1. Sheila came to your office about 8 months ago seeking counseling. She stated that she, "hoped to save her marriage." After a few sessions with Sheila, you suggested that couples counseling might be helpful, but her husband, Roy, refused to participate. Three months ago, Sheila and Roy went through a very nasty breakup of their marriage, and now you have been subpoenaed to produce all of your records pertaining to Sheila's treatment. Sheila has told you not to comply with the subpoena. What should you do? Why? Describe the specific steps you would take in responding to the subpoena.
Counselors are required to protect patient information from leaking to unauthorized persons including the healthcare personnel and the patient’s immediate family, relatives, friends and community members. However, counselors are allowed to breach this requirement depending on the circumstances. In Sheila’s case, I would co-operate with the legal system. Furthermore, the counseling code of ethics recommends the co-operation between the certified counselors and the legal system in order to address these legal issues (National Board of Certified Counselors, 2018). During this process, my actions would be guided by the counselor’s code of ethics. Firstly, I would request the court to withdraw the order citing the negative consequences of disclosure including the adverse effects on Sheila and our professional relationship. If the court refuses to do so, I will request them to specify the required information. I would then extract this information from Sheila’s file and present it to the court after carefully explaining to Sheila my obligations according to the law.
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2. Marcie is a new client and a 22-year-old female who works as a receptionist in a doctor's office. She has just revealed to you during the intake session that she has recently lost interest in most activities, has been sleeping a great deal yet feels tired all the time, and sometimes wishes she could cease to exist. She mentioned feeling as though she has been "on an emotional roller coaster" during the past year, throughout her on-again/off-again relationship with a 35-year-old married man. The last breakup with him seemed final, and Marcie has felt herself sinking deeper and deeper into depression ever since. When probed further about suicidal ideations, Marcie admitted that she has considered killing herself, although she is uncertain whether or not she would actually do it. She said that she is currently in possession of a gun that her friend allowed her to keep in her home following a rash of burglaries in the neighborhood, but she does not know whether she would actually use it. You have consulted with your supervisor, who has agreed that Marcie should be referred immediately for a psychiatric evaluation and has instructed you to arrange for Marcie to go directly from your office to a nearby hospital. Marcie told you that her mother accompanied her and is in the waiting room, but she has emphatically stated that she does not want her mother to know what is going on with her. How should this delicate situation be handled? Why? What are three ethical and/or legal concerns about this case?
In this scenario, I would discuss with Marcie the medical diagnosis regarding her mental health. This would enable her to be aware of the potential risks that her condition poses to both herself and others. I would also advise her to disclose her health condition to her mother in order to achieve family support through the treatment period. In case Marcie fails to adopt my recommendations, I would reveal her health condition to her mother in order to receive consent to take her to the psychiatric hospital.
Marcie’s case poses a threat to the requirement of confidentiality of patient information as there is a possibility of her mother being informed of her condition without her consent. It also poses ethical issues in the decision to take Marcie to a psychiatric hospital without her consent. Howe (2013) observed that while this may be the appropriate decision, counselors are likely to face legal cases due to this. Lastly, the disclosure of the patient’s mental condition may worsen her situation. According to Howe (2013), this can lead to patient hopelessness hence increasing the likelihood of suicide.
References
Howe, Edmund. 2013. Five Ethical and Clinical Challenges Psychiatrists May Face When Treating Patients with Borderline Personality Disorder Who Are or May Become Suicidal. Innovations in Clinical Neuroscience, 10 (1),14-19.
National Board of Certified Counselors. 2016. Code of Ethics. National Board for Certified Counselors, Inc. and Affiliates
