Most clinicians aspire to have a fairly good record-keeping system, as well as procedures for maintaining the confidentiality of those records. As a profession, therapists tend to be quite concerned about record-keeping. This concern is appropriate. Unlike some businesses, the information contained in clinicians’ practice related records is highly sensitive and deserving of great care.
It is surprising, then, that many clinicians have not made arrangements for the care of these records if the clinician is suddenly and unexpectedly unable to continue their practice, such as if the clinician dies or is injured. This may be due to a number of factors, such as a general reluctance on the part of many people to engage in end of life planning, communicate advanced medical directives, write wills, etc. But procrastinate or not, this is something that clinicians really should do.
While some states, such as Oregon and Washington, specifically direct clinicians to prepare a professional will, California is not as explicit. Rather, the direction for clinicians to prepare a can be found in the professions’ respective codes of ethics. The American Psychological Association code of ethics, for example, does not specifically direct psychologists to have a “professional will.” Psychologists are instead expected to “make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement or by the client’s/patient’s relocation or financial limitations.” (APA 2002 Ethics Code 3.12) Psychologists are also directed to “make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice.” (APA 2002 Ethical Principles of Psychologists and Code of Conduct 6.02(c))
The American Association of Marriage and Family Therapists code of ethics has a similar provision, which states that “subsequent to the therapist moving from the area, closing the practice, or upon the death of the therapist, a marriage and family therapist arranges for the storage, transfer, or disposal of client records in ways that maintain confidentiality and safeguard the welfare of clients.” (AAMFT 2001 Code of Ethics 2.5)
The presence of these instructions in the ethics codes is significant because licensure boards use these ethical principles as guides for the determination of misconduct and the standard of care. It is true that once you are dead the threat of disciplinary action isn’t likely to motivate you to draw up a plan. However, there are important reasons for making some advance plans that have little if anything to do with licensing boards.
Reason number one is that it’s just plain easier. After a death or major accident the last thing anyone wants to have to deal with is the thorny issue of confidential records.
Reason number two is that it is good for your patients/clients. The death of a therapist is likely to be very difficult for patients/clients, and the designation of a colleague to manage professional affairs is likely to help the transition and grieving process.
Finally, reason number three is that it’s a good thing to do for your colleagues. Occasionally a trusted colleague is asked to help sort out professional affairs, and a lack of instructions can make her/his job quite difficult.
There are a number of ways to construct these types of “professional wills.” When constructing one it doesn’t necessarily have to be called a “professional will,” just as long as it contains the information specified in the ethics code(s). Ideally, it should be tied to the informed consent process and clients/patients should be informed that there are emergency arrangements. There are a number of different ways to go about constructing these directions, and it’s always a good idea to run it by a colleague, especially if he/she is named.
Of course, if there are any questions it helps to consult. Local professional organizations often have an ethics chair, and if they don’t know the answer they often know who to ask.
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