Working Through the Ethical Code

Q. I would really appreciate some feedback on this ethical concern that has recently come up at my school. Last week, I spoke with a student who had concerns about her friend thinking of suicide. I spoke with the friend in question, and she denied any suicidal ideations or intentions. She did admit to a recent incident of cutting herself but said she did not have thoughts of suicide, thought the cutting was “stupid” and did not intend to do it again. The student is 18. Administration feels strongly that I should call her parents and inform them of the situation. Is this an unethical breach of confidentiality due to the fact that the concern of suicide is based solely on rumors from other students? Is the fact that she is 18 and legally an adult also a part of breaching confidentiality? Please help by giving an interpretation of the ethical code in this situation and what actions we should take from here or in similar situations in the future.

ASCA’s Ethical Standards for School Counselors is a guideline to help school counselors make tough decisions. The code helps us maintain our professional focus on doing what is best for students. We must factor into each scenario the uniqueness of the situation, every individual in that situation and our own style. Therefore, we must use ethical codes as guidelines; they can’t provide concrete answers of yes or no, right or wrong, black or white. Often however we are searching for that unambiguous answer when we have to make difficult professional choices. As one of my counselor educator colleagues always says, “Dealing with ambiguity is one of the components of becoming a good counselor.”

With that said, the situation above offers a chance to consider some of those ambiguous ethical areas that are often present as we work with young people in a school system.

The issue of majority, age of consent and developmental age seems to create a veil around ethical and legal issues of in school counseling. In the case mentioned above, age is one of the factors contributing to this ethical dilemma but perhaps not the most poignant factor. In this situation, we must also consider level of suicide ideation, confidentiality and duty to warn regarding the parents’ rights.

Although this school counselor has already used several steps in decision making, there are some other considerations to be added to this process.

Considerations 
Certainly the confidentiality issue is of great importance, but in the case of possible suicidal ideation, safety for the student trumps confidentiality. Unfortunately, a school counselor must consider the worst-case scenario and assume the threat was real despite what the student is said in the session. The fact that the student is 18 doesn’t make that much difference when safety is concerned, especially when the student is still under parental care.

Because a student turns 18 does not necessarily deny parents’ rights. According to FERPA and the federal tax code, parents still have rights when their child is under their care despite the fact that the student is 18 years old, but the age does muddy the waters. In Bogust vs. Iverson (1960) the counselor was sued for neglect because an18-year-old child committed suicide, and the counselor, who had information on the student’s suicide ideation several weeks earlier, had not notified the parents of the child’s ideation. While the court case did not find the counselor guilty of neglect, this case and others have put school personnel on notice to receive professional development education on suicidal ideation.

In a more current court case, Eisel vs. Board of Education of Montgomery County (1991), the court ruled “school counselors have a duty to use reasonable means to prevent a suicide when they are on notice of a child or adolescent student’s suicidal threat.” Had the school personnel called parents, the case would probably not have gone to court.

While the “threat” in the above-mentioned situation seems benign and based on third-party information, we still must factor the issues of confidentiality and parents’ rights into the decision. The ASCA Ethical Code encourages consideration of parents’ rights in B.1 a.: Respects the rights and responsibilities of parents/guardians for their children and endeavors to establish, as appropriate, a collaborative relationship with parents/guardians to facilitate the student’s maximum development.

Giving consideration to the parents’ rights must be balanced with the moral principle of nonmaleficience, which encourages school counselors to avoid betraying confidentiality that could possibly have a negative impact on the counseling relationship. However, the school counselor must weigh the cost of breaching the trust of the student with the possibility that the student really is at risk. Unfortunately, confidentiality for a student with self-destructive thoughts or behaviors continues to put all school counselors in a double bind – honor the confidentiality or fear the worst.

Section A.7.a. of the Ethical Standards states: “The professional school counselor informs parents/guardians or appropriate authorities when the student’s condition indicates a clear and imminent danger to the student or others. This is to be done after careful deliberation and, where possible, after consultation with other counseling professionals.”

Based on the conversation with the student, clear and imminent danger was not established in this situation. So does that complete the school counselors’ duty in this case? A proactive school counselor will assess not only the lethality of the threat but will also document the process and the outcome. It would be helpful to also document how informed consent and limitations to confidentiality were delivered to the student.

As the school counselor ponders whether to inform parents, the ASCA Ethical Standards are once again helpful guidelines. Section A.7.b states: “The professional school counselor will attempt to minimize threat to a student and may choose to 1) inform the student of actions to be taken, 2) involve the student in a three-way communication with parents/guardians when breaching confidentiality or 3) allow the student to have input as to how and to whom the breach will be made.”

Even though this school counselor feels the student is not a risk to self, the lingering “what if…” is still a concern. Since it is often difficult to be certain of anyone’s intentions, many professional school counselors encourage erring on the side of caution.

An additional aspect of ethical action is board policy. Most states have not established laws regarding limits of confidentiality in the school setting; therefore many school boards have initiated their own regulations. The school counselor will need to verify the board policy on this matter, if there is indeed any board policy regarding confidentiality and parents’ rights. However, as the school counselor goes through all of these considerations, seeking consultation with others professionals should be part of the process.

While consultation with others in the profession is incumbent upon the professional school counselor when considering ethical action, it is important to consult not only peers of like mind but to consult with those who may offer a different point of view. In that way, the school counselor can hear all considerations before making a final decision. This may help in assuring that no unconsidered aspects of the case were missed.

Options and Actions
Given all the information gathered, it’s time to move into the action phase of decision making. As the school counselor considers those actions, the final question at the end of each action should be “at what risk?” Some possibilities for action might include:

• Not sharing with parents and keeping the information confidential. (At what risk?)
• Call the parents without consent from the student. (At what risk?)
• Help the student understand the value of telling her parents about the rumor. (At what risk?) There are multiple ways in which this can be done, but most important to this plan is how will you, the school counselor, know that the student has told her parents?
• Conduct a discussion with the student who shared the rumor with you and the student of concern. (At what risk?) This may clarify the concerns of both students and help with the ethical decision making as the school counselor hears all sides of this story.

Confidentiality is the core of our professional relationship with students; however, the student’s safety supersedes confidentiality. As school counselors, we are often expected to evaluate a student’s level of risk. We must also evaluate the level of risk of not informing parents even when we believe the student’s risk level is low. A wise school counselor once told me, “Make decisions that will allow you to sleep at night.” Words to wisdom in all the ethical decisions we make.

Rhonda Williams, Ed.D., LPC, NCC, is an assistant professor at the University of Colorado at Colorado Springs and the chair of ASCA’s Ethics Committee. She can be reached atrwilliam@uccs.edu