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Suicide & Confidentiality: The Case of Nadia Kajouji

Suicide & Confidentiality: The Case of Nadia Kajouji. Rex Roman, Ph. D. JEMH Conference on Ethics in Mental Health May 14, 2010. Part I. Nadia’s Story. Nadia Kajouji. 18 years old First year student at Carleton University Public Affairs/Policy Lives in residence Home in Brampton

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Suicide & Confidentiality: The Case of Nadia Kajouji

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  1. Suicide & Confidentiality: The Case of Nadia Kajouji Rex Roman, Ph. D. JEMH Conference on Ethics in Mental Health May 14, 2010

  2. Part I Nadia’s Story

  3. Nadia Kajouji • 18 years old • First year student at Carleton University • Public Affairs/Policy • Lives in residence • Home in Brampton • Intelligent March 2008

  4. Should you tell the Parents?

  5. March 9, 2008 - Nadia Missing • Media sensation: Sexual Predator? • Interview with parents • $50,000 reward • Intensive search • University does not reveal information

  6. April 2008 – Body Found

  7. Dr. Ann Cavoukian

  8. Part II What Went Wrong

  9. Pregnancy Insomnia Miscarriage Depression Breakup Antidepressants No friends Alcohol Away from Family Failing School

  10. Pregnancy Insomnia Miscarriage Depression Breakup Solution Suicide Antidepressants No friends Alcohol Away from Family Failing School

  11. Kirby: Out of the Shadows by France Daigle, Suicide Prevention Program, New Brunswick Ministry of Health, who stated that: …the first thing people say is, “I cannot tell you anything because of confidentiality.”  However, when you have someone that is at risk for suicide, and as much as I do respect confidentiality, because we have a code of ethics, what is more important?  You have to let the family and other people know. 

  12. Duty to Care Healthcare Privacy

  13. Practitioner’s Statement I did not see any significant therapeutic value in telling anyone, therefore I respected the client’s privacy.

  14. An Array of Clients

  15. Clients with Different Risk RISK

  16. The Law Disclosure Permitted Without Consent Disclosure Not Permitted Without Consent RISK

  17. No Legal Duty Disclosure Permitted Without Consent RISK

  18. Relative to Practitioner A B C D RISK

  19. The Mental Health Act • Permission • No Duty

  20. Malpractice • Imprecise • No clear direction • Punitive rather than prescriptive

  21. Discretion • Legalisitic* • Culture • Lack of Knowledge • *Legalism, Countertransference, and Cinical Moral Perception, Renmeester & George, The American Journal of Bioethics, 9(10);20-28,2009

  22. Option One • Change the Privacy Law • For example, Section 72 CFSA

  23. Option Two • Change the Culture • Education • Policy • Interprofessional • Inclusion of peers in consults • Inclusion of family & friends in therapy

  24. Role of the Bioethicist • Education • Policy • Advocacy for Suicide Prevention • Mental Health & Ethics Consults

  25. Suicide Prevention Through an exploration of Ethics

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