3
These respondents who rejected patient consent promote disguise as the best way to protect publication of clinical material. Some have managed this by narrowing the clinical material to a short vignette, or grouping a few patients to present a broader picture of a clinical dilemma. Of course, disguise threatens the scientific validity of clinical reports, as we might wonder how well a case presentation mirrors the analytic experience if important aspects of a patient’s history, major life events, and cultural background have been distorted. Other respondents supported the necessity of obtaining consent and working through a patient’s feelings about being presented. Some additionally recommended having the patient read and authorize clinical material that is included in a publication. These analysts believe that the interactive engagement instigated by the request for consent is in fact the optimal ethical action to take. They claim that therapeutic benefits and enhanced scientific accuracy are obtained as a result of adding the patient’s point of view. Many of these analysts point to the losses of nuance in a clinical encounter when elaborate disguises are introduced. Of course, there are also potential losses in involving the patient in the description of the clinical material. Parties from the first camp would challenge the utility of including a patient in the process of writing and would argue that such behavior is ultimately unethical. To write about a treatment with one’s patient in mind as audience would constrain the analyst’s ability to speak into the unconscious dimensions of the treatment—there is no way to do this that would not risk disturbing a patient, and as a result, what gets written about a treatment would inevitably be profoundly diminished. For these analysts, the goal is to write as fully about a treatment as possible, but in a way that anonymizes the material so that even the patient would not recognize herself.
Ways Forward
The irresolvable conflict within our survey of journal editors in how to best present clinical material for publication indicates the range of perspectives on this issue and makes it clear that each journal, and possibly each author, will need to assess a situation-specific solution. Because of these limitations in our capacity to be confident about specific ethical choices, along with conflicting views on how to handle clinical publications, we do not feel able to provide a clear-cut, universal solution to how to publish clinical material. Rather, we aim to highlight the risks and concerns and offer broad guidelines that will support an ongoing concern with protecting patient confidentiality. We aim to foster a “community-of-concern” approach to confidentiality 1 in which protection of the patient’s privacy and dignity becomes a paramount concern at every point in the development, sharing, and presentation of clinical material. Recommendations 1. Journals may opt to prioritize a particular approach, such as disguise or anonymization, or consent with disguise. In these cases, the process of submitting a paper for publication should include a clear statement about how this journal treats clinical papers, and how authors can satisfy the
1 Glaser J.W. (2002). The community of concern: an ethical discernment process should include and empower all people relevant to the decision. Health Prog. Mar-Apr 83 (2) 17-20, cited in IPA Report on Confidentiality, 2018, p. 12.
3
Made with FlippingBook - professional solution for displaying marketing and sales documents online