Breaking patient confidentiality
Life-threatening, contagious diseases require counselors to ethically weigh informing a third party
“I have AIDS.”
It’s the kind of statement a patient might say that puts a licensed mental health counselor (LMHC) in an ethical bind. Is the counselor justified, legally and ethically, to maintain confidentiality or disclose the life-threatening, communicable disease to any affected, identifiable third parties?
“This is a complex question,” says Christine Karper, PhD, College of Social Sciences area chair at the University of Phoenix Central Florida Campus in Maitland, Fla. “Mental health clinicians have an enormous responsibility in caring for the clients they serve. There is also an underlying responsibility to care for the people who are affected by their clients.”
Clients are required to release this privilege to the counselor, in writing, prior to a counselor discussing any information with anyone, including identifiable third parties and, if necessary, authorities, including law enforcement, notes Karper. Similarly, counselors are required to explain the limits of confidentiality to their clients in addition to understanding relevant state statutes.
“Ethics nearly always trump counselor indecision.” However, she adds, the penalties can be severe for counselors for any failure to protect a third party or for wrongful disclosure, including potential suspension or revocation of a license.
Therefore, she recommends counselors follow some basic guidelines when weighing ethics versus disclosure.
Defining who needs to know
Following a specific professional organization’s code of ethics regarding this issue may prove the most effective manner to help LMHCs act ethically, Karper recommends, noting that different standards exist for different professional organizations. The American Counseling Association’s (ACA) code, for example, differs from the American Psychological Association’s, which may differ still from the American Association for Marriage and Family Therapy and the National Association of Social Workers. Each organization, however, helps counselors define who needs to know about contagious, life-threatening diseases.
For example, the ACA’s Code of Ethics states a counselor may deviate from his or her general client confidentiality requirement to protect a third party, “if they are known to be at demonstrable and high risk of contracting the disease.” An example of a third party may be a spouse.
Yet counselors must confirm the disease’s diagnosis prior to disclosure, the ACA warns. This means the counselor must obtain the necessary permissions from the client before the disclosure to verify this sensitive medical information as bound by law, including HIPAA (Health Insurance Portability and Accountability Act) rules, Karper explains.
Consult, consult, consult
Counselors ought never feel the burden of making this judgment call alone — nor does Karper recommend they do so. Turn to professional organizations, she advises. The ACA, for example, is very proactive in its efforts to assist practitioners in resolving ethical dilemmas, including offering ACA members the opportunity to consult with a panel of specialists. The ACA website also posts A Practitioner’s Guide to Ethical Decision Making, she adds.
“As a clinician, I have been trained to consult, consult and consult again when faced with ethical dilemmas. Consultation with colleagues, supervisors and, at times, attorneys is a presumed part of practicing ethically as a counselor.”