| Summary: | This research examines the relationship between professional codes of ethics and ethics in practice. Key issues explored include: (a) to what extent do professionals use their ethical code when making decisions involving ethical dilemmas; (b) how frequently do they disclose information against clients' wishes and how is this justified; (c) are professional judgements so consistent that a common practice standard can be determined; (d) what differences in decision-making exist between nurses, social workers and chaplains and is this related to the extent of 'professionalization' of the occupation into an integrated network? Vignettes describing low-risk community mental health cases, posing ethical dilemmas for the research participants about the disclosure of confidential information, were used as a focus for lengthy semi-structured interviews with 27 nurses, 21 social workers and 7 chaplains. Data was collected about respondents' professional membership and understanding of legal/professional/employer guidance about confidentiality. Responses were analyzed in relation to themes of 'consistency', 'conflict of loyalties', and 'rationalization' of choices. Confidentiality was breached more than it was maintained, although there were considerable differences both within and between professional groups about the points of disclosure. In addition, no standard recipients for information could be determined. Vignettes were sometimes interpreted differently. Disclosure was justified through loyalties conflicting with responsibilities to the named client. This included loyalty to fellow professionals, to third parties, and to oneself. Disclosure could be motivated by desire to obtain a 'good result'. Participants displayed generally poor knowledge of legal/professional/employer frameworks for decision-making, and referred to their codes of ethics rarely as a reason behind decisions. Implications for professional training and employer policy are discussed. Problems in professional accountability are raised, for practitioners, professional bodies, and employers. The utility of a code of ethics which espouses a standard of confidentiality so far removed from day-to-day practice is questioned.
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