Reference · Values and Ethics

Informed consent

The short answer

Valid informed consent needs capacity, adequate disclosure, understanding, and a voluntary choice.[1] It is given in clear language and covers the purpose, risks, costs, alternatives, and the right to refuse or withdraw.[1] Capacity is judged decision by decision; a diagnosis or a guardian does not erase it.[2][1]

The key ideas

  • NASW 1.03(a) Informed consent elements

    Valid informed consent is given in clear language and covers purpose of services, risks, third-party payer limits, costs, alternatives, right to refuse or withdraw, and the time frame of consent, with chance to ask questions.[1]

  • NASW 1.03(c)-(d) Consent: incapacity and involuntary clients

    If a client lacks capacity, seek permission from an appropriate third party, inform the client at their level of understanding, see that the third party acts on the client's wishes and interests, and enhance the client's ability to consent. Involuntary clients should be told the nature and extent of services and the extent of their right to refuse service.[1]

  • NASW 1.03(e)-(i) Consent and technology

    When using technology, discuss technology policies, obtain consent at initial screening, assess capacity and suitability for remote services, verify client identity and location, get consent before recording or third-party observation, and get consent before an electronic search on a client.[1]

  • Informed consent: elements

    Valid informed consent requires capacity, adequate disclosure (purpose, risks, costs, alternatives, right to refuse or withdraw, time frame), understanding, and voluntariness. For social workers NASW 1.03 spells out what to disclose and how to handle low literacy, interpreters, involuntary clients and technology.[1]

  • Decision-making capacity

    Capacity is decision-specific and assessed by abilities: understanding, appreciation, reasoning, and expressing a choice. Lack of capacity in one area does not mean incapacity in all. When a client lacks capacity, seek an appropriate third party while involving the client as far as possible and safeguarding their rights.[2][1]

  • NASW 1.14 Clients who lack decision-making capacity

    When acting for clients who lack capacity, take reasonable steps to safeguard their interests and rights.[1]

  • Research ethics: IRB and informed consent

    Research with human participants needs IRB review, voluntary informed consent (purpose, risks, benefits, right to withdraw), confidentiality, protection of vulnerable groups, and debriefing if deception is used. Belmont principles: respect for persons, beneficence, justice.[3][4]

It varies by state

The exam is national, so it tests the shared principle. Your state's law decides the details below.

  • HIPAA minors and personal representatives

    A parent or guardian is generally the personal representative of an unemancipated minor, but not for care the minor may lawfully consent to alone, or where a court or law allows consent, or where the parent agreed to confidentiality. Disclosure to parents then follows state or other law.[5]

  • Minors consent basics

    Minors generally need parent or guardian consent, with state-defined exceptions: emancipation or marriage, mature minor rules, and specific services such as outpatient mental health, substance use, or reproductive care. HIPAA treats the minor as the individual for care they may lawfully consent to alone. When a minor cannot consent, still seek the minor assent.[6][5]

  • State variation: minors outpatient mental health consent age

    National principle: parents generally consent for minors, but many states let minors consent to outpatient mental health care at a set age or with maturity. What varies: whether minors may consent, the threshold (12 to 16 in a 2015 review, most often 14 for outpatient), inpatient vs outpatient, and parent notification. Compilations disagree and laws change often.[6]

Find your state's licensing guide, then read your state's statute before you rely on any summary.

How the ASWB exam tests it

  • Expect to identify which element is missing from a consent discussion, or what to do first with a new client.[1]
  • Mandated clients still get an explanation of services and of how far they can refuse; their right to refuse may be limited. Incapacity does not end the duty to inform.[1]
  • Searching a client online without consent is a violation unless it protects the client or others from serious, foreseeable, and imminent harm or another compelling professional reason applies.[1]
  • Expect questions on a missing element or on who can consent. Consent is an ongoing process, not just a signature.[1]
  • Do not equate a diagnosis or guardianship with global incapacity; assess the specific decision.[2][1]
  • Capacity is decision-specific, and the worker still involves the client as far as possible.[1]

The common trap

Assuming a signed form means consent happened. Consent is a process: check understanding and revisit it as the work changes.[1]

Covered on other pages

  • HIPAA authorization required

    A valid written authorization is required for uses and disclosures not otherwise permitted, including marketing and sale of PHI. Authorizations can be revoked in writing except to the extent already relied upon, and providers may not condition treatment on signing one, with limited exceptions such as research treatment.

Related explainers

Sources

  1. 1.NASW Code of Ethics (public page). www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-Clients
  2. 2.PMC (peer-reviewed article on decision-making capacity). pmc.ncbi.nlm.nih.gov/articles/PMC13169555/
  3. 3.OpenStax (Rice University open textbook). openstax.org/books/psychology-2e/pages/2-4-ethics
  4. 4.NCBI Bookshelf (StatPearls). www.ncbi.nlm.nih.gov/sites/books/NBK459281/
  5. 5.eCFR 45 CFR 164.502. www.ecfr.gov/current/title-45/part-164/section-164.502
  6. 6.PMC (Kerwin et al., state laws on adolescent treatment consent). pmc.ncbi.nlm.nih.gov/articles/PMC4393016
  7. 7.eCFR 45 CFR 164.508. www.ecfr.gov/current/title-45/part-164/section-164.508

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