Law & Ethics Flashcards
Limits of Confidentiality
- Court order for records
- Abuse of child or dependent adult or elderly adult
- Danger to self or others
Privilege
It gives the patient or client the right to prevent the therapist from disclosing confidential information.
Privilege in terms of couples → have to check in with both people in the couple if they want to waive their privilege
Ethical: Therapists must inform clients of potential risks for subpoenas & waiving their privilege.
Legal: Therapists must assert privilege for clients and must notify clients if there is a subpoena. Statutes that grant privilege to relationships provide the legal protection to clients, not to the therapist. The therapist must notify a client about the subpoena or court order. As a result, if clients sign a form waiving their privilege, then therapists will have to disclose private information that otherwise might have been protected in court proceedings. Exceptions to this include: the client authorizes a ROI, the therapist is legally mandated to breach confidentiality, the client has disclosed a significant part of the information to a third person.
Scope of Competence
Ethical : A therapist is not necessarily competent in something even if it falls into their scope of practice. Unethical to work with populations/diagnoses a therapist has no or little knowledge or education about. Therapists stay aware of changes & maintain competence with education, training, or supervised experience.
Legal: Also defines or limits what the individual within the profession may do and is determined by one’s education, training and experience. Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies.
Example for Exam:
In working with this family, I would want to be trained thoroughly in substance use, early childhood trauma, sexual abuse, and how to best delegate individual and family sessions with this group. As a trainee, these topics would be out of my scope of competence.
Standard of Care around IPV
No legal requirement to assess for IPV. Only could get into the legal realm if a child is exposed to IPV enough to cause suffering or they are getting hurt in the course of IPV.
Use clinical judgment
Informed Consent
Ethical: Ethical obligations are in place for clinicians to promote autonomy, provide information, and avoid unethical forms of bias. Clients have the right to refuse therapy, if they are competent to do so.
Legal: Clients have the right to receive information and ask questions about the recommended treatments so they can make well-considered decisions about the care they are receiving. No one has the right to touch or treat someone without their permission.
For Comp Exam: you should WRITE OUT what you would say to the family as informed consent. Also be case specific. For children, talk to children about confidentiality for 1 on 1 sessions versus family session, as well as substance use of applicable to children. Also discuss if clients are coming into session intoxicated, they cannot consent to care.
Patient Autonomy
Patient autonomy is an ethical, not legal issue.
Respecting the power dynamic that we should not be telling people what they should do with their lives.
One exception would be mandated therapy, discussing that with the client.
Scope of Practice
Ethical: MFTs acknowledge that resolving ethical issues is a process; ethical reasoning (or areas where issues might occur) are consideration of professional values, professional ethical principles, and ethical standards. (More examples include: maintaining boundaries, professional ability, personal problems, maintaining confidentiality, respecting client differences, getting authorities involved, maintain their role, maintain therapy, etc.)
Legal: definition provided by law delineates what the profession does and limits or confines the functions persons within a profession can legally perform.
It’s important to legally protect yourself by acknowledging if something is out of scope of practice, but you can acknowledge you may have information on the topic that is therapeutically relevant. You may also want to discuss with a client if the could benefit from seeing a psychiatrist in regards to medication.
Court Order VS. Subpoena
Subpoenas can be refused, the client/couple/family could also choose to waive their privilege.
Court orders cannot be refused.
Duty to Protect - Danger to Others
Ethical: Confidentiality comes into question if a client discloses that they intend to harm another person, which should be addressed in the initial informed consent and possibly when the client goes into the concerning material. This puts the clinician in a position to breach confidentiality in order to protect the other person
Legal: If a therapist fails to take steps to protect the potential victim from a patient who has made a specific threat against them, that therapist can be found negligent. This protective duty overrides patient confidentiality.
Record Keeping
Ethical: CAMFT code of ethics requires MFTs to create and maintain client records in a way that is “consistent with sound clinical practice”.
Legal: BBS laws lists the “failure to keep records consistent with sound clinical judgement, the standards of the profession, and the nature of the services being rendered” as unprofessional conduct. A marriage and family therapist shall retain a client’s or patient’s health service records for a minimum of 7 years from the date therapy is terminated OR for children, 7 years after they turn 18.
Duty to Protect - Danger to Self
Ethical: Confidentiality of client in disclosing information to victims and notifying others.
Legal: If the client is a danger to self or others, the therapist must legally notify the proper agency to inform them. Notify police if there is an imminent plan. Duty to protect is also triggered if family member warns the therapist of serious danger or violence about client.
Child Abuse & Neglect
Ethical: Process the report with the client if possible. Informed consent about limits to confidentiality. A reporter may, but is not mandated, to report emotional abuse.
Legal: Mandated report - if you have a reasonable suspicion of child abuse/neglect must call in a report to local CPS agency immediately and submit a written report within 36 hours.
Standard of Care
Ethical: Therapists don’t condone or engage in discrimination, or refuse service to anyone based on their background/identities. They don’t perpetuate historical/social prejudices when diagnosing and treating client. Lastly, they don’t abandon or neglect clients/patients in treatment. If they are unable or unwilling to continue to provide professional services, then they will assist the client in making clinically appropriate arrangements for continuation of treatment.
Legal Issues: clinical documentation must be kept for each individual receiving treatment — includes information about diagnosis and assessment, presenting issues, treatment goals, interventions used by the therapist, and person’s progress in treatment.
Dependent Adult & Elder Abuse
Ethical: Not required to report abuse/neglect when all of the following conditions apply: elder/dependent adult that is claiming to have experienced abuse/neglect has a diagnosis of dementia, reporter does not have any independent corroborating evidence that abuse has occurred, or reporter reasonably believes that abuse has not occurred. A reporter may, but is not mandated, to report emotional abuse.
Legal: Mandated to make a report when you gain knowledge of elder/dependent adult abuse and neglect within your professional scope (e.g., physical abuse, abandonment, abduction, isolation, financial abuse, neglect) Report via phone or a confidential internet reporting tool, immediately or as soon as practicably possible to adult protective services or local law enforcement agency. If reported by phone, a written report shall be sent within two working days. Mandated reporters are provided immunity from liability for making a report in good faith. Failing to make a required report may face disciplinary action by the BBS as well as civil and criminal liability.
Boundaries
Ethical: Do not have sexual relationships with relatives/friends of client and avoid treating someone with whom you’ve had a previous sexual relationship.
Legal: It is illegal to have sexual contact during therapy and for 2 years following. If you are seeing a client and they are an adult and they disclose that they had sexual activity with a therapist in the past, you need to provide them with the brochure, “Professional Therapy Never Includes Sex”.
