Ethical and Professional Issues in Counseling

Qn1. Ethical Decision-Making Model 

1a. Background History 

The development of an ethics code has been a process of constant consultation for over six decades. This is because the profession has been evolving and diversifying in function. Initially, the development of the code of ethics seems like a simple feat. This is because psychologist’s primary job description is to analyze and adjust people's behavior. The formulation of the code proved to be a difficult task because the various practitioners had different opinions based on their area of expertise and their length of experience. The starting point lay in collectively agreeing on the relevance and purpose of a code of ethics. 

Establishment of collective sets of values instead of individual interpretations would improve the public image of psychology. This was supposed to encourage the public to consume services offered by psychologists and put their trust in the overall institution of mental health. It would also encourage a balance that ensured that the patients, their families and the psychologist were protected and covered. The code of ethics would establish psychology as a reputable profession with a purpose and collective authority. This would set the pace for psychology students who had to acclimatize themselves to the guidelines in advance. The code was also expected to give the psychologists a body that could represent them in front of other professionals. This method of internal regulation was also encouraged to deter the possibility of outsiders like government agencies setting the pace for them. 

The code of ethics was challenging to the founders because they had to decide whether to form an enforceable or inspirational code. The inspirational code would only contain suggestions and recommendations on the conduct of psychologists. It would not have any disciplinary measures or action for violation of any of the laws. The enforceable code would have guidelines and consequences for adherence or violation of such. After exhaustive consultations and revisions that took place over the span of a few decades, the code of ethics settled on a blend of the two different aspects. The current code has some specific aspects that are inspirational, while the enforceable ones are used to govern and resolve conflicts. The inspirational ones are the five general principles while the enforceable ones are the ethical standards. Revisions that led to this amendment included contributions about increased use and access to electronic media, technological advances that affected the collection and storage of information, various research findings and legal contributions. The expansion and clarification of human rights also contributed significantly. 

Some of the aspects of the code rely heavily on other sectors. For example, the codes must be applied under the confines of the relevant state and federal laws. For example, the code of ethics does not pardon a member who does not adhere to the guidelines from perception. Ignorance is not a defense for both law and the code of ethics. Others also comply with the regulations set out by the general practitioners because they are closely related to medical health care. The adherence to these guidelines must take precedence over personal preference or religious affiliation. This code of ethics was to apply to the members of the practicing psychologists as well as the students who joined the American Psychological Association. The ethics code was proposed to apply to all people and activities that practice psychology. They would be relevant in all settings including organizations, schools, clinical settings and research institutes. Finally, they govern all communication and activities that take place within the confines of psychological practice. 

The code of ethics was finally enacted in clear and relevant wording. It is detailed to avoid over generalization and ambiguity. It is multifaceted to allow the application in diverse settings such as in a school setting or for public services. The code describes the confines of a client-patient relationship. It also defines the organization as a client. The APA Ethics Enforcement is responsible for carrying out the investigations that result after a complaint from a member or affected party. The findings reviewed by the APA Ethics Committee will lead to recommendations to reprimand or censure the guilty party. The findings may also necessitate an expulsion from the APA or a stipulated resignation if the accused is a position to object their expulsion. The ethics code is made up of five aspirational principles and six enforceable standards. The general principles that outline the APA are the following five main concepts. 

Principle A : Beneficence and Nonmaleficence 

Principle B : Fidelity and Responsibility 

Principle C : Integrity 

Principle D : Justice 

Principle E : Respect for People's Rights and Dignity 

Principle A, Beneficence and Nonmaleficence requires a psychologist to avoid harming a patient but to do good to the patient always. Fulfillment of this principle requires paying attention to detail and cooperating with other practitioners and law enforcers. It also requires the practitioners to be fair to the client even if it disadvantages him. A first example, a practitioner in a teaching capacity may be tempted to give some of his weaker student’s poor grades to balance his grade sheet. This would benefit him while disadvantaging the student who had performed well. Principle B Fidelity and Responsibility, encourages faithfulness from a practitioner. This includes professional conduct and responsibility. Principle C Integrity demands honesty and transparency in teaching, treating and carrying out of research. Accuracy in carrying out of activities, avoidance of fraud and impartiality are all covered by principle C. Principle D or Justice requires fairness of access to treatment and research findings. Principle E or Respect for People's Rights and Dignity protects the patient’s right to self determination, privacy, and confidentiality. Such confines affect issues such as the patient's culture, relationships, socioeconomic status and even sexual orientation. 

The enforceable standards or steps are generally categorised into six main concepts. 

Standard 1: Resolving Ethical Issues 

Standard 2: Competence 

Standard 3: Human Relations 

Standard 4: Privacy and Confidentiality 

Standard 5: Advertising and Other Public Statements 

Standard 6: Record keeping and Fees 

These six standards are applicable to all the areas of psychological practice. They can be used to resolve any issues including the additional sections in therapy, clinical assessment of patients, education and training as well as research and publications. The six standards are additionally subdivided into 151 standards that can be enforced by the APA Ethics Committee as well as other bodies that adopt the code of ethics or those that acquire membership to the APA. 

Each of the six sections clarifies its functions into subsections that handle specific aspects of ethical consideration. For example Standard 2 represents competence in the work place. But standard 2.05 goes further. This clause is titled Delegation of work to others. It requires a psychologist to ensure that the duties they delegate should be carried out by people with the appropriate academic qualifications and the relevant work experience. Standard 3 governs Human Relations. This standard can be broken down in Standard 3.11 Psychological Services Delivered to or Through Organisations. This clause defines a person as a client and it goes further to define an organisation as a client. This is applicable when a dressing issues that affect the whole spectrum of employees in an organisation. Standard 4, Privacy and Confidentiality can be applied specifically in standard 4.07. This states Use of Confidential Information for Didactic and Other Purposes. The clause restricts the use of private information that can be used to identify a patient unless steps are put in place to disguise the person. 

1b. Ethical Decision-Making Model 

Different organizations often adopt models that outline their chain of operation. These are adapted to suit the organization and to summarize the APA code of ethics. The models also simplify the process of ethical decision making by giving it a clear structure and breaking it into simple processes The processes follow the guidelines in the code of ethics and they incorporate the clauses in the enforceable standards so as to pursue justice for the different issues that may arise. This model simplify the process of determining the issues that may arise. The process of conflict resolution is done in strict adherence to the sub sections found in the APA standards. 

Ethical complaints are resolved through the ethical committee. A complaint can be raised by any member of the APA or by anyone who is affected by the actions of a member. The Ethics Committee reviews the complaint to see if it meets the jurisdictional criteria set out. If no grounds are found, the Director of the Ethics office dismisses it. The Ethics Committee chair or his designees may also dismiss such a claim. 

Where there is jurisdiction, a case is opened based on specific ethical standards charges that may have been violated. An investigation is started immediately after the accused psychologist relieves a charge letter. He is allowed to present material that may help him defense himself. The Ethics Committee may stop the proceedings if the psychologist brings explicit proof that he is being charged under a different jurisdiction, or in a civil litigation. Some psychologists opt to resignation instead of going through the process. The committee then goes through the whole investigation and a ruling is made based on their findings. 

This process will positively impact the clinical practice. This model is the best fit because it breaks down the APA process into stages. These stages are vital because they enable a practitioner to protect themselves by determining their potential weakness. The practice also applies these principles in the absence of a problem to protect the psychologist in advance. The psychologist uses his weakness and dominant soft spots to create potential scenarios that may result from personal challenges. The psychologist then develops a would-be solution by carrying out the whole process as it was described. This becomes a standard model of operation, such that if a psychologist were to fall into trouble, there would be a ready course of action to deal with it. The main advantage that the model gives is that the psychologist creates personal awareness that allows him to avoid situations where ethical issues may occur. The model also raises awareness of the society’s perception of unethical behavior by exploring a comprehensive set of conflicts of interest. This will determine the actual unethical areas and differentiate them from grey areas in ethics. The grey areas will be explored to establish their ethical relevance. Overall, the model helps the practice to avoid full-blown ethical issues by nipping them in the bud. It also encourages speedy resolution of problems by removing a psychologist from the situation immediately it is discovered that he or she is emotionally biased. 

Qn2. Case Study 1 

A. What is the ethical dilemma? 

The client in case study one raises an ethical dilemma of negligence. Mr. T, the psychologist who was responsible for her care was negligent in the discharge of his duties. First, he did not set clear boundaries with the patient. He tells his supervisor Dr. G that the patient would want to stay beyond the assigned time for the therapy session and that she would call him countless times. On her part, the patient complained that Mr. T spoke to her in an unpleasant manner and that he wasted her session time talking about himself. These complaints should have alerted the supervisor Dr. G of possible misconduct by his student psychologist. 

Second there was a recurrent issue of missing clinical notes that should have been made during the therapy sessions. The issue was raised twice in a span of four months, by the staff at the medical records department. The absence of clinical notes should have been the first indicator that there was some truth in the patient's complaint. It is clear that this student psychologist did not take his job seriously. He was also biased towards this particular patient and he dismissed her issues without giving her ample time to express herself. Mr. also proves to be dishonest when he lies about the records a second time. He clearly failed to discharge his duties in the treatment of this particular patient. 

Lastly, there was a disconnect between the information the doctor received in supervision and the scanty information that had been filled in the medical records. The student psychologist gave conflicting details about the patient in question. He said that she had a borderline personality disorder as well as depression, while she was also abusing alcohol. His notes did not support these findings despite attending to this patient for more than six months. His notes were also mixed up, and the doctor found some entries from other patients under Mr.’s care. 

B. What standard of the APA Ethics Code applies? 

The student psychologist violated the ethical standards of human relations. This falls under Principle E that calls for Respect for People's Rights and DignityThe code of ethics allows its members to choose which individuals to accept as clients. This is because personal bias and stereotypes in one's mind can affect the way they relate to a patient. Mr. T should have rejected this patient on the basis that she gave him the perception of lacking commitment to his attempted interventions. Instead, he responded to her with aggression and unkindness which additionally violated the Avoiding Harm standard. It also goes against principle A of Beneficence and Nonmaleficence. The patient in question was delicate as she was in a fragile state of mind that required gentle attention. There is no indication that Mr. monitored the psychological status of his patient. There are usually warning signs before a person commit suicide and this should have pre-empted Mr. to organize for emergency services. They also violated the Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work standard in the handling of the patient's notes. 

When Dr. G realized that Mr. had some apathy towards his patient, he should have reassigned her care to somebody else. In this case, both Dr. G and Mr. violated the standard for competence. They both violated the standard of emergency care and suicide which falls under the standard for competence. The student psychologist should have informed the supervising doctor of the state if his patient as well as appealing for helps to deal with her. This inaction violated Principle D Justice because a patient who sought help did not get it and she instead took her own life. 

C. Use your ethical decision-making model to solve the issue 

The ethical decision making model can be used to solve the problem. First, a complaint can be filed against Dr.G and Mr.T. The Ethics Committee will discuss the case and ascertain its jurisdictional merit. When it is confirmed to be of merit, then the two psychologists will receive charge letters. Dr G 's will be based on Standard 2.05 ,Delegation of Work to Others. This is derived from Principle D of Justice.The forensic investigators will try to identify the problem. They will talk to the family and friends of the deceased to ascertained her frame of mind. They will also learn from the experience that the patient has in the months leading up to her death. The investigator will also go through the clinical notes of Mr. to determine the competence in his service delivery. This should run concurrently with a fresh evaluation of the other patients under Mr. T to ensure that his clinical notes are accurate and a true reflection of the patient's condition. 

Investigations will continue by examining every person's contributions, including the medical records department, the supervisor and all the other patients conduct with other attending psychologists. The investigators will try and find legal and ethical resources to resolve the case. Dr.G had earlier attempted to resolve the ethical violations of Mr. T through dialogue though this was unsuccessful. This attempt may be used in her defense and also to show that Mr. had received some warning or caution. 

The Ethics Committee will discuss solutions for this matter. If the investigations find evidence of gross negligence and misconduct as is suspected, the psychologist will be held responsible for his patient’s suicide. The supervising doctor will also be charged with negligence but to a lesser degree. If there is insufficient evidence to support the claims identified in the problem, then the case can be dismissed without any consequences. The committee will consider the consequences of dismissal or charging of this pair. The student psychologist will be found guilty of negligence and malpractice by using patient time inappropriately. Then, Mr. T will be found to have violated the standard of competence and the standard for emergency care and suicide. He will be removed from the APA list of members after the decision is upheld by the APA Ethics Enforcement. The institute will then put measures in place to prevent future misconduct by carefully pairing patients and their psychologists. 

Case Study 2 

A. What is the ethical dilemma? 

The new appointee to the state board that classifies and monitors sexual offenders is disappointed. On joining the team, he learns that the classification is limited to the statutes that the government put in place ten years ago. He is disappointed because he has uncovered other factors that are more useful and accurate in the best practice of this activity. He feels frustrated that they are bound by the statutory requirements while he is an expert who has experience in the treatment of service offenders. He feels that his time on the board will not yield as much progress as it should as he will be operating below the best practice principle of the day. 

The ethical dilemma arises from Dr. K's reluctance to use the statutory requirements, while his expertise shows him a better way to get the job done. He is tempted to break the law to do the most good in the area he is serving. The other dilemma arises in the compliance of the people he found working for the board. They are reluctant to use his criteria to assign risk levels, and they are comfortable using their old statute. He tries to change the laws by approaching the chair of the board. This frustrates him as well because he is shut down and told his vote on any revision regarding the criteria for risk levels must be following the law. The other board members share the chairman's position, and this leaves Dr. K alone in his quest for justice. 

B. What standard of the APA Ethics Code applies? 

This ethical issue falls under the Conflicts between Ethics and Organizational demands. It is covererd under Principle B : Fidelity and Responsibility Dr. K feels that the decision by the board members is violating the rights of the sex offenders. He feels that the erroneous classification criteria are not giving them a fair chance because they are listed in the wrong criteria and risk level. He also feels that it is unethical to follow his organizations directions instead of the best practice possible. The Conflicts between Ethics and Organizational demands require organizations to adhere to the code of ethics even if it goes above and beyond their organizational advantage. 

This issue also falls under Conflicts between Ethics and Law, Regulations, or Other Governing Legal Authority. The state board that Dr. K recently joined is more concerned with adhering to regulations under the statutory law that brought it into existence. Unfortunately for the Dr, the other board members belong to other fields of expertise, so no one understands his point of view. He has left the stone to wage war on the rights of sexual offenders. This violation of their right to fair assessment and classification is backed by the law but is opposed by the code of ethics. 

C. Use your ethical decision-making model to solve the issue 

The first step will be identifying the problem which in this case has been confirmed to be the statute. This issue will be brought before the APA Ethics Committee. The Ethics Committee will discuss the case and ascertain its jurisdictional merit. When it is confirmed to be of merit, then it will be investigated. The instituition will receive a charge sheet asvit will be considered a person under the Standard 3.11 Psychological Services Delivered to or Through Organisations. It will then be investigated by the forensic investigator who will report directly to the APA Ethics Enforcement. They will ascertain that the issue that has been raised by their member Dr.K is valid and relevant to the state board functions and jurisdiction. Step three will proceed if the ethics Committee see there is a case to pursue. The committee will identify the legal and ethical issues that are in question. This stage will incorporate both the ethics committee and the state board. The Ethics Committee will discuss the effect of classifying the sexual offenders using the criteria that were set up by the statute years ago. They will explain the benefits of the new criteria that will make the classification more accurate and bring them up to par with the current best practices. 

The state board’s reluctance to vote the changes and put in place measures to ease the transition will be examined. They will deliberate on the solution to bring a consensus between the two sides. The general principles and the ethical standards of the ethics code will make a ruling. The specific principles affecting them will be Principle A of Beneficence and Nonmaleficence and Principle D of Justice. They will consider the consequences of maintaining the current law or the board voting to amend it. They will then determine the solution and assess the implications of the decision and then implement the decision. This will provide a speedy resolution to a problem that would drag on infinitely.