HIV and Ethics PHASE, Canadian Psychological Association and Health CanadaModule Developed by Lynda J. Phillips, Ph.D., C.Psych. Division of Clinical Psychology, Department of Psychiatry University of Alberta Hospital, Edmonton, Alberta
HIV-Related Ethical Challenges: That stuff that keeps us awake at night. • Duty to warn • Confidentiality • Suicide and euthanasia • Competence • Boundaries
Knowing your place – What’s your guidance system? • The laws of the land • Code of ethics and guiding principles • Being aware of and transcending your own biases or countertransference issues (see case studies “X” and “Y” to illustrate)
Getting to sleep! A plan to work it out. • A model for making ethical decisions
1. Review the facts of the situation. 2. Make an initial plan based on clinical issues. 3. Pause and identify your personal response to the situation. 4. Consult ethical codes and assess ethical issues. 5. Identify the legal issues. 6. Identify and assess options. 7. Choose a course of action and share it with your client. 8. Implement the course of action; monitor and discuss outcomes. A model for making ethical decisions From the Companion Manual to the Canadian Code of Ethics for Psychologists (1991). Canadian Psychological Association.
Duty to warn — a rare event • Dispelling the myths and fears about duty to warn • Warning third parties rarely occurs – Can you think of an example?
The therapist’s role in the “final exit” can be confusing. • Support client’s desire to discuss death options. • Discuss with client your ethical responsibilities around suicide, assisted suicide, and euthanasia. • Know the legal implications around “assisting” the final exit.
Tell clients, early on in the therapeutic relationship, how often, where and when you will see them. Continually review the new commitments you make in light of how many HIV-infected clients you are seeing at various stages of the disease. Know the resources in your community and how to use them. Develop congenial relationships with providers who work in various settings of HIV service delivery. Anticipate the emerging needs of clients and assess services before needs become desperate. Maintaining boundaries and avoiding burnout