Confidentiality: Ethical and Legal Aspects for Canadian Psychologists
Cram, Susan J., Dobson, Keith S., Canadian Psychology
This paper focusses on the ethical and legal aspects of confidentiality for Canadian psychologists, with particular emphasis on clinical psychology. The concepts of confidentiality, privileged communication, and privacy are clarified. The law of privileged communication in Canada is presented. Ethical standards, provincial and federal legislation, and case law bearing on confidentiality in clinical practice are discussed. Issues of mandatory child abuse reporting, the duty to protect, informed consent, and third party and client access to records, are explored. Suggestions are made to the psychologist regarding the management of confidentiality. The helping relationship is the most fragile of all professional relationships. More than any other it requires the client to disclose intimate personal information. The confidentiality of the relationship has long been regarded as its cornerstone (Keith - Spiegel & Koocher, 1985). The area of confidentiality is complicated, however, by misunderstandings about the commonly used terms, confidentiality, privacy, and privilege (Keith - Spiegel & Koocher, 1985). Further, the ethical and legal requirements surrounding the topic of confidentiality have rarely been clarified, and never in the Canadian context.
The purpose of this paper is to explore the ethical and legal aspects of confidentiality for Canadian psychologists, with particular emphasis on clinical psychology. Space limitations preclude covering all of the relevant issues. It is not possible, for example, to cover the literature relating to research, the educational system, or the prison system. Ethical standards related to confidentiality in clinical practice will be reviewed. The issue of confidentiality as it pertains to the areas of mandatory child abuse reporting, the duty to protect, informed consent, third party access, and client access to records, will be addressed. The issue of privileged communication in Canada will be reviewed. In addition, provincial and federal legislation, and case law bearing on the practice of psychology will be considered.
Privacy, Privilege, and Confidentiality
Privacy is a basic human right accorded to all Canadian citizens. It reflects the right of an individual to control how much of his or her thoughts, feelings, or other personal information can be shared with others (Keith - Spiegel & Koocher, 1985). Section 7 of the Canadian Charter of Rights and Freedoms (1982) guarantees that "Everyonehas the right to life, liberty, and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice" (p. 260). Further, British Columbia, Saskatchewan, Manitoba, and Quebec have all adopted privacy legislation: the Privacy Act of British Columbia (1979), the Privacy Act of Saskatchewan (1978), the Privacy Act of Manitoba (1987), and the Quebec Charter of Human Rights and Freedoms (1977). Confidentiality and privilege developed from the individual's right to privacy. Privilege is a "legal term that describes the quality of certain specific types of relationships that prevent information, acquired in such relationships, from being disclosed in court or other legal proceedings" (Keith - Spiegel & Koocher, 1985, p. 58). Historically, privileged communication was applied to the solicitorclient relationship, and grew from the belief that discussions between a client and solicitor had to be protected in an adversial justice system, if justice was to be served (Picard, 1984). In those circumstances where a psychologist has been accorded privileged communication in court, he or she is required to retain the client's confidence, unless the client has waived the right to privilege, or has made mental status an element in legal proceedings. Confidentiality implies "an explicit contract or promise not to reveal anything about a client, except under circumstances agreed to by both source and subject" (Keith - Spiegel & Koocher, 1985, p. 57). Confidentiality and its limits are defined in codes of ethics for psychologists, in statutes, and in court rulings. Thus, disclosure of a client's communications may subject the psychologist not only to professional reprimand, but (also) to criminal or civil liability. In their management of confidentiality, psychologists in Canada are subject to provincial and federal legislation regarding mental health records and legal constraints imposed by the common law (Eberlein, 1990). Psychologists must also be guided by ethical standards of the discipline. For most psychologists in Canada this means the Canadian Code of Ethics for Psychologists, adopted by the Canadian Psychological Association (CPA) in 1986, as well as other documents adopted by CPA (1978, 1989). These controls, however, are not likely to protect psychologists from the dilemma created by the fact that "Society wishes to know what the client wishes to keep private" (Everstine et al., 1980, p. 830), a dilemma which has intensified in recent years (Baird & Rupert, 1987; Rozovsky, 1980; Rubanowitz, 1987). In particular, ethical standards can be difficult to interpret and to implement (Pettifor, 1980), and sometimes increase rather than decrease the problems surrounding confidentiality (O'Neill, 1989). The Law of Privilege
More than two - thirds of the United States have statutes which grant privileged communication to physicians. The first was enacted in New York, in 1828 (Picard, 1984). The first law granting privileged communication to the psychologist - client relationship in the United States was passed in Kentucky in 1948 (Slovenko & Usdin, 1966). Today 47 states and the District of Columbia provide such a privilege (Knapp & VandeCreek, 1988). Much criticism has been levelled at the privilege, and in recent years exceptions to this legislation have proliferated.
Statutory privilege for physicians does not exist in Canada, with the exception of civil proceedings in Quebec, and a limited privilege contained in the mental health legislation of several provinces. Section 29(7) of the Mental Health Act of Ontario (1980) states that where a disclosure is required by the courts, and the attending physician writes that such a disclosure is likely to harm the patient, the court will examine the clinical record, and "if satisfied that such a result is likely, the court or body shall not order the disclosure ... unless satisfied that to do so is essential in the interests of justice" (p. 44). Similarly, section 26(6) of the Mental Health Act of Manitoba (1987) states that if the court is satisfied that disclosure will result in harm to the patient, it will not order the disclosure. Privilege as it pertains to the psychologistclient relationship is not discussed in the Quebec, Ontario or Manitoba legislation. It is noteworthy that two provincial legislatures have enacted a clerical privilege: Quebec, in the Code of Civil Procedure (1965) and Newfoundland, in the Evidence Act (1970). The clerical privilege specifies that the clergy shall not be compelled to give evidence as to any confessions made to them.(f.1)
No privilege is recognized in common law with respect to confidential communications received within a professional relationship, apart from the solicitor - client privilege (Picard, 1984). The rule that communications between a doctor and patient are not privileged has been in effect since the bigamy trial of the Duchess of Kingston in 1776 (Picard, 1984). Here, Lord Mansfield stated the law that:
If a surgeon was voluntarily to reveal these secrets, to be sure he would be guilty of a breach of honour, and a great indiscretion; but to give that information in a court of justice, which by the law of the land he is bound to do, will never be imputed to him as any indiscretion whatever. (cited in Picard, 1984, p. 11)
Courts in Canada have followed this rule and have refused to recognize privilege for confidential information given to physicians (R. v. Burgess, 1974; R. v. Potvin, 1972), psychologists (R. v. Warren, 1974), social workers (Brysh v. Davidson, 1963; R. v. St. Jean, 1976; R. v. Fehr, 1984), and journalists (Attorney - General v. Mulholland; Attorney - General v. Foster, 1963).
LAW REFORM COMMISSION OF CANADA REPORT ON EVIDENCE
Public concern about the need for privacy, and the growth of professional therapy services encouraged the re - evaluation of existing privileges for confidential communications in Canada in the early 1970's. The Law Reform Commission of Canada undertook a study of the laws of evidence and in 1975 published the Evidence Code. The Evidence Code was not enacted because of opposition to the idea of codifying the laws of evidence. It will be discussed for it provides information regarding the legal position on privilege.
Section 4, General Rules, laid the foundation to the Code. It stated that all information relevant in determining the issues was admissible in court. This philosophy was reinforced by other provisions in the Code: section 54 which stated that "every person is competent and compellable to testify to any matter" (p. 37) and section 32 which stated that "no person has a privilege to refuse to disclose any matter ... or to prevent another from disclosing any matter" (p. 29). Sections of the Code did set rules for the exclusion of evidence, but only when strong policy reasons outweighed the interest in the admission of the evidence. Section 41 described the general professional privilege. It stated that any person who had consulted a professional had a privilege against disclosure of any confidential communication reasonably made in the course of the relationship if, in the circumstances, the public interest in the privacy of the relationship outweighed the public interest in the administration of justice. In their comments on section 41 the Commission noted that the common law did not recognize a privilege for confidential communication between clients and such professionals as social workers, physicians, psychiatrists, psychologists, or clergy. It was acknowledged that these professions had asserted the rights of their clients to claim a privilege regarding communications made during the professional relationship. Ultimately, however, the Commission decided against granting absolute privilege to the professions because of the strong interest in admitting all relevant evidence. They recommended that the judge should weigh the competing interests whenever privilege was claimed, and that a decision be reached depending on the circumstances of the particular case. The criteria earmarked for consideration in making a decision regarding privilege are those adopted by Wigmore (1940). Wigmore (1940) stated that four fundamental conditions were recognized as necessary to the establishment or recognition of a privilege against disclosure: 1. The alleged privileged communication must have originated in a confidence that it would not be disclosed.
2. The asserted confidentiality must be essential to the satisfactory maintenance of the relationship between the parties.
3. This relationship must be one that, in the opinion of the community, ought to be sedulously followed.
4. The damage resulting from disclosure must exceed the benefit which would ensue from a more expeditious disposition of the cause. (cited in the Report of the Federal/Provincial Task Force on Uniform Rules of Evidence, 1982, p. 419)
THE FEDERAL/PROVINCIAL TASK FORCE ON EVIDENCE
The Federal/Provincial Task Force on Uniform Rules of Evidence was established in August, 1977. Its aim was to attempt to bring about uniformity in all Canadian jurisdictions on the rules of evidence. As with the Law Reform Commission, the Task Force acknowledged that the disclosure of confidential information in open court could harm professional relationships, and that disclosure could involve invasion of privacy. It concluded, however, that this was secondary to the primary importance of the administration of justice. It did not accept that the public interest would be best served by the enactment of privileged communication for a professional or confidential relationship. The Task Force stated that "by depriving the parties of the opportunity to present the whole truth to the court, privileges can cause injustice" (1982, p. 418). To suppress a confidential communication, one had to convince the court, on balance, that the public interest favoured nondisclosure from disclosure. The Task Force advised that:
privileges should expand, at common law and by statute, as the need emerges in specific situations ... little would be accomplished by attempting to anticipate what problems, if any, will develop in future. The discriminating analysis which is required of a court or legislature to balance competing public interests and uphold or reject a claim of privilege should not be made in advance. The risks of inaccurate judgement are too great. (1982, p. 422)
The Task Force did propose an amendment to the Criminal Code of Canada (1970) which would enact a privilege for statements made by an accused to the assessing psychiatrist (or other assessing clinician) during a remand for observation. Such a privilege would make the accused's statements inadmissible in any proceeding, except that involving fitness to stand trial, and would be waived if the accused made mental status an issue in his or her defense. The Task Force asserted that such a privilege would serve the public interest, as it would encourage the accused to speak freely with an assessing psychiatrist, thereby resulting in more accuracy in assessments, and hence advancing the administration of justice. The recommendations of the Task Force were incorporated into the Uniform Evidence Act, for consideration by the federal and provincial governments. Despite the work of the Task Force, uniform legislation has not been achieved.
SLAVUTYCH V. BAKER (1976)
The Supreme Court of Canada in Slavutych v. Baker (1976) stated that judges could evolve new privileges for confidential communications, and adopted Wigmore's (1940) criteria as a test of the appropriateness of privilege. Prior to Slavutych the Canadian courts had been restricted to certain recognized and fixed categories in determining whether a confidential communication was privileged as in, for example, the solicitor - client privilege, or the spousal privilege. The significance of the decision was that a discretionary approach, the flexible principles advocated by Wigmore, was substituted for the traditional category approach. Prior to Slavutych some Canadian courts had refused to compel a psychiatrist to disclose confidential communications because of the recognition that the psychiatrist - patient relationship often satisfied Wigmore's criteria (Dembie v. Dembie, 1963; R. v. Hawke, 1974). In Dembie v. Dembie (1963) a psychiatrist refused to answer questions about his female patient, stating that the information was confidential and disclosing it would be a breach of the Hippocratic Oath. The judge, in response, stated that:
I think it is inimical to a fair trial to force a psychiatrist to disclose the things he has heard from a patient, and, in addition to that, I think it rather shocking that one profession should attempt to dictate the ethics of another, which the courts are doing when they see fit to state what a doctor will say and what he will not. (cited in Picard, 1984, p. 13) Canadian courts have, however, been slow to adopt a discretionary approach to the provision of privilege (McLachlin, 1980), and have resisted the extension of privilege for confidential communications beyond narrowly defined limits (e.g., R. v. St. Jean, 1976; R. v. Fehr, 1984). EXCEPTIONS TO THE LAW
Communications made by a client to a psychologist in situations in which the psychologist is the agent of a solicitor are privileged (e.g., Kowall v. McRae et al., 1980). Clinical records from a previous relationship between the psychologist and client, where the psychologist was not acting as an agent of the solicitor, would not be protected by such a privilege (C. Levy, personal communication, November 28, 1990).
Communications made by parties to a psychologist during negotiations to settle litigation are also privileged. The privilege attaching to such communications belongs to all parties and the waiver of all parties is required if any of the communications are to be admissible (Piercy v. Piercy, 1990). To obtain common law privilege in settlement negotiations, there must be evidence to indicate that the parties considered the occasions to be confidential or without prejudice, and evidence to indicate that the focus of the negotiations was the settlement of a litigious issue. Some Canadian courts have suggested that the common law privilege accorded to settlement negotiations protects all communications by a spouse to a third party mediator in the process of attempted spousal reconciliation (e.g., Dembie v. Dembie, 1963; Henley v. Henley, 1955; Keizars v. Keizars, 1982; McTaggart v. McTaggart, 1948; Mole v. Mole, 1951; Porter v. Porter, 1983; Shakotko v. Shakotko et al., 1977; Sinclair v. Roy, 1985). Section 10(5) of the federal Divorce Act (1985) prohibits the admission in any legal proceeding of any evidence as to what occurred during an endeavour to assist spouses to reconcile. It is not a privilege that can be waived; it is a statutory rule of evidence. Judges have, however, interpreted the similar section in the old Divorce Act (1970) in different ways. In Shakotko v. Shakotko et al. (1977) the Ontario High Court concluded that the prohibition applied to any reconciliation attempt. On the other hand, the Ontario High Court had previously restricted the prohibition to reconciliation attempts conducted by a person appointed by the court under the Divorce Act (e.g., Robson v. Robson, 1969). RESISTING EXTENSION OF PRIVILEGE
Privilege for confidential communications to a psychologist is not generally recognized in Canada, except where the psychologist is the agent of the solicitor or where the psychologist is a mediator in settlement negotiations. The Slavutych decision was proclaimed to be an indication that the Canadian courts would be more flexible in granting privilege; however, the courts have continued to resist the extension of privilege to other confidential relationships.
As indicated in the Report of the Federal/Provincial Task Force on Uniform Rules of Evidence (1982), the lack of privilege in the professional helping relationship does not mean that a confidential communication to a psychologist must be disclosed in court. Where a psychologist insists on maintaining the confidence of the client, a judge may suggest to counsel that the issue should not be pressed (e.g., Cronkwright v. Cronkwright, 1970). In practice, counsel frequently complies with such a request. In a situation where counsel insists upon disclosure of confidential information, the psychologist might argue that his or her relationship with the client satisfies Wigmore's criteria, and therefore he or she should be granted privilege. The granting of the privilege is at the judge's discretion. If privilege is not granted, and the psychologist refuses to disclose, the judge does not have a discretion to excuse the psychologist from answering the question, on the grounds that confidentiality has to be protected. The judge does have a discretion as to the penalty to be imposed for refusal to disclose, and the subsequent finding of contempt of court. Mandatory Child Abuse Reporting
Standard I: 34 of the Canadian Code of Ethics for Psychologists (CPA, 1988) states that psychologists share confidential information with others only with the informed consent of the client or if the client cannot be identified, except as required by law or in circumstances of possible physical harm. Child protection statutes make it obligatory for psychologists to report suspected child abuse. Ethical considerations (Standard I: 17) require that the psychologist inform the client of the legal duty to report. When the client is a child, ethical considerations (Standard I: 25) require making efforts to explain why disclosure is necessary, and helping the child to take the initiative in making the disclosure.
REVIEW OF REPORTING LAWS
As indicated in the Canadian Family Law Guide (1989), all of the common law jurisdictions in Canada, except the Yukon, make it mandatory to report suspected child abuse. Table 1 indicates the relevant provisions in child protection statutes.
Mandatory reporting is required of anyone who has information that a child is in need of protection. In addition, Ontario and Northwest Territories legislatures impose a specific duty to report on professionals who learn of child abuse in the course of their professional duties. In all provinces, except Prince Edward Island and Saskatchewan, legislation specifically requires that information be reported, notwithstanding that it may be confidential or privileged; with the exception of Newfoundland and Saskatchewan, all the statutes provide that nothing in the relevant sections revokes any privilege that may exist between a solicitor and a client (Canadian Family Law Guide, 1989). In all jurisdictions, legislation protects any person giving information about a child in need of protection from civil liability unless a report is made maliciously or without probable grounds. All jurisdictions that legislate mandatory reporting, except Saskatchewan, make the individual who fails to report vulnerable to criminal prosecution. The New Brunswick act limits criminal liability to a professional; the Manitoba act directs that the professional be reported to their professional association or society.
There is some case law on the mandatory reporting of child abuse. In R. v. Stachula (1984), for example, an Ontario case, a physician was acquitted of a failure to report the incestuous relationship between a 14 year old girl and her 16 year old brother. Ontario law, at that time, legislated mandatory reporting of suspected child abuse wherein the abuser was one who had charge of the child. In this case it was not established that the suspected abuser, a sibling, had charge of the child. Current law in Ontario requires reporting past or present abuse, regardless of the relationship of the abuser to the child.
In R. v. Cook (1984), another Ontario physician was charged with failure to report a case of suspected child abuse. The trial established that the physician had reason to believe that the child had been abused in the past, but not that abuse was ongoing. He was, therefore, acquitted. REACTION TO THE DUTY TO REPORT
Child abuse reporting laws require professionals to make an immediate report without consideration to the implications of doing so. The response of the psychological community to this obligation has been mixed. Heymann described the duty to report as constituting the "most far - reaching, legally mandated breach of the professional confidentiality privilege, in an ever - broadening course of gradual erosion" (1986, p. 145). The mandatory reporting law functioned as an all - or - none law that left unaddressed a host of issues and considerations. Heymann pointed out that it made a difference to the clinician whether the abuse was an isolated instance years ago or was an ongoing chronic pattern; whether the individual had come to the psychologist for the very purpose of seeking help with sexual behaviour, or whether a third party had provided information about the sexual behaviour. Heymann warned that "an indiscriminate reporting duty" (p. 146), would not serve the interests of anyone; that it was a duty that required clinicians to suspend their professional training and plunge into mindless reporting. A child, adult, or family who had been encouraged to trust the therapist was betrayed. On a broader level, it is important to note that the implications for confidentiality have to do with the social roles of psychologists (Heymann, 1986). The primary social role of a psychologist is to help people with their personal problems in a setting of confidentiality. This is how psychologists are perceived by the public and how they generally see themselves. According to Heymann, mandatory reporting requires that if in the course of therapy, a client reveals abuse, the psychologist change roles to become a police agent: "The clientis still the same person, but there has been a sudden and drastic switch in social roles, whereby the therapist exits and the informer bursts in at the door" (Heymann, p. 152). Heymann acknowledged the necessity of laws for the protection of society, as well as the difficulty of achieving a balance between the protection of society and the protection of the client. He argued, however, that the psychologist, not the police or the social service worker, was best suited to decide on a course of action in situations of suspected child abuse. Weisberg and Wald (1986), on the other hand, argued for the strengthening of the laws on mandatory reporting of suspected child abuse. These authors maintained that while the privacy basis for confidentiality was a strong one, the child's interests and greatest possible protection from harm was greater. They suggested that what often appeared to be a conflict between the parents' privacy interest and broad social interests, was actually a conflict between the parents' privacy interest, and the interest of the individual child. They concluded that the child's interest was more compelling than the adult's.
Early studies on the mandatory reporting of suspected child abuse suggested that psychologists were unaware of child abuse reporting laws and also that the majority would not report abuse (e.g., Swobodo, Elwork, Sales, & Levine, 1978). Current research suggests that the majority of psychologists accept that client confidentiality should not be absolute, and that the majority would breach confidentiality to report suspected abuse (Muehleman & Kimmons, 1981; Pope, Tabachnick, & Keith - Spiegel, 1987). In summary, ethical and legal obligations require that psychologists report suspected child abuse. The reaction to such an obligation in the psychological community has been mixed. Some psychologists are vehemently opposed to what is considered a police role for psychotherapists; others see such laws as a reflection of the increased consideration to and protection of the rights of children. Despite the concern of the profession about the mandatory duty to report, recent research suggests that psychologists have accepted the legitimacy of such an obligation. The Duty to Protect
No legal event has raised more concern about the confidentiality of the therapeutic relationship than the case of Tarasoff v. Board of Regents of the University of California (1974, 1976). In this case, which has influenced legal thinking beyond the California jurisdiction, the court held that:
when a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. (1976, p. 425)
Such a duty may require therapists to warn the victim, inform the police, or take whatever steps are reasonably necessary under the circumstances. The facts of the Tarasoff case are discussed in many sources (e.g., Birch, 1992). Our own focus will be on the effects of Tarasoff and related cases for the management of confidentiality.
Following Tarasoff, the American Psychological Association (APA) added the ethical duty for psychologists to reveal confidences when not to do so would break the law, or result in clear and imminent danger to the client or others (APA, 1981). The duty to protect has also been included in the Canadian Code of Ethics for Psychologists (CPA, 1988). The Code states in Principle I that respect for the dignity of persons, should generally be given the highest weight except when "there is a clear and imminent danger to the physical safety of any known or unknown individual" (CPA, 1988, p. 12). Standard II: 34 states that a psychologist do "everything possible to stop or offset the consequences of actions of others when these actions are likely to cause serious physical harm or death" (CPA, 1988, p. 42). The psychologist is informed that this might involve reporting to the authorities or the intended victim, and that this responsibility is greater than that of confidentiality.
The Canadian Code also states that the psychologist must balance the interests of both the client and society. While the psychologist has an obligation to society he or she also has an ethical obligation to the client, and therefore should seek the client's permission to inform appropriate authorities or warn the intended victim (Eberlein, 1990). Principle I of the Code states that while there may be circumstances where the possibility of danger to the client or others will disallow some of the client's constitutional rights, any action taken must involve respect for the dignity of the client to the greatest extent possible. Only the minimal amount of information required to handle the situation should be released. In a situation where the psychologist feels it is necessary to release confidential information without the client's consent, proper records demonstrating careful thought and consideration are crucial to a defense if malpractice or ethical misconduct action is taken (Soisson, VandeCreek, & Knapp, 1987).
Eberlein (1980) recommended caution in reporting that a client is dangerous. He suggested that it would be better to limit the duty to protect to cases where the psychologist has fairly clear knowledge of to whom and when a violent act will likely occur. Truscott (1990) advised that where there are no readily identifiable victims but clear evidence that the client is dangerous, the psychologist should initiate civil commitment proceedings, even if there is doubt as to whether the client meets criteria. In Alberta, for example, section 10(1) of the Mental Health Act (1988) states that anyone who has probable reason to believe that a person is suffering from a mental disorder and is in a condition likely to present a danger to the self or others, may bring information to a provincial judge, who may issue a warrant to apprehend the person for an examination. DILEMMA FOR PSYCHOLOGISTS
The duty to protect creates a dilemma for the psychologist. Failure to warn may lead to a charge of failing to act; warning may also lead to a lawsuit, with the client claiming breach of confidentiality and defamation (Eberlein, 1980). Eberlein (1980) suggested that since the primary responsibility of the psychologist was to the client, the threat of suit for the latter alternative was more likely should the client suffer financially because of confinement by some authority. Eberlein concluded that the best course of action for the psychologist was to consult widely with colleagues. This advice is reflected in the Code of Ethics. Standard III: 34 states that when faced with an ethical dilemma psychologists must seek consultation with colleagues, and details of such consultation should be well documented in the client's files (CPA, 1988). Psychologists should also stay abreast of the literature on the criteria for dangerousness. In summary, the Tarasoff duty is reflected in ethical codes for psychologists in Canada, requiring psychologists to do everything possible to stop or offset those actions of their clients' likely to result in physical harm or death. The issues raised by Tarasoff continue to generate concern in the psychological community. Survey research suggests, however, that psychologists (e.g., Baird & Rupert, 1987; Pope et al., 1987) have accepted the duty to protect, and that they had been warning potential victims prior to the Tarasoff case.
Although the profession offers some guidelines to psychologists about when it might be appropriate to breach confidentiality, these guidelines are not necessarily applicable to all situations. Ethical standards recommend that in duty to protect situations, psychologists consult widely with other professionals, and document the decision making process. Research is needed to assess how best to fulfil the duty to protect.
Confidentiality necessarily involves informed consent. The concept of informed consent will be discussed briefly in this section. Readers interested in a comprehensive discussion of informed consent with adults and children are referred to Crowhurst and Dobson (this issue), and Hesson, Bakal, and Dobson (this issue), respectively.
Principle I of the Canadian Code of Ethics for Psychologists (CPA, 1988) states that psychologists have a responsibility to protect and promote the client's rights to privacy, self - determination, and autonomy, and to develop procedures for informed consent and confidentiality that protect these rights. All individuals, adults and children, must be assessed on an individual basis to determine the capacity to give informed consent. Specifically, Ethical Standards I: 10 to 18 define expectations for psychologists regarding informed consent. Psychologists are required to seek full and active consent from others in all decisions that affect them. No information should be withheld if it would interfere with the clients' understanding of the facts in a way that would influence their decision to give informed consent (Standard III: 27). Standard I: 16 requires that in obtaining informed consent, the psychologist should provide as much information "as a reasonable or prudent person would want to know before making a decision or consenting to a psychological process, procedure, or service" (CPA, 1988, p. 26). This standard incorporates the Supreme Court of Canada's decisions on May 20th, 1980, and October 7th, 1980, of Hopp v. Lepp and Reibl v. Hughes, respectively, which set the legal standard for what a patient must be told to give informed consent to treatment (Rozovsky & Rozovsky, 1990).
Standard I: 33 of the Code requires that the psychologist clarify measures that will be taken to protect confidentiality in a marital, family, or group therapy situation, and explain that in such situations, confidentiality is a shared responsibility. Matters such as the degree of confidentiality granted to a minor child and parental access to the child's file should be agreed upon at the beginning of the professional relationship. In Canada, legislation in some provinces has arbitrarily decided the age at which consent of a minor is valid (Picard, 1984). Psychologists must be familiar with relevant provincial statutes, and adopt policies that are consistent with these statutes. Nothing in common law prevents a minor from giving informed consent to treatment (Rozovsky & Rozovsky, 1990). In the absence of legislation therefore, if a minor is capable of understanding the nature of treatment, its risks, benefits, and so forth, the minor should be treated as a mature individual capable of giving consent (Rozovsky & Rozovsky, 1990).
Parents do, however, have rights to their minor children. Ethically, to the extent that is possible, the psychologist should attempt to accomplish a cooperative treatment plan between parents and children. In particular, problems present in a situation where a child is adamant that parents not be informed. The dilemma which faces the professional is that while a minor may be legally and mentally capable of consent, treating a minor without parental permission may be unethical by professional codes of ethics (Rozovsky & Rozovsky, 1990).
Ethical standards IV: 11 and 12 require that psychologists abide by governmental and institutional laws and regulations, unless those laws and regulations conflict with the ethical code. Where there is conflict, the psychologist is advised that the decision is considered to be a matter of personal conscience, and is urged to seek consultation with colleagues. Third Party Access
Psychologists working within institutions or agencies are restrained both by their professional code of ethics and the disclosure statutes applying to the institution. There are a number of statutes in every province which govern the confidentiality of mental health information and which allow for access to treatment information by a variety of third parties (Rozovsky & Rozovsky, 1984). These statutes specify the type of informationdeemed to be confidential rather than the type of professional relationship that must exist. Each province is different, so reference should be made to the mental health and hospital legislation of the province in which the psychologist practices. In addition, many of a patient's rights in a hospital setting are dealt with in detailed provincial legislation, making it imperative for psychologists to be familiar with this legislation. Finally, psychologists working in hospital settings are obliged by professional ethical codes to inform their clients of the limits of confidentiality in such settings. This obligation requires a knowledge of provincial legislation and institutional requirements.
Generally speaking, without the client's consent, legislation provides that no clinical record or portion of one should be revealed to anyone. For example, in Rights and Responsibilities, the guide to the Mental Health Act (1980) in Ontario, it is held that "the public interest in the treatment of mentally disturbed patients requires that communication during their examination should be privileged" (1988, p. 15). There are, however, numerous statutory exceptions to the requirement that information not be released without the client's consent (Rozovsky & Rozovsky, 1984). Exceptions in the Mental Health Act (1980) of Ontario (section 29 (3) & (5)) provide that disclosure may be made for example, to hospital staff involved in the patient's care, the administrator of another facility where the patient is currently being treated, and in emergencies where a delay would endanger the patient. Similarly, sections 17(1) to (12) of the Alberta Mental Health Act (1988) describe the obligation to protect the confidentiality of patient information, while providing that information may be released under a variety of circumstances: (a) to the agency or physician responsible for providing continued treatment; (b) to the Workers' Compensation Board; (c) to the Discipline Committee under the Psychology Profession Act, with the patient's consent; (d) in responseto a subpoena pursuant to the Child Welfare Act, and so forth. The Hospitals Act of Alberta (1980) likewise states that information obtained from hospital records is to be treated as private and confidential, and then specifies numerous circumstances wherein information may be disclosed (section 40 (3) - (13)). Similar exceptions to confidentiality are noted in other provincial mental health acts.
INFORMED CONSENT FOR THIRD PARTY ACCESS
Psychologists frequently receive third party requests for information about their clients. Clients may often consent to the release of information to third parties without realizing fully the consequences of such action. Pettifor (1980) advised that when a third party request for information was made subsequent to the establishment of a professional relationship with a client, the professional must determine the reason for the request and the impact of releasing the information on the client. The issue of informed consent must be discussed in detail. Keith - Spiegel and Koocher (1985) recommended that a consent form for release of information to a third party contain the following:
the name of the person to whom the records are to be released; which records are to be sent; the purpose or intended use; the date the form was signed; an expiration date; any limitations on the data to be provided; the name and signature of the person authorizing the releases, as well as that person's relationship to the client (if not the client him/ herself); and the signature of a witness. (p. 67) The authors also recommended that a copy of the consent form be given to the client, while the original record remain a part of the client's file. The psychologist should maintain a record of what records were sent, to whom, and for what purpose. Only material appropriate to the request should be sent. Material should be marked confidential and the recipient should be informed of the confidential nature of the record.
Information should only be released to knowledgeable professionals (CPA, 1988). Standard II: 5 of the Code of Ethics requires that psychologists make every effort to ensure that psychological knowledge is not misused. Standard II: 26 requires that psychologists be discrete in recording and communicating information to prevent misuse or misinterpretation by others. This includes not recording information which might be misinterpreted. Section V of the Practice Guidelines for Providers of Psychological Services (CPA, 1989) similarly requires that providers establish unequivocal procedures for releasing records, and avoid releasing to individuals not having the training necessary to interpret such information.
In summary, provincial statutes governing institutions and agencies protect the confidentiality of clinical records. Various exceptions to the confidentiality of clinical records are, however, provided for. Psychologists working in institutions have an ethical obligation to inform their clients of these exceptions.
In response to any third party request, psychologists carry a primary obligation to protect the well - being of their clients. This is accomplished by securing informed consent for third party release. Client Access to Records
Client access to records is a controversial issue. Some authors advocating more open access state that open access may lead to clients who are more relaxed and cooperative (e.g., Roth, Wolford, & Meisel, 1980); others argue against the assumptions that the professional knows best, and the client is too fragile. Opponents to client access argue that harm may be done by sharing information that clients are not equipped to understand. The client's record belongs to the institution or the person who compiled it (Rozovsky, 1980). Access to institutional records is governed by provincial statute, and most provinces have legislation that permits the client access to his or her hospital record. In the Alberta Hospitals Act (1980), legislation states that if a client is refused access, he or she may make application to the courts, which may order access (section 40). Section 26.9(4) of the Mental Health Act (1987) of Manitoba, similar to Alberta legislation, states that a person who has attained 18 years of age and is mentally competent, is entitled to examine and copy his or her clinical record. Also, where a person is allowed to examine a clinical record, the person may request correction of the information (section 26.9(9)).
There is considerable case law that supports the right of the client to access. For example, in Alberta, see Lindsay v. D.M. (1981) and Tomkow v. Oldale (1981). In Newfoundland, see Murphy v. General Hospital (1980). In Ontario, see Strazdins v. Orthopaedic and Arthritic Hospital (1978) andMitchell v. St. Michael's Hospital (1981).
Statutory requirements also address the privacy of communications to and from patients. For example, section 15 of the Mental Health Act (1988) of Alberta states that communications written by a patient or to a patient in a facility shall not be opened or examined in any way, and that delivery shall not be obstructed or delayed in any way by staff. Section 97 of the Mental Health Act (1987) of Manitoba states that every person confined in a psychiatric facility shall be furnished with writing materials for communicating with any person, and that no such communication, nor any communication received by the patient shall be examined, censored, or withheld. Section 20.(1) - (3) of the Mental Health Act (1980) of Ontario outlines exceptions to the general rule that communications written or sent to a patient shall not be examined or obstructed in their delivery. Exceptions include a reasonable and probable cause to believe that the contents written by a patient would be offensive or not in the best interests of the patient, or that contents of a communication sent to a patient would interfere with treatment or cause unnecessary stress. Under these conditions, the communication may be opened and examined, and withheld if deemed necessary. Communications between a patient and his or her solicitor, however, may not be examined.
THE PATIENT'S RIGHT TO INSPECT
The records retained by psychologists in private practice are not covered by specific legislation. However, Picard (1984) suggested that the client may still be entitled to such information. In addition, in the Report of the Commission of Inquiry into the Confidentiality of Health Information (1980) in Ontario, Mr. Justice Horace Krever recommended that legislation be enacted to express the general rule that a patient has the right to inspect and receive copies of any health information of which he or she is subject.
Ethical codes recognize a client's right to access. Standard III: 11 of the Canadian Code of Ethics for Psychologists (CPA, 1988) requires that psychologists provide, on the request of the client, suitable information about the results of assessments. In Alberta, the Code of Professional Conduct (1987) sections 10 and 11, require that a psychologist provide original results to another chartered psychologist within 30 days, at the request of the client, and provide the psychological report to the client or his or her agent, within 30 days, on request. Part V of the Practice Guidelines (CPA, 1989) requires that psychologists must respect the right of the client to access their record, and develop procedures to allow client access and client correction of errors. Psychologists should assume that clients will request the opportunity to review their records, and records should be written with this in mind.
Violations of Confidentiality
The confidentiality of client information is subject to ethical and legal controls. Disclosure of confidential information is a breach of a psychologist's ethical code, for which he or she may be subjected to disciplinary proceedings by the profession. Provincial mental health legislation states that unauthorized disclosure of information from clinical records is an offense and renders the offender liable to a fine. Theoretically, the failure to disclose the limits of confidentiality and to inform the client of the risks of therapy may leave the psychologist vulnerable to legal action for failure to obtain valid consent to treatment. In addition, Rozovsky and Rozovsky (1984) suggested that legal action for disclosure of confidential information could possibly be taken on the basis of breach of contract, breach of confidence, breach of privacy, or negligence in breaching confidentiality.
The Ethics Committee of the American Psychological Association (1988) reported that the actual number of complaints made against psychologists had risen by approximately 56% over the last few years. The number of complaints per year, averaging 56.5 in 1983 and 1984, had risen to 88 in 1986 and 1987. In the five years since 1983, 4% of the violations by psychologists had involved the failure to preserve appropriate confidentiality of client information.
NUMBER OF COMPLAINTS
An attempt was made to calculate the number of complaints regarding confidentiality filed against psychologists practicing in Canada. The first author contacted all provincial regulatory bodies in the fall of 1990, and although it must be borne in mind that the definition of "complaint" may vary somewhat from province to province, the following number of complaints involving confidentiality were reported:
1. The College of Psychologists of British Columbia: one since 1988. 2. The Psychologists Association of Alberta: The number of complaints involving confidentiality in the year ending March, 1990 was not available. One complaint involving confidentiality was made in the year ending March, 1991.
3. The Saskatchewan Psychological Association: one since 1988. 4. The Psychological Association of Manitoba: one since 1985. 5. The Ontario Board of Examiners in Psychology: three in the year ending May, 1989.
6. The College of Psychologists of New Brunswick: none.
7. The Nova Scotia Board of Examiners in Psychology: one since 1980. 8. The Prince Edward Island Psychologists Registration Board: none. The registration board of this association was just empowered in 1991. 9. The Newfoundland Board of Examiners in Psychology: none. 10. Corporation professionnelle des psychologues du Quebec: no report available.
To date, no civil suits have been won against psychologists in Canada, in the area of confidentiality. There has been only one Canadian case relating to a duty of care.(f.2) In Haines v. Bellissimo (1978), a psychiatrist, psychologist, and McMaster University Medical Centre were sued by the widow of a client who had committed suicide. The court decided that the actions of the psychologist were reasonable and no negligence was established. However, the judge indicated that the duty and standard of care imposed on the psychologist was the same as that required of physicians and surgeons. PERSON'S LIABLE
In the 1980 Report of the Commission of Inquiry into the Confidentiality of Health Records, Mr. Justice Horace Krever recommended the creation of a statutory right to permit a patient whose health information had been disclosed without consent to maintain a civil action for the greater of his or her damages or $10,000.00 against: (a) a person under obligation to keep health information confidential, or (b) any person who induced anyone under obligation to keep health information confidential. This recommendation aimed to establish a precise cause of action for breach of confidentiality of health information. No such legislation has been adopted to date. The result is that violations of confidentiality by the psychologist are associated with little risk of civil suit (C. Levy, personal communication, September 12, 1991). The legal courses of action suggested by Rozovsky and Rozovsky (1984), while theoretically possible, are likely to be discouraged by counsel in practice. Prosecutions are likely to be difficult and legal costs prohibitive (C. Levy, personal communication, September 12, 1991). Similarly, Eberlein (1980) suggested that suits in Canada are discouraged because of the difficulty of proving negligence, and because in Canadian courts legal costs are assessed against the losing party. The existence in Canada of a crimes compensation system, and the fact that few Canadian solicitors take cases on a contingent fee basis, operate as further impediments to psychologists being sued (Eberlein, 1980). Canadian psychologists will, however, be sued, as indicated by the Haines Case, and psychologists are only prudent to take care to preserve confidentiality in their professional relationships. Conclusion
It is important for all psychologists to be active in the protection of their clients' rights to confidentiality. This means not only knowing and exercising ethical and legal obligations, but communicating such information to the public, and influencing legal policy to promote clients' rights. Canadian law regarding privilege has been formulated by the legal experts and does not recognize privilege between psychologists and their clients. In future, psychologists should use their special research skills to help influence legal decisions regarding professional privilege (Ryan & Bagby, 1985). The Canadian Code of Ethics for Psychologists (CPA, 1986) was developed by CPA to guide the professional behaviour of psychologists in Canada. There are, unfortunately, no data available which have assessed the degree to which members believe in or follow these guidelines, in general, or as they pertain to confidentiality in particular. There are no data on the knowledge of psychologists regarding the federal and provincial legislation that has implications for mental health treatment, nor are there data on the perception of the Canadian public regarding these issues. Such information would be a useful guide to provincial psychology associations, and to those responsible on a national level for the future development of the profession.
Footnotes 1 On October 24, 1991, in R. v. Gruenke, the Supreme Court of Canada ruled that the communications between a pastor and lay counsellor of a fundamentalist Christian church, and a church member, about involvement in a murder were admissible into evidence. The court stated that the communications did not satisfy the first requirement that the communications originate in a confidence that they would not be disclosed. Note that the communications did not constitute a formal confession. 2 In Wendell v. Trikha et al. (1991), (116 A.R. 81) a voluntary psychiatric patient eloped from hospital and caused an accident, injuring the plaintiff. The plaintiff sued the patient, the hospital, and the psychiatrist. The Alberta Court of Queen's Bench stated that hospitals and psychiatrists owed a duty of care to their patients. Hospitals and psychiatrists also owed a duty of care to persons other than its staff or patients if it was foreseeable that harm would likely occur to such persons as a result of a patient's behaviour, and provided there was a relationship between the hospital and that third party. The court found, however, that the psychiatrist and the hospital had acted appropriately and were not in breach of any duty of care they might have owed to Trikha. The action against the psychiatrist and the hospital was dismissed, and damages were found against Trikha. We would like to thank Dr. Derek Truscott for informing us of this case.
Dans cet article, les auteurs mettent l'accent sur les aspects deontologiques et juridiques du probleme que pose la confidentialite aux psychologues canadiens en general, et aux psychologues cliniciens en particulier. Les concepts de confidentialite, de communication privilegiee, d'intimite et de vie privee sont clarifies. On y presente la loi canadienne relative au concept de communication privilegiee. On y traite aussi des standards deontologiques, des lois provinciales et federales ainsi que de la jurisprudence qui ont un lien avec la question de la confidentialite dans l'exercice de la psychologie clinique. Certaines questions, telles que l'obligation de signaler les cas d'abus sur un enfant, l'obligation de proteger l'entourage d'un patient, le consentement eclaire, ainsi que l'acces d'un client ou d'une tierce personne aux dossiers psychologiques, sont explorees. Les auteurs proposent finalement quelques avenues qui aideront les psychologues a faire face aux problemes relies a la question de la confidentialite. References
American Psychological Association. (1981). Ethical Principles of Psychologists (Rev. ed.). Washington, DC: Author.
Attorney - General v. Mulholland; Attorney General v. Foster, 2 Q.B. 477 (1963).
Baird, K.A., & Rupert, P.A. (1987). Clinical management of confidentiality: A survey of psychologists in seven states. Professional Psychology: Research and Practice, 18, 346 - 352.
Birch, D.E. (1992). Duty to protect: Update and Canadian Perspective. Canadian Psychology, 33, 2.
Bloom, B.L., & Asher, S.J. (Eds.). (1982). Psychiatric patient rights and patient advocacy. New York: Human Sciences Press, Inc.
Brysh v. Davidson, 44 W.W.R. 654 (1963).
Canada. (1982). The Charter of Rights and Freedoms: A guide for Canadians. Ottawa: Author.
Canadian Family Law Guide. (1989). Don Mills, Ontario: CCH Canadian Ltd. Canadian Psychological Association. (1978). Standards for providers of psychological services. Old Chelsea, Quebec: Author.
Canadian Psychological Association. (1986). Canadian Code of Ethics for Psychologists. Old Chelsea, Quebec: Author.
Canadian Psychological Association. (1988). Canadian Code of Ethics for Psychologists: Companion Manual. Old Chelsea, Quebec: Author. Canadian Psychological Association. (1989). Practice Guidelines for Providers of Psychological Services. Old Chelsea, Quebec: Author. Charter of Human Rights and Freedoms, R.S.Q., C - 12, s. 5 and s. 9; Civ. C. art. 1053 (1977).
Code of Civil Procedure, R.S.Q., c. C - 25 s. 308 (1965).
Criminal Code of Canada, R.S.C., c. C - 34 (1970).
Cronkwright v. Cronkwright, 2 R.F.L. 241 (1970)
Crowhurst, B., & Dobson, K.S. (this issue). Informed consent: Legal issues and applications to psychology.
Dembie v. Dembie, 21 R.F.L. 46 (Ont. H.C. 1963).
Divorce Act, R.S.C., c. D - 8, s. 21 (1970).
Divorce Act, S.C. 1986, c. 4 s. 10(5) (1985).
Eberlein, L. (1980). Legal duty and confidentiality of psychologists. Canadian Psychology, 21, 49 - 58.
Eberlein, L. (1990). Client records: Ethical and legal considerations. Canadian Psychology, 31, 155 - 166.
Ethics Committee of the American Psychological Association. (1988). Trends in ethics cases, common pitfalls, and published resources. American Psychologist, 43, 564 - 572.
Everstine, L., Everstine, D.L., Heymann, G. M., True, R.H., Frey, D.H., Johnson, H.G., & Seiden, R.H. (1980). Privacy and confidentiality in psychotherapy. American Psychologist, 35, 828 - 840.
Evidence Act, R.S.N., c. 115 s. 6 (1970).
Federal/Provincial Task Force on Uniform Rules of Evidence. (1982). Report on evidence. Toronto: Carswell Company Limited.
Haines v. Bellisimo, 82, D.L.R. (3rd), 215 (1978).
Henley v. Henley, P. 202,  2 W.L.R. 851 (1955).
Hesson, L., Bakal, D., & Dobson, K.S. (this issue). Legal and ethical issues concerning children's rights of consent.
Heymann, G.M. (1986). Mandated child abuse reporting and the confidentiality privilege. In L. Everstine & D.S. Everstine (Eds.) Psychotherapy and the law (pp. 145 - 156). Florida: Grune & Stratton, Inc. Hopp v. Lepp,2 S.C.R. 192 (1980).
Hospitals Act, R.S.A., c. H - 11 (1980).
Keith - Spiegel, P., & Koocher, G.P. (1985). Ethics in psychology. Hillsdale, NJ: Lawrence Erlbaum Associates.
Keizars v. Keizars, 29 R.F.L. 223 (1982).
Knapp, S., & VandeCreek, L. (1988). Privileged communications for psychotherapists in federal courts: In the light of reason and experience. Psychotherapy in Private Practice, 6, 69 - 78.
Kowall v. McRae et al., 108 D.L.R. (3d) 486 (1980).
Krever, H. (1980). Report of the commission of inquiry into the confidentiality of health information (Vol. 1). Ottawa, Ontario: Queen's Printer.
Law Reform Commission of Canada. (1975). Report: Evidence. Ottawa: Information Canada.
Lindsay v. D.M., 3 W.W.R. 703 (Alta. C.A.) (1981).
McLachlin, W. (1980). Confidential communication and the law of privilege. In D. N. Weisstub (Ed.) Law and psychiatry in the Canadian context (pp. 881 - 885). Toronto: Pergamon Press.
McTaggart v. McTaggart, P. 94  2 All E.R. 754 (C.A. 1949). Medical Act, R.S.Q., c. M - 9, s. 42 (1977).
Mental Health Act, R.S.M., c. M - 110 (1987).
Mental Health Act, R.S.O., c. 262 (1980).
Mental Health Act, S.A., c. M - 13.1 (1988) [am. 1990].
Ministry of Health of Ontario. (1988). Rights and responsibilities: A guide to the mental health act. Queen's Printer for Ontario.
Mitchell v. St. Michael's Hosp., 29 O.R. (2d) 185 (1981).
Mole v. Mole, P. 21, 66(2) T.L.R. 129 (1951).
Muehlman, T., & Kimmons, C. (1981). Psychologists' views on child abuse reporting, confidentiality, life, and the law: An exploratory study. Professional Psychology: Research and Practice, 12, 631 - 638. Murphy v. Gen. Hosp., 25 NFLD. & P.E.I.R. 355 AT 359 (NFLD. S.C. 1980) O'Neill, P. (1989). Responsible to whom? Responsible for what? Some ethical issues in community intervention. American Journal of Community Psychology, 17, 323 - 341.
Pettifor, J.L. (1980). Practice Wise: Privacy of Information. Canadian Psychology, 21, 187 - 190.
Picard, E.I. (1984). Legal liability of doctors and hospitals in Canada (2nd ed.). Toronto: Carswell.
Piercy v. Piercy, B.C.J. No. 2138 (1990)
Pope, K.S., Tabachnick, B.G., & Keith - Spiegel, P. (1987). Ethics of practice: The beliefs and behaviors of psychologists as therapists. American Psychologist, 42, 993 - 1006.
Porter v. Porter, 40 O.R. (2d) 417 (1983).
Privacy Act, R.S.B.C., c. 336 (1979).
Privacy Act, R.S.M., c. P. 125 (1987).
Privacy Act, R.S.S., c. P - 24 (1978).
Psychologists Association of Alberta. (1987). Code of professional conduct. Edmonton, Alberta: Author.
R. v. Burgess, 4 W.W.R. 310 (B.C. Co. Ct. 1974).
R. v. Cook, 37 R.F.L. (2d) 93 (Ont. Prov. Ct. 1984).
R. v. Fehr, 2 W.W.R. 334 (1984).
R. v. Gruenke, 3 S.C.R. 263 (1991).
R. v. Hawke, 3 O.R. (2d) 210 (H.C. 1974).
R. v. Potvin, 16 C.R.N.S. 233 (Que. C.A. 1972).
R. v. Stachula, 40 R.F.L. (2d) 184 (Ont. Prov. Ct. 1984)
R. v. St. - Jean, 34 C.R.N.S. 378 (Que. C.A. 1976).
R. v. Warren, 14 C.C.C. (2d) 188 (1974).
Reibl v. Hughes, 2 S.C.R. 880 (1980).
Robson v. Robson, 2 O.R. 857 (1969).
Roth, L.H., Wolford, J., & Meisel, A. (1980). Patient access to records: Tonic or toxin? American Journal of Psychiatry, 137, 592 - 596. Rozovsky, L.E. (1980). The Canadian patient's book of rights. Toronto: Doubleday Canada Limited.
Rozovsky, L.E., & Rozovsky, F.A. (1984). The Canadian law of patient records. Toronto: Butterworths.
Rozovsky, L.E., & Rozovsky, F.A. (1990). The Canadian law of consent to treatment. Toronto: Butterworths.
Rubanowitz, D.E. (1987). Public attitudes toward psychotherapy - client confidentiality. Professional Psychology: Research and Practice, 18, 613 - 618.
Ryan, D.P., & Bagby, R.M. (1985). Psychologists and privileged communication. Canadian Psychology, 26, 207 - 213.
Shakotko v. Shakotko et al., 27 R.F.L. 1 (1977).
Sinclair v. Roy, 47 R.F.L. (2d) 15 (1985).
Slavutych v. Baker (1976) 1 S.C.R. 254.
Slovenko, R., & Usdin, G.L. (1966). Psychotherapy, confidentiality, and privileged communication. Springfield IL: Charles C. Thomas. Soisson, E.L., VandeCreek, L., & Knapp, S. (1987). Thorough record keeping: A good defense in a litigious era. Professional Psychology: Research and Practice, 18, 498 - 507.
Strazdins v. Orthopaedic & Arthritic Hospital: Toronto 22 O.R. (2d) 47 (H.C. 1978).
Swoboda, J.S., Elwork, A., Sales, B.D., & Levine, D. (1978). Knowledge of and compliance with privileged communication and child - abuse laws. Professional Psychology, 9, 448 - 458.
Tarasoff v. Board of Regents of the University of California, 529 P. 2d. 533, 118 Cal. Rptr. 129 (1974).
Tarasoff v. Regents of the University of California, 17 Cal. Rptr. 3d 425, 551 P. 2d 334 (1976).
Tomkow v. Oldale, 118 D.L.R. (3d) 755 (Alta. Q.B. 1981).
Truscott, D. (1990). Psychologists and the duty to warn. Alberta Psychology, 19, 6 - 8.
Weisberg, R., & Wald, M. (1986). Confidentiality laws and state efforts to protect abused or neglected children: The need for statutory reform. In L. Everstine & D.S. Everstine (Eds.) Psychotherapy and the law (pp. 157 - 206). Florida: Grune & Stratton, Inc.
Weisstub, D.N. (Ed.). (1980). Law and psychiatry in the Canadian context. Toronto: Pergamon Press.
Wendell v. Trikha et al. 116 A.R.. 81 (1991).
Wigmore, J. (1940). Evidence (3rd ed., vol. 8). Boston: Little Brown. TABLE 1 Canadian Child Protection Statutes
British Columbia: Family and Child Service Act, s. 7. Alberta: Child Welfare Act, s. 3. Saskatchewan: The Family Services Act, s. 16. Manitoba: The Child and Family Services Act, s. 18. Ontario: Child and Family Services Act, 1984, s. 68. New Brunswick: Family Services Act, s. 30. Nova Scotia: Children's Services Act, s. 77. Prince Edward Island: Family and Child Services Act, s. 14. Newfoundland: The Child Welfare Act, 1972, s. 49. Northwest Territories: Child Welfare Act, s. 30.1. Yukon(f.a): Children's Act, s. 115
a Section 115 of the Yukon Children's Act provides for the reporting of child abuse, but does not make such reporting mandatory.…
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Publication information: Article title: Confidentiality: Ethical and Legal Aspects for Canadian Psychologists. Contributors: Cram, Susan J. - Author, Dobson, Keith S. - Author. Journal title: Canadian Psychology. Volume: 34. Issue: 3 Publication date: July 1993. Page number: 347. © Canadian Psychological Association Aug 1996. Provided by ProQuest LLC. All Rights Reserved.