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Ethical and Legal Considerations in Postdisaster Collaborations 81

doctor–patient relationship can seem blurry. Doctors who may be com-
fortable working collaboratively with other disciplines within their hospi-
tals or clinics may forget that, while their coworkers in a medical setting
are all permitted to share information within a circle of confidentiality,
these same rules do not apply to fellow disaster responders. In this case,
the patient may have a legitimate basis for a legal claim against the doctor
for sharing information about her private life without her permission.

Conclusion

In each of these three vignettes, bad outcomes resulted from some form
of communication problem. In the first case, a plan for communication
between the church and mental health professionals could have avoided
the misperception of discrimination. In the second and third cases, sur-
vivors felt betrayed by communications from a pastor to a psychiatrist
and from psychiatrist to a pastor. Thus, we must not only learn how to
communicate more, but also how to communicate wisely. Because con-
fidentiality standards and standards of care vary by jurisdiction and
vary over time, there is no one perfect resource to determine whether
something is legal and ethical. Even when certain practices are generally
accepted as legal and ethical (as in Vignette 2), there is no guarantee that
a dissatisfied individual won’t create tremendous anxiety and disruption.
Consider using the Internet for up-to-date rules about laws in your area.
However, another resource that should be considered is your own nondi-
saster standard practice. How would you handle such a situation if this
were not a disaster? All too often we assume that a disaster suspends all
the rules when, in fact, the rules become more important than ever.
How important are these considerations? The bottom line is that there
have not been systematic studies on how frequently these legal problems
arise. This may prove an important area for future research. In the mean-
while, communication and an awareness of these issues is the best way to
reduce distress, liability, and other bad outcomes.

For Further Study

The information provided above concerning HIPAA and the meaning
of different legal terminology is based on common information avail-