Session 14: Ethics in Counseling

LEARNING OBJECTIVES

• Identify key ethical and legal issues in HIV/AIDS counselling.

• Discuss the legal rights of the counsellor and client.

• Explain the implications of counselling and the right to privacy.

• Identify the counsellors duties to the client.

• Discuss unresolved moral dilemma for the counsellor.

• Demonstrate the ability to relate legal and ethical issues to the
various counselling situations.
2
Brainstorm (5mins)

•What are ethics?

3
Ethical Code of Conduct for HIV Counselors

• A code of ethics outlines the fundamental values of counselling.

• Counsellors, should understand these values so as to maintain a

professional relationship with our clients.

• The standards followed by counsellors serve to safeguard integrity,

impartiality and respect, with regard to both parties.

• The following slides outlines the main features of an ethical code of

conduct for social workers, counsellors, clinical psychologists and
other help professions engaged in counselling and testing for HIV.

4
Ethical Code of Conduct for the HIV/AIDS
Counselor : Competence 1
Counselors

•Are responsible for their own physical safety, effectiveness,

competence and conduct, thereby avoiding any compromise of the
counseling profession.

•Must ensure that they have received the required training in counselling
skills and techniques.

•Should regularly monitor their competence through supervision or

consultative support, and by seeking the views of their clients and other
counsellors.

•Must recognize their boundaries and limitations of competence, and

provide services, skills and techniques for which they are qualified by
training and practice 5
Ethical Code of Conduct for HIV/AIDS
Counselor : Competence 2
Counselors

•Must refrain from any claim that they possess qualifications or

expertise that they do not.

•Must make appropriate referrals to others with expertise that they

do not possess.

•Must refrain from making exaggerated claims about the

effectiveness of the intervention offered by their services in
relation to HIV prevention and care

6
Ethical Code of Conduct for the HIV/AIDS
Counselor : Consent 1
Counselors
•Counsellors must obtain their clients‘ consent to engage in the
counselling and/or testing process, unless sanctioned by legal
authorities on criminal or mental health grounds.

•Counselling is to be voluntarily undertaken by clients, and should

take place in a private and confidential setting.

•It is the counsellor‘s responsibility to inform clients about the nature

of counselling offered and contractual obligations such as timing,
duration and confidentiality.

•All persons taking HIV test must give informed consent (written or
verbal) prior to being tested. 7
Ethical Code of Conduct for the HIV/AIDS
Counselor : Consent 2
Counselors
•Counsellors are expected to ensure that clients have adequately
understood all of the issues involved in HIV Counselling and Testing
before giving informed consent for HIV testing.

•Counsellors must recognize the rights of those whose ability to give

valid consent to HIV testing may be diminished because of age,
learning disabilities or mental illness.

•Counsellors must recognize the right of clients to withdraw their

consent at any time, even after their blood has been taken for HIV
testing.

•Non-consented HIV testing cannot be justified in any circumstance.8

Ethical Code of Conduct for the HIV/AIDS
Counselor : Confidentiality 1
Counselors
•Counsellors must maintain adequate records of their work with clients
or patients and take all reasonable steps to preserve the confidentiality
of the information obtained.

•The results of HIV tests must also be kept absolutely confidential.

•However, shared confidentiality with other professionals such as

counsellors and health workers may be necessary in order to provide
appropriate care. It is important to inform clients and obtain their consent before
this is done.

•Counsellors must not disclose any information about a client or

patient to colleagues not directly involved in their care without first
seeking consent of the client. 9
Ethical Code of Conduct for the HIV/AIDS
Counselor : Confidentiality 2
Counselors

•Counsellors must take all reasonable steps to communicate clearly

the extent of confidentiality they are offering to clients. Normally, this
should be made clear in the pre-counselling information session.

•Counsellors must work within the current confidentiality agreement.

Any agreement between the counsellor and the client or patient
about confidentiality may be reviewed and changed by joint
negotiation.

•Counsellors must make provisions for maintaining confidentiality in

the storage and disposal of client or patient records.
10
Conditions for breaking the confidentiality
agreement:

• Counsellors may break the confidentiality agreement in the following

situations:

• Believing that a client will cause serious physical harm to

himself/herself or to others.

• Believing that a client is no longer able to take responsibility for his or

her decisions and actions.

• When a court orders the disclosure of such information

These decisions should be made only after consultation with a

counselling supervisor or an experienced counsellor.
11
Counselors may take an oath of
confidentiality
Which specifically states that they should:
• Not disclose any identifying information about their clients without the
client’s written permission;

• Take reasonable steps to ensure that a client’s record is only identifiable

to the individual client;

• Destroy records no longer required for services being offered;

• Ensure the security of records and prevent access to them by anyone

not involved in the services being offered;

• Takes steps to ensure that colleagues, staff and trainees understand

and respect the need for confidentiality in the counseling services. 12
 Other Elements of Code of Ethics:
Respect for Human Rights.
• Counsellors must recognize the fundamental rights, dignity and
worth of all people. Like any other health professionals, counsellors
are expected to provide services to people irrespective of their race,
culture, religion, values, or belief systems.
• Specifically, counsellors should:
• Be aware of sociocultural differences of gender, race, ethnicity, religion, e.t.c.
• Be aware of personal prejudices and biases based on the above differences.
• Refer clients to another counsellor if differences interfere with counselling.
• Refrain from participating in or condoning any discriminatory practices.
• Ensure that clients suffer no physical or psychological harm during counselling
• Strive to promote clients‘ control over their own lives, and respect clients‘ ability
to make decisions and change in the light of their own beliefs and values

13
 Other Elements of Code of Ethics:
Personal Conduct.
Counselors
•Must conduct their counselling activities in a way that does not jeopardise
the interests of their clients or undermine public confidence in their service
or that of their colleagues
•Must maintain respect for clients in the counselling relationship by not
engaging in activities that seek to meet counsellors‘ personal needs at the
expense of clients.
•Should not exploit any counselling relationship for the gratification of
personal desires.
•Should refrain from use of alcohol, drugs or other substances that can
impair judgement at work.
•Should appear professional and presentable in dress and manner.

14
 Other Elements of Code of Ethics:
Integrity.
Counselors:
•Must seek to promote integrity through honesty, fairness and respect for others.
•Should not engage in a personal or sexual relationship with clients.

•Should not accept to counsel clients with whom they have engaged in former
sexual relationship or have a current personal relationship.

•Should not engage in any relationship (including counselling) with a client in

another service facility except on referral.

•Have a responsibility both to individual clients and to the institution within which
counselling services are performed, in order to maintain high standards of
professional conduct

15
Other Elements of Code of Ethics:
Disciplinary measures.
• Counsellors and Counsellor Supervisors have a responsibility to
other counsellors and must take measures to correct them when
wrong doing is observed.

• Counsellors who breach the code of ethics would face disciplinary

measures in line with the local policy in their facilities.

• Erring counsellors would be sanctioned by the National HIV/AIDS

Counselling Professional Association when established, but in the
interim the National HCT Task Team can perform that function

16
Experience Sharing (5mins)

•Identify an ethical or legal dilemma encountered in your

facility.

•How did you tackle it?

17
Ethical Dilemmas

HIV/AIDS counsellors should be aware that they may face a

number of ethical dilemmas, including issues of:
•Confidentiality

•Client dependence

•Disclosure of test results to partners

•Provision of services to minors

•Appropriateness of gifts received or offered

18
Other Ethical Considerations
• Counselors may encounter situations not covered in this training.

• When facing an unfamiliar situation, counselors should remain calm, use

their judgment and call on the techniques of counseling to help the client.

• If counselors are unsure of how to respond in any given situation, they

should seek help according to the rules and procedures in function at their
counseling center.

• Knowing when to ask for help, and being able to accept it, are essential
qualities for a counselor. When a client’s problem is beyond a counselor's
capabilities, it is far more effective and useful from the client’s point of
view if the counselor refers the problem to an appropriate agency rather
than attempting to solve it by her or himself.
19
Case Study 1: Ethical Issues

Ene (24 years old) had diarrhoea for two weeks, loss of weight
and fever. Her mother took her to the doctor who took some
blood specimens for investigations. After two days, he informed
Ene‘s mother that Ene was HIV positive. Ene threatened to sue
the doctor.

•What grounds does Ene have for suing the doctor?

20
 Case study 1: Ethical issues

• What are the issues?

• How do you respond?

• What are the rights of the client? What are the rights of the wife?

• What are your obligations as his counselor?

• What do you see as the central ethical and cultural issues in this
case?

21
22
• Summary

23