When patients disclose past sexual offending: a comparative analysis between confidentiality and mandatory reporting frameworks in Spain and Germany

When individuals voluntarily seek treatment and disclose past sexual offending, mental health professionals face an ethical dilemma: protect confidentiality to maintain treatment and potentially prevent future victimisation, or report those past offences to ensure justice for known victims. This comparative doctrinal and bioethical study analyses case law from Spain and Germany against the four principles of principlism, incorporating a synthesis of treatment-effectiveness evidence so far. Spain’s mandatory reporting system (Articles 262–263 Criminal Procedure Law) requires therapists to report disclosed offences and therefore interrupt treatment, whereas Germany’s confidentiality framework (§34, §203 Penal Code) permits treatment to continue. Considering perspectives of patient-offenders, victims, therapists and society, it is found that neither framework is ethically superior, but each one prioritises different ethical goods. Across both perspectives, five common topics emerged: treatment-effectiveness assumptions, attrition and secondary victimisation, retributive versus distributive justice, temporal discounting of harms, and uncertainty tolerance. The article finishes with practical guidance on informed consent, documentation and risk assessment, and considering prevention-focused and hybrid alternatives.