Sunday, April 8, 2012

Inadvertent Breaches and Disclosure of Communicable and Life Threatening Disease

In Case # 5 Confidentiality and HIV/AIDS: The Case of Norma (Herlihy & Corey, 2006), the first confidentiality issue becomes evident when the counselor has to decide whether to report to Javier about Norma testing positive for HIV.  Norma confided in the counselor that she did test positive but had not told Javier.  Although she believes Javier may have transmitted the virus to her, Norma is afraid to tell Javier for fear of violent retribution.  The counselor has to decide if she will tell Javier about Norma's positive test result, and if she does, how to convey the information while simultaneously protecting her client.

In Case # 6 An Inadvertent Breach of Confidentiality (Herlihy & Corey, 2006) the student counselor has left confidential information on her laptop and has been accessed by a friend using the laptop for a school project.  Keeping client information confidential is crucial.  In this case, compromising the client's confidentiality will cause her significant additional trauma during a time when she is already fragile.  Clients need to trust under normal circumstances their private information will remain that way.  Without upholding confidentiality, clients would probably not be as open about personal circumstances.  On the contrary, however, people who test positive for HIV/AIDS, should be ethically and legally accountable to notify sexual partners of their status. 
The confidentiality and the duty to warn issues are critical in counseling.  Both of these issues speak to the responsibility of protecting clients as well as the social circles within which they interact.  As advocates and protectors, maintaining privacy is an essential protection that must be upheld by counselors.  As evident in the Tarasoff (Simone & Fulero, 2005) case, the duty to warn is a critical decision that must be made by a counselor.  In the Tarasoff case, the counselor failed to warn the victim about her client's intention to harm her and in this case, the counselor must warn Javier about his high risk of contracting a communicable and life threatening disease from her client.  Failure to warn is not only an ethical infraction, but in most states, there are legal ramifications as well.
When working with children, there may be many day-to-day issues with confidentiality.  The counselor must respect the child's privacy and honor confidentiality but is required by law to keep the parent apprised of critical information.  I imagine this line is a fine one, and leaning toward the wrong side of the line could open the counselor up to parent's filing claims against the counselor or the children refusing to intimate additional personal information.  As in Case # 1 (Herlihy & Corey, 2006), there were several responses to the situation depending on the child's age, and the issue. 
Applying Hill, Glaser, & Harden's (1995) ethical decision-making model, I would follow steps that include using ethical codes, consultation, and an intuitive sense of the most appropriate decision.  I like this model because in many cases, there is no right answer but the counselor has to choose the most appropriate action.  Protecting children is critical, even when it is protecting them from themselves. For the ultimate sake of the child, I would keep the parents informed.

Another issue is maintaining confidentiality in record keeping.  This includes training clerical and other support staff about confidentiality and the office protocol for handling confidential files.  As in Case # 6, if files are maintained digitally, they should be password protected.  Confidentiality is more difficult to keep as more individuals become involved in the maintenance of information.  If support staff had compromised confidential information, I would use Hill, Glaser, and Harden's (1995) model to determine the most appropriate course of action.  This would include referencing the ethical codes, consulting with peers for a range of solutions, and reviewing the effects of my solution, at every step monitoring the steps from a logical and intuitive perspective.  When confidentiality is breached by support staff, it is the responsibility of the counselor.  It would be essential to have some type of contractual agreement regarding confidentiality when support staff handle private information.  
Hill, M., Glaser, K., & Harden, J. (1995). Chapter 2: A feminist model for ethical decision making. (1995). In E. J. Rave & C. C. Larsen (Eds.), Ethical decision making in therapy: Feminist perspectives (pp. 18-37). New York: Guilford Press.

Herlihy, B., & Corey, G. (2006). ACA ethical standards casebook (6th ed.). Alexandria, VA: American Counseling Association.

Simone, S. & Fulero, S. M. (2005). Tarasoff and the duty to protect. Journal of Aggression, Maltreatment & Trauma, 11(1/2), 145–168.

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