Westmead Psychotherapy Program, Sydney University, Cumberland Hospital, 5 Fleet St, North Parramatta, NSW, Australia.
J Bioeth Inq. 2019 Sep;16(3):469-471. doi: 10.1007/s11673-019-09925-1. Epub 2019 Jul 29.
"Jane" is a mother of two, who was referred for psychotherapy. However, Jane had misgivings about engaging in the offered psychotherapy because of threats made by her domestically violent partner. The therapy sessions are audio recorded for the purpose of professional supervision and clinician reflective practices. Jane's partner had threatened to subpoena the therapy recordings to legally separate Jane from her children. This article focuses on how three different parts of Jane's multidisciplinary care (i.e. clinicians, policy professionals and medico-legal professionals) exhibit different competing ethical priorities. Psychotherapeutic clinicians private use of audio recordings of the therapy enhances patient care and their own professional development but with the risk of concealing possible unethical behaviour by either party. Medico-legal access to the therapy recordings preserves potentially relevant evidence in the pursuit of justice but risks the interpretation of the psychotherapeutic information outside of the therapeutic context. Policies advocating the inclusion of the therapy recordings in the medical record improves clinician (and health service) accountability but risks harming the vulnerable patient due to threats to patient-therapist confidentiality.
“简”是两个孩子的母亲，她被推荐接受心理治疗。然而，由于她的家暴伴侣的威胁，简对接受所提供的心理治疗心存疑虑。治疗过程会被录音，目的是为了专业监督和临床医生的反思实践。简的伴侣曾威胁要传唤治疗录音，以便将简从她的孩子身边合法分离。本文重点介绍简的多学科护理（即临床医生、政策专业人员和医疗法律专业人员）的三个不同部分如何表现出不同的竞争伦理优先级。心理治疗临床医生对治疗录音的私人使用可以增强患者的护理和他们自己的专业发展，但也存在隐瞒任何一方不道德行为的风险。医疗法律方面可以获取治疗录音，以维护司法公正，但可能会冒着在治疗背景之外解读心理治疗信息的风险。倡导将治疗录音纳入医疗记录的政策可以提高临床医生（和卫生服务）的问责制，但由于对医患保密的威胁，可能会伤害到弱势患者。
