case study

Clearly, as a human service provider, you will encounter situations in which you are confronted by an ethical dilemma. The situation may include if and when to disclose confidential information without a client’s consent (e.g., a suicidal client) or the ethics of limiting a client’s right to self-determination (e.g., when involuntary hospitalization is required) or even the appropriateness of engaging in nonprofessional relationships with a former client. These ethical dilemmas are difficult to resolve, because by one definition, that of Kitchener as cited in Shiles (2009), an ethical dilemma occurs when “there are good but contradictory ethical reasons to take conflicting and incompatible courses of action” (p. 43). As such, the ethical dilemmas we encounter are by definition often subtle and always, by definition, without a singular clear path to resolution. Consider the findings of one study assessing 450 members of the American Psychological Association’s Division 29 (Psychotherapy) by Pope, Tabachnick, & Keith-Spiegel (1987). Of the 83 separate behaviors the members were asked to rate according to ethicality, very few—for example, having sex with a client or breaking confidentiality if clients are suicidal or homicidal—were clear-cut. Most of the 83 fell in what the authors termed “gray areas” between being ethical and unethical. Such data highlights the difficulty one experiences when faced with an ethical dilemma and the need for a sound model of ethical decision-making. Ethical Decision-Making: A Range of Models Life—at least our professional lives—would be easier if all practice decisions and ethical dilemmas were black or white. As should now be evident, the ethical nature of our practice decisions are most often colored in many shades of gray, and thus the path to follow is not always clear. For some, the goal is to follow the ethical codes from a mandatory perspective and thus be true to the letter of the law. While this is a basic level of ethical functioning and may serve to protect the human service provider to avoid legal trouble, this should not be the main focus of our ethical choices. We are called to embrace our ethics on an aspirational level. For one embracing aspirational ethics, the goal is not self-protection but rather client welfare. While it is our duty, our responsibility, to understand and embrace our codes of ethics (i.e., mandatory ethics ), the execution of these codes in practice demands that we engage in self-reflection and the employment of a decision-making process that results in what is best for each of our clients (i.e., aspirational ethics ). Reliance on one’s “gut-feelings” or intuition, in the absence of reflection on that which is both mandatory and aspirational, presents an ethical problem in itself, given the greater risk to the public (Welfel, 2010). In complex situations, the American Counseling Association’s (ACA) Ethics Committee, for example, recommends that counselors explore professionally accepted decision-making models and choose the model most applicable to their situation (Kocet, 2006). This position has even been codified in the ACA Code of Ethics where it is noted: “When counselors are faced with an ethical dilemma, they use and document, as appropriate, an ethical decision making model … ” (ACA, 2014, Code I.1.b). While there is no one specific ethical decision-making model that has been identified as most effective and globally embraced, it is important, as noted by the ACA (2014, p. 3), for practitioners to be familiar with a credible model of decision-making. To this end, numerous authors have offered models for ethical decision-making, a sampling of which is offered in the next section. Each model offers a unique perspective or lens through which to view practice decisions and ethical dilemmas and as such are worthwhile, considering as each may reflect your style of practice and/or the context in which you work. Ethical Justification Model Kitchener (1984) has provided what some feel is the foundation for ethical decision-making (see Sheperis, Henning, & Kocet, [2016]). In fact, many of the ethical decision models use Kitchener’s virtues as a springboard for their development (Urofsky, Engels, & Engerbretson, 2008). Kitchener (1984) was aware of the then existing limitations to ethical codes and thus directed psychologists to consider the fundamental ethical principles that not only serve as the foundation for professional codes but provide a conceptual vocabulary for analyzing ethical issues when direction is less than clear. Kitchener invited practitioners to employ the values of autonomy, nonmaleficence, beneficence, fidelity, and justice (see Chapter 3 ) as reference points when making ethical decisions. From this perspective, clinicians would ensure that their decisions not only treated each client equally given equal circumstances (justice) but also supported client freedom to choose (autonomy). Further, based on these principles, a practitioner’s ethical decisions would be made in a way that not only avoided harming the client (nonmaleficence) but promoted help and health (beneficence). For example, while having a sexual relationship with a client is clearly unethical, the question of ethics when applied to other nonsexual, multiple-role relationships with former clients may be less obvious (Anderson & Kitchener, 1998). In these situations, the codes may not be clear and directive. Kitchener (1984) would suggest that clinicians allow their concern about not undoing therapeutic gains (i.e., nonmaleficence) along with their desire to refrain from affecting client self-determination (i.e., autonomy) to guide their decision to engage or not to engage in these nonsexual, multirole relationships. To further clarify this perspective, we invite you to engage in Exercise 7.1, applying foundational values. When exploring an ethical dilemma, reflection on these moral values or principles may offer insight into the path best chosen. However, it has been suggested (e.g., Forester-Miller and Davis, 1996) that in complicated cases the employment of a step-wise decision-making model may be useful.

Step 1: Identify the problem articulating the ethical concern. During this step, the practitioner needs to gather information that sheds light on the depth and breadth of the situation. The authors suggest that the practitioner consider questions such as, is this an ethical, legal, professional, or clinical problem or perhaps some combination? Is the issue a reflection of me, the client, others in the client’s life, and/or the system in which I work? Answering these questions helps focus the targets for resolution. Step 2: Apply the ACA Code of Ethics. While developed for use by counselors and thus the reference to ACA Code of Ethics , this decision-making process could be employed by all mental health professionals by making reference to the appropriate professional standard and code at this step in the process. It is important to review the codes in order to identify all standards that may apply to the situation. If the codes do not provide clear and direct insight into the path of resolution, additional steps of the decision-making process will be necessary. Step 3: Determine the nature and dimensions of the dilemma , noting the scope of the issue engaging the current professional literature, colleagues, and even professional associations to ensure the most current perspective on this type of problem is incorporated. Step 4 : Generate a possible course of action that could result in resolution. During this step, be creative; brainstorm in order to develop the widest possible selection of options. Step 5: Consider the potential consequences of all options. It is important to identify all possible implications of each course of actions as it may impact the client, others, and even yourself. Identify the option or combination of options that best serve the situation. Step 6: Evaluate the selected course of action. At this step, it is especially important to be sure that the path selected will not create additional ethical concerns. Step 7: Implement the course of action . Once the pathway has been selected and implemented, it is important to assess to ensure that the desired impact or outcomes were achieved. The employment of such a

Parsons, Richard D.,Dickinson, Karen L.. Ethical Practice in the Human Services (p. 314). SAGE Publications. Kindle Edition.

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Parsons, Richard D.,Dickinson, Karen L.. Ethical Practice in the Human Services (pp. 304-305). SAGE Publications. Kindle Edition.