/pubs/code/code.asp.

Answer:

With this in mind, the correct answer to the question above is B: maintain confidentiality according to professional standards.  A is not the best answer because it provides the mother with information that should be kept confidential -- we don't know if the client had informed his mother that he was in ongoing treatment, we only know that treatment began when he was a minor.  C is not the best answer because as far as the question is concerned, the therapist doesn't have a current release of information -- it doesn't matter if there was a release of information at one time -- if it's expired, it's expired.  D also goes too far; while emotionally the therapist might want to try to find a way to honor the mother's request, the first responsibility is to the client and the client's right to privacy and confidentiality.  It might seem like a case in which an exception should be made, but that would likely be the therapist's desire to make the mother (or him/herself) feel better in the face of this tragedy coming through.  There is no legal or "compelling professional" reason to disclose confidential information in this case.

Think our straightforward, sensible approach could help you PASS your social work exam or MFT exam? If you're preparing for the social work exam click here- Social Work Exam Prep; if you're preparing for the MFT exam, click here MFT Exam Prep. Learn more about our exam prep at the The Therapist Development Center home page.

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