Integrity Matters
February 26, 2003

Professional faces ethical quandary

Question: (E-025) I am a professional in a specialty that is carefully, monitored by a state licensing board. Recent demands from health insurance organizations now put my colleagues and myself at ethical risk regarding client confidentiality. While we understand that our clients want to use insurance for health related service, we find ourselves in the untenable position of feeling "bullied" by managed care to breach ethics and give access to confidential information. How can we behave with integrity, protect our client’s confidentiality and answer the demands of an entity that asks us to breach ethics that are already monitored by our state board?

Response: Your concerns about integrity cross multiple boundaries.

  1. Ethical issues: When an informed patient signs a form authorizing the counselor/doctor to furnish information to insurers, this signals to the doctor/counselor that the patient has chosen to utilize funds from a third party (insurance). This is called informed consent and is both ethical and legal. In this way insurers can protect themselves against those who would abuse the system. It does, however, open the door to some potential for abuse of information.
  2. Legal concerns: It is likely that you and your colleagues belong to a professional association with access to attorneys who can assist regarding conflicts of interest and compromising situations. Seek advice and provide input, lest those who are paid to represent you miss the message. It seems that unless you are able to function (consistent with your ethical priorities), your productivity and service will decline, along with adequate income to support the professional association founded to assist you in the carrying out your professional expertise.
  3. Financial implications: Obviously, you must understand all of the requirements of your state's certification procedures as well as your profession or you could lose your privileges to practice. Morally, legally and financially you would be wise to know, in detail, the best approach to remain in compliance with any and all professional obligations.

Unless or until these issues are resolved, the only way for you to guarantee strict confidentiality is for the client to pay for your services without the benefit of third party insurance. Those who can afford this may choose this rather than enable an insurer to know their particular problems.

In summary, I suggest you to define your principles regarding the ethical execution of your duties and measure them against what is now provided for those in your profession. Where there are differences, you have choices: work to create regulations that cause the principles to match or choose to modify your behaviors to live with the existing operating principles.

If these options are not adequate, you can always select a new way to make a living.

"Coupon" published February 26 with the Integrity Matters column

JIM BRACHER is founder of the Bracher Center for Integrity in Leadership in Monterey. His column, "Integrity Matters," appears Wednesday on the Business page. Readers are invited to submit questions on business-related ethics and values. Please write in care of INTEGRITY to The center's Web site is

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