Duty to Protect vs Patient Confidentiality Essay

Clearly, confidentiality is essential to the healing process. However, though it may appear to be a relatively easy concept, its application in the therapeutic atmosphere has proven to be quite complex (Younggren & Harris, p. 589). One issue that causes confusion for many professionals pertains to the differences between confidentiality and legal privilege. Quite often, ethical obligations overlap with the legal requirements. Frequently, the practitioner is not well informed about these particular limits on confidentiality and this lack of knowledge can place both the client and the helping professional at risk (Younggren & Harris, p.590, 598).

In the relationship between counsellor and client the need for confidentiality is vital as it is not only the bases that the relationship is built on and it is a legal obligation.

This paper is a response to a video discussing the issues of confidentiality, privilege, reporting, and duty to warn. This paper looks at these issues and their explanations in the American Counseling Association Code of Ethics as well as the Georgia State Board of Professional Counselor’s ethical guidelines and provides a commentary on the laws. It was found that these issues are not always black and white, but there is some debate on these issues. Confidentiality is both an ethical and a legal responsibility yet there are often times when the ethical demands clash with the legal demands. This paper explores some of those crashes and explains what I have learned from the video and the professional and stage guidelines concerning confidentiality and its implications and how I will apply what I have learned into future practice.

I selected the article “Duty to Warn and Protect: Not in Texas” for review, as it applies to the state in which I reside. The article cites Texas Health and Safety Codes, based on a 1999 Texas Supreme Court ruling that states counselors do not have a duty to warn or protect. Having a duty to warn and protect is defined as protecting clients or others from perceived harm (Jackson-Cherry & Erford, 2014). An example would be that a client tells their counselor in a confidential session that he is considering stabbing his ex-girlfriend. The duty to warn would mean the counselor should notify authorities and the ex-girlfriend thus breaking confidentiality. The duty to protect would be to admit client to a facility for the client to be assessed for a propensity for violence towards the ex-girlfriend. This became important after a 1969 incident where a counselor, had a client expressed harm towards a girl and the counselor contacted the authorities, yet never contacted the girl, who was subsequently killed by the client a few months later, known as the Tarasoff v. Regents of the University of California case (Jackson-Cherry & Erford, 2014).

Remley and Herlihy (2016) defines confidentiality as an ethical concept which refers to the counselor 's obligation to respect the client 's privacy and in session discussion will be protected from disclosure without their consent (p.108). The receptionist never disclosed what was being discussed in wife A session; however, her inadvertent breach of confidentiality occurred the moment she divulged the fact that wife A is a patient at a mental health facility. An important premise to understanding the ethical principle of confidentiality is base that a counselor respects the client 's right to privacy (Remley & Herlihy, 2016; Quigley, 2007). Premise one states the "counselor honor the rights of clients to decide who knows what information about them and in what circumstances" (p.110).

These three characters in this vignette brought up many good questions related to confidentiality, mandated reporting privileged information, and the Therapists responsibility related to reporting suspected child abuse, elder abuse and/or suicidal ideations, and the Therapists responsibility to warn third parties if it is apparent that they are in imminent danger. Constance states she believed the victim should be allowed to win in this case as they failed to avoid an avoidable harm. In so saying it is obvious to me that confidentiality cannot be an absolute, nor do we work in a perfect world. So as one goes forward working as a therapist and the mental health field it is important to understand the standards of our profession and how it is important for us to know whether a victim is in peril and that we always have the duty to warn or protect individuals in our care are affected by those that we provide mental health care for

There are several ethical dilemmas that the mental health professionals that are working as a team will face including “ensuring that the client has given informed consent, maintaining client confidentiality, and involving professionals, paraprofessionals, and family in appropriate coordinated processes that benefit the client” (Paproski & Haverkamp, 2000, p.96).

The ethical dilemma I wish to explore is The Duty to Warn. This refers to the duty of a counselor, therapist to breach one of the most important bonds between a client and a therapist; the law of confidentiality. The therapist has the right to break confidentiality without the fear of being brought up for legal action. If the therapist believes that the client poses a danger, or is a threat to himself, someone else, or society as a whole, the therapist must decide how serious of a threat the client may be, then if he decides it’s a serious issue, he must notify the person in danger, which would e the third party, or the police, or other people who may be in the

Tarasoff versus Regents of the University of California (1974) a court case which Tatiana Tarasoff, a University of California Berkeley’s student was killed. Prosenjit Poddar pursued Tatiana while she was alone in her home. He started the aggression in her home and chased into the street and stabbed her seventeen times causing her death. Previously he described his intentions and depression when he asked Dr. Laurence Moore at Berkeley medical center. The diagnosed of paranoid schizophrenia was presented by the doctor. Dr. Moore felt the risk against Tarasoff and shared the situation with two other doctors and determined that Poddar should be committed to a psychiatric hospital and to the police. Poddar was release after he promised to stay away from her. She never received any alert about her risks by the doctor or pilice. Poddar killed her on the night of October 27, 1969. During the criminal trial he pleaded not guilty because of his insanity. His prior evaluation to the murder presented evidence that Poddar was no guilty because of his mental state because he was insane and demonstrated a paranoid schizophrenia. He came back to India and had a normal life. Tarasoff’s family sued the doctors and police. The charges against the police were dropped because the police were immune to the suit. It was consider that the psychiatrics failed in their duty to warn and protect Tatiana.

As healthcare providers, maintaining a patient’s confidentiality, human dignity and privacy is expected at all times. Nurses are faced with maintaining patient confidentiality on a daily basis. The Coded of Ethics for Nurses is the framework of nonnegotiable ethical standards and obligations that all nurses are to uphold. Nurses are to be accountable for their actions and are expected to advocate and strive to protect the rights, health and safety of patients (American Nurses Association, 2011).

The main focus of the article is to look at the absolute value of patients’ confidentiality. Blightman et al. look at the pros and cones of breaking patient’s confidentiality and conclude that a breached of confidentiality is in order when it is necessary to obtain consent, as required by law, or when it is in the best interest of the public. The article is useful to my subject, since it examines in details the main issues involving the safeguard of patients’ information. In addition, the authors define confidential information, looks at breaching confidentiality for consent, audits, protection of children, disclosure to family and friends, statutory disclosure, prevention of crime, public interest, public safety, public health, and disclosure to the media. The paper publication is Continuing Education in Anaesthesia, Critical Care & Pain, which s a joint publication of the British Journal of Anaesthesia and The Royal College of Anaesthetists in the UK. It is also the official journal of The Faculty of Pain Medicine and The College of Anaesthetists of Ireland. Publication in such an esteemed journal requires utterly scrutinized of reliability and credibility of the information provided. I found the article educational and thorough in its coverage of aspects of breach of patient information. It is also well written and easy to understand.

In the mental health profession of counseling, therapy, psychology, psychiatric and social services ethical dilemmas are faced primarily on a daily basis. Being that mental health professionals are working with clients who are often fragile and vulnerable, they must develop an intense awareness of ethical issues. On the other hand, mental health professionals would never intentionally harm their clients, students or colleagues and others whom they work with. Unfortunately, good intentions are not enough to ensure that wrong doings will not occur and mental health professionals have no choice but to make ethically determined decisions. Depending upon the experience and expertise of the professional determines the outcome of the ethical

Because of the doctors’ profession, a psychiatrist must abide by the ethic of nonmaleficence when it comes to their patients. This article is true, “When conflicts occur among psychologists’ obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm” (Ethical Principles of Psychologists and Code of Conduct, n.d.). For this profession, this is very important because their judgment can have a serious effect on a person mind. If there were no ethics to guide them not to do no harm, psychology could become an unethical profession within the health care system. This ethic could also be the reason for the raise of concern that Dr. McHale has for the detainee.

The supervisor is ultimately liable for the welfare of the supervisee’s clients. The supervisee is expected to discuss with the supervisor the counseling process and individual concerns of each client. Inform supervisor immediately of any of the following incidents: restraint, violence to themselves or others, suicidal thoughts, breach of appropriate boundaries, violations of confidentiality and/or clients rights, any disclosure of abuse or neglect. The supervisor must be available by phone, web-camera, or in person to answer clinical questions that correspond directly to the clients’

The second ethical issue occurred when the psychologist disclosed information about Mr. Hartwig’s to his psychiatrist without Mr. Hartwig’s consent. The psychologist motivations for contacting Mr. Hartwig’s psychiatrist appears to be ethical. He was attempting to establish a collaborative relationship with the psychiatrist in order to maximize the effectiveness of each for of treatment in order to best serve the client (APA, 2002). However, The APA guidelines on stipulate that while psychologist should attempt to establish a collaborative relationship they must request release from the client before disclosing confidential information (APA, 2002). The client shared the name of his psychiatrist, but there was no evidence that the client consented to an exchange of information between the two professionals. In addition to the psychologists’ obligation to obtain consent to disclose information to the psychiatrist; he was also ethically obligated to ensure that the client understands what he/she is giving consent for. Koocher and Keith-Spiegel, suggest elements that a release-of-information form should include; who the information is to be released to, and any limitations on the information to be released (2008). If the client consented to disclosure with the