Concern for one's moral integrity is often a part of discussions about moral conflicts in health care. The presumption is that moral integrity is good, even though the full meaning of the concept and its relative worth are not completely understood.

The word “integrity” comes from the Latin integritas, which referred to a state of completeness or wholeness and a quality of purity. The subject of integritas included all of life. More recent understandings of integrity are limited in scope to specific areas of life, though the early meaning of an unimpaired condition has survived. But the scope of integrity is commonly limited to a firm adherence to a code of moral standards.

There is a considerable literature on the phenomenon of “transfer trauma” — the suffering a person experiences from being involuntarily transferred from one nursing home to another. While the explication of transfer trauma remains the domain of researchers and those caring for nursing home patients, the issue has recently surfaced in a number of court opinions, and judges have been asked to assess the significance of transfer trauma in deciding whether or not nursing home patients have a right to a hearing before the facility is closed or decertified as a Medicare provider. Two such cases will be discussed in this column.

This case concerns a new strand to an old yarn, the eternal triangle. It is new in that in addition to the usual cast, le mari, la femme, et l'amant (the husband, the wife, and the lover), new characters, the husband's “psychiatric team,” have been joined as parties. In fact, the “team” has been sued for the injuries inflicted on l'amant by le mari.

This is the first paragraph of a recent opinion by the Court of Special Appeals of Maryland entitled Shaw v. Glickman. The case is noteworthy not because of its racy facts, but because it stimulates further discussion of an important issue — the duty of a psychotherapist to reveal confidential information about a patient to protect the public or a specific individual.