Ethics, a form of philosophy involves dealings with morality and
judgements of proper conduct (Frankena, 1973), denoting the significance of
psychotherapists moral obligation towards the client. Its purpose is to reflect a straightforward value system, and to communicate decisional and behavioural rules with clarity To illustrate this further, the Australian Psychological Society (APS) Code of Ethics specifies ethical principles and accepted guidelines governing the psychologists actions and methods to make the public known of their professional practices. The ethical standards define the best practices of professionals and ensure the high quality of practice.
A psychologist must bring and maintain appropriate skills and learning within her area of practice. Falling under the Prudence principle, The Code of Ethics (2007) section B.1.2 states that a psychologist may only provide psychological services within boundaries of their professional competence, where a) working within their limits of training, education, and experience and b) basing their service on established knowledge of discipline and profession of psychology. However, the psychologist concerned is specialized in clinical psychology for adults, and now is dealing with adolescents, whom are clients beyond her scope of expertise. This raises the issue of limited professional competence. Nonetheless, rural regions often see a high demand due to lack of specialists normally found in urban locations. A change to the rural location brings pressure toward the psychologist to practice beyond their capability. The ethical trap possibilities lay in the fact that her qualification does not apply for the therapy, however there is no other way to go about it. Deemed as the Circumstantiality trap by Steinman et al (1998), it entails the circumstances on which they occurred must be taking into consideration for the decision. Therefore, the psychologists should determine which cases take precedence in importance to those that need psychotherapy the most. This abides with section 6.2 APS guideline for rural settings (2007) where strategies of triage, backed by both sound knowledge of resources in the local area, should be incorporated into rural psychologists practice.
Within a rural is setting, it is harder to maintain anonymity as it is a smaller, close-knit community. This is so as psychologists are more likely to encounter their clients in settings outside their therapy sessions as other roles. This creates the issue of dual-relationship, which poses as a potential difficulty for both psychologists and clients as the professional boundaries are blurred. A multiple relationship occurs when a psychologist, whom is giving psychological service to a client within the current period, engages in a non-professional relationship with the client or a non-professional relationship with an associated party (Code of Ethics, 2007). The strategy of referral options in rural settings do not apply, as it was made known that mental health services are limited. Therefore, the psychologist must take precautions to ensure their strategies with the client. However, Case 2 shows the psychologist not wanting to damage her relationship with Jenny, placing the client in possible lethal danger. Within APS Guidelines for Young People (2007), it is stated, when making judgement whether to disclose a young persons information, psychologists consider the young persons best interest as paramount. The concern for Jennys feelings signals a non- professional relationship being formed. The psychologists decision puts Jennys wellbeing at risk, overriding the aforementioned ethical code. The psychologist should have made clear boundaries with her client. She should also not forget her rights as a psychologist regarding the rules and terms of informed consent, where a breach of confidentiality is agreed to by the client in permitted circumstances.
Before a psychologist begins any counseling with a client, informed consent is necessary. Within code of ethics (2007), section A.3.1 states psychologists must fully inform clients regarding the psychological services they intend to provide. A psychologist has to make sure that consent is informed by explaining what nature, procedure, how information would be collected and kept, the confidentiality and limits to confidentiality, and making clear the conditions where psychological services may be terminated. According to the Child Act (2001), a child is defined as a person under the age of eighteen years. Being a minor, a young person is only capable to give informed consent if the adolescent achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed(APS, 2007). The psychologist has to establish whether the young person client is of sound intelligence by determining if he or she can understand the nature of the proposed psychological service, the benefits and risks, and can understand confidentiality limits. According to Mitchell (2002), adolescents 14 years or older are perceived to be just as capable as adults when it comes to decision-making concerning entering therapy. Moreover, Croston, Churchill, and Fellin (1988) asserted the consideration for 14 years of age to be the standard for consent to counseling. Thus, It can be assumed Jenny is of reasonable intelligence and understanding, thus entitled to receive, engage, continue or terminate psychological services, with the understanding that the psychologist would respect the clients confidentiality. However, circumstances of rural settings may fare differently, as they dont have the same opportunities within metropolitan settings as those in Croston et als (1988) study. Furthermore confidentiality is limited to legal requirements and whether there are risks to the young person or others.
Confidentiality is the common standard for professional conduct, which obliges one not to discuss information regarding the client with anyone (Koocher, 2007). In this case, the ethical problem arises when the psychologist faces the dilemma of whether to remain silent to preserve confidentiality, or to inform parents, those involved, and medical authorities of the risk the client faces thus breaching confidentiality. The ethical traps possibly present within this are deemed as the Commonsense, objectivity trap (Steinman et al, 1998) where the client is in dilemma to break confidentiality and embarrass her within a small community, or to keep silent while her health and others involved are at grave stake. The violation of confidentiality constitutes as the main question concerned. If breached, it poses a threat for legal claim of negligence, infringement of contract, violation of confidence, and having professional conduct complaints brought against the psychologist (Kampf, Mchsherry, Thomas, & Abrahams, 2008). However, psychologists may also have an ethical or legal duty to disclose information, providing the circumstances permit. Failure to disclose may cause the psychologist to be legally liable for non-disclosure and risking their client to be in harms way or putting others in danger.
The main key principle concerned is Suffering Prevention, which involves not only the prevention of suffering, but its allevation (Francis, 2009). Applying this principle would mean the psychologist ought to not engage in activities that would produce or increase suffering (Francis, 2009). Therefore, a psychologists decision to breach confidentiality is well understood to the extent mandatory to prevent clients causing harm to others or themselves (Koocher, 2007). This is in- line with the code of ethics (2007), where section A.5.2 states that psychologists may disclose confidential information if there is an immediate and specified risk of harm to an identifiable person or persons that can only be averted by disclosing information. Lamb, Clark, Drumheller, Frizzel & Surrey (1989) argued that the diagnosis of HIV positivity is made by a physician, thus the incompetence for a non-medical professional (a psychologist) may raise questions on the confidentiality breach. However, this was strongly refuted by the Management of People with HIV Infection Who Knowingly Risk Others (2007) issued by Australian HIV Laws. Section 4.1 within the guideline states If a responsible person is responsible for the care, support or education of a suspected HIV person and is aware or has reason to believe that the person engages in activity that carries a risk of exposure to HIV to another person, she has the responsibility under the ACT Public Health 1997 to take reasonable measures to ensure that others are not unknowingly placed at risk of infection. Similarly in accordance with the 1974 Tarasoff court case, it was concluded, When a doctor or a psychotherapist in the exercise of his professional skill and knowledge determines, or should determine, that a warning is essential to avert danger arising from medical or psychological condition of his patient, he incurs a legal obligation to give that warning.
Therefore, it can be said that the psychologist decision to prolong psychotherapy while Jenny is still sexually active is inappropriate. This is because the risk of her partner to contract the virus in between the prolonging is high. The principle of Goodwill refers to building a reputation through actions, being concerned for others, and having concern of others interest, not just self- interest (Francis, 2009) Applying this principle entails doing more than the minimum for the client. Section 5.2.1 of APS (2007) states that disclosure of a young persons information should be in the best interest of the minor. In regard with informed consent, Section 5.2.3 asserts that it is a psychologists duty to maintain the young persons confidentiality, and to limit any disclosure in accordance with the express wishes of the young person, unless there is a clear risk of the young person of other. Based on the aforementioned codes, the psychologist would have the responsibility and authorization to disclose Jennys health status for her own wellbeing and those involved. The information should however, only be disclosed to those concerned; the parents, since they have legal responsibility over the young person (APS, 2007), medical officials, to handle Jennys heath situation appropriately, and her sexual partner, as the psychologist has the duty to warn.
In order to come to a probable resolution, the ethical decision making model may prove useful. To begin, it entails identifying the ethical standard involved. With the main key principles being Suffering Prevention, Goodwill, and prudence. This covers the general principles of Respect for the rights and dignity of people and peoples, Propriety, and Integrity (Code of Ethics, 2007). Confidentiality falls under this, of which the legal requirement to disclose is involved. Step 2 is the determination of ethical trap possibilities, which in this case is the Commonsense Objectivity Trap. Step 3 involves framing a Preliminary Response. The code mentions an immediate and specified risk of harm to an identifiable person or persons that can only be averted by disclosing information of which the law supports. Step 4 involves consequences to be considered. Short term consequences may involve the client to feel humiliated. However, long term consequences involve appropriate medical care for the client, resulting with improved health and not putting others in danger. Step 5 requires preparing ethical resolutions. With consideration of the codes and laws previously stated, a proposed action would be to notify parents, sexual partner, and medical authorities of the health danger. Step 6 involves getting feedback from reliable sources. Lastly, action is taken to conclude the dilemma.
1570 words.
References
Australian Psychological Society. (2007). Code of ethics. Melbourne: Author.
Croxton, T. A., Churchill, S. R., & Fellin, P. (1988). Counseling minors without parental consent. Child Welfare, 67(1), 3-14. Francis, R. D. (2009). Ethics for psychologists (2nd ed.). Chichester: The British Psychological Society and Blackwell Publishing.
Guideline for psychological practice in rural and remote settings (2007). Ethical Guidelines. Melbourne.
Guidelines for working with young people (2007). Ethical Guidelines. Melbourne.
Kmpf. A ., Mcsherry. B., Thomas. S. & Abrahams.H.(2008). Psychologists' perceptions of legal and ethical requirements for breaching confidentiality. Australian Psychologist, 43(3), 194-204. Koocher.G.P(1995). Confidentiality in psychological practice. Australian Psychologist, 30(3), 158-163. Lamb, D. H., Clark, C., Drumheller, P., Frizzell, K., & Surrey, L. (1989). Applying Tarasoff to AIDS-related psychotherapy issues. Professional Psychology: Research and Practice, 20(1), 37.
Mitchell, C. W., Disque, J. G. & Robertson. P (2002). When Parents Want to Know: Responding to Parental Demands for Confidential Information. Professional School Counseling, 6(2),1096-2409. Steinman, S. O., Richardson, N. F., McEnroe, T. (1998). The ethical decision-making manual for helping professions. Pacific Grove, CA: Brooks/Cole.
Tarasoff v.Regents of the University of California (1974). P.2d 553 The Management of People with HIV Infection Who Knowingly Risk Infecting Others (2007). ACT Health.
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