1.
ISSUES AND ETHICS IN THE HELPING PROFESSIONS Zulkefly Othman

2.
ISSUES AND ETHICS IN THE HELPING PROFESSIONS <ul><li>CONFIDENTIALITY: ETHICAL AND LEGAL ISSUES </li></ul>WEEK #5

3.
OBJECTIVES <ul><li>Understand what is confidentiality </li></ul><ul><li>Understand the importance of confidentiality to the client </li></ul><ul><li>Aware some of the issues regarding confidentiality </li></ul><ul><li>Knowing the limits/ exceptions to confidentiality </li></ul><ul><li>To develop a sense of professional ethics and knowledge of laws towards making a good judgment </li></ul>

4.
LECTURE’S OUTLINE <ul><li>What is confidentiality? </li></ul><ul><li>Exceptions to confidentiality </li></ul><ul><li>Issues regarding confidentiality: </li></ul><ul><ul><li>Confidentiality in a school setting </li></ul></ul><ul><ul><li>Duty to protect and to warn </li></ul></ul><ul><ul><ul><li>Duty to protect potential victims </li></ul></ul></ul><ul><ul><ul><li>Duty to protect suicidal clients </li></ul></ul></ul><ul><ul><ul><li>Duty to protect children from harm </li></ul></ul></ul><ul><ul><ul><li>Confidentiality and HIV/ AIDS issues </li></ul></ul></ul><ul><li>Suggestions for counselors who are asked to divulge confidential client information in a legal proceeding. </li></ul><ul><li>Conclusions </li></ul>

5.
CONFIDENTIALITY IN COUNSELING PRACTICE <ul><li>Clients have the right to expect that communications will be kept within the bound of the professional relationship (Benke, 1998) </li></ul><ul><li>It is an ethical responsibility and a legal and professional duty to safeguard clients from unauthorized disclosures of information given in the therapeutic relationship. </li></ul>

6.
CONFIDENTIALITY IN COUNSELING PRACTICE <ul><li>Although it is an important obligation of practitioner in the various mental health professions to maintain the confidentiality of their relationships with their clients, it is not absolute . </li></ul><ul><li>Challenges arise when third parties demand that counselors release confidential information that clients do not want released (Glosoff, Herliky & Spence, 2000) </li></ul>

7.
CONFIDENTIALITY IN COUNSELING PRACTICE <ul><li>Psychologist have a primary obligation and take reasonable precautions to respect the confidentiality rights of those with whom they work or consult, recognizing that confidentiality may be established by laws, institutional rules, or professional or scientific relationships (APA, 1992) </li></ul>

8.
CONFIDENTIALITY IN COUNSELING PRACTICE <ul><li>The professional school counselor informs the counselee of the purposes, goals, techniques and rules of procedure under which she/ he may receive counseling at or before the time when the counseling relationship is entered. Notice includes confidentiality issues such as the possible necessity for consulting with other professionals, privileged communication, and legal or authoritative restraints . The meaning and limits of confidentiality are clearly defined to counselees through a written and shared statement of disclosure. (ASCA, 1998) </li></ul>

9.
CONFIDENTIALITY IN COUNSELING PRACTICE <ul><li>When counseling is initiated and throughout the counseling process as necessary, counselors inform clients of the limitations of confidentiality and identify foreseeable situations in which confidentiality must be breached (ACA, 1995) </li></ul>Back

10.
EXCEPTIONS TO CONFIDENTIALITY <ul><li>All major professional organizations have taken the position that practitioners must reveal certain information when there is clear and imminent danger to an individual or to society as to protect others from harm. </li></ul>

11.
EXCEPTIONS TO CONFIDENTIALITY <ul><li>The general requirement that counselors keep information confidential does not apply when disclosure is required to prevent clear and imminent danger to the client or others or when legal requirements demand that confidentiality information be revealed . Counselors consult with other professionals when in doubt as to validity of an exception (ACA, 1995) </li></ul>

12.
EXCEPTIONS TO CONFIDENTIALITY <ul><li>According to Corey (2003), the confidential information can be disclose when: </li></ul><ul><ul><li>Authorized by law </li></ul></ul><ul><ul><li>Authorized by client </li></ul></ul><ul><li>According to Remley and Herlihy (2001), the conditions where exceptions to confidentiality applies when: </li></ul><ul><ul><li>Disclosure is ordered by court </li></ul></ul><ul><ul><li>Clients file complaints against counselors </li></ul></ul><ul><ul><li>Clients claim psychological damage in a lawsuit </li></ul></ul>

13.
EXCEPTIONS TO CONFIDENTIALITY <ul><li>Psychologist disclose confidential information without the consent of the individual only as mandated by law , or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/ patient, psychologist, or others from harm; or (4) obtain payment for services from client/ patient , in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. (APA, 2000) </li></ul>Back

14.
Confidentiality in School Setting <ul><li>Birdsall and Hubert (2000) warn school counselors of their responsibility to safeguard a student’s right to privacy when teachers or principals ask counselor to divulge confidences of students . </li></ul><ul><li>Another ethical issue in school counseling is the balance between student rights and parent/ guardian rights . </li></ul><ul><li>Parent/ guardian have some legal right to request information about counseling session, but minors have an ethical right to expect confidentiality in the relationship. </li></ul>

15.
Confidentiality in School Setting <ul><li>When counseling clients who are minors or who are unable to give voluntary informed consent, parents or guardians may be included in the counseling process as appropriate. Counselors act in the best interest of clients and take measures to safeguard confidentiality . (ACA, 1995) </li></ul>Back

16.
EXCEPTIONS TO CONFIDENTIALITY <ul><li>The general requirement that counselors keep information confidential does not apply when disclosure is required to prevent clear and imminent danger to the client or others or when legal requirements demand that confidentiality information be revealed . Counselors consult with other professionals when in doubt as to validity of an exception (ACA, 1995) </li></ul>Back

17.
Duty to Protect Potential Victims <ul><li>According to Bednar and his colleagues (1991), counselors must exercise the ordinary skill in: </li></ul><ul><ul><li>Identifying those clients who are likely to do physical harm to third parties. </li></ul></ul><ul><ul><li>Protecting third parties from those clients judge potentially dangerous. </li></ul></ul><ul><ul><li>Treating those clients who are dangerous. </li></ul></ul><ul><li>Inadequate assessment of client dangerousness can result in liability for the therapist, harm to third parties, and inappropriate breaches of client confidentiality. </li></ul><ul><li>The issue: deciding whether a particular client is dangerous! </li></ul>Back

18.
Duty to Protect Suicidal Clients <ul><li>Therapists have an ethical and legal obligation to break confidentiality when they have good reason to suspect suicidal behavior in their client. </li></ul><ul><li>Counselors can be accused of malpractice for neglecting to take action to prevent harm when a client is likely to commit suicide, yet they are also liable if they overreact by taking actions that violate a client’s privacy when there is not a justifiable basis for doing so (Remley and Herlihy, 2001) </li></ul><ul><li>The issue: to know when to take a client’s hints seriously enough to report the condition because not every mention suicidal thoughts or feeling justifies extraordinary measures! </li></ul>Back

19.
Protecting Children from Harm <ul><li>If children disclose that they are being abused or neglected, the professional is required to report the situation. If adult reveal in therapy session that they are abusing or have abused their children, the matter must generally be reported. The confidentiality must be breached. </li></ul><ul><li>It is counselor responsibility to protect the children from being abuse/ harm – duty to protect. </li></ul>Back

20.
Confidentiality and HIV/ AIDS Issues <ul><li>The duty to warn and to protect may arise when a counselor has reason to believe that an HIV-positive client intends to continue to have unprotected sex or to share needles with unsuspecting but reasonably identifiable third parties (Ahia & Martin, 1993) </li></ul><ul><li>The issue: the choice between protecting the client-therapist relationship and breaking confidentiality to protect at-risk populations! </li></ul>

21.
Confidentiality and HIV/ AIDS Issues <ul><li>A counselor who receives information confirming that a client has a disease commonly known to be both communicable and fatal is justified in disclosing information to an identifiable third party, who by his or her relationship with the client is at a high risk of contracting the disease. Prior to making a disclosure the counselor should ascertain that the client has not already informed the third party about his or her disease and that the client is not attending to inform the third party in the immediate future. (ACA, 1995) </li></ul>Back

22.
Suggestion for counselors who are asked to divulge confidential client information in a legal proceeding (Glosoff, Herlihy, and Spence, 2000) <ul><li>Make use of informed consent staements regarding the parameters of confidentiality </li></ul><ul><li>Inform clients of the situation and involve them in the process </li></ul><ul><li>Take reasonable steps to protect client confidentiality </li></ul><ul><li>If information is required to be disclosed, provide only minimal disclosure </li></ul><ul><li>With permission, contact the client’s attorney </li></ul><ul><li>Document all action taken and what information was disclosed </li></ul><ul><li>Make it a practice to consult with colleagues regarding clinical judgments and with attorney regarding legal obligations </li></ul>Back

23.
Conclusions <ul><li>Confidentiality is an ethical concept and it is an important obligation to maintain the confidentiality of the relationship with clients. </li></ul><ul><li>Ethical dilemmas arise when there are conflicts between responsibilities. </li></ul><ul><li>Confidentiality is not absolute, there are some exceptions to it. </li></ul><ul><li>Therapists are vulnerable to malpractice action when they demonstrate negligent failure to diagnose dangerousness, negligent failure to warn and protect a victim, negligent failure to commit a dangerous person. </li></ul><ul><li>Counselors must develop a sense of professional ethics and knowledge of laws in order to make a good judgment of when and how much the confidential information should be breached. </li></ul>

24.
ASSIGNMENT GROUP PROJECT #2 <ul><li>Investigate the laws in Malaysia pertaining to confidentiality and present the findings in our next meeting. </li></ul><ul><li>Write at least THREE pages report on it. The report should be in my pigeon hole by Friday morning - 16 Jun 2006. </li></ul>