Rights and Responsibilities of Psychologists and Clients – Informed Consent

Dr. Donna L. Roberts

The ethical duty to involve patients in their health care

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A fundamental aspect of the ethical practice of psychology involves clearly defining the rights and responsibilities of both the client and the psychologist as they engage in the collaborative task of therapy. These guidelines permeate all phases of the treatment relationship and represent issues paramount for protecting all parties and serving the best interest of the client. The topic encompasses both moral and legal issues, including informed consent, record keeping, involuntary hospitalization, malpractice, confidentiality, and the duty to warn and protect.

Informed Consent

Informed consent “involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it. The main purpose of informed consent is to increase the chances that the client will become involved, educated and a willing participant in his or her therapy” (Corey, Corey & Callahan, 2002, p. 149). It originates from the legal right patients have to direct the course of their therapy and from the ethical duty of the therapist to involve patients in their health care.

Complete informed consent includes a discussion of the following elements:

  • the nature of the decision/intervention/treatment
  • reasonable alternatives to the proposed intervention
  • the relevant risks, benefits, and uncertainties related to each alternative
  • assessment of patient understanding
  • acceptance of the intervention by the patient (Edwards, 1999).

Additionally, in order for the consent to be valid, patients must be considered competent to make the decision and the consent must be voluntary. Psychologists must guard against potentially coercive situations in therapeutic settings. Patients experiencing emotional difficulties often feel powerless and vulnerable and can be easily persuaded by someone they consider an authority figure. The true goal of informed consent is active participation in the decisions and progress of therapy, not merely securing the required signature on a form.

Therapists often find that they encounter a fine line between directing the process of therapy along their preferred theoretical orientation and allowing patients the maximum autonomy in their therapy, particularly with regard to aspects of treatment which tend to elicit client resistance. This ethical dilemma can be best dealt with by developing a strong therapeutic relationship and taking the time to ensure full understanding on the part of their patients, whenever possible. This includes addressing informed consent issues at the onset of therapy and also strategically sharing insights about the progress of therapy with patients throughout the course of treatment.

Ethically speaking, comprehension on the part of the patient is equally as important as providing the information. This requires not only clearly explaining the situation at the patients’ level of comprehension, but assessing their understanding of the whole process.

With regard to assessing an appropriate level of disclosure and explanation, the literature and law in this area suggest one of three approaches:

· Reasonable professional standard: What would a typical professional say about this intervention?This standard allows the therapist to determine what information is appropriate to disclose. However, it is probably not enough, since most research in this area shows that the typical therapist tells the patient very little. This standard is also generally considered inconsistent with the goals of informed consent as the focus is on the professional rather than on what the patient needs to know.

· Reasonable Patient Standard: What would the average patient need to know in order to be an informed participant in the decision? This standard focuses on considering what a patient would need to know in order to understand the decision at hand.

· Subjective Standard: What would this patient need to know and understand in order to make an informed decision? This standard is the most challenging to incorporate into practice, since it requires tailoring information to each patient. (Edwards, 1999).

Ethical issues involving aspects of the rights and responsibilities inherent in each role of the therapeutic relationship can be complex and controversial. While the basic mandate of acting in the best interests of the client seems straightforward, in practice, it can require challenging professional assessments and judgment calls, and is thus subject to debate and conflicting interpretation. The issues are further complicated by the various legal standards and requirements related to patient issues. Practitioners must be firmly grounded in their professional standards and clearly demonstrate their continued commitment to serving the psychological well being of their clients, even when, or more precisely, especially when, difficult ethical dilemmas arise.

References

Corey, G., Corey, M. and Callahan, P. (2002). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.

Edwards, K. A., University of Washington, School of Medicine. (1999). Ethics in medicine: Informed consent. http://eduserv.hscer.washington.edu/bioethics/topics/consent.html

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