Leadership in organisations involves the management of boundaries between different people in different types of relationship. Many of the ethical dilemmas about confidentiality that arise for managers involve tensions between two different kinds of professional space (e.g. should what I learn in this space be told in another?) or tensions between conflicting professional obligations. In this chapter, we review some of these dilemmas and suggest ways of thinking about them.

There is limited guidance for psychiatrists on confidentiality, despite the range of guidance and training on information governance. The only national-level guidance is the advice produced by the General Medical Council (GMC, 2009) and the Royal College of Psychiatrists (2010, but under revision). There is also an NHS code of practice on confidentiality (Department of Health, 2003), which still has advisory force, and NHS England issued a policy statement on confidentiality. All of these are freely available online.

The GMC has advised that each discipline needs to develop guidance that deals in appropriately greater detail with situations of particular concern and relevance; for psychiatry, this would include concerns about reporting to multi-agency public protection arrangements (MAPPA) and multidisciplinary working. What we discuss here are the general ethical, legal and professional principles that underpin the management of personal information in the NHS across the UK (including Scotland and Northern Ireland). This chapter has no legal standing and if faced with a dilemma about sharing information, we advise discussion with senior colleagues, the Caldicott guardian and information governance staff.

Confidentiality: the ethical context

The principle of confidentiality has a lengthy history in medical ethics. The ethical duty to respect this principle is usually grounded in terms of the beneficial consequences of doing so. Keeping patient information confidential benefits the patient by promoting trust between doctor and patient, which is in the patient's interest because it promotes the type of frank discussion that is essential to any therapeutic encounter. If the patient does not feel able to trust the doctor with information, this may mean that the doctor's clinical opinion is compromised in a way that may harm the patient.