John Smith, M.D., is a psychiatrist with a private practice. He has been extremely successful in helping child-abusing parents. Many of his clients have sent him others; at present, nearly seventy per cent of his clients are people who have physically, mentally, or sexually abused their children.
Dr. Smith’s provision of effective therapy is not the only reason for his exceptional concentration on child-abusing clients. He also systematically refuses to report child-abuse cases to the authorities, and he includes no mention of child abuse in his clients’ files. Because of this, a number of his clients are serious abusers who have not previously sought counselling and who will not take their abused children to physicians because of their fear of being reported to authorities. Dr. Smith believes that by rigorously protecting confidentiality, he is able to help precisely those people who are most likely to injure their children.
1. What ethical issue questions can you think of that pertain to this case? Is there one issue question in particular that you think captures the most important moral problem to be addressed here?
2. Suppose the main issue question is this: “Is Dr. Smith’s confidentiality policy morally justifiable?” What are the possible answers to this question that should be analyzed?
3. What are the likely consequences of Smith doing what he does, and what are the likely consequences of him doing otherwise? How do these consequences compare with one another, morally speaking?
4. Given the issue question of whether or not Smith’s confidentiality policy is justifiable, what answer would you support and by what reasoning would you support it?