Lethal sex: conditions of disclosure in counseling sexually active clients with HIV

Confidentiality in psychological counseling is necessary if clients are to feel comfortable in revealing their darkest secrets. But this bond of trust has its moral limits. These limits are crossed in some cases in which HIV positive clients are sexually active with unsuspecting third parties. Distinguishing between Type 1 and Type 2 cases, the author shows how he has used applied ethics in drafting and defending a model rule for the American Counseling Association's Code of Ethics that permits, and sometimes morally requires disclosure in the former cases, but not in the latter.

Judicial responses to the protected confidential communications legislation in Australia

The article examines the background, aims and scope of recent legislation enacted in New South Wales, Victoria and South Australia to protect from disclosure in court of "confidential communications" generated in the context of counselling persons who allege that they were victims of sexual offenses. In drafting the "confidential communications" legislation, the legislators undertook a difficult task of balancing the public interest in therapeutic confidentiality that would encourage victims of sexual assaults to report these offenses and seek psychological and psychiatric care on the one hand, and the public interest in fairness of the trial, which may be prejudiced by exclusion of evidence pertinent to the forensic process on the other. In South Australia this task was fulfilled with greater success than in New South Wales and Victoria.

Beneficial effects on employment and preventive health care: the concept and results of counselling processes from a German project

Since December 1998 a project of working time counselling named "Design of Modern Working Times" is supported by the federal state of North Rhine-Westphalia in Germany and the European Union; AWiS-consult is entrusted to carry out this project. The service offered to all companies, institutions, work committees, and employees interested covers information, assessment of existing working time schedules, development of alternative or new working time schedules, and accompanying implementation processes. Up to June 2001 nearly 300 inquiries were worked on, most of them from industry, service companies, and from the field of care and hospitals. Working time design in this project aims not only at work safety and health care but also at beneficial effects on employment. In a special campaign from May 2000 to May 2001, 61 companies were supported by AWiS-consult, with the result of more than 400 new employees and 16 companies with employment secured, so the combination of preventive health care and beneficial effects on employment by working time design can be assessed as successful.

[Delivery of counselling to divorcing families--new ways of interdisciplinary cooperation for the benefit of the child]

The essence of the reformed German law of parent and child (Kindschaftsrecht) for families who have filed for divorce is that parents need counselling and assistance rather than patronizing from the state when it comes to decisions regarding the custody of children. Prior to the passing of the new law, critics doubted whether parents would of their own accord avail of the services of youth counselling institutions. A survey of all youth welfare offices in Bavaria documents practices since the law was revised. The results indicate that closer cooperation between the parties involved is of vital importance and that the youth welfare offices must invest a great deal of energy in public relations in order to encourage families to avail of counselling. A pilot project, in which family courts and youth welfare offices work in close cooperation, illustrates how this might function.

Physicians, firearm counseling, and legal liability

To explore the potential legal consequences to physicians of counseling their patients about gun violence, I consider the question: If a patient divests herself of a firearm upon the advice of her physician and is subsequently the victim of a rape, robbery, aggravated assault, or homicide, could she or her survivors argue convincingly that her physician was negligent? In attempting to answer this question, the four elements that a patient must establish to prevail in a malpractice action against a physician are discussed, and possible strategies for establishing them in the hypothetical case are explored. I conclude that plausible arguments can be made against the hypothetical physician engaged in firearm counseling as described. Conversely, physicians not engaging in discussions of gun safety face substantially lower liability risks.

Abortion, information & the law: what every doctor needs to know

1. Before commencing any treatment, doctors must inform patients of all material risks of the treatment (Rogers v. Whitaker, 1992). 2. It is not up to the professional judgment of doctors to decide how much information to give to patients (Rogers v. Whitaker, 1992). 3. The same duty to inform applies to abortion ("Ellen's Case," 1998). 4. GPs and counsellors who refer for abortion also have a legal duty to inform women of risks, because everyone who gives specialized or professional advice may be sued for negligence if that advice is given without due care (Evatt's Care, 1969). 5. Doctors have been inadequately informed on the medical risks of abortion, by writers seeking to present abortion as a risk-free procedure. 6. Abortion may increase the risk of cancer. 7. Abortion carries risks of injury and illness. 8. Abortion caries risks of future reproduction. 9. Abortion may have adverse psychological and psychiatric sequelae. In some women, these sequelae are severe and intractable, and may occur irrespective of a woman's personal attitudes towards abortion (Melinda Tankard Reist, Giving Sorrow Words: Women's Stories of Grief After Abortion, Sydney, Duffy & Snellgrove, 2000). 10. Women still die in Australia from abortion. 11. It has not been proved that pregnancy and delivery are more dangerous than abortion. 12. The risks of mortality and morbidity in carrying a pregnancy to term are often exaggerated, in an effort to make abortion appear safer. 13. Doctors are not required to refer for abortion. On the other hand, doctors do have a duty to inform themselves of the professional competence of any practitioner to whom they refer any patient for any procedure. Doctors who are referring for abortion can avoid legal jeopardy by informing women fully of the risks, and by keeping very comprehensive records of the information they have given. Alternatively, doctors can avoid legal liability by declining to refer for abortion. There are compelling medical reasons for treating abortion as a social, non-therapeutic, potentially harmful procedure with which conscientious doctors would choose not to involve themselves.

Legal guidelines related to end-of-life decisions: are nurse practitioners knowledgeable?

Public demand and professional standards dictate that primary care providers must be prepared to offer guidance and advance care planning for end-of-life decision-making to their patients. The purpose of this study was to describe the relationship between nurse practitioners' (NPs) knowledge of legal guidelines for end-of-life decision-making, their knowledge of the clinical application of advance care planning (ACP), and their comfort in counseling patients on these issues and personal attitudes toward end-of-life care. This descriptive, correlational study used survey data from a convenience sample of 145 Washington State NPs. Most NPs in this study were reasonably knowledgeable about the legal guidelines for end-of-life decision-making and clinical applications for ACP. They were somewhat comfortable with counseling patients on end-of-life decisions and expressed positive attitudes toward end-of-life care. However, a significant number of NPs were ill-informed about the legal guidelines and few actually incorporated ACP into their clinical practice. The authors suggest educational programs should focus on addressing the problem of stable misinformation related to legal guidelines. In addition, education should offer NPs didactic information and role modeling to skillfully incorporate ACP into clinical practice.

Screening trauma patients for alcohol problems: are insurance companies barriers?

BACKGROUND

Impairment caused by alcohol is the leading risk factor for trauma. However, many physicians do not screen for alcohol use because of concerns about confidentiality and denial of insurance coverage. The purpose of this study was to examine objectively the confidentiality issues and insurance statutes affecting alcohol screening in trauma centers.

METHODS

We conducted a survey of insurance commissioners in all 50 states to determine the prevalence of statutes allowing denial of coverage for injuries sustained while impaired due to alcohol, reviewed state insurance laws, and reviewed federal regulations protecting the confidentiality of alcohol information in patients seeking alcohol treatment.

RESULTS

Special federal regulations protecting confidentiality of alcohol screening data depend on how such information is acquired and do not routinely cover trauma patients. Concerns about screening on insurance coverage are valid in 38 states.

CONCLUSION

Segregating information about alcohol use in the medical record and assigning designated chemical dependency counselors to screen all trauma patients would provide confidentiality of alcohol information under current federal regulations, allowing denial of release of such information, except under subpoena.

Legal, ethical, and professional issues to consider when communicating via the Internet: a suggested response model and policy

Providing nutrition information via the Internet enables dietetics professionals to expand their practices, markets, and networks, but also presents new legal, ethical, and professional issues. Based on her experiences responding to unsolicited questions through a Spanish-language nutrition Web site, this author presents issues related to electronic communication, a process for formulating responses, and makes suggestions for a policy. The issues include the global nature of cyberspace; cultural variations in Spanish-language food terms and models, credentialing, licensure, and scope of practice; presentation of credentials; the inquirer's knowledge and information sources; the nature of the cyberspace relationship; and protection of the client and the professional. These issues have created a need for an electronic communication policy and some components of such a policy are identified, including the nature of electronic nutrition, distinguishing between public and client-specific communication, question-and-answer formats, opening and closing caveats, and recording processes.

Anonymous or confidential HIV counseling and voluntary testing in federally funded testing sites--United States, 1995-1997

Human immunodeficiency virus (HIV) counseling and voluntary testing (CT) programs have been an important part of national HIV prevention efforts since the first HIV antibody tests became available in 1985. In 1995, these programs accounted for approximately 15% of annual HIV antibody testing in the United States, excluding testing for blood donation. CT opportunities are offered to persons at risk for HIV infection at approximately 11,000 sites, including dedicated HIV CT sites, sexually transmitted disease (STD) clinics, drug-treatment centers, hospitals, and prisons. In 39 states, testing can be obtained anonymously, where persons do not have to give their name to get tested. All states provide confidential testing (by name) and have confidentiality laws and regulations to protect this information. This report compares patterns of anonymous and confidential testing in all federally funded CT programs from 1995 through 1997 and documents the importance of both types of testing opportunities.

[Counseling, psychotherapy or psychological counseling? On the profile of therapeutic work in child guidance counseling]

The children's and young people's assistance law authoritatively pointed out more clearly, what counselling in educational guidance services offered by the youth welfare can be. Then a difference is to be made between psychotherapy as a free offer made by educational guidance services and psychotherapy as a service offered by the medical care system and financed by the health insurance. Important criteria for discrimination can be deduced from the purposes of the children's an young people's assistance law and from their interpretations. The law demands a stronger pedagogical orientation, and it even demands an orientation towards underprivileged groups dealing with everyday matters. An analysis of the current practice confirms this trend. Meanwhile the educational guidance services have developed an independent methodology. Much more than the therapy offered by the medical care systems this therapy is marked by pragmatic purposes and a generic orientation. This therapy is getting more and more profiled on the basis of the children's and young people's assistance law still is lacking however a theory bringing it forward as well as systematics studies of their effects.

Procreative torts: enhancing the common-law protection for reproductive autonomy

Roe v. Wade's twenty-fifth anniversary is likely to herald widespread scholarly commentary on the decision's continued vitality and the future of abortion in the United States. However, if such commentary focuses solely upon the constitutional dimensions and political aspects of a woman's right to privacy, an important dimension of this right will be overlooked. Few commentators have considered the extent to which tort law safeguards a woman's interest in reproductive autonomy. In this article, Professor Northern argues that the interest in reproductive autonomy has not yet received the full protection to which it is entitled and that tort law is poised to evolve distinct causes of action for the interference with procreative autonomy interests. Professor Northern begins with an overview of the medical and psychological literature on abortion-related risks. She goes on to discuss current trends in abortion malpractice litigation. The author then reviews the three basic types of malpractice causes of action--battery, negligence, and lack of informed consent--and explores their application to abortion malpractice claims. The focus of the article then shifts to the development of specialized procreative torts, and Professor Northern contends that courts should go beyond previous decisions to redress any substantial interference with procreative autonomy. Finally, the author asserts that legislative alternatives to the common-law development of procreative torts, such as right-to-know statutes, are less protective of women's interests. Professor Northern concludes that tort law could and should be used to more fully protect women's interests in procreative autonomy.