Confidentiality is something that doesn’t exist in Trinidad. A secret here is something you tell other people, one person at a time.

Such views have wide currency socially, not without good reason. People have heard their business delivered as “testimony” in prayer meetings; at cocktail parties inebriated professionals have “shared” client confidences; and nurses, indeed, nurses’ assistants, will tell you which “big man” in society has an STD.

In every society, social trust means social capital, but reserves of social capital are not unlimited. Confidentiality is an irreplaceable constituent of social capital, but, here as in other such areas of value, it’s easier to squander and waste than to replenish.

The value of confidentiality for professional services is obvious. For centuries a principle in the Hippocratic oath set the aspirational standard for healthcare: “Whatever, in connection with my professional service, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.”

The standard has allowed patients to set aside hesitancy in speaking of their behaviours, ailments, and concerns to their physician.

Confidentiality is perhaps an even more important feature in psychoanalytic disciplines, and it’s not difficult to see why. It allows individuals to get help for dealing with issues they may think too shameful or socially embarrassing to share with family or friends.

A “covenant of trust” with a psychotherapist constitutes a save haven. Confidentiality helps to build the patient’s trust in the psychotherapist and in the process. Full disclosure on the patient’s part is impossible without it.

In non-professional contexts, the issues are not so much the creation of a safe haven or conditions of full disclosure, but the ability to control information about oneself. Here confidentiality is closely related to the right to privacy.

A right to privacy is essential to everyone’s freedom of self-determination. An individual has a right to keep her thoughts, feelings, and personal data from being shared with others. The crucial feature is not the absence of information about us in the minds of others, but, as noted, the control we should have over such information ourselves.

A society with loose standards about the sanctity of confidences disrespects everyone’s claim to privacy as a right. It curtails everyone’s freedom to control what they want told or disclosed about themselves. Such a situation is nothing short of routine assault on human dignity.

Law has traditionally recognised that there are relationships so important to social interaction that they deserve protection from all intrusion. These relationships are termed “privileges” and are, with limited exceptions, exempt from compulsory disclosure. The four such protected relationships are husband and wife, attorney and client, physician and patient, and priest and penitent.

Within recent years, however, such encroachments on privilege have taken place on the medical front that some ethicists argue that “confidentiality in medicine” is a “decrepit concept.” Medical insurers, on the one hand, insist and more on their “right to know,” in making their own assessments of “medical necessity.”

On the other hand, what physicians and patients have traditionally understood as confidential protection no longer exists. The list grows of the numbers of people with needs and responsibilities to examine patients’ charts and records. Thus, what the patient presumes and what is actually the case are two completely different things. Scores of healthcare people with a “need to know” evacuate confidentiality of any real value or meaning.

Surveys also indicate that patients expect a more rigorous standard to obtain in respect of discussion of their situations. They expect physicians to have some discussion with colleagues informally and in professional settings, but they draw the line at discussion with spouses and at parties.

On the legal front, the landmark Tarasoff case in California (1969) struck a tremendous blow to therapeutic confidentiality. The majority opinion held that “the protective privilege (therapist and patient) ends where the public peril begins.”

Policy considerations here, of course, often entail a tragic calculus, but the bottom line is that the law is moving more and more away from protecting patients who divulge their secrets in treatment, towards protecting clinicians who breach confidentiality and report their patients to enforcement authorities.

The sole dissenting judge in Tarasoff reminded his colleagues of the implications of the landmark shift. It cripples “the use and effectiveness” of psychiatry. Patients will be deterred from seeking treatment, and covenants of trust will be seriously imperiled.

In Jaffee vs Redmond (1996), the Supreme Court returned to pre-Tarasoff policy. “Effective therapy,” the justices wrote, “depends upon an atmosphere of confidence and trust, and therefore the mere possibility of disclosure of confidential communication may impede development of the relationship necessary for successful treatment.”

In private settings, breaches of confidentiality do not have the same structurally bad consequences as they do professionally, but there is a more immediate consequence in the erosion in trust between individuals.

When confidences fail, mistrust increases and unfettered interaction diminishes. More people keep themselves to themselves, which means thinner social relations and a much thinner civic life. Privacy becomes less a right claimed as an instrument of self-determination, than a barrier against loose lips and looser ethics.