Ethical dilemma in Hiv Counselling Cases

I have a client whom I know to be HIV positive. I also know that he is sexually active and has not told any of his partners about this. Isn’t it my ethical responsibility to inform someone that he is, in effect, dangerous to others? Even if I am not a counselor, I would not be able to live with the fact that I have such an information and am putting some other life at risk. As a medical doctor, I was also bound by my Hippocrates oath to serve and bring no harm to others, “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

” (Edelstein,1967) By law I must abide by the rules set by the act and by the counseling board. There are 4 matters that I may need to breach (ACA , 1995) :- 1. homicidal thoughts 2. abuse cases/ minor 3. suicide cases 4. court order What is ethics? Ethics is a process of considering right and wrong, in which a choice of behaviour is shaped. I would also imply it as Moral for a common place term and is sometimes contrasted with ethics which is considered an academic discussion of ideals. (Herlihy & Corey ,1996.)

But I will avoid the term “moral” because it carries the connotation of “moralism” which many people think as an imposition on ones values or one another. I would rather discuss the process of ethical discernment; the choosing of action, consequences of choices the values of he or she ants to embody in the action. I see this big part of my future as a counselor. Will I be able to live up to the ethical choices made which will not disturb me morally yet it will also cause no detrimental actions to my clients?

Based on the Malaysian Counselling Code of Ethics, (1994), as a counsellor I m bound by this code to be responsible to my client. Based on this I will be able to deliberate my choices in whether I will disclose the matter or not. Clause 2 Kaunselor hendaklah menghormati privasi klien dan merahsiakan segala maklumat yang diperolehi semasa kaunseling melainkan jikalau maklumat itu akan membahayakan klien atau orang-orang dipersekitarannya. (Counselors shall respect client privacy and confidentiality of all information obtained during counseling except if the information would harm the client or persons in the immediate.

) Clause 11 Dalam kes di mana jelas terbukti bahawa klien, mengikut pertimbangan kaunselor menunjukkan dengan jelas, diri klien atau orang Iain berada dalarn keadaan bahaya, kaunselor hendaklah menggunakan budi bicaranya mengambil tindakan wajar untuk menjaga kepentingan klien dan orang lain yang terlibat. (In cases where it is evident that the client, at the discretion of the counselor shows clearly, themselves or the people Iain client is in danger, the counselor should exercise its discretion to take appropriate action to protect the interests of clients and other people involved.)

By the above clauses, I am morally bound to do the right thing. But I will also analyze further the fear or reservations my client has in this matter. My client is my main focus here. Even though he or her behaviour or disease will be hazardous to the public, but I will need to know why this matter is an issue to be brought up by them. Encouraging HIV-positive patients to disclose their status, especially to their sexual partners was an important challenge faced by the participants.

They mentioned that despite the improvement in their counselling skills due to the trainings received and from their work experience, they still faced difficulties convincing some patients to voluntarily inform their partners about their HIV status. The major reason cited was fear of marital problems which included blame, verbal or physical assault, and even divorce. (Mueller . R. , 2007). Based on the above statement, I would see the the refusal to notify the sexual partners being common because these clients were more likely to have been promiscuous prior to their diagnosis.

They further had experienced that patients who disclosed their status were more likely to engage in safer sex, had better treatment compliance, and outcomes compared to those who concealed their status. In contrast if the patient still insists on not telling the partner on their situation, even though I am going to still make the report but I will also try to make efforts to educate the client to notify the partners. There would be ways to strategies to encourage and ensure the patient to willingly notify their partner.

Part of my strategy would be to; i) couple counselling, even if there is some reluctance to continue. , ii) educating them on the benefits of disclosure, iii) seeking consent from the patients to directly inform their partners in the patients’ presence in scenarios where patients lacked the courage to do so personally, and iv) I would try to contact the people involved in this situation that they are in the possibility of exposure to HIV without releasing the identity of my client (Njozing et al. 2011)

Reference American Counseling Association. (1995). Ethics. American Counseling Association Edelstein, L.: 1967, Ancient Medicine, edited by O. Temkin and C. L. Temkin, Johns Hockins Press, Baltimore Dixon-Mueller R: The sexual ethics of HIV testing and the rights and responsibilities of partners. Stud Fam Plann 2007 Herlihy, B. , & Corey, G. (1996). ACA ethical standards casebook (5th Ed. ). Alexandria, VA: American Counseling Association. Malaysian Counselling Code of Ethics, (1994) Njozing NB, Edin K, Hurtig AK: “When I get better I will do the test”: facilitators and barriers to HIV testing in Cameroon with implications for TB and HIV/AIDS control programs. SAHARA-J 2010 , .

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