Codes Of Ethics Regarding
Competence And Limits Of Confidentiality
In Treatment Of Clients With HIV/AIDS

Complete comparative list of different Codes of Ethics on a variety of topics

By Ofer Zur, Ph.D. and Tom Smith, Ph.D.

This page is part of an online course on Ethics of Working with Clients with HIV/AIDS for 10 CE Credit Hours.

Table Of Contents


This document is a part of an online course on Ethics of Treatment of Clients with HIV/AIDS. It focuses on the sections of the Codes of Ethics of the major professional organizations that deal with issues of confidentiality and reporting as they related to limits of confidentiality regarding harm due to infection to a third party. Ten major codes of ethics are discussed in this paper. The relevant sections of these codes to record keeping and informed consent will be presented and direct links to the codes online will be provided. Each section includes, when available, a direct quote from the code of ethics and annotation about its content.

Besides reviewing the sections on confidentiality and disclosures in the codes of ethics, the search of each code includes keywords, such as HIV, AIDS, disease, contagious, communicable, risk, danger and harm, competence, informed consent, client rights, written authorization, waivers, disclosure, third party payer disclosures, maintain adequate knowledge of laws and ethical codes, boundaries of competency, scope of competence, legal limits of confidentiality, abuse of authority and influence, documentation of informed consent and disclosures, and use of language understandable to the illiterate or uneducated.

Note: The bold lettering in the quotes from codes of ethics were added highlighted for the purpose of this paper and are not included in the original text. The notes in red italic are the authors’ reflections on each code.

American Association of Marriage and Family Therapist – AAMFT

Standard I Responsibility to Clients

1.2 Informed Consent. Marriage and family therapists obtain appropriate informed consent to therapy or related procedures and use language that is reasonably understandable to clients. When persons, due to age or mental status, are legally incapable of giving informed consent, marriage and family therapists obtain informed permission from a legally authorized person, if such substitute consent is legally permissible. The content of informed consent may vary depending upon the client and treatment plan; however, informed consent generally necessitates that the client: (a) has the capacity to consent; (b) has been adequately informed of significant information concerning treatment processes and procedures; (c) has been adequately informed of potential risks and benefits of treatments for which generally recognized standards do not yet exist; (d) has freely and without undue influence expressed consent; and (e) has provided consent that is appropriately documented.

1.8 Client Autonomy in Decision Making. Marriage and family therapists respect the rights of clients to make decisions and help them to understand the consequences of these decisions. Therapists clearly advise clients that clients have the responsibility to make decisions regarding relationships such as cohabitation, marriage, divorce, separation, reconciliation, custody, and visitation.

Standard II Confidentiality
2.1 Disclosing Limits of Confidentiality. Marriage and family therapists disclose to clients and other interested parties at the outset of services the nature of confidentiality and possible limitations of the clients’ right to confidentiality. Therapists review with clients the circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. Circumstances may necessitate repeated disclosures.

2.2 Written Authorization to Release Client Information. Marriage and family therapists do not disclose client confidences except by written authorization or waiver, or where mandated or permitted by law. Verbal authorization will not be sufficient except in emergency situations, unless prohibited by law. When providing couple, family or group treatment, the therapist does not disclose information outside the treatment context without a written authorization from each individual competent to execute a waiver. In the context of couple, family or group treatment, the therapist may not reveal any individual’s confidences to others in the client unit without the prior written permission of that individual.

Standard III Professional Competence and Integrity
3.2 Knowledge of Regulatory Standards. Marriage and family therapists pursue appropriate consultation and training to ensure adequate knowledge of and adherence to applicable laws, ethics, and professional standards.

3.10 Scope of Competence.Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies.

Note: AAMFT Code of Ethics does not mention any direct reference to AIDS, HIV, or to contagious or communicable disease. It does not refer to situations when clients are dangerous to others and only mentions that disclosures may be legally required.

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American Counseling Association – ACA

B.2. Exceptions
B.2.a. Serious and Foreseeable Harm and Legal Requirements
The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.

B.2.c. Contagious, Life-Threatening Diseases
When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if the parties are known to be at serious and foreseeable risk of contracting the disease. Prior to making a disclosure, counselors assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party. Counselors adhere to relevant state laws concerning disclosure about disease status.

ACA Code of Ethics of 2014 is one of the few codes that address the issue of contagious or communicable diseases, such as HIV/AIDS. Unlike almost all other codes it gives therapists some guidelines in regard to confidentiality and disclosures.

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American Mental Health Counselors Association – AMHCA (2020)

A. Counselor-Client Relationship
1. Primary Responsibility

CMHCs value objectivity and integrity in their commitment to understanding human behavior, and they maintain the highest standards in providing mental health counseling services.

  • a. A primary ethical principle of all CMHCs is to ensure client autonomy and self-determination. Therefore, barring cases of imminent harm to self or others, any therapeutic approach that impedes an individual’s right to make informed choices is not in accordance with the AMHCA Code of Ethics.
  • b. CMHCs communicate clearly with clients about the parameters of the counseling relationship. In a professional disclosure statement, they may provide information about expectations and responsibilities of both counselor and client in the counseling process, their professional orientation and values regarding the counseling process, emergency procedures, supervision (as applicable), and business practices.

A. Counselor-Client Relationship
2. Confidentiality

CMHCs have an obligation to safeguard information about individuals obtained in the course of practice, teaching, and research. Personal information is communicated to others only with the client’s consent, preferably written, or in circumstances dictated by state and federal laws. Disclosure of counseling information is restricted to what is necessary and relevant.

  • a. Confidentiality is a right granted to all clients of mental health counseling services. From the onset of the counseling relationship, CMHCs inform clients of these rights, including legal limitations and exceptions.
  • b. The information in client records belongs to the client and shall not be shared without permission granted through a formal release of information. In the event that a client requests that information in client records be shared, CMHCs educate clients to the implications of sharing the materials.
  • c. The release of information without the consent of the client may only take place under the most extreme circumstances: the protection of life (suicidality or homicidality), child abuse, abuse of persons legally determined as incompetent, and elder abuse. CMHCs are required to comply with state and federal statutes concerning mandated reporting.
  • d. CMHCs (and their staff members) do not release information by request unless accompanied by a specific release of information or a valid court order. CMHCs make every attempt to release only the information necessary to comply with the request or valid court order. CMHCs are advised to seek legal advice upon receiving a subpoena in order to respond appropriately.

B. Counseling Process
1. Treatment Plans

  • a. CMHCs and their clients work jointly to devise integrated, individual treatment plans that offer reasonable promise of success and are consistent with the abilities; ethnic, social, cultural, and values backgrounds; and circumstances of the clients.

2. Informed Consent
Clients have the right to understand what to expect in counseling and the freedom to choose whether and with whom they enter a counseling relationship.

  • a. CMHCs provide information that allows clients to make an informed decision about selecting a provider. Such information typically includes counselor credentials, confidentiality protections and limits, the use of tests and inventories, diagnoses, reporting, billing, and therapeutic process. Restrictions that limit clients’ autonomy are explained.
  • b. When a client is unable to provide consent, CMHCs act in the client’s best interest. Parents and legal guardians are informed about the confidential nature of the counseling relationship. CMHCs embrace the diversity of family systems and the inherent rights and responsibilities parents/guardians have for the welfare of their children. CMHCs strive to establish collaborative relationships with parents/guardians to best serve their minor clients.
  • c. Informed consent is ongoing and needs to be reassessed throughout the counseling relationship.

B. Counseling Process
7. Clients’ Rights

Clients have the right to be treated with dignity, consideration, and respect at all times. Clients have the right to:

  • a. Quality services provided by concerned, trained professionals and competent staff.
  • b. Confidentiality within the limits of both federal and state law, to be informed about the exceptions to confidentiality, and to expect that no information will be released without the client’s knowledge and written consent.
  • c. Information such as time of sessions, payment plans/fees, absences, access, emergency procedures, third-party reimbursement procedures, termination and referral procedures, and advanced notice of the use of collection agencies.
  • d. Clear information about the purposes and goals of counseling.
  • e. Appropriate information regarding the CMHC’s education, training, and practice limitations.
  • f. Full, knowledgeable, and responsible participation in the ongoing treatment plan to the maximum extent feasible.
  • g. Obtain information about their case record and to have this information explained clearly and directly.
  • h. Request information and/or consultation regarding the progress of their therapy.
  • i. Refuse any recommended services, techniques, or approaches and to be advised of the consequences of this action.
  • j. A safe environment for counseling free of emotional, physical, or sexual abuse.
  • k. A clearly defined termination process, and to discontinue therapy at any time.

B. Counseling Process
8. End-of-Life Care for Terminally Ill Clients

  • a. CMHCs ensure that clients receive quality end-of-life care for their physical, emotional, social, and spiritual needs. This includes providing clients with an opportunity to participate in informed decision-making regarding their end-of-life care, and a thorough assessment from a qualified professional of clients’ ability to make competent decisions on their behalf.
  • b. CMHCs are aware of their own competency as it relates to end-of-life decisions. When CMHCs assess that they are unable to work with clients on the exploration of end-of-life options, they make appropriate referrals to ensure clients receive appropriate help.
  • c. Depending on the applicable state laws, the circumstances of the situation, and after seeking consultation and supervision from competent professional and legal entities, CMHCs have the option to respect the confidentiality of terminally ill clients who plan to end their lives.

C. Counselor Responsibility and Integrity
1. Competence

The maintenance of high standards of professional competence is a responsibility shared by all CMHCs in the best interests of the client, the public, and the profession. CMHCs:

  • a. Recognize the boundaries of their particular competencies and the limitations of their expertise.
  • b. Provide only those services and use only those techniques for which they are qualified by education, training, or experience.
  • c. Maintain knowledge of relevant scientific and professional information related to the services rendered and recognize the need for ongoing education.
  • d. Represent accurately their competence, education, training, and experience including licenses and certifications.
  • f. Recognize the importance of continuing education and remain open to new counseling approaches and procedures documented by peer-reviewed scientific and professional literature.
  • g. Recognize the important need to be competent with respect to cultural diversity; CMHCs are sensitive to the diversity of different populations and to changes in cultural expectations and values over time.
  • h. Recognize that their effectiveness is dependent on their own mental and physical health. Should their professional judgment or competency be compromised for any reason, they seek capable professional assistance to determine whether to limit, suspend, or terminate services to their clients.
  • i. Have a responsibility to maintain high standards of professional conduct at all times.
  • k. Have a responsibility to empower clients, when appropriate.
  • l. Are aware of the intimacy of the counseling relationship, maintain a healthy respect for the integrity of the client, and avoid engaging in activities that seek to meet the CMHC’s personal needs at the expense of the client.
  • m. Actively attempt to understand the diverse cultural backgrounds of the clients with whom they work. This includes learning how the CMHC’s own cultural/ethical/racial/religious identities impact their own values and beliefs about the counseling process.
  • n. Are responsible for continuing education and remaining abreast of current trends and changes in the field, including the professional literature on best practices.
  • o. Develop a plan for termination of practice, death, or incapacitation by assigning a colleague or records custodian to handle transfer of clients and files.
  • p. Make an effort to avoid using language that may be offensive to individuals.

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American Psychiatric Association – ApA
The Principles of Medical Ethics With Anno­tations Especially Applicable to Psychiatry Library/Practice/Ethics Documents/principles2013–final.pdf

Note: ApA Principles of Medical Ethics provide very general view of medical ethics. It is one of the most broad and general codes that does not detail situations and behaviors like most other codes. Consistent with that, the code does not directly refer to terms, such as AIDS, HIV, or to contagious or communicable diseases. It does not even mention that disclosures may be legally required.

American Psychological Association – APA

General Principles
Principle D: Justice
Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.

2. Competence
2.01 Boundaries of Competence
(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study

3. Human Relations
3.10 Informed Consent
(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code.
(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual’s assent, (3) consider such persons’ preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual’s rights and welfare.
(c) When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.
(d) Psychologists appropriately document written or oral consent, permission, and assent.

4. Privacy And Confidentiality
4.02 Discussing the Limits of Confidentiality
(a) Psychologists discuss with persons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship (1) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities. (See also Standard 3.10, Informed Consent.)
(b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant.

4.05 Disclosures
(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose

Note: APA Code of Ethics does not mention any direct reference to AIDS, HIV, or to contagious or communicable disease. It only mentions that disclosures may be legally required or allowed.

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California Association of Marriage and Family Therapists – CAMFT (2019)

Marriage and family therapists advance the welfare of families and individuals, respect the rights of those persons seeking their assistance, and make reasonable efforts to ensure that their services are used appropriately.

Marriage and family therapists do not condone or engage in discrimination, or refuse professional service to anyone on the basis of race, ethnicity, national origin, indigenous heritage, immigration status, gender, gender identity, gender expression, sexual orientation, religion, age, disability, socioeconomic status, or marital/relationship status. Marriage and family therapists make reasonable efforts to accommodate clients/patients who have physical disabilities.

Marriage and family therapists are aware of and do not perpetuate historical and/or social prejudices when diagnosing and treating clients/patients because such conduct may lead to misdiagnosing and pathologizing clients/patients.

Marriage and family therapists respect client/patient choices, the right of the client/patient to make decisions, and help them to understand the consequences of their decisions. When clinically appropriate, marriage and family therapists advise their client/patient that decisions on the status of their personal relationships, including separation and/or divorce, are the responsibilities of the client/patient.

Marriage and family therapists work with clients/patients to develop and review treatment plans that are consistent with client/patient goals and that offer a reasonable likelihood of client/ patient benefit.

Marriage and family therapists respect the confidences of their client(s)/patient(s). Marriage and family therapists have unique confidentiality responsibilities because the client/patient in a therapeutic relationship may include more than one person.

Marriage and family therapists do not disclose client/patient confidences, (including the names or identities of their clients/patients), to anyone except as mandated by law, as permitted by law, when the marriage and family therapist is a defendant in a civil, criminal, or disciplinary action arising from the therapy (in which case client/patient confidences may only be disclosed in the course of that action), or if there is an authorization previously obtained in writing. Such information may only then be revealed in accordance with the terms of the authorization.

When there is a request for information related to any aspect of psychotherapy or treatment, each member of the unit receiving such therapeutic treatment must sign an authorization before a marriage and family therapist will disclose information received from any member of the treatment unit.

Marriage and family therapists advise clients/patients of the information that will likely be disclosed (such as dates of treatment, diagnosis, prognosis, progress, and treatment plans) when submitting claims to managed care companies, insurers, or other third-party payers.

Marriage and family therapists respect the fundamental autonomy of clients/patients and support their informed decision-making. Marriage and family therapists assess their client’s/patient’s competence, make appropriate disclosures, and provide comprehensive information so that their clients/patients understand treatment decisions.

Marriage and family therapists respect the rights of clients/patients to choose whether to enter into, to remain in, or to leave the therapeutic relationship. When significant decisions need to be made, marriage and family therapists provide adequate information to clients/patients in clear and understandable language so that clients/patients can make meaningful decisions about their therapy.

When a marriage and family therapist’s personal values, attitudes, and/or beliefs are a prejudicial factor in diagnosing or limiting treatment provided to a client/patient, the marriage and family therapist shall disclose such information to the client/patient or facilitate an appropriate referral in order to ensure continuity of care.

Marriage and family therapists inform clients/patients of the potential risks and benefits of therapy when utilizing novel or experimental techniques or when there is a risk of harm that could result from the utilization of any technique.

Marriage and family therapists are encouraged to inform clients/patients of significant exceptions to confidentiality such as child abuse reporting, elder and dependent adult abuse reporting, and clients/patients dangerous to themselves or others.

Marriage and family therapists are encouraged to disclose to clients/patients, at an appropriate time and within the context of the psychotherapeutic relationship, their experience, education, specialties, and theoretical orientation.

Marriage and family therapists continually monitor their effectiveness when working with clients/patients and continue therapeutic relationships only so long as it is reasonably clear that clients/ patients are benefiting from treatment.

Marriage and family therapists discuss appropriate treatment alternatives with clients/patients. When appropriate, marriage and family therapists advocate for the mental health care they believe will benefit their clients/patients. Marriage and family therapists do not limit their discussions of treatment alternatives to what is covered by third-party payers.

Marriage and family therapists document treatment in their client/patient records, such as major changes to a treatment plan, changes in the unit being treated and/ or other significant decisions affecting treatment.

Marriage and family therapists maintain high standards of professional.

Marriage and family therapists create and maintain client/patient records consistent with sound clinical judgment, standards of the profession, and the nature of the services being rendered.

Marriage and family therapists remain current with developments in their field through educational activities or clinical experiences. Marriage and family therapists, when acting as teachers, supervisors, and researchers, stay informed about changes in the field, maintain relevant standards of scholarship, and present accurate information.

Marriage and family therapists actively strive to identify and understand the diverse backgrounds of their clients/patients by obtaining knowledge, gaining personal awareness, and developing sensitivity and skills pertinent to working with a diverse client/patient population.

Marriage and family therapists make continuous efforts to be aware of how their cultural/racial/ethnic identities, values, and beliefs affect the process of therapy. Marriage and family therapists do not exert undue influence on the choice of treatment or outcomes based on such identities, values, and beliefs.

Marriage and family therapists do not engage in sexual harassment or other forms of harassment or exploitation of clients/patients, students, supervisees, employees, or colleagues.

Marriage and family therapists take care to provide proper diagnoses of psychological disorders or conditions and do not assess, test, diagnose, treat, or advise on issues beyond the level of their competence as determined by their education, training, and experience. While developing new areas of practice, marriage and family therapists take steps to ensure the competence of their work through education, training, consultation, and/or supervision.

Marriage and family therapists represent facts regarding services rendered and payment for services fully and truthfully to third-party payers and/or guarantors of payment. When appropriate, marriage and family therapists make reasonable efforts to assist their clients/patients in obtaining reimbursement for services rendered.

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National Association of Social Workers – NASW

Commitment to Clients
Social workers’ primary responsibility is to promote the well­being 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.

1.03 Informed Consent
(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients’ right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.
(b) In instances when clients are not literate or have difficulty understanding the primary language used in the practice setting, social workers should take steps to ensure clients’ comprehension. This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter or translator whenever possible.
c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients’ interests by seeking permission from an appropriate third party, informing clients consistent with the clients’ level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients’ wishes and interests. Social workers should take reasonable steps to enhance such clients’ ability to give informed consent.

1.07 Privacy and Confidentiality
(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 other identifiable person. 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.
(d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made. 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 worker­client relationship and as needed throughout the course of the relationship.
(f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements.

Note: NASW Code of Ethics does not mention any direct reference to AIDS, HIV, or to contagious or communicable disease. It does refer to situations when clients are dangerous to others and does mentions that disclosures may be legally required.

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National Board for Certified Counselors (NBCC)

1. NCCs, recognizing the potential for harm, shall not share information that is obtained through the counseling process without specific written consent by the client or legal guardian except to prevent clear, imminent danger to the client or others or when required to do so by a court order.

16. NCCs shall not release the results of tests and assessments to individuals other than the client without prior written consent except as required to prevent clear, imminent danger to the client or others; by written agreement with the client; or when legally required to do so by a court order or governmental agency.

Note: NBCC Code of Ethics does not mention any direct reference to AIDS, HIV, or to contagious or communicable disease. It does refer to situations when clients are dangerous to others and does not mention that disclosures may be legally required.

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