I need an explanation for this Social Science question to help me study.
Case Study 2:
A 14-year-old boy was infected with HIV during birth. He tells his social worker that he is going to develop an intimate relationship with his new girlfriend. The boy’s parents are concerned about stigma and discrimination and have chosen not to tell the boy about his HIV status.
Respond to at least two different colleagues’ postings in one or more of the following ways:
Provide a constructive critique of your colleague’s post by sharing a different perspective of the dilemma.
Post additional challenges when applying ethical codes.
Refute or validate your colleagues’ ethical decisions. Provide your rationale by referring to the NASW Code of Ethics.
Be sure to use references:
DB 1
Alecia,
I chose scenario 2, where a boy was born infected with HIV and his parents were hesitant to disclose it to him due to stigma. This was a very complex ethical issue The patient was entering a romantic relationship and was unaware of his status. The ethical standards that relates to this scenario is 1.01 Commitment to Clients and 1.07 Privacy and Confidentiality. My concern would be the patient’s health and his knowledge of his status so that he can get proper treatment, education and support. While my commitment to the patient and his family are to provide quality care and protect his privacy, it is worth considering the public health risk and possible infection of his girlfriend and other partners. This has to be balanced with maintaining the confidentiality of the patient’s status unless permitted by law of consent.
Without treatment of the virus, it is a risk to the patient’s health and more of a risk to his partners. Not knowing his status does not give him an opportunity to get the proper care, education and support he needs (medical, psychiatric / psychological) in order to adjust having HIV. There is a delicate balance – the age, intellectual / emotional capacity of the child and developmental stage (sexually mature) have to be factored in the choice to disclose. For that reason, I would ask for permission to involve a mediator so that all of the options could be map out the options to decide which way to go. (Klietzman, et. al, 2008) Klietzman, et. al found that it was most beneficial when caregivers exposed HIV status to the child.
HIPAA, 45 CFR §164.512(b)(1)(i) states that covered HIPAA-covered entities, such as medical providers may (CDPH, 2019) alert the CDC of a person’s status without consent needed (CDPH, 2019; CDPH. 2017) It is mandatory to report the son’s person to the public health officer so that research can be done in effort to contain the incidence and minimize spread. (CDPH, 2019) In the state of California, not reporting to the health authorities can result in a misdemeanor conviction. (CDPH, 2019) With HIV status there are a lot of protections so that disclosure can only happen with consent. (CDPH, 2019) There is also an exception to disclosure that a physician or surgeon can disclose a to a partner without identifying information once a test result is confirmed. I would also have an obligation to disclose this to other medical professionals that are involved in providing services to the son. .
Before disclosure to any one, a test would have to be performed to confirm the diagnosis, if results are not already available. This would require consent. An minor is able to consent as early as 12 years old to testing and services (CDC, 2020), disclosure guidelines are unclear. (Klietman, et. al, 2008)
The law assumes that the parents act in the best interest of the child, so it is important to work with the parents as much as possible until a risk is posed, after which, I would have to re-consider disclosing to the child after consulting our Ethics Committee. (Klietzman, et. al, 2008)
References
California Department of Public Health, CDPH. (2019) Office of AIDS: HIV Laws.
https://www.cdph.ca.gov/Programs/CID/DOA/Pages/HIVLaws.aspx
California Department of Public Health, CDPH. (2019) Office of AIDS: HIV Laws: HIPPAA and public health
disclosures. https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Do…
California HIV/AIDS Policy Research Centers. (n.d.) CA HIV Laws. https://californiaaidsresearch.org/topic-
areas/hiv-laws_final.pdf
Center for Disease Control. (2020) Minors’ consent laws for HIV and STD services.
https://www.cdc.gov/hiv/policies/law/states/minors.html
Klitzman, R., Marhefka, S., Mellins, C., & Wiener, L. (2008). Ethical issues concerning disclosures of HIV
diagnoses to perinatally infected children and adolescents. The Journal of clinical ethics, 19(1), 31–42.
National Association of Social Workers. (2017). Code of ethics of the National Association of Social
DB 2
Katherine,
For the purpose of this discussion I have chosen to focus on case study #2 regarding the 14-year-old boy who was infected with HIV during birth and is wanting to develop an intimate relationship with his new girlfriend, however, his parents are concerned about the stigma and discrimination that their son may face if they let him know of his diagnosis and have chosen not to tell him about his HIV status.
Post an explanation of the ethical dilemma in the case you selected.
When reading this case study immediately it seems as though there are two ethical dilemmas in the case. First, for me is that I feel the 14-year-old boy has a right to know about his diagnosis, yet the parents are wanting to hold off on letting him know due to potential stigma and discrimination that may occur as a result. It results in an ethical dilemma of does the young boy have a right to know the truth about his HIV diagnosis and if so, does this violate the right of his Mother’s privacy regarding her own diagnosis? Another ethical dilemma this may pose for a social worker is the difficulty of hearing the client mention that he plans to become sexually active with an individual, knowing that the client isn’t aware of their own diagnosis due to the parents choice to conceal that information and knowing that that now means another individual is potentially at risk of contracting the HIV without any proper warning.
From the perspective of the medical social worker, explain which ethical standards need to be considered and how those standards may suggest different ethical courses of action.
The first ethical standard that needs to be considered is standard 1.01 Commitment to Clients. in regards to this standard, Barnett (n.d.) points out that one of the major concerns involves the different but related roles of ethics, law, and clinical practice and regards to the “duty to warn and duty to protect” statutes. Another crucial reason why as mental health professionals we must be current with local, state, and federal laws as they pertain to practice with clients. For instance, in the state of California the duty to warn and/or duty to protect statutes do not apply to a client who is HIV positive, disclosing they plan to engage in sexual activities with another individual and therefore the social worker has no grounds to disclose their client’s diagnosis without their consent to do so. This also ties in with ethical standard 1.07 Privacy and Confidentiality.
Explain how you might respond to the ethical dilemma as the medical social worker in this case.
According to Mandalazi, Bandawe, and Umar (2014) it is usually the parents or guardians of children and adolescents who are faced with the task of informing the child living with HIV about his or her positive status, and according to Klitzman, Marhefka, Mellins, and Wiener (2008), healthcare workers often disagree with caregivers or parents about whether, when, and how to disclose HIV serostatus to perinatally HIV-infected children and adolescents. As the medical social worker, I would work with both of the parents separately from the client to provide and empathize with their concerns around telling their son, however, I would also provide psychoeducation around the potential harm that could arise if they continue to choose not to tell him, such as: he becomes sexually active and potentially passes HIV on to someone else, or if he ends up upset or resentful that his parents didn’t tell him sooner, how his adherence to treatment may increase if he is made aware, etc. Essentially respectfully weighing out a lot of the pros and cons that exist around deciding whether or not to tell their son. In the state of California minors can consent to HIV testing or treatment as well as consent to STI services as young as 12 years old without parental consent or knowledge. I would also offer support services around how they can tell their son if they at that point decide to and offer to be present and provide family services if needed. This may help ease the parents to know they will have support present during a high stress conversation. If the parents still decide they are still not quite ready to disclose this information to their son then working with them to determine the best time to move forward with the disclosure process and work out a plan and course of action.
When working with the client providing information around practicing safe sex as well as his rights to any confidential testing/screenings for STI’s or HIV if he so chooses as he is above the age limit of 12 years old to consent in the state of California.
Explain two ethical responsibilities for a medical social worker in response to this case.
There are several ethical responsibilities that exist in this case. One ethical responsibility for a medical social worker in this case would be to demonstrate competence. Under ethical standard 1.04 social workers need to be knowledgeable and comply with laws, regulations, and standards as it pertains to this particular scenario and the ethical dilemmas it poses, while also exercising careful judgment. Another ethical responsibility for the medical social worker falls within ethical standard 1.01 Commitment to Clients, in which the medical social worker has a primary responsibility to promote the well-being of the 14-year-old and also advocate on his behalf.
References
Barnett, J. (n.d.). Is there a Duty to Warn When Working with HIV-Positive Clients? Retrieved from https://societyforpsychotherapy.org/ask-the-ethici…
Klitzman, R., Marhefka, S., Mellins, C., & Wiener, L. (2008). Ethical issues concerning disclosures of HIV diagnoses to perinatally infected children and adolescents. The Journal of clinical ethics, 19(1), 31-42.
Mandalazi, P., Bandawe, C., & Umar, E. (2014). HIV Disclosure: Parental dilemma in informing HIV infected children about their HIV status in Malawi. Malawi medical journal: the journal of Medical Association of Malawi, 26(4), 101-104.
National Association of Social Workers. (2017). Code of ethics of the National Association of Social Workers. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of…
