Question

1. Should test results be kept confidential from other family members who are directly affected (as in examples B & D)?

2. Should a client be given information that will lead to a decision that the counselor believes is unethical (as in examples A&C)?

3. What would you do? (Note: The answers to the first two questions can/may be different from the third).

Thinking Like A Scientist
One of the most difficult parts of being a scientist is knowing how to use information so it does not harm others. Consider these cases:
A. A pregnant woman and her husband both have achondroplastic dwarfism, a dominant condition that affects appearance (very short stature, large head) but not intellect. They want genetic analysis of the fetus; they plan to abort if the child would be of normal height.
B. A 40-year-old woman is tested and is told that she has the BRCA1 gene. That means she has about an 80% chance of developing breast cancer and is at high risk for ovarian and colon cancer. She does not believe these results and wants no one to tell her mother, her four sisters, or her three daughters, some of whom may be I the early stages of cancer.
C. A 30-year-old mother of two daughters (no sons) is a carrier for hemophilia. She requests in vitro fertilization (IVF) and pre-implantation analysis so that only male zygotes without the hemophilia-carrying X chromosome will be implanted. Female zygotes, all healthy but half of them carriers, would be destroyed as would the hemophiliac half of her male zygotes.
D. A couple has a child with cystic fibrosis. They want to know if they both carry the recessive gene, in which case they will have no more children, or if the child’s illness was the result of a spontaneous genetic change, as my happen at conception. The test results make it apparent to the counselor that the couple will not have a child with cystic fibrosis, because the husband is not the child’s biological father.
Answer the following questions in your Blog:
1. Should test results be kept confidential from other family members who are directly affected (as in examples B and D)?
2. Should a client be given information that will lead to a decision that the counselor believes is unethical (as in examples A and C)?
3. What would you do? (Note: The answers to the first two questions can/may be different from the third).

Answer 1

As a counselor or therapists, it is important to maintain confidentiality and ethical code of conduct. It is important to understand the concept of confidentiality and in what cases information can be shared to authorized individuals with the consent of the client. So now let us have a close look at what should be done in specific situations as mentioned in the question.

1) Should test results be kept confidential from other family members who are directly affected (as in examples B and D)?

In specific to example B it is important to inform the family members who are directly affected as it is related to safety of the client as well as other family members. In this particular case the client is in the state of denial so as a counselor it is important that you first explain the client about the seriousness and help the client to accept the reality and reveal the truth to the family members themselves in a particular time slot. Basically discussing it with the client how to go about and revealing the truth to the family as it was not only the matter of her own life but also the matter of life of her own daughters. So explaining the client that it is your duty as a counselor to inform the authorized individuals.

In specific to example D it is responsibility of the Counselor to reveal the actual test results to the couple. In this particular case after revelation of truth it is important to provide the couple help in order to handle the truth.

2) Should a client be given information that will lead to a decision that the counselor believes is unethical (as in examples A and C)?

In specific to example A and C, the Counselor should give the information to the client as it their right to know the truth and decide for themselves. But in such cases the responsibility of the counselor is to make client aware about the unethical aspect of aborting the child and guiding the client through the process of decision making. In short the counselors should have a neutral or a unbiased approach and help the client brainstorm about the pros and cons of their decision and then come to the conclusion.  

3)What would you do?

As a Counselor it is important to adhere to the ethical standards and understand ones duty and responsibility along with having the sensitivity towards your clients and guiding your clients. So in specific to the above cases the response would be the same as explained for questions 1 & 2.