ethical dilemma

Ethical Dilemmas

So after all this…what constitutes an ethical dilemma? Now that we know our ethical obligations, the guiding principles, and what our Code of Ethics dictates as ethical practice, it’s important to know what to do when faced with an actual ethical dilemma. Ethical dilemmas occur when the following factors are present:

· Choice between two courses of action.

· Significant potential consequences for taking either course of action.

· Both courses can be supported by ethical principles.

· Choosing either course will compromise an ethical principle.

Your reading for this week covers choice, ethics and legal challenges in rehabilitation. ( Choice Ethics in Rehabilitation ). Patterson, Patrick and Parker (2000) discuss some of the essential conflicts that exist when choice is in conflict with ethical practice. We will discuss some of those issues here and their conflicts with our guiding principles.

· Autonomy

Rehabilitation Counselors have an obligation to facilitate clients’ freedom of choice. However, that is often influenced by the extent that a client is viewed as capable of rational choice. There is an inherent conflict with promoting autonomy over promoting beneficence. Rubin & Roessler, 2001

· Beneficence

Rehabilitation Counselors have an obligation to clients and to work toward their benefit. But what is perceived as benefit by rehabilitation counselor is colored by the personal values of that counselor. Here is where it is important for rehabilitation counselors to be in a constant state of self-awareness. Knowing your values and having an acute awareness of your moral standards will help to prevent you from unknowingly imparting those values on the unsuspecting client.

· Non-maleficence

This one is easy as it essentially asserts that you may do no harm to the person you are working with. But there might be times where honoring client choices may alter resources or benefits to another client or may conflict with what you feel might be in the best interest of the client (beneficence).

· Justice

Rehabilitation Counselors have a professional obligation to be just. However, what is oftentimes perceived to be fair allocation is greatly dependent on the counselors’ perceptions and can be impacted by personal values.

· Fidelity

Counselors must honor promises to promote choice and present consumers with full range of choices available to them. However the consumer may not have interest in those choices. How do you honor autonomy and promote choice effectively, at the same time?

Here are just a few other examples of how ethical dilemmas might manifest themselves.

· Supporting client choice:

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· Client’s goals versus more realistic/practical goals.

· Client’s requested training versus recommended training from contract evaluations.

· Promoting employment that might negatively affect financial stability (e.g., losing Medicaid benefits as a result of employment or Social Security benefits).

· Honoring agency guidelines versus optimal movement for clients.

· Limits of confidentiality:

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· Maintaining confidentiality of poor work history conflicts versus providing employer with full disclosure.

· Providing clients with case information conflicts with withholding distressing information to client.

· Providing comprehensive services to clients with more significant disabilities versus providing services to those with less significant disabilities and the reverse.

· Multicultural and diversity considerations for ethical practice:

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· Understanding and sensitivity to impact of racial/ethnic status in access and utilization of treatment interventions. Promoting client choice is most relevant when there are cultural considerations of treatment options offered.

· Providing adequate support for clients with language barriers. Client autonomy can rarely be fully achieved when there is a language barrier between the counselor and client.

· Lack of familiarity of cultural impact on disability experience can violate the ethical principle of beneficence and non-maleficence. By not understanding the cultural impact on disability, you can inadvertently cause harm to the client. This could also prevent you from working at the best of your abilities to the clients’ benefit.

Dziekan, 2006.