ETIKA KERAHSIAAN DAN ISU PERUNDANGAN | Crime & Justice ...

ISU ETIKA KERAHSIAAN DALAM KAUNSELING RAMANI A/P RAMACHANDRAN M20122001841

ISU ETIKA KERAHSIAAN 

Kaunselor perlu menyedari bahawa kepercayaan adalah tunjang kepada perhubungan menolong. Justeru, kaunselor hendaklah berusaha untuk mendapatkan kepercayaan klien melalui jalinan perkongsian yang berterusan, dengan mewujud dan mempertahan sempadan yang sesuai, serta mengekalkan kerahsiaan klien. Kaunselor perlu menjelaskan parameter kerahsiaan dengan cara yang cekap dan beradab.

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Seterusnya etika profesional yang sangat ditekankan dalam perkhidmatan kaunseling ialah prinsip kerahsiaan. Berdasarkan etika yang digariskan, seseorang kaunselor tidak boleh mendedahkan maklumat sulit tanpa persetujuan daripada klien. Kaunselor juga harus memastikan bahawa setiap rekod maklumat berkaitan klien seperti laporan, rakaman kaset dan video disimpan di tempat yang selamat dan hanya pihak yang mempunyai kuasa tertentu sahaja boleh mendapatkan rekod maklumat tersebut (ACA, 2005). Prinsip kerahsiaan dalam etika kaunseling ini sangat penting dan perlu diterangkan kepada klien pada setiap sesi kaunseling yang dijalankan.

PRIVASI

KERAHSIAAN

KEISTIMEWAAN

Privacy Privasi dikaitkan dengan kebebasan bersuara dan perlindungan daripada perkara-perkara disebarkan kepada orang lain selain daripada kaunselor itu sendiri Privasi melibatkan hak asasi manusia yang berkaitan dengan fikiran, perasaan atau maklumat peribadi untuk berkongsi dengan orang lain. Privasi penting untuk memastikan maruah klien dan kebebasan penentuan diri sendiri Pelanggaran privasi terhadap klien dinyatakan oleh kaunselor ditakrifkan sebagai pelanggaran kerahsiaan (Bmith-Bell & Winslade 1994) B.1.b. Menghormati privasi • Kaunselor perlu menghormati hak klien untuk mendapat privasi. Kaunselor hanya mendapatkan maklumat sulit daripada klien apabila ianya berfaedah kepada proses kaunseling.

Kes Shalom, an orthodox Jewish émigré from Shana Israel sought counseling regarding her unhappy marriage from Hebrew-speaking therapist Tanya Talmud, M.S.W. Ms. Shalom later complained to the state licensing board that Ms. Talmud had discussed matters she disclosed in therapy to the family rabbi without her knowledge or consent. The rabbi, in turn, communicated some of the content to Ms. Shalom’s spouse. Ms. Talmud replied to the licensing board that in Israel’s orthodox Jewish communities, soliciting the aid from a couple’s rabbi often proves a useful way to address marital problems.

Jawapan The licensing board censured Ms. Talmud, reminding her that she treated Ms. Shalom in her capacity as a licensed social worker in the United States, not Israel. In addition, basic ethical principles of autonomy and human dignity entitled Ms. Shalom to have a voice in any decision about disclosing material offered in confidence.

Kerahsiaan Merujuk kepada standard umum tingkahlaku profesional yang mewajibkan seseorang profesional tidak membincangkan maklumat tentang pelanggan dengan sesiapa. Kerahsiaan adalah kontrak jelas atau berjanji tidak akan mendedahkan maklumat mengenai pelanggan kecuali dalam keadaan tertentu yang dipersetujui kedu-dua pihak. B.1.c. Menghormati kerahsiaan • Kaunselor tidak boleh berkongsi maklumat rahsia tanpa persetujuan klien atau tanpa justifikasi etika atau undang-undang yang mantap.

Kes After the deaths of Nicole Brown Simpson and Ron Goldman (see: Hunt, 1999) Susan J. Forward, a clinical social worker who had held two sessions with Ms. Simpson in 1992, made unsolicited disclosures regarding her deceased former client. Ms. Forward commented in public that Ms. Simpson had allegedly reported experiencing abuse at the hands of O. J. Simpson.

Jawapan  The California Board of Behavioral Science Examiners

subsequently barred Ms. Forward from seeing patients for 90 days and placed her on three years’ probation. In announcing the decision Deputy Attorney General, Anne L. Mendoza, who represented the board commented, "Therapy is based on privacy and secrecy, and a breach of confidentiality destroys the therapeutic relationship" (Associated Press, 1995). Ms. Mendoza also noted that Ms. Forward had falsely represented herself as a psychologist in television interviews. Ms. Forward later asserted that she had not violated patient confidentiality because the patient was dead, but had agreed not to appeal the board's decision in order to avoid a costly legal fight.

Previleged Communication Keistimewaan berkaitan dengan undangundang dimana klien dan kaunselor dilindungi daripada membuat pendedahan dalam prosiding undang-undang.

Kes  Mary Lu Redmond was a police officer in Hoffman Estates, Illinois, a

suburb of Chicago. On June 27, 1991, while responding to a “fight in progress” call, she fired her weapon and killed Ricky Allen, Sr. as he pursued, rapidly gained ground on, and stood poised to stab another man with a butcher knife. After the shooting, Officer Redmond sought counseling from a licensed clinical social worker. Later, Carrie Jaffe, acting as administrator of Mr. Allen's estate, sued Redmond, citing alleged U.S. civil rights statutes and Illinois tort law. Jaffe wanted access to the social worker's notes and sought to compel the therapist to give oral testimony about the therapy. Redmond and her therapist, Karen Beyer, a licensed clinical social worker refused. The trial judge instructed the jury that refusing to provide such information could be held against Officer Redmond. The jury awarded $545,000 damages based on both the federal civil rights and state laws.

Jawapan  On June 13, 1996, the Supreme Court overturned the lower court

decision, upholding the existence of a privilege under Federal Rules of Evidence to patients of licensed psychotherapists by a vote of 7-2. In a decision written by Justice John Paul Stevens, the Court noted that this privilege is “rooted in the imperative need for confidence and trust,” and that “the mere possibility of disclosure may impede development of the confidential relationship necessary for successful treatment,” (Jaffe v. Redmond, 1996, 4492-4493). Writing for himself and Chief Justice Renquist, Justice Scalia dissented, arguing that psychotherapy should not be protected by judicially created privilege and that social workers were not clearly experts in psychotherapy and did not warrant such a privilege (Smith, 1996). Nonetheless, this case has set a new national standard that affords privilege protections across jurisdictions, generally implying that a Federal privilege extends to licensed mental health professionals.

Tugas memberi ingatan dan melindungi B.1.d. Penjelasan mengenai batasan • Di peringkat awal dan sepanjang proses kaunseling, kaunselor perlu memberitahu klien mengenai batasan kerahsiaan dan mengenal pasti situasi di mana kerahsiaan mesti didedahkan

Kes  Lee Morgenstein, age 15, had received psychotherapy from a

New Jersey psychiatrist, Dr. Milano, for 2 years. Morgenstein used illicit drugs and discussed fantasies of using a knife to threaten people. He also told Dr. Milano of sexual experiences and an emotional involvement with Kimberly McIntosch, a neighbor 5 years his senior. Morgenstein frequently expressed anxiety and jealousy about Ms. McIntosch’s dating other men, and he reported to Dr. Milano that he once fired a BB gun at a car in which she was riding. One day, Morgenstein stole a prescription blank from Dr. Milano, forged his signature, and attempted to purchase 30 Seconal tablets. The pharmacist became suspicious and called Dr. Milano, who advised the pharmacist to send the boy home. Morgenstein obtained a gun after leaving the pharmacy and later that day shot Kimberly McIntosch to death.

Jawapan 

Dr. Milano had reportedly tried to reach his client by phone to talk about the stolen prescription blank, but intervened too late to prevent the shooting. Ms. McIntosch's father, a physician who had read about the Tarasoff decision, and his wife ultimately filed a civil damage suit against Dr. Milano for the wrongful death of their daughter, asserting that Milano should have warned Kimberly McIntosch or taken reasonable steps to protect her.

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Dr. Milano sought to dismiss the suit claiming that the Tarasoff principle should not apply in New Jersey for four reasons. First, to do so would impose an unworkable duty because the prediction of dangerousness is unreliable. Second, violating the client's confidentiality would have interfered with effective treatment. Third, assertion of the Tarasoff principle could deter therapists from treating potentially violent patients. Finally, Milano claimed that all of this might lead to an increase in unnecessary commitments to institutions. The court rejected each of these arguments and denied the motion to dismiss the case (McIntosch v. Milano, 1979). The court noted the duty to warn as a valid concept under New Jersey law, and despite the fact that therapists cannot be 100% accurate in predictions, they have the ability to weigh the relationships of the parties. The court drew an analogy comparing the situation with warning communities and individuals about carriers of a contagious disease, and stated that confidentiality must yield to the greater welfare of the community, especially in the case of imminent danger. Ultimately, a jury did not find Milano liable for damages, but the Tarasoff principle had clearly moved East.

Melindungi kanak-kanak daripada dicederakan Kes  James, a juvenile offender, was incarcerated for 18 months at a county facility. During the course of his confinement, James threatened that he would probably “off some kid” (i.e., murder a child) in the neighborhood if released, although he did not mention any particular individual. James obtained parole and did indeed kill a child shortly thereafter.

Jawapan  In the litigation that resulted from this case (Thompson v. County

of Alameda, 1980), the chief concern focused on whether the county had a duty to warn the local police, neighborhood parents, or James' mother of his threats. While recognizing the duty of the county to protect its citizens, the California Supreme Court declined to extend the Tarasoff doctrine it had created a few years earlier to this case, noting that doing so would prove impractical and negate rehabilitative efforts by giving out general public warnings of nonspecific threats for each person paroled. The court also deemed warning the custodial parent futile because one would not expect her to provide constant supervision (Tarasoff duty…, 1980).  After many years of state court decisions clarifying the Tarasoff doctrines, a 1991 Florida decision (Boynton v. Burglass, 1991) complicated matters still further.

Isu Kerahsiaan dalam HIV/AIDs Kaunselor yang mempunyai klien penghidap HIV?AIDS perlu mengambilkira isu tambahan berkenaan dengan kerahsiaan dan laporan (Parry & Mauthner 2004)  B.2.b. Penyakit berjangkit dan mengancam nyawa

Apabila klien memberitahu bahawa mereka mengidap penyakit yang diketahui umum sebagai berjangkit dan mengancam nyawa, wajar bagi kaunselor mendedahkan maklumat tersebut kepada pihak ketiga yang dikenali, sekiranya diketahui secara sah mereka itu menghadapi risiko yang tinggi dijangkiti penyakit tersebut. Sebelum membuat sesuatu pendedahan, kaunselor hendaklah mengesahkan bahawa ada diagnosis seperti itu dan menilai hasrat klien untuk memberitahu pihak ketiga mengenai penyakit mereka, atau melakukan sebarang tingkah laku yang mungkin memudaratkan pihak ketiga yang dikenali.

Kes  Bernard Bizzie, LMHC, was about to leave for the weekend when he received an emergency call from a client, who claimed to have taken a number of

pills in an attempt to kill herself. Bizzie told her to contact her physician and to come in to see him at 9:00 A.M. on Monday morning. He made no other attempt to intervene, reasoning that contacting others on her behalf would breach confidentiality. The client died later that evening without making any other calls for assistance.

Jawapan  Dr. Bizzie clearly behaved in an unethical and negligent manner

by not attending more directly to his client's needs. Even those rare mental health professionals who once asserted that one should never disclose confidential information without the consent of the client in the early post-Tarasoff era (e.g., Dubey, 1974; Siegel, 1979) or those who still advocate “absolute” confidentiality (Karon & Widen, 1998) would not likely counsel inaction in the face of such a risk. There are many steps Bizzie could have taken short of violating the client's confidentiality. Most obviously, he should have attempted (at the very least) to learn her location and assure himself that help would reach her if he could not. Although suicidal threats or gestures may prove manipulative rather than representing a genuine risk at times, only a foolish and insensitive colleague would ignore them or attempt to pass them off glibly to another.

KEPENTINGAN KERAHSIAAN  Prinsip dan etika yang penting  Tanggungjawab dan amanah  Menghormati hak klien  Diterangkan kepada klien

 Menonjolkan diri sebagai orang yang boleh diharapkan

MENGAPA KERAHSIAAN PENTING ?

 Kepercayaan klien  Mempersepsikan masalahnya  Dirinya difahami  Dirinya dihargai  Berasa selamat

BOLEHKAH PRINSIP KERAHSIAAN DIKECUALIKAN  Tidak terbatas kepada perkara-perkara kritikal

seperti : a ) Keinginan membunuh diri b ) Penderaan c ) Menyertai kumpulan kongsi gelap / pertubuhan haram dan lain-lain.

BOLEHKAH PRINSIP KERAHSIAAN DIKECUALIKAN

 Kerahsiaan menggugat hak individu lain /

orang ramai  Bergantung kepada benda yang hendak dirahsiakan.  Klien meminta maklumat (rahsia) didedahkan

• Terdapat beberapa perkara yang menyebabkan

prinsip etika ini sangat rasional ditekankan dalam perkhidmatan kaunseling. Salah satu di antaranya ialah • untuk mengelakkan klien daripada menerima keaiban daripada orang lain, sebagai contohnya klien tersebut mungkin terlibat dengan isu-isu sensitif atau peristiwa trauma yang berlaku dalam dirinya seperti penderaan, menjadi mangsa rogol, masalah seksual, terlibat dengan penyalahgunaan dadah, mempunyai keinginan untuk membunuh diri, menyertai kumpulan haram dan sebagainya.

 Setiap klien yang menerima perkhidmatan kaunseling tidak akan

dapat mengelak daripada meluahkan pengalaman tidak kira pahit atau pun manis terhadap kaunselor. Oleh itu prinsip kerahsiaan dalam bidang kaunseling ini sangat rasional ditekankan agar menjadikan klien lebih yakin, percaya dan berasa selamat dengan maklumat yang mereka dedahkan.  klien juga dapat meluahkan masalah yang dihadapinya dengan

rasa bebas tanpa wujud perasaan ragu-ragu. Kesannya hal ini akan menyebabkan kaunselor mudah mengenalpasti masalah yang dihadapi oleh klien.  Dengan adanya prinsip kerahsiaan ini, kaunselor akan dapat

menonjolkan diri sebagai individu yang boleh dipercayai, amanah dan bertanggungjawab untuk menjaga hak dan kepentingan privasi klien.

Kaunselor tidak terikat dengan etika kerahsiaan dalam soal penderaan dan pengabaian :  kanak – kanak  Warga tua  Dewasa yang hidup bergantung dengan orang lain (dependent adults ) Jika klien dewasa mendedahkan dalam terapi bahawa dirinya pernah atau sedang mendera kanak – kanak ( anak ), kaunselor tersebut mesti melaporkannya.

Physical or mental injury, sexual abuse or exploitation, negligent treatment or maltreatment of a child under the age of eighteen or the a of the age specified by the child protection law of the statein question, by a person who is responsible for the child’s welfare, under circumstances which indicate that the child’s health or welfare is harmed or threatened thereby.

 Dikebanyakan

tempat Jabatan Sumber Manusia bertanggungjawab dalam kes penderaan, pengabaian dan eksplotasi kanak – kanak dan dewasa.  Pada tahun 2003 lebih daripada 550 000 kes penderaan dan pengabaian warga tua telah dilaporkan di United States. Namun, bilangan sebenarnya mungkin 4 / 5 kali ganda daripada yang dilaporkan. ( Egan, James & Wagner, 2004)  Jenis penderaan warga tua yang utama :  penderaan fizikal  penderaan seksual  penderaan psikologi  pengabaian (neglect)  peninggalan (abandonment)  eksploitasi wang dan kebendaan

 melibatkan

penggunaan kekuatan fizikal dan

hasilnya :  kecederaan dibadan (bodily injury )  Kesakitan fizikal ( physical pain )  kecacatan yang kekal / sementara ( impairment )

Melibatkan hubungan seks atas dasar paksaan ( nonconsensual sexual contact ) dengan warga tua.

Merogol warga tua

Tindakan yang menyebabkan ketidakselesaan, kesakitan dan ketekanan secara verbal ataupun bukan verbal. inflicting anguish, pain or distress through verbal or nonverbal acts.

Misalnya serangan verbal, menghina,mengancam, mengugut memalukan dan menganggu

Kegagalan penjaga untuk memenuhi tanggungjawab terhadap warga (old folks home caregivers ) Gagal / enggan menyediakan keperluan asas seperti  makanan  minuman  pakaian  tempat tinggal dengan niat  ubat / tanpa niat  keselamatan  keselesaan

sendiri / suruhan orang

melibatkan pembelotan daripada orang tua oleh seseorang yang telah mengambil alih tanggungjawab untuk menjaga mereka.

didefinisikan sebagai penggunaan wang, harta / aset warga tua secara haram / tidak patut

National Center on Elder Abuse NCEA is dedicated to educating the public about elder abuse, neglect and exploitation and its tragic consequences

Terapist berkewajipan etika dan undangundang untuk melindungi kanak-kanak, orang tua dan dewasa yang hidup bergantung dari penderaan.

 Laporan wajib kes penderaan adalah berbeza beza mengikut negara /negeri di luar negara  Di Pennsylvania, terapist wajib melaporkan apabila situasi dimana kliennya didera saja.  Jika kliennya yang mendera seseorang terapist tidak wajib melaporkannya.  Manakala di New York, terapist wajib melaporkan dengar saja dera tidak kira samaada klien didera/ mendera / saudara mara klien yang mendera.  1989, Maryland telah memurnikannya kepada wajib melaporkan kes dera semasa dan juga masa lampau.

Kalichman and Craig (1991) mendapati faktor umur, tingkah laku kanak – kanak sewaktu sesi dan jenis penderaan mempengaruhi keputusan terapist. Didapati terapist mungkin memutuskan untuk tidak melaporkan kerana bimbang terhadap kesan negatif laporan terhadap diri serta terapi. Namun mereka tidak teragak agak untuk melaporkannya jika pasti penderaan berlaku. Hermann (2002) mendapati 91% kaunselor sekolah percaya mereka amat bersedia untuk menentukan samaada untuk melaporkan penderaan kanak kanak yang disyaki.

Kajian terhadap kerahsiaan dan kaitannya dengan laporan penderaan kanak-kanak menunjukkan bahawa responden tidak konsisten dalam prosedur mereka untuk memaklumkan klien had kerahsiaan. (Nicolai &Scott , 1994) Dapatan kajian juga mencadangkan bahawa perlu untuk menegaskan kepentingan menyediakan klien dengan maklumat terperinci tentang had kerahsiaan dari bermulanya terapi. Walaupun terapist menerima tanggungjawab untuk melindungi kanak kanak, orang tua dan orang dewasa hidup bergantung daripada layanan buruk dari segi fizikal dan emosi, mereka berkemungkinan menghadapi kesukaran dalam menentukan sejauhmanakah boleh membuat laporan.

Martina, a high school counselor , has reason to believe that one of her studentas is being physically abused. As part of the abuse, critical medicationis being withheld from the student. Martina reports the incident to child protective services and gives all the information she has to the caseworkers. She flows up the phone conversation with the caseworkers with a written report. A week later, the student tells her that nothing has been done.

A father stumbbles into his 12 years old daughters’s bedroom and briefly fondles her. Sally cries bring her mother into the room and the incident does not go furtherlater the does not recall the incident. There has been no previous history of molestation. During the therapy the family is able to talk openly about the incident and is working through the resulting pain. Because of this incident, the father has enrolled in a substance abuse program. The family is adament that this situation should not be reported to social services. The therapist knows that the statute in her state clearly specifies that she is required to report this acident, even if it had happened in the past and no further incidents had occurred .

If the therapist obey the law, may be more detrimental to the family than beneficial!

Emily, an elderly client , take great pride to her independence, her ability to take of herself and in not being a burden to her family. Her therapist, Tom, is impressed with her independent spirit. Emily eventually divulges to Tom several episodes of missing that the gas flame was left on in the kitchen. She laughs it off by saying, “I guess I’m not prefect”. Every so often , Emily discloses similar episodes of forgetfulness that have potential lethal consequences. Tom becomes increasingly concerned and suggests that she include her family has wanted her to move to a nursing home. Emily is adamant in her refual to go along with their plan. She tells Tom, “ If you make me leave my home, there is no point in living .”

Apakah tindakan anda sebagai kaunselor Emily dan mengapa?

You are working with individuals with mental disabilities, many of whom are institutionalized. One of your clients, Mike, who has a severe mental disability and lives in a residential home, leads you to believe that he is being sexually abused by at least one member of the staff. You are not really sure about this because it is difficult to separate fact from fantasy when talking with him about other things.

Kerahsiaan dan Isu berkaitan dengan HIV/ AIDs  Orang yang telah diuji HIV positif biasanya memerlukan bantuan jangka pendek.  Mereka perlukan sokongan untuk melaluinya.  Mereka hidup dalam ketakutan tertanya-tanya sama ada mereka akan turun dengan penyakit tidak boleh diubati ini  Pesakit HIV/ AIDs yang berjuang dengan stigma yang berkaitan dengan AIDS  Pesakit HIV / AIDs bukan sahaja hidup dalam ketakutan kerana penyakit yang mengancam nyawa malah dipulaukan oleh insan yang tercinta, kawan kawan dan masyarakat.

 Selain rasa berbeza dan diaibkan, mereka biasanya mempunyai banyak kemarahan, marah terhadap orang lain khasnya pembawa virus ini kepada mereka.  Pesakit HIV/ AIDs juga selalunya turut marah pada ahli perubatan  terutamanya klien terdedah kepada kemungkinan dipulaukan dan menderita akibat diskriminasi  mendapatkan persetujuan termaklum dan mendidik mereka tentang hak-hak dan tanggungjawab mereka

 adalah kritikal bagi terapist mendapatkan informed concern dan mendidik tentang hak dan tanggungjawab mereka  terapist perlu jelas akan batas kerahsiaan, perihal melaporkan, tanggungjawab untuk memberikan amaran dan melidungi pihak ketiga serta membincangkan tangungjawab profesional.  Jika terapist merasakan dirinya tidak dapat memberikan perkhidmatan yang cekap kepada pesakit HIV wajar disisi etika untuk merujuk klien tersebut kepada terapist lain.

Apakah seorang terapist bertanggungjawab untuk memberikan amaran dan melindungi orang ketiga daripada terjangkit sama AIDs / HIV positif melalui perkongsian jarum dan hubungan sex yang tidak dilindungi?

Al and Wilma are seeing Sarina for couples counseling. After a number of sessions Wilma request an individual session, in which she discloses that she has tested HIV positive as a result of an afffair. Sarina finds herself in dilemma : She has concerns for the welfare of the couple , but she also conserned about Wilma’s painful predicament, especailly because Wilma has sincere desire to make her relationship work. Part of Sarina’s quandary is that did not tell the couple her policy about handling confidentiality for private sessions.

Paddy has been seeing a counselor for several months to deal with his depression He comes to one session in a state of extreme anxiety. He has been in a gay relationship with Christopher for 15 years. On a recent business trip Paddy had a sexual encounter with another man. Paddy is now worried that he may have contracted HIV, but he refuses to be tested. He is terrified of confirming his fear and be tested. He also encourages him to discuss this matter with Christopher. Paddy steadfastly refuses to consider either of the counselor’s suggestions. When the counselor asks Paddy what he wants from him, he replies that he wants to be reassured that he is merely overreacting. He also would like to get over feeling depressed most of the time.

Hershel is a vice president in a large company. He is married and has young children. Hershel’s job necessitates transcontinental travel several times this year. During this trip he spends time with a lover. On his last trip he confided that that one of the men that he had recently been sexually involved with hag received an HIV positive diagnosis. Hershel is panic stricken and seeks the help of a counselor, blanche, who immediately recommends that he be tested. He follows her recommendation and his test results are negative. He is elated and now sees no reason to continue therapy. Blanche makes no attempt to persuade him to explore other issues. She has no expertise in the treatment of AIDs clients and lacks essential knowledge pertaining to the latest AIDs research.

Beberapa tahun kebelakangan ini banyak yang telah ditulis mengenai situasi yang mana kerahsiaan mungkin dilanggar dalam terapi AIDS dan isu yang berkaitan dengannya. Mahkamah tidak memberikan amaran kepada kes-kes yang melibatkan jangkitan HIV dan tanggungjawab undang-undang terapis dalam melindungi pasangan seks klien yang dijangkit HIV positif, ianya masih tidak jelas. Pengamal ada sedikit panduan undang undang untuk membantu mereka menentukan bila dan bagaimana memaklumkan pasangan seksual yang berpotensi terancam dengan HIV positif melalui hubungan seksual. Walaupun kekurangan bimbingan undang-undang mengenai isu ini, Erikson berpendapat bahawa terdapat beberapa asas untuk mempertimbangkan pengecualian kepada isu kerahsiaan ini.

The duty to warn and protect may arise when a counselor has reason to believe that an HIV positive client intends to continue to have unprotected sex or to share needles, with unsuspecting but reasonably identifiable third parties.

Pengamal kaunseling perlu berpengetahuan luas dalam HIV dan AIDs agar boleh mengajukan soalan yang wajar dalam sesi.Maka kaunselor ……….  perlu baca bahan yang berkaitan dengan HIV  menghadiri kursus / bengkel HIV  hubungi pihak klinik / hospital