The American Psychological Association’s ethical principles and code of conduct is a tool that should be utilized and followed by all applicable treatment providers. It advocates and mandates the highest standard of care, which ultimately safeguards patients, community, and treatment providers. Even with such a tool set in place, many ethical dilemmas arise in the course of treating diverse populations with myriad medical and mental issues. Disclosure is one such ethical dilemma that is often faced when treating these diverse populations. The APA’s code of conduct maintains that the disclosure of information is ethical when appropriate consent is garnered by the individual, organizational client, or other legally authorized individual on behalf of the client as long as it is not prohibited by law (APA, 2010, Standard 4.05). Moreover, a treatment provider may disclose information without consent when mandated by law or when valid purposes, such as to “(1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose” (APA, 2010, Standard 4.05). When developing a course of action for the given scenario, it is important to particularly pay attention to disclosing information without consent in an effort to protect client, psychologist, or others from harm.
The scenario we were given this week revolves around a mother and daughter who are both HIV positive. The mother transferred the virus to her daughter during childbirth. The daughter does not know of her condition, although she is currently twelve years old. Her mother has only told her that she must take medication due to having issues with her blood. The daughter also does not know that her mother has HIV. The daughter has recently revealed to her mother that she does not like taking the medication and often misses doses. The staff at the clinic feels as though the daughter should be informed of her diagnosis to help ensure that she adheres to her regimen of medications. The mother, however, does not want the daughter to know and has informed the staff that they are not to reveal the daughter or mother’s diagnosis to the daughter. The mother feels as if the daughter is still too young and not ready to know. Additionally, the threat of her daughter transmitting this disease to another is becoming more and more probable as the daughter is at an age where an interest in boys and sexual behavior are at an increase. Nevertheless, while the staff has discussed this with the mother and asked her to reconsider telling her daughter on numerous occasions, the mother refuses and states that her daughter is a “good girl” and will not become sexually active until she is married.
Although there are not any clear guidelines for situations like this, it is in my professional opinion that the clinical staff on this case talk with the mother once more about the extreme dangers of not disclosing the daughter’s diagnosis to her. If the mother still refuses to disclose the information to her daughter, clinical staff should then inform the mother that they are ethically bound to reveal the diagnosis, as the daughter poses a great risk to all others she comes into contact with. Staff can then provide the option for the mother to do it herself, or with the help and support of staff and therapist.
Research illustrates that HIV positive persons have a duty to disclose their HIV status to their partners or anyone who may be vulnerable to transmission (Aultman & Borges, 2010). This is strongly backed by not only the CDC, but the American Medical Association and additional health organizations. Even though HIV positive individuals have the rights to privacy, it cannot come at the expense of exposing others. While it used to be believed that children needed to be shielded against knowing their HIV status, especially at young ages where it was thought to be too complex for them to understand, it is now widely believed and accepted that disclosing the diagnosis to the child as early as possible is more conducive to the child’s overall development, survival rate, and cooperation with medical interventions (Heeren, 2011). In this scenario, the daughter is at an age where she would be able to comprehend her diagnosis. She is also at an age where upon learning of her diagnosis, would then be able to understand the necessity of taking her medications religiously and being better equipped at adhering to taking those medications. Knowing and understanding her diagnosis, the daughter may then be able to take vital precautions when it comes to her interactions with others, most especially sexual interactions. The daughter has the right to know what is going on with her own body. The risk of possibly infecting another individual, who also has the right to NOT be infected, far outweighs the fear of blame, stigma, or isolation. While the mother does have the right to privacy regarding her own diagnosis, I’m not sure what good it would do in this instance. The more open and honest the mother is about both of their diagnoses, the better the chances for positive treatment outcomes. Moreover, research has indicated that keeping information like this from children can have some fairly detrimental impacts on children’s psychological well-being and overall family structure (Nam, et al., 2009). Thus, it is advised that the mother disclose not only the daughter’s diagnosis, but her own diagnosis as well so that they both can receive the highest standards of care.
References:
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments (Links to an external site.)Links to an external site.. Retrieved from http://www.apa.org/ethics/code/index.aspx
Aultman, J. M. & Borges, N. J. (2011). The ethics of HIV testing and disclosure for healthcare professionals: What do our future doctors think? Medical Teacher, 33(1), e50-56. doi: 10.3109/0142159X.2011.530311
Heeren, G. A. (2011). Changing methods of disclosure: Literature review of disclosure to children with terminal illnesses, including HIV. Innovation – The European Journal of Social Science Research, 24(1-2), 199-208. doi: 10.1080/13511610.2011.553506
Nam, S. L., Fielding, K., Avalos, A., Gaolathe, T., Dickinson, D., & Geissler, P. W. (2009). Discussing matters of sexual health with children: What issues relating to disclosure of parental HIV status reveal. AIDS Care, 21(3), 389-395. doi: 10.1080/09540120802270276
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