Ethical Conflicts
Because human services work often involves direct client interaction, ethical dilemmas can arise. Prior to beginning work on this discussion, read the article Ethical and Legal Implications on the Use of Technology in Counselling and review the ethical issues presented: Competence and Responsibility, Confidentiality, and Client’s Rights.
1. Discuss one vignette (Case 1, Case 2, Case 3, etc.) from one of these issues BELOW and present its dilemmas
2. As a human services professional, consider how you would handle this situation and discuss which ethical standards could be relevant from the Ethical Standards for Human Service Professionals (Links to an external site.): National Organization of Human Services Adopted 2015.
3. What role(s) and responsibilities do you think workers have in being ethical? Explain using an example.
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**4.4 CONFIDENTIALITY
Confidentiality is the helper’s assurance that information the client divulges will remain between the two of them. If information is to be shared, it will be shared only with those designated by the client. These two statements regarding the concept of confidentiality provide only general guidelines for the helper. In some situations, laws require confidentiality to be breached: Parents have the legal right to information about their children in most circumstances; courts may require the disclosure of information that would otherwise be confidential; and helpers have a duty to alert authorities if they suspect child abuse (Remley & Herlihy, 2016). The concept is a complex one. This section provides an introduction to confidentiality and gives examples of the difficult situations helpers may encounter in human service practice.
Confidentiality is a complex concept. For example, a term often associated with confidentiality is privileged communication. Both terms address the commitment to keep a client’s identity and communications secret. There is a basic difference. Confidentiality is a moral obligation grounded in values and ethics (Welfel, 2016); privileged communication is a legal term that allows practitioners to legally refuse to release certain information in response to a subpoena. The term legally is used because privileged communication is a right granted to a group of professionals by state lawmaking bodies. Examples of situations in which helpers are ethically or legally obligated to breach confidentiality include, but are not limited to, the following:
1. When the client is dangerous to self or others
2. When there is suspicion of abuse or neglect
3. When the client brings charges against the counselor
4. When the client has already introduced privileged material into litigation
Another example of the complexity of confidentiality is a type often called relative confidentiality. This term refers to the informal sharing of information that occurs in an agency or organizational setting among coworkers or treatment team members and supervisors. The client’s permission is not required for this type of exchange to take place. Typically, agency policy will also guide this sharing by determining who has access to confidential information. The Federal Privacy Act of 1974, which governs confidentiality in federally funded and administered programs such as the Department of Veterans Affairs and the Social Security Administration, states that clients have the right to access to their records and establishes procedures for this to occur. It also supports the concept of relative confidentiality by providing for the sharing of information among those professionals within the agency who need the information in the performance of their duties.
An issue that has recently emerged is maintaining confidentiality within the technological environment. A new cultural norm exists about the acceptability of social media and technology-based communication. There is agreement that one of their serious limitations is the maintenance of confidentiality and privacy (Chan, 2016; Groshong & Phillips, 2015; Harris & Birnbaum, 2015). This is particularly concerning in human service delivery. For example, texting, a widespread communication tool among young people, may be used by helpers who are working with adolescents. Client use of social networking sites (SNSs) like Facebook violates client privacy or the privacy of another individual. These types of electronic communication pose a significant risk to confidentiality and privacy.
Human service professionals have responded to these concerns in a number of ways, many prompted by the impact of HIPAA, mentioned in Chapter 2 and earlier in this chapter. Some of them involve the transmission of records; for example, having clients sign a Notice of Privacy Practices, educating clients about privacy exceptions, and listing approved recipients of notices of appointments or test results.
On a much larger scale, one concern is the safety of records that exist in large management information systems. Organizations and agencies that maintain their records in networks adopt policies and software to ensure limited access. In other words, no one has access to the client files without a security clearance, a password, and the need to know. Personal communication with clients via e-mail must also be regarded as confidential exchanges. Helpers take care to ensure the security of their e-mail systems. Several professional organizations have adopted guidelines for technology-related helping. These guidelines include password-protecting information stored on a computer, storing information on a secure server, storing information on a personal mobile phone, maintaining confidentiality when workspaces are open or shared, and asking individuals to limit the types of information they share on a nonsecure e-mail system.
In summary, privileged communication and relative confidentiality illustrate the complexity of confidentiality. Privileged communication rarely exists for the beginning human service professional, but relative confidentiality is a concept that deserves the worker’s attention. Agency guidelines, the profession’s code of ethics, and the laws of the state in which one practices are important considerations in the delivery of services. A professional should be familiar with all three as guides to circumstances that may arise. Technology-based communication via the Internet brings an additional set of issues regarding confidentiality. The following vignettes provide examples of confidentiality dilemmas that you may face as a beginning human service professional.
CASE 1
Joe works in a small agency that provides educational services to children with developmental disabilities. He promises clients that his records are confidential and is very careful not to divulge the names of the clients or the nature of their problems. The mother of one of his young clients reports to him that “someone at her church” had heard that her child was receiving his services. If it was not Joe who breached confidentiality, it might be the secretary who answers the telephones or the typist who keeps the records.
CASE 2
Faye is a counselor and recreation specialist working in an after-school recreation facility. One of her favorite teenagers has just told her “in confidence” that she is pregnant. Should she keep this information confidential?
CASE 3
Betsy needs to reschedule an appointment she has with a new client tomorrow. When she called the client at home, she got her voice mail. Knowing that anyone can access messages left on voice mail, Betsy decides not to leave a message; instead she e-mails the client at her workplace, using the e-mail provided by the client that is secure. Sometimes Betsy is frustrated because an easier way to communicate with clients would be texting, but that is against agency policy.
CASE 4
Cynthia works in a high-stress hospice program. Working with the dying patient and family and friends is emotionally draining, and she often “takes her work home.” Many of her clients communicate with her via e-mail, since clients and caregivers are home-bound. How does she ensure confidentiality?
CASE 5
Raphael is a vocational rehabilitation counselor working with a veteran who has returned from service in Iraq. His client has been very depressed during the last month, and during his last individual conference with Raphael, he talked of “ending all the agony.” Raphael wonders what he should do and whom he should tell.
These are just a few examples of the many conflicts that can arise over the issue of confidentiality. Many of the troublesome dilemmas result from the constant tension among worker responsibilities, agency policies, and client needs. Privileged communication and relative confidentiality are difficult principles to follow. The preceding cases illustrate the problems helpers may encounter as they translate their values into action in the workplace. An equally complex issue that human service professionals encounter concerns clients’ rights.
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