that he only needs help downloading information from the Internet and then it is his right to weigh the options of proceeding. Rene believes the client’s depression is directly Commitment Client interests are primary . The example above epitomizes the difficulties often faced by mental health practitioners when the principles of law, personal belief, professional codes of ethics, client need, and cultural and societal norms intersect and at times contradict one another. The professional is then faced Self-determination Another standard that strongly reflects the mental health practitioner’s commitment to a client is that of self- determination. Professionals have an obligation to support and assist clients in accomplishing their goals, only deviating from this standard when a client’s goal puts them or others imminently at risk. Defining risk can be difficult; most mental health professionals cannot argue that suicide or homicide fail to present clear risk Suicide: Right to choose vs. duty to protect Sometimes a mental health practitioner may be faced with a choice between a client’s right to choose suicide and the duty to protect his or her life. The request by the emotionally stable and rational terminally ill client is a good example of a situation that is not as “cut-and-dried” as that involving a severely depressed young woman contemplating suicide. Would one client deserve individual consideration and thus not be assessed for possible hospitalization over the other? Most workers choose this profession because it supports respect for the strengths and abilities of clients, and thus their ability to learn, make good decisions, and be self-sufficient. But aside from laws prohibiting assisted suicides, workers also rely on intuition and judgment in determining whether to take action to protect a client from harm. This scenario blurs the line between respect for the client’s wishes and society’s obligation to protect. It also raises the issue of client autonomy versus the professional obligation to prevent discrimination. Thus it is essential that mental health practitioners establish clear procedures that ensure impartial assessment while valuing client autonomy and individual treatment. Since laws and professional codes of ethics are not always clear and do not always spell out our specific duties and responsibilities, it is recommended that workers not only do everything to assist clients in taking advantage of any options to alleviate their distress, but also rely on practice guidelines that call for: ● Careful evaluation, such as the client’s ability to make rational choices based on their medical and mental state and social situation. ● A good therapeutic alliance, and ● Consultation. Informed consent is a surprisingly recent ethical and legal requirement. Even after the mid-20th-century trials that showcased Nazi human experimentation, test subjects were often unaware that they were involved in experiments. This happened in spite of the publication of the Nuremberg Code in 1947, which mandated that “the voluntary consent of the human subject is absolutely essential” (National Institutes of Health, n.d.). Many people have heard of the Tuskegee syphilis study (the Tuskegee Study of Untreated Syphilis in the Negro Male; Tuskegee University, 2020), which continued until 1972, denying its African-American subjects treatment for syphilis even after use of penicillin became widespread (McVean, 2019; Nix, 2019). However, the Department of Energy was conducting radiation experiments on Americans into the 1980s (Resnick, 2020). The term “informed consent” originated in a 1957 judge’s ruling related to a surgeon who had not been forthcoming concerning
related to the pain, because the client is otherwise of sound mind, and therefore has a right to determine his future.
with a conundrum that offers a multitude of potential decisions, actions, and consequences. We will discuss more about how the worker can best weigh all these considerations to make the most ethical decision later in this course.
to the client or to others. Other client choices such as staying in an abusive relationship or living in squalor or on the streets may challenge a professional’s personal values and sincere desire to protect – also known as “professional paternalism” (Reamer, 2006). In the absence of clear and present harm, the client has a right to choose his or her own path and make his or her own decisions, whether we agree or disagree. A controversial issue is the Duty to Protect, or the Duty to Warn. It addresses the degree of action that a professional – including social workers – must take if a client informs the practitioner that he or she has a plan to harm someone else, and the duty to warn that individual. Laws vary throughout the 50 states. In California, the case of Tarasoff v. Regents of the University of California became a legal milestone in 1974, when the state’s Supreme Court ruled that mental health professionals have a duty to warn potential victims. Tatiana Tarasoff was murdered by a stalker, who had been consulting a psychologist at the Cowell Memorial Hospital, which was associated with the University of California at Berkeley. In the stalker’s final session before breaking off therapy, he announced that he intended to kill Ms. Tarasoff. Although the psychologist alerted the police that the client should be hospitalized, the police released him after he promised to stay away from the young woman. The psychologist’s supervisor ordered that the psychologist make no further attempts to detain the client, and nobody warned Ms. Tarasoff of the threats. The victim’s parents sued the psychologist and the University. The case, and a subsequent case in 2001, codified what had already been an ethical mandate for mental health professionals. For example, in the NASW Code of Ethics, Standard 1.07(c) allows disclosure of information when such disclosure “is necessary to prevent serious, foreseeable, and imminent harm to a client of others.” (However, the Standard also instructs that only directly relevant information be disclosed.) In 1976, the Tarasoff v. Regents case was amended to add the duty to protect (GoodTherapy.com, 2015).
INFORMED CONSENT
the hazards of a surgical procedure that left a plaintiff paralyzed (Skloot, 2010). Mainly in response to the Tuskegee study, Congress passed the National Research Act for the Protection of Human Subjects of Biomedical and Behavioral Research, which was signed into law in 1974 (Department of Health, Education, and Welfare, 1979). In 1976 a government-appointed commission met at the Belmont Conference Center near Washington, D.C., where they produced what became known as the Belmont Report (Kirsh, 2019). The report referred back to the Nuremberg Code and addressed the problem of separating practice from research. The distinction had become blurred, with poorly defined “experimental” practices taking place. The commission concluded that: Research and practice may be carried out together when research is designed to evaluate the safety and efficacy of a therapy. This need not cause any confusion regarding
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