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Introduction介绍
咨询师应始终保持高度的客户保密性。然而，有时辅导员会被迫披露这些信息。这一决定不仅侵犯了客户的权利，还可能危及客户的安全和福祉。因此，尽管咨询师在其职责中遇到了困境，英国咨询和心理治疗协会希望咨询师应用道德法律和法规，并使用道德决策模型对复杂问题做出决策。本案例研究中确定并讨论了几个伦理问题。本文采用Welfel（2013）伦理决策模型解决案例研究中的困境。
Counselors are expected to maintain a high level of client confidentiality at all times. However, there are times when counselors are pressured to disclose this information. This decision not only breaches the rights of the client, but it could also jeopardize the client's safety and well-being. Hence, regardless of the dilemmas experienced by counselors in their duty, the British Association for Counselling and Psychotherapy expects counselors to apply ethical laws and regulations, and use ethical decision-making models to make decisions on complex issues. Several ethical issues are identified and discussed in this case study. This paper uses the Welfel (2013) ethical decision-making model in the resolution of the dilemmas in the case study.
Client Background客户背景
玛丽是一个新毕业的领域，她目前是一所小学的咨询培训生。在她攻读研究生学位的同时，玛丽为几个客户、大多数学生和他们的父母提供咨询。现在她在一所小学工作，在那里校长的信息保密性很低。
Mary is a fresh graduate in the field of, and she is currently working as a counseling trainee at a primary school. While she undertook her graduate degree, Mary counseled several clients, most of the students and their parents. Now she works at a primary school where the principal has been known to have low information confidentiality.
Case Background案例背景
在这种情况下，小学校长玛丽的雇主要求她披露与她以前的客户有关的信息，并提交她以前向社会福利部门推荐过的患者的客户名单。校长打算利用这些信息完成学校关于学校资源和活动的年度报告。他计划通过使用Mary提交的信息来找到合适的面试主题来完成这项工作。校长相信真实的个人故事会对捐赠者产生更好的吸引力，而不仅仅是对案件的统计。收集到的信息将有助于枪手为学校提供更多更好的资源。提供更好的资源将使学生受益，因为额外的资金将提高他们的教育质量。
In this case, Mary is requested by her employer, the principal of the primary school, to disclose information regarding her previous clients, as well as submit the client list of the patients she had previously referred to the Social Welfare Department. The principal intends to use the information to complete the school's annual report on the resources and activities of the school. He plans on accomplishing this by using the info Mary submits to find suitable interview topics. The Principal is convinced that real personal stories will make a better appeal to the donors as opposed to mere statistics on the cases. The information gathered will help him to gunner support for more and better resources for the school. The provision of better resources will benefit the students because the additional funds will increase the quality of their education.
In her previous experience, Mary trusted her judgment in deciding on client information disclosure. She is once again faced with the same ethical dilemma but judging from her previous experience; she does not wish to trust her judgment. Mary feels compelled to keep the confidentiality of her clients in spite of the benefits that her disclosure may have on the school. On the other hand, however, she is at risk of losing her current job at the primary school if she fails to disclose information. She cannot just easily quit the job to preserve her work ethics because she needs to gain the required experience and skills to get a good employment opportunity. Furthermore, she may very likely be confronted with a similar dilemma in her next workstation. Thus, it is only appropriate for Mary to use an ethical decision-making model and the laid out moral codes to make the best decision in this situation.
Ethical Issues Identified in this case study
The first ethical issue is Mary's breach of trust as a practitioner. According to the BACP guidelines, trust is the most significant ethical principle in counseling and psychotherapy (BACP, 2018). It not only assists the client to attain their aspirations, it the basis on which the practitioner relates and interacts with the client. The counseling process requires the client to be open and honest and sharing sensitive information may leave them vulnerable (Kinsinger, 2009). Thus a practitioner is expected to be ethically responsible for the well-being and security of the client. In this case, Mary will be breaching that trust between her clients and herself if she discloses the confidential information to maintain a good working relationship with her boss.
The second ethical issue is the use of a client's confidential information without their consent. A practitioner is not at liberty to use a client's information without their permission. Only the client has the full right to give or withhold consent for the use of their data. In addition to that, the client should not be coerced into giving his consent (ECBPS, 2009). Hence, Before Mary hands over the data to the principal of the school, she is required to seek their approval first. She should openly explain to the clients why the information is needed and how it will be used. The clients can then decide whether or not to give their consent.
The third ethical issue is the dishonest use of the information. The principal of the primary school wants to use the data to complete the school's annual report on its activities and resource use. This is dishonest as the information is not based on data collected from students at the school. Using this information to gunner support from the donors may be of great benefit to the students, but the school may not be merited for the donations. Accepting to hand over the information can be considered as conspiring in deceit and fraud which is not only unethical but also unlawful (BPS, 2017).
Using the Ethical Decision Making Model
The ethical decision-making model consists of ten steps:
Step 1: Being Sensitive to the Moral Dimension of Practice
It is imperative for Mary to observe the code of ethics as she navigates through this dilemma. She should take the circumstances and the needs of her clients into account before making any decision. According to the British Code of Ethics and Conduct (2009), Mary is obligated to maintain good professional relationships with her former and current clients as well as with the principal. To do this, she should observe the following value ethics principles, justice, informed consent, fidelity, confidentiality, beneficence and autonomy (Kitchener, 1984).
Mary should observe justice by protecting the information of her former clients or only using it after obtaining their consent. She should exercise integrity by refusing to disclose her clients' information at all cost. Maintaining a high level of confidentiality is just and safeguards the well-being of her clients (Bodenhorn, 2006). Nevertheless, to keep a good professional relationship with her employer, Mary should consider the principle of beneficence, and agree to ask her clients to make their contribution in the report by willingly providing their information. This gives students and their patients an opportunity to autonomously make their own choices based on their judgment and not coercion.
From the principal's point of view, acting in the best interest of the student is what justice involves. The principal is putting the needs of the students above his own by taking an extra mile to ensure that the annual report is appealing enough to get the school the required resources. However, the principal should observe integrity by allowing the interviewed students, parents and clients referred to the Social Welfare Department to act autonomously (Levitt et al., 2015). He should also maintain fidelity through obtaining information from students from his school in an honest manner.
Step 2: Identification of the Relevant Facts, Socio-cultural context
Some of the cultural factors that Mary may consider while making her decision include the well-being of the students at the primary school she is currently training at. Getting additional resources will improve the quality of education that the students aquire at the school. Besides the annual report, the principal indicates no other source of hope to convince the donors to support the school. On the other hand, however, Mary is expected to maintain the confidentiality as a practitioner. Disclosing her former clients' information may jeopardize the mental well-being of the students which would have a retrogressive effect on the studies (Levitt et al., 2015).
Step 3: Define the Central Issues in the Dilemma and the Available Options
In this case, Mary can violate her clients' confidentiality by providing the requested information without their consent. If she does this, she will probably secure her job, and assist the school to obtain the necessary donations. On the other hand, Mary jeopardizes her clients' well-being and trust in her as the chances of the principal and the deputy principal keeping the information confidential is very minimal. Mary may as well decide to engage all the stakeholders in the matter and give everyone a chance to make autonomous decisions on the issue, but she risks losing her job if her clients fail to offer the information willingly. #p#分页标题#e#
Step 4: Refer to Professional Ethical Standards and Relevant Laws and Regulations
The British Psychological Society (2017), recognizes counseling trainees to be psychologists and so Mary is subject to the laws and regulations stipulated in the code. According to these stipulations, Mary is expected to exercise integrity, responsibility, , and respect in her daily practice. Besides that, the Equality Act of 2010 provides for the fair treatment of all people, thereby compelling Mary to not only uphold integrity in her duty but also to treat people equally without discriminating (Ministry of Ethics, n.d.). Hence, in this case, it will be unfair to provide the information about her clients to enable the students in her current school to get a quality education while violating the privacy rights of her other clients.
The Data Protection Acts of 1998 also prevents Mary from disclosing the information about her former clients. This act gives clients the right to know what confidential information about them is held by the practitioners and protects the data from being deliberately or accidentally compromised (Kinsinger, 2009). Section four of the guidelines stipulates laws that psychologists' duty to promote and safeguard the welfare of children (Kinsinger, 2009). Thus, Mary may not be at liberty to disclose information about her former clients to the principal because the principal's low level of confidentiality may affect the students' mental wellbeing. Mary is therefore obligated to work in close collaboration with both the school management and the parents to achieve the students' best interests.
Step 5: Searching out the relevant ethics literature
The most pertinent ethical issues, in this case, are confidentiality, beneficence, and autonomy. According to the UK Ministry of Ethics (n.d.), confidentiality entails the protection of a client's personal information from unauthorized parties. According to Article 8 of the 1998 Human Rights Act, all individuals have the right to privacy with regards to his life, his correspondence and his home (Ministry of Ethics, n.d.). The act also provides minors who wish to conceal information about their medical history from their patients with the right to do so and therefore; Mary has to ensure that this information is well respected.
According to Kinsinger (2009), beneficence is an act of kindness or charity from a sense of moral obligation. In this case study, Mary has to solicit the beneficence of her clients for the information about them so that they can decide whether to give it or not. The third ethical issue is the autonomy. Mary should allow her clients to make their own choices with regards to the therapy sessions and the information held about them without coercion or pressure to submit from Mary or the principal. Thus, if the clients find the need to support the school with their confidential information, then they will independently do so.
Step 6: Apply Fundamental Ethical Principles and Theories to the Situation
Mary will have broken the confidentiality that her clients have in her if she discloses the information about them to the principal. Her clients may not feel motivated to speak openly and honestly with her during future counseling sessions. The sessions may therefore not be useful for the clients. In addition to that, Mary will be breaching the Code of Ethics thereby compromising her career as well.
In this case, Mary should consider taking a decision that is in the interest of all parties. First, she should refrain from handing over her clients' information to the principal, and instead seek their consent to share the information by explaining to them how sharing their information will be beneficial to the students at the school. Then she should allow her clients to decide to give or withhold the information autonomously. Mary will as well encourage the principal to act in the best interest of all the stakeholders.
Step 7: Consult with Colleagues about the Dilemma
At this stage, Mary should as well consult with colleagues in the counseling field such as her supervisor concerning the dilemma. Experienced psychologists are likely to have experienced the same issues in their past experiences and may offer Mary good professional advice. It would also be advisable for Mary to consult other professionals such as social workers as they may have experience on the psychological problems that students undergo when information about them is shared without their consent.
Step 8: Deliberate independently and decide
After considering all issues at hand, Mary should make a decision that best safeguards the integrity of her work. She should protect her clients' right to privacy by withholding information about them from the principal. Then she should encourage collaboration among the students, parents and the school on how to help the school to get the needed donations. Then after deliberation, Mary should allow all parties to make their own decision concerning the issue autonomously. At this point, the principal would have understood the importance of protecting the students and parents right to information and may not likely press Mary to disclose the information if they choose not to. The chances are that the principal will seek another way of getting the needed donations.
Step 9: Informing the Appropriate People and Implement the Decision
The final step is to inform all the stakeholders of the decision and to implement it. In this case, no action will be taken if Mary's clients refuse to provide their information to the school principal, but if they willingly offer it, then the school principal will use it to make the annual report for the school. Mary will also regularly meet her clients to monitor their progress after the disclosure of their confidential information.
Step 10: Reflecting on the Actions Taken
Disclosing personal information about oneself is a big decision. It may positively or negatively affect the individual. Mary will have to continually monitor the patients for negative impacts arising from their choices. Although both Mary and the principal are both obligated to act in the students best interests, Mary has to consider what effect the impact of the disclosure will have on them. Hence, she may be required to counsel the principal on client confidentiality so that in the future the principal may consider every individual's interests with as much importance as the school's interests.
Bibliography
Bodenhorn, N. (2006). "Exploratory study of common and challenging ethical dilemmas experienced by professional school counselors." Professional School Counseling,10(2), 195-202.
British Association for Counselling Psychotherapy (BACP). (2018). Ethical Frameworks for the Counselling Professions. Leicestershire, British Association for Counselling Psychotherapy, pp. 4-35.
Decision-making practice versus theory." Counseling & Values, 60(1), 84-99.
Ethics Committee of the British Psychological Society (ECBPS). (2009). Code of Ethics and Conduct. Leicestershire, Ethics Committee of the British Psychological Society.
Kinsinger (2009). "Beneficence and the Professional's Moral Imperative." Journal of Chiropractic Humanities, vol. 16(1): 44-46.
Kitchener, K. S. (1984). "Intuition, Critical Evaluation and Ethical Principles: The Foundation for Ethical Decisions in Counseling Psychology." Counseling Psychologist, 12 (3), 43-55.
Levitt, D. H., Farry, T. J., & Mazzarella, J. R. (2015). "Counselor ethical reasoning:
The British Psychological Society (BPS). (2017). Practice Guidelines. The British Psychological Society, 4th Ed.
The Ministry of Ethics. (n.d.) Principles of Confidentiality. Accessed from: https://www.ministryofethics.co.uk
Tim Bond. (2004). Ethical Guidelines for Researching Counselling and Psychotherapy. Leicestershire, British Association for Counselling and Psychotherapy.
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