05 Apr 2018
Ethics pertains to beliefs we hold about what constitutes right conduct. They are moral principles adopted by an individual or group to provide rules for right conduct and represent aspirational goals or the maximum standards which are set and enforced by professional associations. The American Counseling Association's (2005) Code of Ethics states that when counselors encounter an ethical dilemma they are expected to carefully consider an ethical decision making process. While counseling a client, the counselor is presented with countless challenges to recognize when and where a specific ethical concept, standard and guideline might be crucial. Ethical standards and guidelines inform our judgment as they help us recognize, think through and find or create path to deal with a dilemma. The way we respond to a dilemma has a great deal to do with our sense of what is valuable and right. In this perspective, the response is seen as being fair and judicious for the client or perhaps is in the client’s best interest for continued development. When counselors operate from this highly personal and subjective position, they call upon a sense of morality. Morality is concerned with perspectives of right and proper conduct and involves an evaluation of actions on the basis of some broader cultural context or religious standard. Morality serves as a foundation to ethical practice and decision making. To decide ethically is to first decide morally. (Values and Ethics in Counselling: Real –Life Ethical Decision Making, Dana Heller Levit)
Values pertains to beliefs and attitudes that provide direction to everyday living.
Client's ethical issues becomes a dilemma when they pit ethical, legal or organizational requirements against each other or when the ethical codes become silent on the client's issues. With respect to these , finding occasional inconsistencies among resources are inevitable. As a result, to select a preferred course of action from among the conflicting guidelines, counselors use a decision making model that allows them to weigh the relative importance of the information obtained. A structured method of information collection and review can facilitate the ethical decision making process. The application of this model may help counselors to avoid ethical misconduct and to pursue ethical ideals. The counselor essentially needs to be inquisitive at the beginning phase of an ethical decision making process. The initial step is to identify the problem or the dilemma based ethical, moral and legal dimensions by gathering all relevant information that illuminates the situation. In other words, counselors need to obtain a clear description of the nature of the problem through the usage of effective counseling skills such as reflexive questions. The second step involves a careful evaluation of the most critical issues abstracted from all the information gathered previously. At this point, attempts should be made to review the rights, responsibilities and the welfare of clients and other stakeholders concerned with the dilemma. This review extends to the point of considering the cultural aspects of the situation influencing the client's welfare. Furthermore, the use moral principles of autonomy, nonmaleficence, beneficence, justice and fidelity to address the situation is inevitable here. With regard to autonomy, the counselor should allow clients the right to choose and act according to their preference. Nonmaleficence is a primary concern that emphasizes on refraining from actions that may risk harming clients. An example would be inappropriately labeling clients with diagnostic terms that may denote abnormality, which could pose serious consequences to the welfare of the client. Beneficence is applied when counselors respect client's dignity and promote the welfare of clients. The principle of justice refers to being fair and nondiscriminatory towards clients. Fidelity deals with faithfulness to promises made and to the truth. There lies a problem in upholding fidelity when a counselor works with a minor client and is obligated to be loyal to the client, while the principle of beneficence may suggests that disclosure may be best for the whole family. In such circumstances, when counselors are left between the conflicting principles, they may need to prioritize certain principles over others as required by the situation. The third step is to review the ethical codes that are relevant to the problem situation. Ethical codes prompt, guide and inform significant values and concerns regarding ethical behaviour. Professionals sought the code of ethics and examine the particular sections relevant to the dilemma to consider if they offer possible solutions. At this point, they also consider if their values and ethics are consistent with or are in conflict with the relevant codes. In the event of an inconsistency with a particular standard, counselors seek supervisory guidance and clarify the issues. Upon rectifying the inconsistencies, they produce a rationale to support their position and document their judgment and reasoning to justify their actions to solve the dilemma. The significance of the fourth step involves keeping up to date on the relevant state and federal laws that might apply to ethical dilemmas. In order to do so, the counselor needs to be knowledgeable in the applicable laws and regulations. At the same time, interpreting these legal statutes as according to how they may relate to client's issue becomes a fundamental aspect of the decision making process. This would be pertinent in matters of breaching confidentiality, reporting abuse of the vulnerable , dealing with issues that pose a danger to self or others, parental rights and record keeping. It will also suffice to seek guidance from professional bodies concerning ambiguous ethical or legal situation. After thorough assessment of all ethical, clinical and legal issues pertaining to the dilemma, counselors present their facts of the situation and obtain consultation from professional authorities in the fifth step . This is especially useful when counselors are grappling with an ambiguous ethical issue. As an ethical dilemma can be intellectually overwhelming and emotionally distressing for both the client and the counselor, objective feedback from various reliable sources such as colleagues, supervisors or inter-organizational bodies can provide a wider view of the problem or even a new focus on unconsidered facts. Besides consulting professionals who share the same viewpoints, it may also suffice to seek expertise from cross cultural entities, as required by the nature of the dilemma.
With adequate information and guidance at hand, the counselor is now at a position to formulate possible solutions to the dilemma (Frame & Williams, 2005). In essence, the sixth step is about contemplating the possible and probable causes of actions. Apparently, it requires an extensive exploration process that would allow counselors to lay out the possible courses of action, while at the same time accounting for the ethical obligations of such actions. As counselors review the possibilities, it may be imperative to involve clients in the exploration process before deciding on the most probable courses of action. This is to ensure that decisions are made to the best interest of the client. As it was done in earlier steps, documenting these discussions and would be helpful for counselors to justify their actions in the event of them being questioned. The seventh step entails the previous one as it informs the counselor to enumerate the consequences of various decisions that were taken after evaluating the possible courses of action. This involves considering the positive and negative consequences of each option while at the same time weighing the relative significance of each option. Client's involvement matters during this analysis to ensure that the decisions gravitate towards the best interest of the client. To achieve this the counselor may employ the five moral principles of autonomy, nonmaleficence, beneficence, justice and fidelity as a framework to consider the consequences of a particular course of action. In the last step of the model the counselor decides on what appears to be the best course of action. After generating the best possible decisions and their outcomes, counselors together with clients and other supervisory consultation, would be select and implement the most appropriate course of actions. Implementation of decisions is followed by assessing the appropriateness of the outcomes of those decisions. The decision making process reaches the final phase when the counselor reflects on this assessments and communicates them with clients. However, a follow up may be necessary to determine if the actions taken are effective or if they require a modification. Last but not least, it is essential to document steps taken so as to clarify options, facilitate reasoning and avoid redundant efforts. More importantly, having a documentation is significant if evidence of these efforts are later requested during an investigation. In overall this ethical decision making framework serves as a deliberative and creative approach that guides counseling professionals to fulfill their ethical responsibilities amidst an elusive situation. It assist baffled counselors to think though an ethical dilemma and to arrive at an ethically appropriate decision. Moreover, the framework also helps to prevent ethical violations by enabling counselors to acknowledge the intricacies of ethical decision making as a basis on which competent, ethical and professional counseling can be practiced. Despite its useful aspects, the decision making model does falls short in certain areas.
In evidence, Corey, Corey and Callanan (1998) indicate this model cannot be applied in an automated or generalized manner, as practitioners often find themselves confronted with a complexity of personal values, social context, as well as a prescriptive professional code. As in the model fails to correspond with this reality or address the level of complexity they confronted. For instance, the general guidelines that states the counselor's responsibility to minor clients and to their parents, may provide little help to a counselor who is struggling with an adolescent client who feels alienated from his chaotic family and wants the counselor to keep his violations of curfew and experimentation with alcohol from his parents. The counselor is in a dilemma determining how much material from counseling must be shared with parents and what does that disclosure mean to the progress of the therapy. As it is, the burden of analyzing ethical issues falls squarely on the professional who obviously requires critical thinking and intellectual ability that allows careful reasoning to arrive at the best solution. At the same time, reviewing numerous ethical codes and standards in an attempt to abstract those that relate to the dilemma can be a painstaking as well as a time-consuming process. On the other hand, after checking on all ethical and legal obligations, considering the available courses of actions can be again challenging as it may require the client's and the counselor's collaborative efforts to speculate all possible options open to them. It may be exhaustive in the sense that it involves an in-depth exploration process where all possible actions and their outcomes have to be thoroughly scrutinized before arriving at a decision. Nevertheless, the ethical decision making model is of much relevance to the current practices of various professional organizations and is widely used by practitioners to find their way out of an ethical dilemma. The following scenario demonstrates the application of the ethical decision making model. Joe, a 17 year old tells her school counselor, Anne that she was sexually abused by her stepfather and now intends to leave the house to stay with her close friend Mary. Joe also reports that she has not been able to focus in her studies due the trauma caused by the incident and hesitates to tell her mother as it is shameful to do so. In this case, Anne's first task is to gather all relevant details of the problem situation such as Joe's emotional health, sociocultural background, her current status with the her mother and stepfather and other and other relevant details. Anne also identifies Joe's mother, stepfather, Mary and other members of the household as the stakeholders involved in the problem. Anne then attempts to safeguard Joe's rights and works in line with the moral principles of autonomy, beneficence, nonmaleficence, justice and fidelity to protect Joe's welfare. In Joe's case it is highly likely that different principles may lead to incompatible conclusions. At this point, Joe seeks guidance and evaluates on which principle should take priority over the others. Anne also reviews the relevant ethical codes to check on ethical obligations regarding her actions. For instance, she may evaluate if a disclosing the issue to her mother would compromise Joe's welfare. To mitigate this ambiguity, Anne refers to the ethical codes and standards. Then, Anne explores if any legal statutes are relevant to her actions and is careful about not violating them. Subsequently, Anne talks to her supervisor about Joe's case to obtain feedback and solicits ideas from her colleague who works with teenagers. With all the information, Anne identifies a number of possible courses of actions. She lists down the potential responses such as encouraging Joe to talk about it to her mother while maintaining confidentiality of Joe's case or as another alternative, informing Joe that she (Anne) would like to consult her mother. In Joe's presence and with some supervision, Anne then considers the consequences and outcomes of the possible actions and evaluates the most probable options. Upon arriving at a decision which is ethically appropriate, Anne assesses the outcomes of those decisions and reflect on how they will set an impact on Joe. She communicates these to Joe and documents her action for record-keeping.
Another case scenario would involve a family whose child has leukemia and the parents are addressing the situation with prayers rather than medical treatment. They have sought Paul for counseling. To begin with, Paul is faced with a dilemma, as he recognizes a serious problem. On one hand, safety and the welfare of the child and on the other, maintaining client confidentiality are two issues of concern.
Conclusion: As counseling focuses on important perspectives such as client's needs, hope,risk and expectations to the point where lives can be at stake, counselors need to reason ethically through challenging situations and determine the most appropriate course of action that ultimately is in the best interest of clients. This requires counselors to be aware of professional and personal issues influencing their decisions, especially when considering the potentially profound, harmful ramifications to clients and the counseling profession when sound ethical judgment is not made.
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