Issues of confidentiality in fertility counselling

Confidentiality is arguably the most frequent source of ethical dilemmas for counsellors of all types, but especially those working within or alongside multidisciplinary teams in clinical settings. Infertility counsellors fall within this category and are frequently faced with difficult decisions about what issues to treat as strictly confidential to the counselling relationship and when to disclose information to other members of the clinical team. This article examines the professional parameters within which infertility counsellors make these decisions under the Human Fertilisation and Embryology Authority (HFEA) Code of Practice. These parameters place considerable reliance on the professional judgement of the counsellor, which raises the issue of how best to conceptualize these dilemmas. The second part of this article examines how some counsellors working in a closely related field, namely HIV counselling, have ameliorated this dilemma by distinguishing ethical stances appropriate to different circumstances. The positive response of participants at the British Infertility Counselling Association Conference at the Tavistock Centre in London on 25 May 1999 suggests that this type of ethical framework would be useful for informing the ethical decision-making of these counsellors and developing a positive appreciation of ethical diversity of practice within the multidisciplinary team. The final sections of this article examine these potential applications.