Professional and Ethical Responsibilities
This domain tests ethical standards, confidentiality, boundaries, scope of practice, and documentation. The exam presents dilemmas and expects you to identify the controlling rule, consult, act, and document.
Core rules
- Core ethical principles: autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.
- Informed consent covers the nature of services, limits of confidentiality, fees, alternatives, and the right to withdraw.
- Confidentiality limits include imminent danger to self or others, child/elder/dependent adult abuse, court orders, and qualified service organization arrangements. Know your state duty-to-warn law.
- 42 CFR Part 2 governs SUD records; HIPAA also applies. Use the minimum necessary disclosure.
- Practice within training and scope; refer or supervise when outside it.
- Avoid dual relationships, bartering, sexual relationships, and social media connections; follow policy on gifts.
- Document contemporaneously, objectively, and without alteration.
Worked example
A client says he plans to seriously injure his ex-partner tonight. Reasoning: confidentiality is not absolute. Assess immediacy and means, consult a supervisor, follow state duty-to-warn/protect law (notify the intended victim and/or law enforcement as required), document actions, and continue safety planning. Do not promise secrecy, and do not disclose more than necessary.
Traps
- Promising absolute confidentiality.
- Disclosing to family without valid consent.
- Treating a client outside scope.
- 'Friendly' dual relationships and social media.
- Altering records.