Confidentiality and Communicable
Diseases
Confidentiality and HIV/AIDS: The
case of Norma
Norma is a 21 years old college
student who immigrated to the United States with her parents from El Salvador
when she was 2 years old. She is bicultural in the sense proudly identifies
herself as a Latina while at the same time having learned the instrumental
behaviors that allow her to be effective and successful in the host culture.
She speaks English and has been able to advance educationally to the point that
she will soon graduate with a bachelor’s degree. Socially, she interacts with
people from different cultures.
Two years ago Norma started dating
a young Latino man about her age named Javier. They became close very quickly
and started spending a lot of time together. Even though she is aware of the
need for protection, they have had sex repeatedly without safety precautions.
Javier refuses to engage in safe sex, and Norma has not been able to assert
herself in this situation. Although he never went to college, Javier finished
high school and was able to keep a job for a while. He was fired when he
stopped going to work regularly. About a year ago Norma learned through common
friends that Javier has been engaging in antisocial behavior such as dealing
drugs and joining groups that commit acts of violence. She has also been the
victim of his violent and abusive behavior. Because of his behavior, Norma has
been slowly separating herself from Javier, which makes him even angrier. Last
semester she attended workshop about HIV and realized that she could be at
great risk, so was tested for the virus. To her extreme shock, she found out
that she was HIV positive; she became so disturbed that she started seeing a
counselor at the university. Norma thinks that Javier may have transmitted this
disease to her, but she is not entirely sure as she had sexual relations with
other people before Javier (sometimes unprotected).
Soon the counselor realized that
she had an ethical dilemma because Norma has not disclosed her condition to
Javier, even though she did inform her other partners. Informing Javier would
allow him to make a decision about seeking testing and treatment if necessary.
The counselor wonders whether she has the duty to warn Javier about the danger
about being infected with the HIV virus. The counselor shared with Norma that
she may have to disclose Norma’s condition to Javier, under her duty to warn,
unless Norma agreed to do it herself. Norma replies fearfully that if such
information is disclosed to Javier she will be in imminent danger of being
attacked by him to the point of fearing for her life. This belief is consistent
with the history of Javier’s violent behavior as reported by Norma. The
counselor realized that this ethical dilemma has suddenly become more complex.
1. A brief analysis of two key
confidentiality issues from case study in the ACA Ethical Standards Casebook.
Explain why you think these issues are critical elements in a counseling
practice. Then, analyze two challenges a counselor could face as he/she adheres
to these elements of day-to-day practice. Conclude with an explanation of how
you would address these challenges, including which decision-making model
guided your decisions.
2. Brief summary of the case and
ethical dilemma in case (i.e., the nature of the ethical dilemma you chose from
this case study.
3. Potential actions you would
take or would have taken as an ethical counselor; what would you have done
differently? Consider which decision-making model you would use and why? How
would your actions solve the dilemma?
4. Given the actions you noted
above, which do you think is the best solution and why?
