Tag Archives: Ethical Issues

Ethical and Legal Issues in Diagnosis


There are certainly some potential issues that need to be addressed when balancing desires of managed care and the ethical diagnosis and treatment of individuals entrusted to our care.  First among my concerns are situations where an individual is in obvious need of treatment but the necessary treatment falls outside of managed care coverage.  This may occur because they do not fit the standard illness category or because treatment recommendations fall outside of what the managed care organization deems the best course of action.  “Many insurance carriers will not pay for treatment that is not defined as an ‘illness’ for which treatment is medically necessary.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 427)

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This may tempt a clinician to engage in some unethical and inaccurate diagnosis practices in effort to get the client the help they need.  I believe most clinicians would do this out of what they consider to be the best interest of the individual clients themselves.  However, “the road to hell is paved with good intentions.”  (Kristian Delaney, personal communication) “Under no circumstances should clinicians compromise themselves regarding the accuracy of a diagnosis to make it ‘fit’ criteria accepted by an insurance company.”  (Corey et al., 2007, p. 427-428)

Personally, I see some benefits to managed care that I think we as practitioners sometimes choose to neglect.  Honestly, even if therapy was covered just by my insurance, EAP (managed care) usually provides 6 sessions every year with zero deductible.  We use them every year without fail, and there are some situations where we use them “just because they are there…”  If they cost us anything, even a deductible… we probably wouldn’t utilize the sessions.  Although I think the short sessions do frustrate some practitioners, especially those who have to deal with extremely complex situations in as little as 6 sessions… I think the primary source of frustration is the paperwork!  From what I gather, submitting paperwork for reimbursement to some of these managed care organizations (Magellan, etc) is a real pain.  I don’t understand why they have to make it so difficult… I don’t think there’s any situation where we should spend more time on paperwork than we do with clients.

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Reference

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Ethical Issues to Consider When Counseling Minors


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Four ethical issues consistently emerge when one considers children as clients outside the school setting; counselor competence, informed consent and a minor’s ability to enter into a contractual relationship, confidentiality, and child abuse reporting.  (Lawrence & Robinson-Kirpius, 2000)  Although no plan of action can completely remove the possibility of a malpractice lawsuit, there are strategies that would allow us to minimize that risk.

On the subject of competence, there are specific skills and knowledge required when one intends to counsel children. Aside from familiarity with the disorders that are specific to and primary found among children (i.e., ADHD, Separation Anxiety Disorder, and RAD), being an effective counselor for children requires a foundation in theoretical models that are generally applied to children and their needs.  Examples might include theories of ego identity, moral, psychosexual, and cognitive development specific to the context of serving children.  All levels of the clinical experience need to be modified to be developmentally appropriate, including assessment, diagnosis, and treatment.  “Because minors are a special, diverse client population, ethical practice mandates distinct education, training, and supervised practice before commencing independent practice that includes minors.”  (Lawrence & Robinson-Kirpius, 2000, expression ETHICAL ISSUES)

“Informed consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 160)  Typically, a minor can enter into a contractual agreement in one of three ways; with parental consent, involuntarily at a parent’s insistence, or by court order.  The most common scenarios involve getting parents or caregivers involved with the process.  Without that involvement, we risk being sued for failure to gain consent.  Although court ordered treatment does not typically require parental consent, it is considered best practice to inform parents as soon as it is reasonably possible.  Similarly, in the case of emergency, minors can typically provide informed consent when delay of treatment would endanger their life or health, but again, parental consent should be obtained when possible.  (Lawrence & Robinson-Kirpius, 2000)

Confidentiality is of primary concern when working with minors, primarily because inconsistencies exist where what is legally required may not coincide with what is ethically desired.  “The basic dilemma with respect to confidentiality is who is the client, the parent or the child.”  (Lawrence & Robinson-Kirpius, 2000, expression Confidentiality)  Ideally, counselors should involve parents and create a “three-way bond of trust.”  When that is not possible, or otherwise resisted by the minor in question, it is suggested that we encourage disclosure by underscoring possible benefits.  Once parental consent is obtained, it is critical that we strive to maintain balance and clearly define limits to our ability to disclose information.

Child abuse, and the reporting of that situation, is one of the most common breaches of legal and ethical standards.  “This may be because reporting abuse can disrupt not only the therapeutic relationships but also disrupt and irrevocably destabilize the family in which the abuse occurs.”  (Lawrence & Robinson-Kirpius, 2000, expression Child Abuse Reporting)  Nonetheless, reporting child abuse is mandatory in all 50 states, and should be considered as one of our primary responsibilities as practicing clinicians.

As one can surmise, there are a number of possible scenarios where ethics and legal obligations collide.  Because I am going to be entering the profession as a novice counselor, I am most concerned with the definition of “competence.”  If at that time I have any withholdings regarding working with the minor population, I would certainly seek out supervision or continuing education.  Furthermore, I can minimize the risk of working with this population by familiarizing myself with state law that pertains to informed consent with minors.  Although it is not exclusive to practicing with this population, I would attempt to keep accurate and objective records of all interactions with both the parents and the child client.

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References

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.

Lawrence, G., & Robinson-Kirpius, S. E. (2000, Spring). Legal and ethical issues involved when counseling minors in nonschool settings. Journal of Counseling and Development : JCD, 78(2), 130-137. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=52748628&sid=1&Fmt=3&clientId=4683&RQT=309&VName=PQD