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Home HIV Case  Confidentiality and HIV Literature Review  Ethical Issues and Legal ConsiderationsCounselor Interview Decision Making Model

the best course of action for handling this ethical dilemma.
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**__ Identify the Problem __**
The client, Norma, has recently learned of her positive HIV status. She has informed her counselor of this information, but has not disclosed her status to her boyfriend, Javier, who she has previously had unprotected sex with. Norma reports being scared to disclose to Javier because of his violent nature. Should the counselor break confidentiality to warn Javier of his possible HIV infection?

__ Apply the ACA [|Code of Ethics] __
A.1.a- Primary Responsibility A.4.a- Avoiding Harm B.1.c- Respect for Confidentiality B.2.b- Contagious, Life-Threatening Disease B.2.d- Minimal Disclosure H.1.b- Conflict in Codes and Laws
 * Consider Ga Legal Codes 24-9-47 & 16-5-50

[Full discussion of Codes and Law here: Ethical Issues and Legal Considerations]

__Determine the Nature and Dimensions of the Dilemma__
//Autonomy//: (foster self-determination) -Encourage Norma to make the disclosure herself, allowing her to be in control of the situation.

//Beneficence//: A.1.a- Respect Dignity and Promote Welfare of Clients "The primary responsibility of counselors is to respect the dignity and promote the welfare of clients." - It is essential to consider Norma's safety and welfare in handling this disclosure due to Javier's violent nature. According to the Code of Ethics, this is the counselor's primary responsibility.

//Non-maleficence//: (Do no harm) A.4.a- Avoiding Harm " Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm." -By not disclosing Norma's diagnosis to Javier ourselves, we believe we are avoiding causing harm to her, especially the threat of physical harm from Javier.

//Fidelity//: (fulfilling a responsibility of trust, be faithful in promises made, keep disclosures confidential) B.2.d- Minimal Disclosure "To the extent possible, clients are informed before confidential or privileged information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed." -By allowing Norma the opportunity to disclose her diagnosis herself, we believe we are respecting the ethical standard of minimal disclosure and Norma's right to privileged communication. If Norma doesn't disclosure herself and we need to take steps to warn Javier, we will keep Norma informed of our actions.

//Justice//: (Fairness) We might ask Norma if the tables were turned, would she want to know she had been exposed to HIV so she could start treatment as soon as possible? -We agree that we would want to know as soon as possible if we were in Javier's place.

//Veracity//: (truthfulness) We might ask Norma if she is not truthful with Javier if she will be able to live with the emotional consequences of that decision. -We all agree that we would not be okay with the consequences with not informing Javier of his possible exposure to HIV.

Consult with other professionals: Counselor Interview

__ Generate Potential Courses of Action __
1. Inform Javier that he has been exposed to HIV through sexual relations with an infected individual, but do not disclose who. 2. Honor Norma's rights to confidentiality and do not disclose her HIV positive status to Javier. 3. Encourage Norma to disclose her diagnosis to Javier, either in a counseling session or over the phone. 4. If Norma refuses to disclose her diagnosis, gain her consent to inform the public health department of Javier's possible exposure to HIV and allow them to contact Javier for potential testing.

__ Consider the Potential Consequences of All Options, Choose Course of Action __
1 Javier can choose to be tested and pursue treatment if necessary. He may also figure out that he has been infected by Norma, can may retaliate in a violent manner. The counselor will also be breaking laws that require that AIDS Confidential information is not shared without consent.

2. The counseling relationship with Norma will remain in tact and trust will be preserved. However, Javier will not know of his possible HIV infection, meaning he cannot seek treatment. The counselor will be also be breaking the ethical duty to warn (B.2.d) of Contagious, Life-Threatening Diseases.

3. The counselor will respect Norma’s autonomy by allowing her to disclose to Javier, and will not be breaking confidentiality. Javier will know of his possible infection. Javier may retaliate in a violent manner, threatening or potentially fatally harming Norma.

4. The counselor will honor Norma’s confidentiality and not threaten the client’s safety or break the law by disclosing confidential AIDS information without consent. The counseling relationship will be preserved and trust will not be broken. Javier will be given an opportunity to be informed, be tested, and seek treatment if necessary.

__ Evaluate the selected c ____ ourse of action __
If we were the counselor in this situation, we would encourage Norma to disclose her diagnosis to Javier after helping to ensure her safety. We do not believe that it is ethical or appropriate for Javier to be uninformed of his potential exposure to a deadly disease. If Norma refuses to disclose to Javier herself, we will get her permission to inform the public health department of Javier’s need to be tested for HIV. We believe this passes the test of justice, as it appears to be fair (both Norma and Javier’s needs are met) and we would apply it to other’s in a similar situation. We also believe that is passes the tests of publicity and universality, as it is a course of action that we would be comfortable with others knowing about and would recommend to other counselors.

__ Implement the course of action __
We would begin working with Norma to devise a plan of safety and helping her understand the reasons why Javier must know of his exposure to HIV. After working to ensure Norma's safety, we would work to identify the best way for her to disclose her status to Javier in a way that she felt comfortable doing. If Norma's safety could not be ensured or she would not consent to disclosing to Javier, we would discuss our professional ethical obligations and gain her consent to contact the local public health department. We would hope to continue seeing Norma to help her continue to deal with the repercussions of her diagnosis.

References

Remley, T. & Herlihy, B. (2010). Ethical, Legal, and Professional Issues in Counseling

(Third ed.). Saddle River, NJ: Pearson Education River, NJ: Pearson Education