Ethical Decision Making 

and Practice when

Confronted with Ethical Challenges 

This Photo by Unknown author is licensed under CC BY.

Group 3
 Issue

▪ Client A has been married for 10 years to her husband, and

they have two children. Client A has been active with
therapeutic services for one year. Client A shared that she
and her husband have unprotected sex because they are
trying to have a third child. During her last session, she
disclosed to the social worker that she is having an affair
with her coworker and does not always use protection. The
coworker revealed he might have been exposed to HIV,
but she is afraid to get tested. Client A ended the affair but
is unwilling to get tested because she fears the outcome.  
 Issue
▪ The conflict is whether the social worker should honor her ethical obligation to maintain the client’s confidentiality or her
ethical (and maybe legal) obligation to warn the husband about the potential for harm. Consultation with a supervisor and
trusted peers is also imperative. Legal counsel may be considered. All consultations and considerations should be
documented. 

▪ Things to consider:

o "Nature of client communication" 

o "Explicit threat to kill or inflict serious bodily injury" 

o "Apparent intent and ability to carry out the threat" 

o Whether the social worker has taken "reasonable precautions" to communicate   the potential threat.

▪ Either outcome could result in legal action later. The client could file a complaint about a breach of confidentiality, or her
husband could file a lawsuit alleging that the duty to warn was not honored. 
 The Dilemma Equation

▪ Should the social worker honor her duty to maintain confidentiality or her duty to warn the husband
that he (and their baby if Client A becomes pregnant) may be at risk of HIV infection?

▪ To arrive at a decision, we must proceed to the next step in the model.

1.07 Privacy and Confidentiality
                                    NASW Code of Ethics 
(a) Social workers should respect clients’ right to privacy. Social workers should not solicit private information from or
about clients except for compelling professional reasons. Once private information is shared, standards of confidentiality
apply.

(b) Social workers may disclose confidential information when appropriate with valid consent from a client or a person
legally authorized to consent on behalf of a client.

(c) Social workers should protect the confidentiality of all information obtained in the course of professional service,
except for compelling professional reasons. The general expectation that social workers will keep information confidential
does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or others. In all
instances, social workers should disclose the least amount of confidential information necessary to achieve the desired
purpose; only information that is directly relevant to the purpose for which the disclosure is made should be revealed
(National Association of Social Workers, 2023).

 .
 NASW Code of Ethics (continued)
1.07 Privacy and Confidentiality

(d) If social workers plan to disclose confidential information, they should (when feasible and to the extent possible)
inform clients about the disclosure and the potential consequences prior to disclosing the information. This applies
whether social workers disclose confidential information on the basis of a legal requirement or client consent.

(e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of
clients’ right to confidentiality. Social workers should review with clients circumstances where confidential information
may be requested and where disclosure of confidential information may be legally required. This discussion should occur
as soon as possible in the social worker–client relationship and as needed throughout the course of the relationship.

(n) Social workers should develop and disclose policies and procedures for notifying clients of any breach of confidential
information in a timely manner (National Association of Social Workers, 2023).
 Other NASW Ethics to Consider
1.01 Commitment to Clients

Social workers’ primary responsibility is to promote the well-being of clients. In general, clients’ interests are primary.
However, social workers’ responsibility to the larger society or specific legal obligations may, on limited occasions,
supersede the loyalty owed clients, and clients should be so advised. (Examples include when a social worker is required
by law to report that a client has abused a child or has threatened to harm self or others.)

1.02 Self-Determination

Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify
and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’
professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or
others (National Association of Social Workers, 2023).

 .
 Policies & Laws

▪ States or cities may have partner notification laws. This means that if someone tests positive for
HIV, they (or their healthcare provider) may legally be obliged to tell that person’s sex or
needle-sharing partners. In some states, it is a crime for those with HIV to not tell their partners.
Some health care providers may be required by their health department to disclose the names of
clients’ sex and needle-sharing partners (if they have this information), even if the client refuses
to do so (United States Department of Health and Human Services [USDHS], 2017). 

▪ The Ryan White HIV/AIDS Program requires that health departments receiving money from the
Ryan White program show “good faith” efforts to notify the marriage partners of a patient with
HIV (Ryan White HIV/AIDS Program, 2022).
 Policies & Laws
▪ Florida Statute 384.24(2) 

▪ 3rd degree felony

▪ "It is unlawful for any person who has human

immunodeficiency virus infection, when such person knows
he or she is infected with this disease and when such person
has been informed that he or she may communicate this
disease to another person through sexual intercourse, to
have sexual intercourse with any other person, unless such
other person has been informed of the presence of the
sexually transmissible disease and has consented to the

sexual intercourse" (Florida Legislature, 2023).

Policies & Laws
▪ Florida Statute 384.34(6) 

▪ 3rd degree felony

▪ "Any person who obtains information that identifies an

individual who has a sexually transmissible disease, who
knew or should have known the nature of the information
and maliciously, or for monetary gain, disseminates this
information or otherwise makes this information known to
any other person, except by providing it either to a
physician or nurse employed by the Department of Health
or to a law enforcement agency, commits a felony of the
third degree" (Florida Legislature, 2023).
 Policies & Laws

▪ Federal acts such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protect an
individual’s health information, which includes medical information such as their HIV status (Johnson,
2022).

▪ “Duty to warn” requires that clinical staff notify a third party if they think a person is at risk for exposure to
HIV (USDHS, 2017). 

▪ Mandatory duty to warn law enforcement for mental health professionals in Florida took effect on July 1,
2019, as part of the recommendations from the Marjory Stoneman Douglas School (Parkland) Shooting
Commission's report (Hall & Tardif, 2020). 
 Policies & Laws

▪ Florida courts have a history of not imposing liability based on a defendant's failure to control the conduct of a third party:

o Bankston v. Brennan, 507 So.2d 1385 (Fla. 1987) (social host not liable for serving alcoholic beverages to individual who then

injures another)

o Paddock v. Chacko, 522 So.2d 410 (Fla. 5th DCA 1988) (psychiatrist had no duty to forcibly detain patient who later attempted to

commit suicide)

o Vic Potamkin Chevrolet, Inc. v. Horne, 505 So.2d 560 (Fla. 3d DCA 1987) (automobile dealer not liable for buyer's negligent

driving once ownership of automobile transferred to buyer). 

 When the duty sought to be imposed is dependent upon standards of the psychiatric profession, we are asked to embark upon a journey
that "will take us from the world of reality into the wonderland of clairvoyance" (AnyLaw, 2023).
 Policies & Laws
▪ Florida Statute 394.4615

o "Information from a clinical record  may be released under the Mental Health Act when the patient has declared an
intention to harm other persons. If such a declaration is made an administrator may authorize the release of sufficient
information to provide adequate warning to the person threatened with harm by the patient. Any facility or private
mental health practitioner who acts in good faith in releasing information under this section are not subject to criminal
or civil liability" (National Conferenced of State Legislators, 2023). 

 Florida Statute 491.0147

o "Any communications between psychotherapists or counselors and patients are confidential but may be waived when
in the clinical judgment of the professional there is a clear and immediate probability of physical harm to the patient,
to other individuals, or to society. The professional may communicate information to the potential victim, appropriate
family member, or law enforcement or other appropriate authorities. The professional is immune from liability for
disclosure under this section" (National Conference of State Legislators, 2023).
 Tarasoff v. Regents of the University of California
(1976)

▪  Prosenjit Poddar and Tatiana Tarasoff were students at UC Berkeley in the 1970s. Poddar a
university psychologist that he intended to kill Tatiana Tarasoff. The psychotherapist did not
directly warn Tarasoff but he did alert the police, who interviewed Poddar and briefly detained
him. The police only warned Poddar to stay away from Tarasoff. After Tarasoff returned to
California after a summer vacation, Poddar murdered her with a knife. Tarasoff’s family sued
the campus police and the university health service for negligence (Granich, 2014.

▪ The California Supreme Court concluded: "The protective privilege ends where the public
peril begins." 

▪ All Tarasoff cases have involved threats with weapons or arson.

 Tarasoff v. Regents of the University of California
(1976)

▪ Melchert and Patterson (1999, as cited in Granich, 2014)

discuss how being HIV-positive may pose a different
situation from that of the Tarasoff case. Mental health
professionals do not have the legal right to disclose that a
person is HIV-positive to another person. This is at the
discretion of physicians in many states. However, social
workers and mental health professionals must struggle with
this legal situation if a client insists on potentially harming
another person through risk of transmission of HIV.
 Relevant Research

 Unprotected sex with an HIV-positive person who has acute HIV infection
could carry a transmission risk of up to 2% (the equivalent of 1 transmission
per 50 exposures) for receptive vaginal sex and over 20% (equivalent to 1
transmission per 5 exposures) for receptive anal sex (Patel et al., 2014).

 Without treatment, 25 to 30% of babies born to a mother living with HIV will
get HIV. However, if mothers are aware of their HIV infection and treated
along with their infants, the chances of the infant getting HIV are less than 2%
(Perinatal (Mother-To-Child HIV Transmission) - Minnesota Dept. Of Health,
2022).
 Ethical Obligation  - 1

▪ The social worker must treat the client with dignity and manage their personal
biases.  Perhaps the social worker can help the client overcome her ambivalence and
empower her to get tested and disclose to her partner (explore inviting the partner to
a session).  In all instances, social workers are obligated to be respectful, build trust
and promote self-determination.  It is normal to have some concerns; however, the
social worker should not impose their values on the client or appear upset. 
 Ethical Obligation - 2 

▪ If the partner agrees to join the counseling sessions, the social worker must remain
neutral and clarify with all parties which individuals will be considered clients and
the nature of social workers’ professional obligations to the various individuals
receiving services (NASW).  

▪ The social worker is obligated to seek supervision and consultation, especially if

their values could present a problem. Moreover, social workers must engage
in continuing education and training to strengthen their skills.
 Ethical Obligation - 3  

▪ Cultural competence – understanding the

client's background and avoid conflicts of
interest

▪ Collaborate with colleagues as needed

▪ Advocate for the well-being of everyone

▪ Research

▪ Avoid dishonesty and misrepresentation 

 Possible Solutions &
Potential Consequences

▪ Solution 1: The therapist is able to discuss and formulate a plan with the client t to get tested and if it is positive,
to tell  her husband. 
Consequence: (1)The client could become angry at the therapist for their role and lose the client if the spouse
doesn't handle the news well 

▪ Solution 2: The therapist isn't able to discuss and formulate a plan that includes getting tested . The therapist
then informs the client it is a felony offense if she does not get tested and inform her husband.
Consequence : The client could become angry at the information and it could lead to the therapist losing the
client. 

▪ Solution 3: The client refuses to get treatment and does not care about the felony offense and threatens if the
therapist discloses anything she would sue due to HIPPA violation. The therapist explains the ethical obligations
and the legal requirements regarding possible HIV exposure and therefore informs the client's husband of the
need to get tested. 
Consequence: The therapist loses the client and is reported to the ethical board for possible HIPPA violation. 
 Thought Process 
SOLUTIONS CONSEQUENCES

The social worker may be violating their ethical and legal duties by failing to
Honor client confidentiality and do not inform the husband.
provide appropriate warnings to those who may be in danger.

If the husband's colleague is HIV positive, it might have severe ramifications

for both.

Inform the husband about potential harm without disclosing client A's The social worker may still violate ethical and legal requirements to protect
identity. client privacy.

The social worker may still violate ethical and legal requirements to protect
client privacy.
Encourage client A to disclose her affair and potential exposure to her An ethical social worker may encourage clients to make decisions and be
husband. truthful with their assessments.

Client A's mental health might deteriorate, and HIV could spread if she
refuses and stops treatment.

There is a risk of an adverse reaction from the husband, which might

lead to the breakup of the marriage.
 ​
                            SOLUTIONS​ CONSEQUENCES​
​

Report the coworker's potential HIV exposure to the appropriate authorities. The social worker may comply with legal and ethical requirements to
disclose public danger.

Coworkers may be mandated to receive HIV tests and treatment to stop the

spread of the virus.

Discuss the risks and benefits of getting tested with client A and encourage her It is consistent with ethical norms for social workers to promote client
to take responsibility for her actions and protect her health and her family's autonomy and responsible action.
health.
Client A may resist treatment, which might seriously affect her health.

Seek legal counsel to determine the appropriate course of action based on state The social worker may be meeting legal requirements and reducing
laws and regulations regarding mandatory HIV testing and disclosure. potential legal liability.

Getting legal representation may be complicated or costly and may not

clarify the next steps.

Client A may still expose her husband to HIV if she refuses to be tested
or talk about the possibility of her exposure
 Barriers 

▪ If the social worker decides to warn the husband, they must ensure that they have taken
reasonable precautions to communicate the potential threat. 

▪ balancing the ethical obligation to maintain client confidentiality with the ethical and legal
duty to warn the husband about the potential harm of HIV transmission. conflicts with the
duty to warn when harm to others is involved.

▪ Discussing the risks and options with the client, notifying the co-worker of the potential harm,
and encouraging the husband to get tested for HIV.

▪ the client may face is the fear of stigma and discrimination related to HIV/AIDS. 

▪ The social worker must acknowledge the client’s fear and provide support and resources to
help them cope with the potential stigma and discrimination. 
 Implement Solutions

▪ Reflect
▪ Participate in reflective supervision 
▪ Engage with peers
▪ Understand  the law
▪ Consult the code of ethics 
▪ Practice effective decision making 
▪ Always ensure the reward outweigh the risk
 Evaluate & Document
•There are always multiple answers to a complex ethical dilemma, and occasionally several solutions can be considered
correct. It is essential to understand that different professionals may choose other action plans for the same
situation.  However, suppose you follow a systematic model, similar to or the same as  the Reamer model; you can be assured
that you can give a professional explanation for the course of action you choose.  

•Highly detailed and accurate documentation is essential for any activity conducted during a session. The mentioned is to
protect yourself as well as the organization.  All choices that the NSWA guides will be met with ethical backing and suggests
the therapist has maintained personal and professional boundaries & integrity. The social worker would have chosen to
prioritize the client’s best interests. Lastly, the worker can justify the actions as the best judgment of what should be done
based on all current information and the best practices.  
 References
District Court of Appeal of Florida. (1991, September 23). Wayne Boynton v. Milton Burglass. Any Law.
https://www.anylaw.com/case/wayne-boynton-v-milton-burglass/district-court-of-appeal-of-florida/09-24-1991/kqmWSWYBTlTomsSBPDbp

Florida Legislature. (2023). The 2022 Florida Statutes. Online Sunshine.

http://www.leg.state.fl.us/statutes/index.cfm?
App_mode=Display_Statute&Search_String=&URL=03000399/0384/Sections/0384.24.html

Florida Legislature. (2023). The 2022 Florida Statutes. Online Sunshine.

http://www.leg.state.fl.us/Statutes/index.cfm?
App_mode=Display_Statute&Search_String=&URL=0300-0399/0384/Sections/0384.34.html

Granich, S. (2014, November 16). Duty to warn, duty to protect. The New Social Worker.
https://www.socialworker.com/feature-articles/ethics-articles/Duty_to_Warn%2C_Duty_to_Protect/

Hall, R. C. W., & Tardif, I. (2020). Florida law enforcement policies for and experience             
        with Tarasoff-like reporting. Mental Health Law Weekly, 663. https://doi.org/10.29158/jaapl.200065-20

Johnson, J. (2022, February 23). HIV confidentiality laws by state: What to             

        know. Medical News Today.
https://www.medicalnewstoday.com/articles/hiv-confidentiality-laws-by-state#laws-surrounding-hiv
 References
National Association of Social Workers. (2023). Social workers' ethical responsibilities to clients. 
https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-Clients

National Conference of State Legislators. (2022, March 16). Mental health professionals' duty to warn. 
https://www.ncsl.org/health/mental-health-professionals-duty-to-warn

Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J. (2014). Estimating per-act HIV transmission risk. AIDS, 28(10), 1509–1519.
https://doi.org/10.1097/qad.0000000000000298

Perinatal (Mother-to-Child HIV Transmission) - Minnesota Dept. of Health. (2022, October 20). Www.health.state.mn.us.
https://www.health.state.mn.us/diseases/hiv/prevention/perinatal.html

Ryan White HIV/AIDS Program. (2022, September). Part B: Grants for states and territories. HRSA's 

Ryan White HIV/AIDS Program. 
https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/program-factsheet-part-b-gst.pdf

United States Department of Health and Human Services. (2017, May 15). Limits on 
Confidentiality. HIV. 
https://www.hiv.gov/hiv-basics/living-well-with-hiv/your-legal-rights/limits-on-confidentiality

Fabian, K. E., Huh, D., Kemp, C. G., Nevin, P. E., Simoni, J. M., Andrasik, M., Turan, J. M., Cohn, S. E., Mugavero, M. J., & Rao, D. (2019). Moderating
Factors in an Anti-stigma Intervention for African American Women with HIV in the United States: A Secondary Analysis of the UNITY Trial. AIDS and
behavior, 23(9), 2432–2442. https://doi.org/10.1007/s10461-019-02557-x 

 Mulligan, A. (2021). Patient Confidentiality and Disclosure of HIV Status: Disentangling the Entitlement to Disclose from the Duty to Warn. Medical Law
Review, 29(4), 688-698. https://doi.org/10.1093/medlaw/fwab005 
              References

gSingh, J. A., Moodley, D., Little, M., Luna, F., Littler, K., & Kumarasamy, N. (2022). The ethics of exclusion: why pregnant and lactating women must be
front and centre of HIV research. Journal of the International AIDS Society, 25(Suppl 2).

Fauci, A. S., & Lane, H. C. (2020). Four decades of HIV/AIDS much accomplished, much to do. New England Journal of Medicine, 383(1), 1-4.

ACS.(2023).HIVandCancer.
https://www.cancer.org/healthy/cancer-causes/infectious-agents/hiv-infection-aids/hiv-aids-and-cancer.html#:~:text=HIV%20doesn't%20seem%20to,cancer%
20than%20people%20without%20HIV

OASH. (2021, February 18). Facts about HIV and AIDS. Office on Women's Health. 
https://www.womenshealth.gov/hiv-and-aids/hiv-and-aids-basics/facts-about-hiv-and-aids

WHO. (2022, July 27). Hiv. World Health Organization (WHO). https://www.who.int/news-room/fact-sheets/detail/hiv-aids

h, J. A., Moodley, D., Little, M., Luna, F., Littler, K., & Kumarasamy, N. (2022). The ethics of the International AIDS Society, 25(Suppl 2).