Analysis of Two Ethical Challenges

Section A.l.a. (ACA Code of Ethics, 2005) tells us that the "primary responsibility of counselors is to respect the dignity and to promote the welfare of clients" (p. 4).  In my opinion, one of the most challenging ethical conflicts could occur when a client becomes involved in some type of litigation and counseling notes are subpoenaed.  When the court demands sensitive information regarding a client, counselors are obligated to provide the documentation (Section B.2.c.) although it is important to limit the access of information to what is essential and pertinent (Section B.2.d.). 

If a main goal of the counseling relationship is, according to Section A.1.a, to promote the welfare of clients, (ACA Code of Ethics, 2005), it would be difficult to expose the  client's sensitive information knowing it could be detrimental to her psychological health and well-being.  In any situation in which records are court ordered, Section B.2.c. presents an opportunity for counselors to legally prohibit the disclosure if the counselor believes such disclosure will be harm the client.  Counselors do, however have an obligation to uphold legal requirements and government authority as stated in Section H.1.b. (ACA Code of Ethics, 2005).

I think this type of ethical dilemma would be extremely challenging, especially when the client is coping with critical issues such as rape, molestation, or extreme psychological trauma.

I have a colleague who, many years ago, was involved in an interesting situation in which her client had been diagnosed with cancer but prior to her diagnosis had been planning to begin fertility treatment to become pregnant.  She decided to proceed against her doctor's advice and without his knowledge.  Her doctor told her specifically that pregnancy could cause the cancer to become much more aggressive from a combination of refraining from treatment for the cancer and also from hormonal changes that take place during pregnancy.  There was a good chance that it would change her prognosis from treatable to terminal.  The client decided to go to the mainland (where the doctor would have no idea of her diagnosis) to do the fertility treatments.  The client told the counselor about her decision and the counselor struggled with the conflict between maintaining confidentiality and reporting her health status to the fertility doctor as well as her primary care physician.  The counselor thought of this as a duty to protect her client as well as the baby.  She discussed with her client the possible ramifications of her choice, as well as the counselor's belief that she was hurting herself with the decision.  After the woman died, her parents tried to sue the counselor for malpractice claiming the counselor should have stopped her and contacted both doctors.  Ultimately, the counselor was not held responsible because the doctor could not have definitively determined how the pregnancy would have hurt her, and the counselor, obviously, couldn't have made that determination either.  In this case, duty to warn might not have been enough to stop her from getting the fertility treatments.    

Section 164.512 (j) of the HIPAA defines disclosures for which "consent, an authorization, or opportunity to agree or object is not required" (HIPAA, p. 82462) when averting a serious threat to health or safety.  The ACA (2005) section B.1.c. requires counselors to keep client information confidential if the client refuses to consent to its dissemination or because of legal justification.  Section B.2.b. of the ACA Code of Ethics (2005) allows breaches in confidentiality in cases of "serious and foreseeable harm or when legal requirements demand that confidential information must be revealed" (p. 7), but it is easy to see the difficulty in this dilemma when "the primary responsibility of counselors is to respect the dignity and to promote the welfare of clients" (Section A.l.a., p. 4).  

U.S. Department of Health and Human Services (n.d.) Health Information Privacy: Summary of the HIPAA Privacy Rule. Retrieved April 4, 2012 from http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html.

American Counseling Association (ACA). (2005). 2005 ACA code of ethics [White Paper]. Retrieved from the ACA website: http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf-848c-f98489937dda

 Remley, T. P., & Herlihy, B. (2001). Chapter 6, Records, Subpoenas, and Technology. In Ethical, legal, and professional issues in counseling (pp. 129-163). Upper Saddle River, NJ: Merrill Prentice Hall.

U.S. Department of Health and Human Services (n.d.) Health Information Privacy: Summary of the HIPAA Privacy Rule. Retrieved April 4, 2012 from http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html.