Informed Consent, Confidentiality and Client Rights - Literature review Example

Informed Consent, Confidentiality and Client Rights s Ethical issues pose great significance in the area of healthcare and particularly treatment of mental problems. Therefore, such aspects as confidentiality, client rights and informed consent play an important role in psychological counselling, for it deals with the most fragile domain of human health – psyche. These ethical issues have been subjects for numerous researches in the area of psychological treatment - with being considered in the range of codes and rules of psychological practice - and the following three articles are devoted to empirical research of specific cases where client rights, confidentiality and informed consent are applied. The first article written by Duncan and colleagues (2013) belongs to the area of counselling psychology and gives a scientific insight into the problem of confidentiality and its breach in treatment of adolescents. The topic is undoubtedly extremely relevant for the area, for adolescents are among the risk groups who are the most likely to need psychological counselling. Moreover, as the authors indicate referring to the previous researches, “98% of adolescents believed that confidentiality within a school counselling setting was either essential or important” (Duncan et al., 2013, p.410). However, considering the differences in psychological maturity and life experience between adults and minors, Duncan et al. emphasize the higher probability of the situations, when breach in confidentiality may be necessary despite the client’s right: those can involve risk behaviors and danger of inducing harm either on others or on adolescents themselves. Therefore, replicating the study of American scientists, the authors sought to clarify whether there is consensus in necessity of confidentiality breach among Australian psychologists and examine “the circumstances in which Australian psychologists believe it is appropriate to breach confidentiality with adolescents» (Duncan et al., 2013, p.411). Due to the nature of the study, the sample to be surveyed included psychologists selected based on a set of criteria including experience of working with minors and education in psychology (the participants were to be studying for a degree in psychology or be registered psychologists working in Australia (Duncan et al., 2013, p.411). The sample incorporated 264 respondents, 87% of them being female and the average age being 39 years. The design of the experiment implied filling an online questionnaire, which provided possible risk behaviors for a hypothetical adolescent boy. Therefore, the respondents were to decide, whether confidentiality breach is possible and indicate what factors might influence their decisions. The key methodological strength of the study lies in the rather wide sample of professionals and the diverse range of risk-related situations they were required to consider. Relying on these two factors, it is possible to evaluate the experiment positively, all the more as it was based on the previous reliable research and added geographically narrower data on Australia. Results of the study show that a high degree of consensus is reached on breaching confidentiality in 11 of 68 variables controlled by the researchers, while more than 80% of respondents decided not to breach confidentiality in 28 cases (Duncan et al., 2013, p.413). Furthermore, the higher the risk was, the greater level of consensus was reached on disclosure. Based on the findings, the researchers were able to conclude that possibility of confidentiality breach in adolescents’ counselling grew with the rising level of risk posed by their behaviors. The study bears great practical values, as it demonstrates variation in opinions of psychologists and brings the issue of confidentiality to reconsideration. The implications of the study in the field of psychological counselling might include greater need for clear and open communication with minor clients and their parents about limitations of confidentiality and for balancing between confidentiality breaches and principles of informed consent in order to protect client rights. The second article authored by Harris & Robinson Kurpius (2014) focuses on another aspect of mental healthcare ethics, which is informed consent. What is more, the core value of this study lies in the research of interplay of psychologist’s ethics and such relevant and widespread phenomenon of nowadays as social networking. The authors seek to clarify whether social networking habits of young counselling professionals affect maintaining ethical norms, namely, obtaining informed consent of the clients before searching the information about them on the internet or disclosing information about them. “Online membership is becoming a cultural norm rather than an exception underscores the importance of research related to this new medium» (Harris & Robinson Kurpius, 2014, p.11). Moreover, as “younger mental health professionals are the active members of social networking sites” (Harris & Robinson Kurpius, 2014, p.11), the purpose of the study was to examine their online practice, testing two hypotheses. It was hypothesized that a set of criteria including low scores in ethical decision-making and greater social networking experience increase probability of client information disclosure through via social media. Secondly, the study tests the hypothesis that “credits, direct client hours, and years of social networking experience will be positively related to online searches of client information» (arris & Robinson Kurpius, 2014, p.13). The research involves a rather wide population sample consisting of 315 volunteer graduate students, with the lion’s share of them being females; the participants were selected from psychological counselling educational programs and invited via emails for subsequent completion of the online questionnaire. However, the methodology has one weak point, which is possible bias in data collection, for, as the authors themselves mention, participants needed to have certain skills of internet browsing. The five key measures of the research include client search, online disclosure, privacy knowledge, ethical decision-making and informed consent. Manipulating these measures, the researchers applied a set of data analysis strategies (e.g. descriptive analysis and others) and managed to support the hypotheses, while the findings indicated that greater social networking experience increases probability of client search online. At the same time, the experiment shows that the majority of those searching for client information online didn’t have the latters informed consent and, therefore, breached ethical norms. At the same time, most such students never consulted their supervisors concerning the issue of online search and informed consent. In other words, the authors draw a conclusion that the educational programs should be enhanced, so that young professionals are given appropriate information on ethical implications of client search and disclosure as well as the need to obtain their informed consent before doing so. Nevertheless, the main weakness of this research is, in contrast to the previous one, that the results cannot be applied to a wider population, for the study is deals predominantly with students under 30, while it remains unclear whether the tendency of client search differs in professionals under 54 (for psychologists under 54 are stated to be involved in social networking to certain extent). Finally, the article authored by Fear et al. (2012) investigates such aspect of client rights as anonymity in a rather peculiar sample of the UK military personnel deployed in Iraq. The article is of empirical nature, involving experimental methods to deal with interrelation of anonymity and reporting of mental disorders’ symptoms. The authors state that “individuals who have a mental health problem are more likely to experience barriers to care and hold stigmatizing beliefs» (Fear et al., 2014, p.1). Fear of being stigmatized as mentally ill often prevent people from seeking medical assistance. Therefore, the research was intended to trace tendencies in mental disorders symptoms’ reporting in case of identifiable and completely anonymous questionnaire. The sample of the experiment was rather large with 315 and 296 militants engaged for filling each type of questionnaire respectively. The participants were engaged in UK military bases in Iraq during the deployment of 2009. The method included surveying (with the questionnaire including 11 stigma statements) and further analysis of the data obtained. Expecting to find disparities in symptom reporting in identifiable and anonymous questionnaires, the authors received the data indicating no significant disparities in reporting of common mental disorders’ symptoms, yet there was difference between reporting PTSD and sub-threshold symptoms – anonymous questionnaire increased the probability of reporting twice. Moreover, the results indicate that the key barriers to care revolve around fear of being seen as weak, embarrassing nature of the situation and discouragement on the side of leaders. The conclusion made by Feat et al. implies that anonymity encourages reporting of more serious mental disorders reporting (e.g. PTSD), while openness of the questionnaire prevents from reporting it for fear of ‘public’ reaction. The implication of this study for the field of psychological counselling can be seen in its use for treatment of militants with PTSD and other related disorders in U.S. and UK. Particularly, the findings might be useful for alternating the policy of psychological counselling for militants in order to encourage them report symptoms for care and protect their rights, preserving their anonymity during subsequent treatment. However, the limitation of this study is that its results are unlikely to be applied for a wider population, as military personnel forms a very peculiar stratum of population, which is characterized by its specific mental disorders and rather fragile nature of the treatment process. Reference list Duncan, R. A. (2013). Adolescents, Risk Behaviour and Confidentiality: When Would Australian Psychologists Breach Confidentiality to Disclose Information to Parents?. Australian Psychologist, 48(6), 408-419. Harris, S. E., & Robinson Kurpius, S. E. (2014). Social networking and professional ethics: Client searches, informed consent, and disclosure.Professional Psychology: Research And Practice, 45(1), 11-19. Fear, N. T., Seddon, R., Jones, N., Greenberg, N., & Wessely, S. (2012). Does anonymity increase the reporting of mental health symptoms?. BMC Public Health, 12797. Read More