Trends

The contributions to this volume demonstrate that expectations and standards defining the professional duty of confidentiality are now in an unprecedented state of flux. In an important sense there is nothing new about the obligation to safeguard individuals’ privacy and therefore protect their communications with a promise of non-disclosure: it has been a key feature of the professional relationship at least since Hippocrates. But when we set this continuing obligation against the contemporary context of professional practice we see that the traditional promise, although ostensibly as highly valued as ever, is becoming increasingly problematic to interpret and to apply. What, then, has changed?

The conclusions of this book can be summarised in the following terms. At least four broad contemporary currents of change are shifting, and possibly eroding, the ethic of confidentiality between professionals and clients. It remains as vital as ever to protect individual rights and privacy, but this now has to be done by means of new and much more complex interpretations of the need to know and the right to keep silence. Personal information gathered in the course of professional practice can no longer be imagined as sealed in a locked container accessible only to the professional delivering the service and a small handful of select keyholders. Instead, we should think of personal information as located in a porous space of variable accessibility to different individuals, interests and agencies. It is the porosity that is the problem in both normative and technical senses: who should have access, and to what? And how can we make sure that a complex pattern of differential entitlement to know is actually maintained in the chaotic world of service delivery?

The first broad trend that is changing confidentiality is the increasing complexity of service delivery in the social and health services. It is driven by the discovery of new needs (or the rediscovery of old ones) and the invention of new treatments and methods of service delivery. Alongside this is the growing emphasis on the prevention and the management of current and potential future risk both to vulnerable individuals and the wider community. In the field of care for people with major disabilities, for example, reliance on the asylum as the principal model of provision has been swept away in a torrent of community-based interventions such as intensive home care, supported accommodation, new kinds of supported employment, self-advocacy and so forth. In the health services, constant new discoveries from medical research point the way to addressing hitherto intractable health problems, while new technologies open up therapies previously inconceivable.