Ethics concepts and applications

John

Ethics

A therapist is bound to keep his or her patient's confidentiality unless the patient presents a danger to himself or others. In the case of 'John' an HIV-positive patient who is engaging in unprotected sexual relationships, there is clearly a risk being posed to John's partner. Additionally, in the state of Indiana, there is a legal obligation to reveal John's HIV status: "it is a felony in Indiana for an HIV-positive person to engage in high-risk behavior that deliberately exposes another person to the virus, whether such actions are first discovered by the police or by the health department" or another individual with an obligation to report the patient's behaviors (Indianapolis Star, 2010, the Body). Regarding John's girlfriend, "the health department can file a civil suit in court to put restrictions on HIV-positive individuals" and if infected, a criminal case could arise (Indianapolis Star, 2010, the Body).

Ideally, the counselor should stress to John the need to be forthright about disclosing his HIV-positive status to his girlfriend. The counselor should make John aware of the laws of Indiana, and the counselor's own, ethical obligations to disclose John's behaviors. The counselor should explain to John his ethical obligations under the law and according to the generally accepted counseling code of ethics, which reads as follows: "The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed…When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if they are known to be at demonstrable and high risk of contracting the disease. Prior to making a disclosure, counselors confirm that there is such a diagnosis and assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party" (Barnett & Zur 2010).

No matter how professionally objective an individual counselor may strive to be, it is only natural to feel a certain sense of revulsion at John's behavior, and to wish to help John's girlfriend. It could also be added that this points to a larger dilemma within the field of counseling -- what should the counselor do if he or she does not 'like' his or her patient? Of course, many counselors may not like their patients, and give professional advice to individuals with whom they might not personally choose to associate with on a daily basis. A utilitarian view would suggest that if every time a counselor did not like a patient's immoral behavior and 'dropped' the patient, no one could sustain therapy beyond a few sessions! However, John's indiscretions are so morally objectionable, a counselor might not feel as if he or she can legitimately continue the therapeutic relationship in good conscience, and suggest John seek another counselor.

The counselor can at least take relief in the fact that he or she has an ethical code to back up his or her views about reporting John's behavior. That is one of the 'reliefs' of having an ethical code -- a counselor does not have to engage in soul-searching as to whether his or her personal beliefs about John's actions are impinging upon his or her judgment. The counselor can refer to the law and to the code of ethics for the profession, and know that informing upon John is correct, given that someone's life is at stake. A counselor must strive to be objective, and in this case back up his or her actions based upon the law, and standardized codes of counseling ethics. A counselor who counsels ethically questionable individuals, such as a counselor in prison or for a support group of inmates, must still be mindful of ethics and the law when negotiating such ethical minefields.

In this instance, a deontological, or categorical, ethical system is required -- a counselor cannot rationalize that this situation is better or worse, relative to similar situations. "Rule deontological ethics...may be understood as the seeking of 'duty to do right'…why a decision was made and if it is based on a principle good for all…. rules to guide and protect individuals and groups and to prescribe desirable decisions and proscribe undesirable ones… State laws and policies, although a variation on the rule ethics idea, often prescribe what is endorsed by others," and in this case professional ethics and state law coincide (Bradley et al. 2010: 219-220). John should be informed of the counselor's ethical obligations; however, before the counselor takes the necessary actions, given the legal repercussions he might face as a result of the counselor's actions.