Privacy, Confidentiality,
Autonomy
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Balancing client rights and best
interests in victim advocacy
Privacy refers to that which is held
secret; not publicly expressed ; a
state of being free from intrusion or
disturbance in one’s affairs
Privacy is individual in nature
What is the meaning of privacy?
Tied to our sense of personhood
 Bound up with feelings of
 pride
 shame
 fear
 boundaries
 dignity
 respect

Why do we value privacy?
1. Reliance on another’s
discretion
2. Marked by intimacy or a
willingness to confide
What is the meaning of
confidentiality?

Confiding in another requires trust

Keeping a confidence signals
trustworthiness of the receiver and
respect and care for the one confiding
Why do we value confidentiality?

The conception of human beings as autonomous
arose in the 1700s

The notion of human autonomy is based upon
our ability to reason, i.e., think for ourselves

Capacity for rational thinking (i.e., the ability to
reason) is essential to the meaning autonomy
What is autonomy?
Definition of self-determination: Determining one’s
own fate or course of action without compulsion

Self-determination reflects an person’s preferences,
goals, values concerns

Self-determination may be expressed not only
through rational thinking but through our verbally
and non-verbally conduct

Autonomy and SelfDetermination
The ability to weigh interests such as privacy
and confidentiality against each other and
against other interests such as physical and/or
emotional health and safety, the strength and
commitment to personal relationships, the
well-being of other family members, and to
arrive at a reasoned basis for choosing a
course of action, reflects the exercise of
autonomy.
The Relationship of Autonomy,
Privacy, Confidentiality
When a client has the capacity to
reason, i.e., to exercise autonomy, law
and ethics both favor deference to the
client’s decision(s)
The Ethical and Legal Significance
of Capacity
What is it?
“Sufficient understanding and memory to
comprehend in a general way the situation in
which one finds oneself and the nature, purpose,
and consequence of any act or transaction into
which one proposes to enter “ – MerriamWebster Dictionary
Who determines whether an individual has
capacity?
Why is an understanding of capacity important?
Defining “Capacity”

Capacity is the presumption

Lack of capacity is a
conclusion

The advocate’s role is to
advocate for capacity
Considering capacity
Functional View (Process Based)
Substantive View(Outcomes Based)
Two Views of Capacity
Legal capacity
vs.
Clinical capacity
Has capacity
Has capacity
Diminished
capacity
Lacks capacity
Lacks capacity
Assure that situation supports (rather
than undermines) client’s capacity
Advocate for client capacity
Supporting Client Capacity: The
Advocate’s Critical Role

Mandatory reporting of elder
abuse

Threat of harm to another
When disclosing a confidence is
required – 2 examples
Susan Mitchell is on the staff of a victim advocate organization.
She lives next door to Molly Kramer, a 76 year old woman with
physical frailties that make it difficult for her to do her household
chores or to get out to do her shopping . Susan looks in on Molly
from time to time to help her by running errands and straightening
up. Recently she has noticed bruises on Molly’s arm and face.
Molly says she fell off a step ladder. However, Sally knows that
Molly’s son has a drug problem and that a PFA order had been
taken out against him by the mother of his son so he has recently
returned to live with Molly. Susan tries to question Molly about
the bruises but Molly becomes tearful and denies there’s a
problem and pleads “I love my son. Please don’t cause any
problems for us.” Must Susan report the suspected abuse to
Protective Services?
Poll - Case vignette #1
Sally Miner is a social worker employed by a home care
agency. She visits an agency client, Mrs. Kramer, in her home
from time to time to coordinate services. On her most recent
visit Sally notices bruises on Mrs. Kramer’s arm and face. Mrs.
Kramer says she fell off a step ladder. However, Sally notices
that Mrs. Kramer’s son seems to have moved into the house
and Mrs. Kramer seems more anxious than on past visits, more
fearful and confused and reluctant to talk with Sally. When
Sally asks if her son is hurting her Mrs. Kramer becomes tearful
but denies there’s a problem, insists she fell, and pleads “I love
my son. Please don’t cause any problems for us.” Must Sally
report the suspected abuse to protective services?
Poll – Case Vignette #2
§ 15.151. General requirements.
(a) Administrators or employees [of a facility] who have
reasonable cause to suspect that a recipient is a victim of
abuse shall:
(1) Immediately make an oral report to the agency.
(2) Make a written report to the agency within 48 hours.
(b) Employees making oral or written reports shall immediately
notify the administrator or designee of these reports.
(c) Agencies shall notify administrators, or their designees, and
State agencies with facility licensing responsibilities
immediately when written reports of abuse are received.
(d) Employees required to report abuse may request
administrators or their designees to make, or assist the
employees to make, oral or written reports
Act 13 – Mandated Reporting
Requirements
Facility—Any of the following:
(i) A domiciliary care home as defined in sections 2201A—2212-A of The Administrative Code of 1929 (71 P. S.
§ § 581-1—581-12).
(ii) A home health care agency.
(iii) A long-term care nursing facility as defined in the
Health Care Facilities Act (35 P. S. § § 448.101—
448.904b).
(iv) An older adult daily living center as defined in the
Older Adult Daily Living Centers Licensing Act (62 P. S. §
§ 1511.1—1511.22).
(v) A personal care home as defined in section 1001 of
the Public Welfare Code (62 P. S. § 1001).
Act 13 – Mandatory Reporting –
Definition of Facility
Employee—Includes the following:
 (i) An individual who is employed by a facility.
 (ii) A facility contract employee who has direct contact with residents or
unsupervised access to their living quarters.
 (iii) An individual who is employed by, or who enters into a contractual
relationship with, or who establishes any other agreement or arrangement
with a home health care agency to provide care to a care-dependent person
for a fee, stipend or monetary consideration of any kind in the person’s place
of residence.
 (iv) A student doing an internship or clinical rotation, or any other individual,
who has been granted access to the facility to perform a clinical service for a
fee.
 (v) An individual, employed by an entity which supplies, arranges for, or refers
personnel to provide care to care-dependent persons, who is employed to
provide care to care-dependent persons in facilities or their places of
residence.
Act 13 – Mandated Reporting
Who Is an “Employee”?
§ 15.151. General requirements.
(a) Administrators or employees who have reasonable cause
to suspect that a recipient is a victim of abuse shall:
(1) Immediately make an oral report to the agency.
(2) Make a written report to the agency within 48 hours.
(b) Employees making oral or written reports shall immediately
notify the administrator or designee of these reports.
(c) Agencies shall notify administrators, or their designees, and
State agencies with facility licensing responsibilities
immediately when written reports of abuse are received.
(d) Employees required to report abuse may request
administrators or their designees to make, or assist the
employees to make, oral or written reports
Act 13 – Mandated Reporting
Requirements
If the employee or administrator believes the abuse
involves sexual abuse, serious physical injury, serious
bodily injury or suspicious death, s/he is also required to
make an oral report to law enforcement and to the PDA
in addition to the oral and written report to the AAA.
Within 48 hours of receiving a report of abuse as above,
the AAA shall forward a written report to the PDA.
Mandatory Reporting – Making a
Report
Administrative penalty: Licensing agency for the facility
has jurisdiction to determine any administrative
violation and may issue a civil penalty of up to $2500.
Criminal penalty: Up to one year imprisonment
Penalties for Failure to Comply with
Act 13
Pennsylvania
Older Adult
Protective
Services
Case Management
Flow
Victim is over 60
 Finding of abuse
 Unable to care for self
 Lacking responsible caregiver
 Willing to accept protective
services

Substantiation of Elder Abuse

The Supreme Court of California held that mental health
professionals have a duty to protect individuals who are
being threatened with bodily harm by a patient.

The original 1974 decision mandated warning the
threatened individual, but a 1976 rehearing of the case by
the California Supreme Court called for a "duty to protect"
the intended victim.
Duty to Warn: Tarasoff v. Regents
of the University of California

Truthfulness

Transparency

Trust
How Can an Advocate Reconcile
Obligations