issues and ethics in the helping professions

ISSUES AND ETHICS IN THE ISSUES AND ETHICS IN THE HELPING PROFESSIONSHELPING PROFESSIONS

Zulkefly OthmanZulkefly Othman

ISSUES AND ETHICS IN THE HELPING PROFESSIONSISSUES AND ETHICS IN THE HELPING PROFESSIONS

CONFIDENTIALITY: ETHICAL AND CONFIDENTIALITY: ETHICAL AND LEGAL ISSUESLEGAL ISSUES

WEEK #5

OBJECTIVESOBJECTIVES

Understand what is confidentialityUnderstand what is confidentiality

Understand the importance of confidentiality to the Understand the importance of confidentiality to the clientclient

Aware some of the issues regarding confidentialityAware some of the issues regarding confidentiality

Knowing the limits/ exceptions to confidentialityKnowing the limits/ exceptions to confidentiality

To develop a sense of professional ethics and To develop a sense of professional ethics and knowledge of laws towards making a good judgmentknowledge of laws towards making a good judgment

LECTURE’S OUTLINELECTURE’S OUTLINE

What is confidentiality?What is confidentiality?Exceptions to confidentialityExceptions to confidentialityIssues regarding confidentiality:Issues regarding confidentiality:

Confidentiality in a school settingConfidentiality in a school setting Duty to protect and to warnDuty to protect and to warn

Duty to protect potential victimsDuty to protect potential victimsDuty to protect suicidal clientsDuty to protect suicidal clientsDuty to protect children from harmDuty to protect children from harmConfidentiality and HIV/ AIDS issuesConfidentiality and HIV/ AIDS issues

Suggestions for counselors who are asked to divulge Suggestions for counselors who are asked to divulge confidential client information in a legal proceeding.confidential client information in a legal proceeding.ConclusionsConclusions

CONFIDENTIALITY IN CONFIDENTIALITY IN COUNSELING PRACTICECOUNSELING PRACTICE

Clients have the right to expect that Clients have the right to expect that communications communications will be kept within the bound of will be kept within the bound of the professional relationshipthe professional relationship (Benke, 1998) (Benke, 1998)

It is an It is an ethicalethical responsibility and a responsibility and a legallegal and and professionalprofessional duty to duty to safeguard clients from safeguard clients from unauthorized disclosuresunauthorized disclosures of information given in of information given in the therapeutic relationship. the therapeutic relationship.


Although it is an important obligation of Although it is an important obligation of practitioner in the various mental health practitioner in the various mental health professions to maintain the confidentiality of their professions to maintain the confidentiality of their relationships with their clients, it is relationships with their clients, it is notnot absoluteabsolute..

Challenges arise when Challenges arise when third parties demand that third parties demand that counselors release confidential informationcounselors release confidential information that that clients do not want released (Glosoff, Herliky & clients do not want released (Glosoff, Herliky & Spence, 2000)Spence, 2000)


Psychologist have a Psychologist have a primary obligation primary obligation and take reasonable precautions to and take reasonable precautions to respect the confidentiality rightsrespect the confidentiality rights of those of those with whom they work or consult, with whom they work or consult, recognizing that confidentiality may be recognizing that confidentiality may be established by laws, institutional rules, or established by laws, institutional rules, or professional or scientific relationships professional or scientific relationships (APA, 1992)(APA, 1992)


The professional school counselor informs the The professional school counselor informs the counselee of the purposes, goals, techniques counselee of the purposes, goals, techniques and rules of procedure under which she/ he may and rules of procedure under which she/ he may receive counseling at or before the time when receive counseling at or before the time when the counseling relationship is entered. the counseling relationship is entered. Notice Notice includes confidentiality issues such as the includes confidentiality issues such as the possible necessity for consulting with other possible necessity for consulting with other professionals, privileged communication, and professionals, privileged communication, and legal or authoritative restraintslegal or authoritative restraints. The meaning . The meaning and limits of and limits of confidentiality are clearly defined to confidentiality are clearly defined to counseleescounselees through a written and shared through a written and shared statement of disclosure. (ASCA, 1998)statement of disclosure. (ASCA, 1998)


When counseling is initiated and throughout the When counseling is initiated and throughout the counseling process as necessary, counselors counseling process as necessary, counselors inform clients of the limitations of confidentiality inform clients of the limitations of confidentiality and identify foreseeable situations in which and identify foreseeable situations in which confidentiality must be breachedconfidentiality must be breached (ACA, 1995) (ACA, 1995)

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EXCEPTIONS TO CONFIDENTIALITYEXCEPTIONS TO CONFIDENTIALITY

All major professional organizations All major professional organizations have taken the position that have taken the position that practitioners must reveal certain practitioners must reveal certain information information when there is clear and when there is clear and imminent dangerimminent danger to an individual or to an individual or to society as to protect others from to society as to protect others from harm.harm.


The general requirement that counselors The general requirement that counselors keep information confidential does not keep information confidential does not apply apply when disclosure is required to when disclosure is required to prevent clear and imminent danger to the prevent clear and imminent danger to the client or others or when legal client or others or when legal requirements demand that confidentiality requirements demand that confidentiality information be revealedinformation be revealed. Counselors . Counselors consult with other professionals when in consult with other professionals when in doubt as to validity of an exception (ACA, doubt as to validity of an exception (ACA, 1995)1995)


According to Corey (2003), the confidential According to Corey (2003), the confidential information can be disclose when:information can be disclose when:• Authorized by lawAuthorized by law• Authorized by clientAuthorized by client

According to Remley and Herlihy (2001), the According to Remley and Herlihy (2001), the conditions where exceptions to confidentiality conditions where exceptions to confidentiality applies when:applies when:• Disclosure is ordered by courtDisclosure is ordered by court• Clients file complaints against counselorsClients file complaints against counselors• Clients claim psychological damage in a Clients claim psychological damage in a

lawsuitlawsuit


Psychologist disclose confidential information Psychologist disclose confidential information without the consent of the individual only as without the consent of the individual only as mandated by lawmandated by law, or where , or where permitted by lawpermitted by law for a valid purpose such as to for a valid purpose such as to (1) provide (1) provide needed professional services; (2) obtain needed professional services; (2) obtain appropriate professional consultations; (3) appropriate professional consultations; (3) protect the client/ patient, psychologist, or protect the client/ patient, psychologist, or others from harm; or (4) obtain payment for others from harm; or (4) obtain payment for services from client/ patientservices from client/ patient, in which , in which instance disclosure is limited to the minimum instance disclosure is limited to the minimum that is necessary to achieve the purpose. that is necessary to achieve the purpose. (APA, 2000)(APA, 2000)

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Confidentiality in School SettingConfidentiality in School Setting

• Birdsall and Hubert (2000) warn school counselors Birdsall and Hubert (2000) warn school counselors of their responsibility to of their responsibility to safeguard a student’s right safeguard a student’s right to privacy when teachers or principals ask to privacy when teachers or principals ask counselor to divulge confidences of studentscounselor to divulge confidences of students..

• Another ethical issue in school counseling is the Another ethical issue in school counseling is the balance between balance between student rights and parent/ student rights and parent/ guardian rightsguardian rights..

• Parent/ guardian have some legal rightParent/ guardian have some legal right to request to request information about counseling session, but information about counseling session, but minors minors have an ethical righthave an ethical right to expect confidentiality in the to expect confidentiality in the relationship.relationship.

Confidentiality in School SettingConfidentiality in School Setting

• When counseling clients who are When counseling clients who are minors or who are unable to give minors or who are unable to give voluntary informed consent, parents voluntary informed consent, parents or guardians may be included in the or guardians may be included in the counseling process as appropriate. counseling process as appropriate. Counselors act in the best interest of Counselors act in the best interest of clients and take measures to clients and take measures to safeguard confidentialitysafeguard confidentiality. (ACA, . (ACA, 1995)1995)

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The general requirement that counselors The general requirement that counselors keep information confidential does not keep information confidential does not apply apply when disclosure is required to when disclosure is required to prevent clear and imminent danger to the prevent clear and imminent danger to the client or others or when legal client or others or when legal requirements demand that confidentiality requirements demand that confidentiality information be revealedinformation be revealed. Counselors . Counselors consult with other professionals when in consult with other professionals when in doubt as to validity of an exception (ACA, doubt as to validity of an exception (ACA, 1995)1995)

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Duty to Protect Potential VictimsDuty to Protect Potential Victims• According to Bednar and his colleagues (1991), According to Bednar and his colleagues (1991),

counselors must exercise the ordinary skill in:counselors must exercise the ordinary skill in:• Identifying those clients who are likely to do physical Identifying those clients who are likely to do physical

harm to third parties.harm to third parties.• Protecting third parties from those clients judge Protecting third parties from those clients judge

potentially dangerous.potentially dangerous.• Treating those clients who are dangerous.Treating those clients who are dangerous.

• Inadequate assessment of client dangerousness Inadequate assessment of client dangerousness can result incan result in liability for the therapist, harm to liability for the therapist, harm to third parties, and third parties, and inappropriate breaches of client inappropriate breaches of client confidentiality.confidentiality.

• The issue: deciding whether a particular client is The issue: deciding whether a particular client is dangerous!dangerous!

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Duty to Protect Suicidal ClientsDuty to Protect Suicidal Clients• Therapists have an ethical and legal obligation to Therapists have an ethical and legal obligation to

break confidentiality when they have good reason to break confidentiality when they have good reason to suspect suicidal behaviorsuspect suicidal behavior in their client. in their client.

• Counselors can be accused of malpracticeCounselors can be accused of malpractice for for neglecting to take action to prevent harm when a neglecting to take action to prevent harm when a client is likely to commit suicide, yet they are also client is likely to commit suicide, yet they are also liable if they overreact by taking actions that liable if they overreact by taking actions that violate violate a client’s privacy when there is not a justifiable basisa client’s privacy when there is not a justifiable basis for doing so (Remley and Herlihy, 2001)for doing so (Remley and Herlihy, 2001)

• The issue: to know when to take a client’s hints The issue: to know when to take a client’s hints seriously enoughseriously enough to report the condition because not to report the condition because not every mention suicidal thoughts or feeling justifies every mention suicidal thoughts or feeling justifies extraordinary measures!extraordinary measures!

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Protecting Children from HarmProtecting Children from Harm

• If children disclose that they are being If children disclose that they are being abused or neglected, the professional is abused or neglected, the professional is required to report the situation. If adult required to report the situation. If adult reveal in therapy session that they are reveal in therapy session that they are abusing or have abused their children, the abusing or have abused their children, the matter must generally be reported. The matter must generally be reported. The confidentiality must be breached.confidentiality must be breached.

• It is counselor responsibility to protect the It is counselor responsibility to protect the children from being abuse/ harm – duty to children from being abuse/ harm – duty to protect.protect.

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Confidentiality and HIV/ AIDS IssuesConfidentiality and HIV/ AIDS Issues

• The The duty to warn and to protectduty to warn and to protect may arise may arise when a counselor has reason to believe when a counselor has reason to believe that an HIV-positive client intends to that an HIV-positive client intends to continue to have unprotected sex or to continue to have unprotected sex or to share needles with unsuspecting but share needles with unsuspecting but reasonably identifiable third parties (Ahia reasonably identifiable third parties (Ahia & Martin, 1993)& Martin, 1993)

• The issue: the choice between protecting The issue: the choice between protecting the client-therapist relationship and the client-therapist relationship and breaking confidentiality to protect at-risk breaking confidentiality to protect at-risk populations!populations!

Confidentiality and HIV/ AIDS IssuesConfidentiality and HIV/ AIDS Issues

• A counselor who receives information A counselor who receives information confirming that a client has a disease confirming that a client has a disease commonly known to be both communicable commonly known to be both communicable and fatal is justified in disclosing and fatal is justified in disclosing information to an identifiable third party, information to an identifiable third party, who by his or her relationship with the who by his or her relationship with the client is at a high risk of contracting the client is at a high risk of contracting the disease. Prior to making a disclosure the disease. Prior to making a disclosure the counselor should ascertain that the client counselor should ascertain that the client has not already informed the third party has not already informed the third party about his or her disease and that the client about his or her disease and that the client is not attending to inform the third party in is not attending to inform the third party in the immediate future. (ACA, 1995)the immediate future. (ACA, 1995)

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Suggestion for counselors who are asked to divulge Suggestion for counselors who are asked to divulge confidential client information in a legal proceeding confidential client information in a legal proceeding (Glosoff, Herlihy, and Spence, 2000)(Glosoff, Herlihy, and Spence, 2000)

• Make use of informed consent staements regarding Make use of informed consent staements regarding the parameters of confidentialitythe parameters of confidentiality

• Inform clients of the situation and involve them in Inform clients of the situation and involve them in the processthe process

• Take reasonable steps to protect client confidentialityTake reasonable steps to protect client confidentiality• If information is required to be disclosed, provide If information is required to be disclosed, provide

only minimal disclosureonly minimal disclosure• With permission, contact the client’s attorneyWith permission, contact the client’s attorney• Document all action taken and what information was Document all action taken and what information was

discloseddisclosed• Make it a practice to consult with colleagues Make it a practice to consult with colleagues

regarding clinical judgments and with attorney regarding clinical judgments and with attorney regarding legal obligationsregarding legal obligations

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ConclusionsConclusions• Confidentiality is an ethical concept and it is an Confidentiality is an ethical concept and it is an

important obligation to maintain the confidentiality of important obligation to maintain the confidentiality of the relationship with clients.the relationship with clients.

• Ethical dilemmas arise when there are conflicts between Ethical dilemmas arise when there are conflicts between responsibilities.responsibilities.

• Confidentiality is not absolute, there are some Confidentiality is not absolute, there are some exceptions to it.exceptions to it.

• Therapists are vulnerable to malpractice action when Therapists are vulnerable to malpractice action when they demonstrate negligent failure to diagnose they demonstrate negligent failure to diagnose dangerousness, negligent failure to warn and protect a dangerousness, negligent failure to warn and protect a victim, negligent failure to commit a dangerous person.victim, negligent failure to commit a dangerous person.

• Counselors must develop a sense of professional ethics Counselors must develop a sense of professional ethics and knowledge of laws in order to make a good and knowledge of laws in order to make a good judgment of when and how much the confidential judgment of when and how much the confidential information should be breached. information should be breached.

ASSIGNMENTASSIGNMENTGROUP PROJECT #2GROUP PROJECT #2

Investigate the laws in Malaysia pertaining Investigate the laws in Malaysia pertaining to confidentiality and present the findings to confidentiality and present the findings in our next meeting.in our next meeting.

Write at least THREE pages report on it. Write at least THREE pages report on it. The report should be in my pigeon hole by The report should be in my pigeon hole by Friday morning - 16 Jun 2006. Friday morning - 16 Jun 2006.

issues and ethics in the helping professions

Health & Medicine

hiv aids issues

legal requirements demand

negligent failure

counseling practice

important obligation

client patient

imminent danger

general requirement