Ethics of Disclosure

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Course Description

E20   Ethics of Disclosure, 3 CE hours, $21

Description: Intentionally or unintentionally, every individual chooses what he discloses and what he, for one purpose or another, neglects to disclose. The selection of this, especially among professionals, is an ethical issue.

Objectives: At the end of this course, you will  understand  1.  the relationship between disclosure, secrecy and privacy, 2. the basics of administrative, counseling, medical and social disclosure, and 3. the principles of the ethics of disclosure.

Course Exam

Study this web-site for 3 hours for an approved (RN-CEP 16144) 3-hours Continuing Education Certificate (0.3 CEUs). Click here for the self-correcting test.

Warmup Exercise

Do the following for self-study. Do not submit the answers.

  1. T F – Privacy and secrecy are the same.
  2. T F – Total disclosure is not practical.
  3. T F – There is less privacy than 100 years ago.
  4. T F – Most people regret the lack of privacy.

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1. Disclosure, Secrecy and Privacy

To take the privacy  quiz, go to: http://www.regreform.hhs.gov/hipaaquiz_0204171/sld001.htm

Disclosure involves much more than the communication of a secret. According to Steele (1975, p. 3), it is “a critical variable to all of us as individuals in relation to the world around us.” Thus the area of disclosure really deals with many aspects of the larger field of communication.

Disclosure has a big impact on every life. “We are rewarded and punished for what we disclose, not for the absolute realities of what we are and do” (Steele, p. 5). Many people advocate openness and free discussion, but disclosure goes farther than this. It concerns not only the communication style but also the individual’s life style.

Disclosure has its costs and its gains. Generally individuals develop behavior patterns of disclosure to maximize the gains and minimize the costs of disclosure. No person would advocate full and complete disclosure of everything. This would not only clog the human communication systems but also interfere with rational decision-making. Thus, intentionally or unintentionally, every individual chooses what he discloses and what he, for one purpose or another, neglects to disclose. The selection of this, especially among professionals, is an ethical issue.

Classifications

Information may be classified broadly into three kinds, namely,

  1. Free and open information,
  2. Judicious information, that is free to a special public but that may be used with digression in a general way, and
  3. Secrets, that are not to be communicated to, others except those officially cleared  to receive them. 

Another way of stating it is in reference to low, middle, and high disclosure. In this case, low or very low disclosure is secrecy, middle disclosure is judicious use, and high disclosure is open free communication of all information.

What Limits Disclosure

Steele presents three threats that he considers the underlying causes of low disclosure. The first threat concerns the evaluation of the information. That is the threat that the person disclosing the information will be rejected or harmed by the disclosed information. Secondly, the person receiving the disclosure may be angered or alienated by the disclosure, then there is the threat of social loss. The third threat concerns the loss of control. Once a disclosure is made, the person disclosing it has given up various problem-solving strategies (p. 9, 10).

In evaluating disclosure, just like in all communication, four aspects may be considered, that is the content, the sender, the receiver, and the climate. Disclosure takes time. The sender needs the personal and job security to open up the information. The receiver must have a high commitment to relationship maintenance. Further, only a climate of trust can stimulate a move toward a higher disclosure level. Thus, like all administration, the proper level of disclosure is situational. In some circumstances, a low level is appropriate, in others a high level of disclosure may be possible.

Facts may be considered as either being friendly or unfriendly. The realist will tend toward the first conclusion, the idealist or materialist toward the second one. While facts may be friendly, the professional will try to make some effort to have them fall into friendly hands. For unfriendly hands may disturb even the most friendly facts. But the possibility that the facts may fall into unfriendly hands cannot be a reason for a blanket of low disclosure. As stated before, the amount of information makes selections in disclosure necessary.

The professional will have to consider what information should be disclosed to whom, at what time, and in what way. Information may be disclosed in a responsible way or in an irresponsible one. Irresponsible disclosure is a kind of manipulation that generally does more harm than a low disclosure level. There are other limits to disclosure. “A society in which everyone somehow had to disclose everything about his or her self to everyone would be psychologically unlivable. People would have no way of establishing or maintaining an identity or boundary sense of where they leave off and others begin” (Steele, p. 7). This desire for privacy, private rights, and public trust calls for a low disclosure level in some life areas. While self-managed disclosure is usually acceptable, forced disclosure is not. The issue becomes complicated by third-party disclosure of confidential information presented to a second party.

There are three generally accepted rules that limit disclosure on controversial issues in formal meetings:

  1. A person should not disagree with his or her superior when others are present
  2. A controversial topic should not be raised unless it has been cleared in advance with anyone who might be embarrassed by it
  3. Negative feelings about superiors or subordinates should not be expressed with others present (with peers, however, these feelings can be expressed as long as they are put in non-emotional terms).  (Steele, p. 59)

These principles do not hold true for informal meetings, thus placing much strain on the formal/informal organizational boundaries. High disclosure is thus generally reserved for informal meetings and low disclosure for formal ones. Instead of disclosure, public meetings are often given over to descriptions of rosy pictures and display of good images. Steele presents three major costs of low disclosure resulting from the above three principles. These are the conducting of a larger number of meetings, the repeating of issues, and an inability to really discuss issues and a resulting forfeiture of group influence (p. 64).

The Decision to Disclose

The decision to disclose or not to disclose must often be made by one individual, since the sharing of information in the disclosure decision-making process itself is already a disclosure. Thus each individual must judge by himself if disclosure, or study of disclosure, is relevant or irrelevant. At times it may be appropriate to bring another individual into this decision-making process, thus in fact limiting the initial disclosure to one individual. These two, or in some cases more individuals, then decide the relevancy or irrelevancy of further disclosure. With current freedom-of-information concepts this latter group decision-making process regarding disclosure may be open to question.

Some aspects encouraging low disclosure in organizations include unchangeable agendas, rigid parliamentary procedures, an enforced “positive” attitude, and the classification of information as secret or confidential.

Motivation to Disclose…or Not

Disclosure may be motivated either by the holder or the prospective receiver of the information. The prospective receiver of the information may have just a desire to know, or he may have a need to know, or he may have a right to know. The level of the prospective receiver’s desire for information influences the disclosure process.

“What people don’t know, won’t hurt them” is a common maxim. There exists a common belief that the disclosure of information, rather than the fact itself is to blame. Thus in the Watergate-trials, much discussion centered on the fact that President Nixon could have saved himself if the tapes would have been destroyed. The impression was often given that the tapes brought him down, rather than the acts and speeches that were recorded on the tapes. The existence or nonexistence of the tapes would not have changed the actual facts.

While many individuals state that they have nothing to hide, all have some to hide, and all hide some things. Among them are “taboos” such as matters concerning salaries, career decisions, and personal feelings and thoughts.

According to Steele, “Every disclosure act provides some person with an opportunity for learning, action, or control that was formerly held only by the discloser” (p. 113). Thus disclosure is related to control and power in organization. Wisely used, disclosed information strengthens both the hearer and the discloser. The hearer is enriched by the information, and the discloser is enriched by the hearer’s reaction and response to his disclosure. Thus low disclosure attempts to control people, high disclosure involves all people in concerted control of events.

Disclosure, that is the entering of information into the economy of an organization, demands time and effort. Basically, disclosure, in one sense, is expensive. Thus the value of nondisclosure of a certain Issue as compared to the value of beneficial by-product of disclosure must be constantly studied. “A system that consistently suppresses information about the consequences of the actions of its members will be unable to really learn from either its success or its failures. Policy-making in such a system will tend to make long-range plans based more on assumptions or individual biases than on generalizations derived from their own experiences in their environment” (Steele, p. 140).

Many restraining and driving forces act on every disclosure situation. Restraining forces include such forces such as fear of failure, desire for unilateral control, lack of disclosure skills. Driving forces may include desires to collaborate and inform, interest in the area, and a desire to learn.

confroom

2. Organizational Secrecy and Disclosure

A closed organization has a low disclosure level, an open one has a high disclosure level. Steele lists seven qualities of an open organization:

  1. Secrecy as a policy is the exception rather than the rule.
  2. Facts are usually friendly, it is better to deal with them than to avoid them.
  3. When people share their reactions and responses, it is less necessary to speculate how people feel.
  4. The disclosure process is not blamed for problems.
  5. Information will be selectively screened for disclosure.
  6. A group is not required to avoid a topic because one or two members are uncomfortable with it.
  7. A relatively small proportion of information is labeled private. (pp. 193-195)

OREGON LAW: “ORS 192.420: Right to inspect public records: (1) Every person has a right to inspect any public record of a public body in this state, except as otherwise expressly provided by ORS 192.501 to 192.505.

ORS 657.665 provides that information secured from employing units, employers or other individuals pursuant to Oregon unemployment compensation law shall be confidential and for the exclusive use and information of the Director of the Employment Department in the discharge of duties and shall not be open to the public or to public officials except as otherwise provided in ORS 657.665.”

Areas of Administrative Secrecy

The four large areas of administrative secrecy concern information related to purchase or lease of property, personnel problems, collective bargaining negotiation strategies, and legal consultation involving finances. Recent laws, usually called sunshine laws, in many states require public business and board deliberation in all areas except the above four areas to be conducted in open public sessions.

Agencies and organizations acquire property, and in the process raise the value of adjoining properties. Unless this type of business is undertaken in secrecy, unscrupulous individuals may take advantage of the early information and profit from it in a financial way.

In any investigation, there is a desire to protect an individual’s privacy. Personnel problems, in order to isolate them and solve them, are then often best conducted in secrecy in order to minimize adverse and uninformed publicity. Eventually some information is released. But individuals would not be willing to speak honestly and frankly, or give positive or negative recommendations or statements, if their every word would be public information.

Labor negotiations require secret strategies and plans. Without these, there would be no slow unfolding of information, and the required give and take.

Also many legal matters may be difficult to discuss in public. Especially is this true in cases when open meeting would have detrimental financial effects.

Sunshine laws in many states require that all board meetings, except those concerning the above mentioned four areas, be open to the public. Many of these laws also prohibit the closed executive sessions preparatory to board meetings.

Administrative Disclosure

Administrators are privy to personnel information that, if it fell into malicious hands, could be used very destructively. Thus administrators have a duty to screen disclosures in order to judiciously minimize these possibilities. Of course this does not mean that all or much of potentially harmful personnel information should be stamped “secret,” rather it must be released judiciously.

Current freedom of information laws open up many organization’s files to the public. Thus the information is screened for disclosure before It is placed in these files.

Administrators perform, among others, counseling functions. The information then incidentally obtained is, as a rule, not confidential in the same way as is a counselor’s information. Wise administrators, before these sessions, clearly lay the ground rules so that no misunderstandings follow. These ground rules may or may not provide for confidentiality.

Administrators may have a tendency to disclosure image building information and to keep in secrecy potentially image depreciating information. Realistic administration calls for judicious disclosure of both positive and negative information.

Administrative disclosure is in a large part limited by the available resources. Thus most organizations can afford to allocate only a small portion of their administrative expense for disclosing purposes. In many organizations, administration accounts for about ten percent of the expenses, and of this, generally no more than a quarter would go for disclosure expenses. The above proportions are based on general observations, rather than on researched data.

Financial Disclosure in Elections

ELECTIONS: “In 1987, New York State enacted the Ethics in Government Act. The Act made sweeping reforms intended to restore the public’s trust in government through the prevention of corruption, favoritism, undue influence and abuses of official positions.

The Act imposes restrictions on the business and professional activities of State officers and employees and political party officers. It also requires Statewide elected officials and candidates for Statewide elected office, certain State officers and employees, members of the Legislature, legislative employees and others to file financial disclosure statements. Many State employees know the Commission only through the requirement that they file annual statements of financial disclosure. More than 18,000 State employees file each year.

The Annual Statement of Financial Disclosure provides the Commission and the public with information about the activities and investments of those required to file which might reasonably tend to indicate the existence of a conflict of interest or potential violation of the public trust.”

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3. Counseling Disclosure

While administrative disclosure concerns generally group actions, counseling disclosure concerns the practitioner-client relationship. This relationship may be one of a professional counselor, of a minister, or of a psychologist.

The agency for whom the counselor works may require access to the information the counselor obtains. This may be particularly true of written information, such as case reports and case notes. Confidential information may also be required or desired by colleagues in their helping professions.

The relationship between a counselor and his client is that of a contract. Generally, this contract, whether written or oral, whether fully expressed or just understood, calls for confidentiality of the information disclosed by the client to the counselor. There are exceptions to this contract relationship, and every counselor sometimes walks the fine line between exceptions and information misuse.

Merchant, in a volume edited by Blackham, argued for absolute confidentiality in the counseling relationship. Basically, he argued that the responsibility for disclosure should remain always with the client, and should never move to the counselor. He further stated that the client has the right to know the boundaries of the contract (p. 34).

The counselor, in many ways, is effective because he is able to deal with confidential information without increasing the circle of people in the know. While society thrives on a high disclosure level, there must be in this world some corner where a person may seek private, that is confidential, rather than public help.

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4. Medical Disclosures

The physician is, among other things, a specialized counselor. He practices medicine, employing counseling as one method of client communication. While the matters described in the foregoing section also apply to medical information, there are special areas of disclosure that mainly pertain to medicine. J. S. Norell observed that “Doctors may pass in and out of important and significant areas of their patients’ lives effortlessly, and with the minimum of formality. Their intrusion into very personal matters scarcely may give rise to embarrassment–rather the reverse, expression of relief.” Yet in court, more so than lawyers or priests, he may be directed to disclose whatever he knows about a medical case. Further, he is required by law to report infectious diseases, industrial diseases, and other medico-legal matters.

Doctors, in order to treat their patients, need full and unreserved access to information that might have a bearing on their patient’s condition. This access to information, if not protected by a high standard of confidentiality, would not be available to the doctor. The doctor-patient relationship is based on a trust relationship that, while not explicitly, presupposes a high degree of confidentiality. While the doctor may treat his medical information as confidential, he usually readily discloses medical matters in the act of consultation with other physicians, and also to nurses and social workers. The primum, non norece, that is the “first of all do no harm” principle of medical ethics relates, on the part of the patient, to the needed confidence in the doctor, that he will do his best on the patient’s behalf while exercising care and tact.

Case

“Only one case of HIV transmission from health care professional to patient has been documented. The case involved an HIV+ dentist who might have infected a patient. Currently, the debate centers around the argument of disclosure of HIV status. Should HIV+ family practitioners inform their patients about their illness? What about HIV+ surgeons? Nurses? Are current protective measures enough? Many hospitals have a “don’t ask, don’t tell” policy towards infected employees. In fear of litigation from both HCPs and patients, they turn a blind eye.”

Disclose

“The main argument for disclosure for HCPs relates to the idea that people have the right to know all risks–no matter how small–associated with their care. In turn, this argument is founded on the assumption that HIV+ HCPs pose a risk to their patients. Proponents of disclosure argue that no protection is enough. In this age when we’re constantly learning new facts about HIV transmission, we cannot afford to take any risks. Every day nurses and physicians across the country stick themselves accidentally with needles. What guarantees are there that they won’t accidentally bleed into patients during surgical or invasive procedures? Similar arguments can be made for disclosure on the parts of other patients. Spouses or partners should know so they can protect themselves from infection. Other family members should know simply for emotional reasons — they must be prepared to handle the worst. ”

Do Not Disclose

“The primary argument against disclosure revolves around the idea that HCPs do not pose a risk to patients in the first place. Without fluid-to-fluid contact, HIV cannot be spread. In addition, physicians and nurses wear gloves when handling needles. Often, in emergency rooms, they double up on gloves. Certain doctors who do not perform invasive procedures present no risk to patients. Others take more than adequate protection. While there’s no guarantee, the empirical evidence indicates that the risk is negligible. While a number of HIV+ HCPs are known to be practicing medicine, only one — the Florida dentist — has ever been accused of passing the virus to his patients.

Again, similar claims can be made for hiding the HIV status of non-HCPs. Most people with AIDS pose no risk to their co-workers. Many might be able to carry out their responsibilities for years after being diagnosed (Note: Most would agree that there is no argument for hiding HIV status from spouses or partners.)

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5. Social Disclosures

In society at large, disclosure relates closely to privacy. The legal concept that each man’s house is his private castle includes the protection from forced disclosure. Individuals or homes may not be searched without cause, suspects may withhold information that may incriminate them. In these, and many other ways, society protects the individual’s rights to privacy. In industry, business, and in government, these rights are further protected by anti-espionage laws. Newspaper reporters, as highlighted in the Pentagon Paper’s issue, stand on their right to protect the sources of their information through their silence. The-President of the United States claims the right to confidential communication through what is called executive privilege. While the records of most private organizations are generally not open, those of governmental agencies are. The Freedom of Information laws have extended the openness of both private and public organizations. Credit card and bank records, while at one time confidential, have been disclosed to government agencies. Most personnel records, both in private and public organizations, have been pried open to the inspection of specified individuals.

Some government and organizations limit information disclosure through censure. School and college newspapers usually limit the rights of the editors, if not through direct and open pre-publication censure, then through guidelines on administrative procedures.

The absolute secrecy of written documents has diminished in recent years. Government classified and specially court ordered documents still enjoy a certain level of secrecy. So does oral communication. But the erosion of privacy in a high disclosure society is a great concern to many citizens.

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6. Toward an Ethics of Disclosure

One perspective to the ethics of disclosure deals with a God-centered view, be it Christian, Jewish or Moslem:

God could personally have swept that first Eve-snake encounter under a large Eden rock and stamped it super-secret. Or he could have “recalled” Lucifer as a defective product and easily squelched the rebellion in the bud–all without anybody knowing about it. God who can do everything is a God who can keep secrets, and who can impose secrecy on his creatures. But God’s principle is not one of secrecy, but one of disclosure. It is one of progressive disclosure, disclosing more and more as man is able to bear it. Throughout eternity, God will not only disclose more and more of His mysteries, but He will also add to our capacity to appreciate and understand His disclosures.

The human record opens with a rush of disclosures. Before Adam march all created species of nature, and he names them all. God openly reveals himself to Adam and Eve, there is no secrecy. Secrecy enters into the record with sin. Not God, but man hid himself. Eventually the open door of Eden swings shut on the human race, but not for eternity.

Sin limits the open relationship between man and God, it hinders open disclosure on the part of both. Limited disclosure leads to mystification, to puzzlement, to secrecy.

God has granted to the after-Eden man secrecy as a blessing. Before sin, man’s personhood was perfectly secure in the dominant man-God relationship. Man had nothing to hide, nothing to keep secret. Everything was good and sharable. With this dominant relationship broken or damaged, sinful man has something to hide, something to protect. His personhood would be constantly threatened if his every questionable thought, motive, or act would be open to the observation of all. In mercy, God made Adam and Eve clothing to hide their nakedness. In mercy, He veiled Himself in a cloud so that His brightness would not destroy the sin-occupied individual. In mercy, He revealed Himself slowly and progressively, for man otherwise could not understand or comprehend God’s wonderful ways with men. In mercy He dimmed our vision and other senses so that our information might be limited, and also our need to disclose.

Secrecy is not a cardinal principle of the God. Heaven is not a land with all gates marked “no trespassing, keep out.” Heaven is not a secret installation that progressively provides more and more access to a chosen few. Heaven does not automatically classify all or most records as secret and open them up only to the insistent and prying.

Disclosure is a cardinal principle of the God. Heaven makes all information available as man is able to comprehend it. Total disclosure of all information would bury man under an avalanche of irrelevant data. God opens Himself up before man a little bit at a time, more and more each time. In this way, God provides time to mature a lasting personal relationship.

God did not censure Satan’s rebellion from the heavenly records and communications. He honestly faces the good and the bad. He did not blot out Eve’s fall as a happening. He has another way of taking care of it.

In His relationship with man, God works for maximum disclosure. He sent His Son to show the love of the Father. He disclosed His thoughts and acts, and made these disclosures permanent in the written records of the Holy Writ. He provides for man’s full disclosure to Him in private prayer.

Yet the same God willingly protects each person against the exploitations of the evil one. He at times covers sin in secrecy and in love, and He asks His followers to follow In His steps.

Both disclosure and secrecy are being used and misused in the present world. While there are justified purposes of disclosure and secrecy, there are also unjustified ones. Among the latter ones are calculated disclosures for the purpose of hurt and secrecy for the purpose of deceit.

Conclusion

In conclusion, the writer would like to suggest the following general principles of the ethics of disclosure and secrecy:
  1. Information is open and free for disclosure, except where specially classified as secret or confidential according to rational purposes or for personal reasons.
  2. Love demands that the desire of individuals for privacy or secrecy, where legally permissible, be respected.
  3. A high trust level between individuals sustains a high level of disclosure, a low trust level a low level of disclosure.
  4. The righteous have a larger degree of disclosure freedom than the unrighteous, for the latter have larger secrecy/evil life-areas.
  5. While secrecy may be used for a given time-period, all will eventually be fully disclosed.

7. Bibliography

  • Andrew, Brother. The Ethics of Smuggling. Wheaton, Illinois: Tyndale House Publishers, Inc., 1974.
  • Barry, R. J. Ecology and Ethics. London: Inter-Varsitly Fellowship, 1972.
  • Blackham, H. J. Ethical Standards of Counselling. London: National Council of Social Service, 1974.
  • Ellul, Jacques. The Ethics of Freedom. Grand Rapids: William B. Eerdmans Publishing Company, 1976.
  • Fletcher, Joseph; and Montgomery, John Warwich. Situation Ethics. Minneapolis, Minn.: Dimension Books, 197T
  • Fulmer, Robert M. Supervision: Principles of Professional Management. Beverly Hills: Collier Macmillan Publishers, 1976.
  • Gardner, E. Clinton. Biblical Faith and Social Ethics. New York: Harper and Row, Publishers, 1960.
  • Geisler, Norman L. Ethics: Alternatives and Issues. Grand Rapids: Zondervan, 1975.
  • Glass, Bentley. “The Ethical Basis of Science,” Science 3, December 1965.
  • Griffin, Emory A. The Mind Changers,_ The Art of Christian Persuasion. Wheaton, Illinois: Tyndale House Publishers, 1976.
  • Halfleld, Charles, ed. The Scientist and Ethical Decisions. Downer Grove, Illinois: InterVarsity Press, 1973.
  • Hastings, A. W., and Hastings E., eds. Important Moral Issues. Edingburgh: T.V.T. Clark, 1966.
  • Henry, Carl F. H., ed. Baker’s Dictionary of Christian Ethics. Grand Rapids: Baker Book House, 1973.
  • Heyne, Paul T. The World of Economics. St. Louis: Concordia Publishing House, 1965.
  • Hill, Ivan, ed. The Ethical Basis of Economic Freedom. Chapel Hill, North Carolina: American Viewpoint, Inc., 1976.
  • Hill, Ivan. How to Make America More Honest. Chapel Hill, North Carolina: American Viewpoint, Inc., 1974.
  • Lehman, Paul L. Ethics in a Christian Context. New York: Harper and Row, Publishers, 1963.
  • Milton, Charles R. Ethics and Expediency In Personnel Management. Columbia, South Carolina: University of South Carolina Press, 1970.
  • Ramsey, Paul. The Patient as Person. New Haven: Yale University Press, 1970.
  • Silver, Michael. Facing Issues of Life and Death. St. Louis, Missouri: Milliken Publishing Co., 1976.
  • Steele, Fritz. The Open Organization. Reading, Mass.: Addison-Wesley Publishing Company, 1975.
  • Thomas, George F. Christian Ethics and Moral Philosophy. New York: Charles Scribner’s, 1955.

Library

Explore your concerns in ethics at three of the following sites:

 


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