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Ethical and Legal Considerations in Postdisaster Collaborations 79

and restricts information from being disclosed in almost all circum-
stances except for a few exceptions. The laws governing confidentiality
may vary from jurisdiction to jurisdiction, but federal law, including
the Health Insurance Portability and Accountability Act (HIPAA), pro-
vides a uniform set of protections for medical information. Although
HIPAA only applies to certain broadly defined covered entities, it is
increasingly becoming a universal standard that may be expected of
medical records in other situations, even when it is not strictly required.
However, HIPAA does not prevent individuals who are not providing
any form of medical care from contacting medical personnel, and it
also has exceptions for necessary disclosures to ensure safety in emer-
gencies. Calling 911 would be such an emergency, so even if Dr. Katz
had seen this patient, he would have been allowed to violate her confi-
dentiality to get help after an overdose.
However, it is important to remember that disasters are not inherently
assumed to be emergencies. Individuals retain both an expectation and
legal protection to their privacy even after a disaster. As with Vignette 1,
even though a lawsuit would unlikely be successful in this circumstance,
we all would want to avoid this conflict. Aside from any legal obligations,
we all would feel an ethical obligation not to betray the trust of individuals
who we are attempting to help and who may be less likely to get neces-
sary help in the future. This risk could be decreased if Rev. Jones created
explicit expectations about how he can help and when he will need to
bring in others. Having those explicit discussions are especially difficult
after a disaster when there is an urge to be flexible and accommodating
with people who are suffering.
Rev. Jones may have a separate concern about whether he is liable for
charges of malpractice by not getting psychiatric help for the lawyer ear-
lier. Such liability would be more clearly defined if his work with this law-
yer was defined as pastoral counseling. Although most clergy develop a
comfort zone dealing with a broad range of issues, empathy for victims
and the urge toward heroism after a disaster may lead some pastoral coun-
selors to stretch themselves into areas where they do not have expertise.
In general, we all may have the wish to believe that we can solve things on
our own, and, after a disaster when we may feel especially vulnerable, we
may be especially likely to try to do whatever we can, rather than stick-
ing to traditional boundaries. Also, because responders are often acting as
volunteers and because of a positive sense of community that can develop
after disasters, many may assume that there is very limited liability in
these situations. However, it is important to remember that disasters are