consent & Ethics
Complications stemming from patient-counselor interactions remain a key source of ethical violations and complaints. Informed consent is a major issue with a direct bearing on the counselor-patient relationship. In clinical avenues, the origin of informed consent continues to have a direct outgrowth of advances in professional ethics, legal precedents, and continuous moral development. Through informed consent, patients have been able to take responsibility and explore options for their well-being (Welfel, 2012). They achieve this through considering the benefits and costs associated with the procedures and services offered to them and options to those services. Informed consent tends to be integrated to self-determination, ethics, and patient autonomy. It is determinately the starting point of the counselor-patient provider relationship. In this way, it poses as the genesis of the three main components of ethical conduct: beneficence, nonmalefience, and autonomy.
The American Code of Ethics for Psychologists had as of recently made express the need for informed consent for any counseling services and evaluation. Statutes in numerous states are seemingly all tying to a licensed counselor. They do not normally differentiate evaluation from medicine exercises and view all exercises as psychological administrations. In 1997, Johnson-Greene and his partners remarked on the need for informed consent in counseling assessments and offered suggestions for its conveyance and content (Welfel, 2012). There has been a developing familiarity with the need for counselors to educate their patients genuinely about expected administrations and potential advantageous and harmful impacts. Based on such advancements, the APA’s modified Ethical Principles and Code of Conduct now covers more explicit necessities for informed consent in the behavior of psychological appraisal.
The patient may also be given sufficient chance to ask questions and get answers. Although it is explicitly needed by the reconsidered Ethics Code, there may be exceptional ethical and practical reasons to give data concerning the referral source, predictable dangers, distresses, and profits. Time dedication on the indicated components might also be intrinsic to assent that is informed satisfactorily. Where compulsory reporting necessities exist like those connected with the engine vehicle organization in a few states, the involvement and confidentiality limits of these entities must be foreseen in neurological victims and talked over with patients as a conceivable restriction of secrecy at the start of an assessment. The revelation is also restricted to the base essential to accomplish the reason. There are additionally numerous other uncommon circumstances needing informed consent, incorporating the utilization of translators (Remley & Herlihy, 2010).
Informed consent is not needed in a few cases in which consent is characterized as the nonappearance of protest to appraisal methods may be acknowledged as sufficient. Such scenarios include:
a) Testing is ordered by law or legislative regulations,
b) Educated assent is inferred since testing is directed as a standard instructive, institutional, or organizational movement; or c) Where the reason for testing is to assess decisional capacity (Remley & Herlihy, 2010).
There is likewise a need to utilize language that is sensibly understandable in such cases. Patients must be educated on their entitlement to the refusal to consent without prejudice or penalty. However, they rarely do. Although one may assume that the assessment of decisional limit is an objective in each assessment of a counseling patient, no doubt this prohibition just applies when there is a sensible desire that a patient might be unable to give informed consent. This results in a priori objective of the evaluation to verify decisional capacity (Sommers-Flanagan, 2006).
The 2002 APA Ethics Code does not have express guidelines for informed consent for young children (Besley, 2012). On the other hand, it is acceptable that children are included because they are evidently unable to give informed consent. Obviously, children may also be titled to the same contemplations noted above under patient consent. This means that they must be furnished with essential data about the methods, their preferences must be noted, and their consent must be archived with the consent of their parents) or lawful guardian. Cases involving forensic investigations may be seen in a comparative perspective. Typical patient-counselor relationship does not exist, but the essential parts of patient-consent are acknowledged. Individual in forensic may likewise be blocked from getting an illustration of their test outcomes legally accorded to patients under AMA, which must be explained ahead before any evaluative system (Corey, & Callanan, 2011).
Consent is the primary language that patients use to guarantee appropriate correspondence and understanding of cultural variables important to the approval procedure is crucial. While correct informed consent requires a comprehension of the data that may affect consent rather than an insignificant introduction to such data, and given the weakened citizens with which professionals frequently work, counselors are always urged to learn their patient’s grasping of appropriate data through examining inquiries (Welfel, 2012). The patient’s precision may be utilized to show their comprehension. This may be used to uncover zones needing extra clarification. Is such a case, there be a high level of affirmation that exact cognizance of the benefits and risks of an evaluation has been attained. Counselors are also encouraged to portray the comparative dangers and profits of procedures, incorporating the potential alternate choice to do nothing.
The 2002 APA Ethics Code does not comprehensively state if the patient’s consent must be oral or written (Pope & Vasquez, 2011). Therapists must record oral or written consent, assent, and consent. While it may be commonplace and practical to be written consent in most outpatient environments, patients discovered that inpatient settings may be less amiable to formal consent in light of the acuity of their disease, psychiatric aggravation, or different elements. In the intensive care facility setting, Neuropsychology might be undoubtedly one of the few professions looking for written consent. Clinic always ensures that patients have signed the consent form when admitted to the care facility. It is suggested that counselors must seek written consent, either through documentation given by intermediaries or their won documents, but oral consent can be accepted based on prevailing conditions of the case. Informed consent is seen as an adaptable substance whose details are reliant partially on defined circumstances connected to a patient (Pope & Vasquez, 2011). Since no two evaluations are precisely much the same, and subsequently there may be a need for some change of auxiliary data while core segments of the informed assent bundle will be constant.
Barriers to informed consent
False Expectations — even in the absence of religious impediments or language barriers to thwart communication between the counselor and the patient, still, misunderstandings occur due to the patients’ false expectations of the counseling outcome. Researchers have advanced studies to examine success rates of whether counselors were understood by patients (Besley, 2012).
Religious Influence — the process of informed consent is meant to enable participants have the liberty to make decisions whether to refuse or accept recommended medical treatments. According to research, this form must factor in adverse impacts likely to face patients because of their religious beliefs as they attend counseling sessions. Acquiring full knowledge of approaches involved in the counseling session enables patients to make adequate judgments whether to participate in the counseling session. Counselors are required to consider how the approaches may conflict with rules and policies set by a patient’s religion (Fisher, 2013).
Techniques for improving Informed Consent
With the importance of informed consent for conformity to AMA and human rights protection, it is ethical and important to resolve the problems occasioned by the misunderstanding of the data. One method is recommended:
Increasing time for explanation — counselors can use this method to avoid misunderstanding. It requires additional time for one to explain the details of the consent form comprehensively. Studies indicate that counselors can analyze possible areas in their programs where misrepresentation may occur. For instance, in the event of false explanation, counselors may expect patients to have confidence about the success of a therapy session. For this discrepancy to be corrected, counselors may emphasize to patients the actual success rates of the therapy (Besley, 2012).
Self-determination and autonomy is promoted when clients properly understand the expected goals of counseling evaluation. It is ironic that some patients tend to decline to be evaluated although they are likely to be beneficiaries of neuropsychological consultations. However, patients have the absolute right of exercising this prerogative with the assumption that they have the intact capacity to make decisions and assessments are not mandatory (Welfel, 2012). The apparent professional standards require that neuropsychologists must inform patients about the purpose and nature of an evaluation by providing pertinent data. Depending on the prevailing situation, generic terms about the importance of assessing cognitive ability may be inadequate. The capacity of a patient to comprehend and understand information will determine whether he/she can understand generic statements. Counselors must embrace active steps like probing questions to guarantee that a patient has a satisfying grasp of the information.
The counseling academy in collaboration with the AMA code of conduct and ethical principles strongly encourages counselors to furnish adequate information to clients. This will enable them to be completely compliant with federal and state laws like the U.S. Health Information Portability and Accountability Act (HIPAA).
Besley, T. (2012). Counseling youth: Foucault, power, and the ethics of subjectivity. Westport, Conn. [u.a.: Praeger.
Corey, M.S., & Callanan, P. (2011). Issues and ethics in the helping professions. Belmont, Calif: Brooks/Cole.
Fisher, C.B. (2013). Decoding the ethics code: A practical guide for psychologists. London: SAGE.
Fisher, M.A. (2013). The ethics of conditional confidentiality: A practice model for mental health professionals. Oxford: Oxford University Press.
Pope, K.S., & Vasquez, M.J.T. (2011). Ethics in psychotherapy and counseling: A practical guide. Hoboken, N.J: John Wiley & Sons.
Remley, T.P., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling. Boston: Merrill.
Sommers-Flanagan, R. (2006). Becoming an Ethical Helping Professional: Cultural and Philosophical Foundations. Hoboken: John Wiley & Sons.
Welfel, E.R. (2012). Ethics in counseling and psychotherapy. Belmont, Calif: Wadsworth.
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