Ethics concepts and applications

Ethics

In counseling, the most important consideration, in addition to providing a healing paradigm for patients, is probably the fact that this paradigm should be provided in an ethically acceptable way. This also extends to the confidentiality of clients who disclose information that could be harmful or incriminating to themselves. According to the American Association for Marriage and Family Therapy Code of Ethics, counselors are obliged to keep confidential all information disclosed to them by clients. However, if such information could be harmful to the patient or other persons, the confidentiality should be disregarded in favor of reporting this to the relevant authorities. This decision should be based not only upon legislation, but also upon a general decision model based upon a deontological and utilitarian paradigm. In the case of John, for example, the decision is to help him see the ethical obligation he has to disclose his status to his girlfriend. Failing that, the counselor is obliged to disclose the client's behavior, not only to the girlfriend, but also to the relevant authorities.

In John's case, his behavior to date appears to indicate similar future behavior. His unwillingness to disclose his status to his girlfriend appears to indicate future behavior towards both his current girlfriend and those who were sexually involved with him in the past. According to Indiana state law, for example, those with a positive HIV test result must be advised to inform past and current sexual and needle sharing partners of their status. This will enable these persons to take the necessary precautions to ensure that their lives are not unnecessarily endangered (Should You Get Tested for HIV, n.d.).

The first step in the counseling environment is then to inform John of this responsibility. This will entail that the counselor must use every possible means of persuasion before confidentiality is broken. This will include informing the client of the possibility that the counselor will disclose his status if he is not willing to do this himself. Furthermore, the relevant authorities will also be informed of the person's potentially dangerous behavior.

The duty to warn is a clearly deciding factor here. Lives are at stake, and therefore this should be the primary consideration in future action taken by the counselor and relevant authorities. If efforts at modifying behavior fails, it is the counselor responsibility to take measures to inform and warn those whose lives are in danger because of continuing irresponsible behavior by the client.

Notification must also be made to public health officials and documented (Schlossberger and Hecker, 1996). If such notification is not made by the counseling professional, the State of Indiana regards this as a crime in itself, by association (Indianapolis Star, 2010, the Body). Furthermore, if John does not concede to terminate his high-risk behavior and/or disclose his status to his partner, the health department is within its rights to fie a civil suit in court. A criminal case could arise as a result (Indianapolis Star, 2010, the Body).

At the basis of the decision-making process is that John should be informed of the potential consequences of his actions, not only for his girlfriends, but also for himself. John could face severe legal penalties if he continues his behavior. The laws of Indiana should therefore be disclosed to John so that he can understand the full implications of his actions.

The ethical obligations of the counselor in this case is not so much in question as the timing of disclosure. The main question is: Should the counselor disclose the dangers of withholding HIV status before clients disclose this? This would be more ethically acceptable to clients' need to be informed of the disclosure obligations of the therapist before entering therapy. On the other hand, the drive to safeguard lives could result in a lack of initial disclosure, as this might discourage clients from disclosing possibly incriminating behavior.

However, withholding this type of information from John or future clients like him could result in legal difficulties for the counselor, and indeed for the counseling profession in general. The counselor is obliged to disclose all ethical obligations to the client, and particularly those that could impact upon the confidentiality of the client. Only in this way can the client make an informed decision regarding the information he or she wishes to disclose to the counselor. Furthermore, it is only on this basis that the client can be obliged to disclose vital information to those who are affected by his actions.

In the decision-making process then, the counselor is obliged to follow a code of ethics that obliges him or her to provide full disclosure to potential clients. Only on this basis can the counselor then provide disclosures to other entities, as these could potentially harm the client. Any information that client provides to the counselor subsequent to such disclosure is then subject to the laws and ethics governing counseling in Indiana.