Ethical Dilemma
Professionals encounter ethical dilemmas in their everyday life, some dilemmas are small while others are critical. Ethical dilemmas are different from problems, because they present impossible options. With an ethical dilemma, there is no right and wrong, and the individual has to weigh the advantages and disadvantages of each option before making a step. Despite the many ethical theories that can be used to analyze and come up with the right decisions, ethical dilemmas are still challenging and it requires an individual to have a personal ethical framework to guide the decision making process.
Description of the Case
Psychologists are change agents for the individuals and community in general. In the process of evaluating challenges faced by patients, ethical dilemmas are bound to arise. Common ethical issues include: confidentiality, conflict of interest, informed consent and relationships with vulnerable patients. For instance, an ethical dilemma involving confidentiality arises when a patient is treating a patient with PTSD. The psychologist has been treating the patient for over 6 months and the patient seems to be making progress. In a recent session, the patient confesses that she was abusive to her children and she appears remorseful about it. The psychologist is mandated to report the incident, but he is afraid that he is making so much progress with the patient and reporting the incident will jeopardize the progress. However, he is not confident that the patient is no longer abusive to the children, hence he does not know what to do.
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Significant Ethical Issues
The case above is a reflection of the many ethical issues in the field of psychology. Psychologists deal with sensitive patient information on a day to day basis, and sometimes the information breaks legal and ethical codes. Psychologists are guided by the APA Code of Ethics, which defines the responsibilities, proper conduct and limits. Psychologists also have a responsibility to help their patients. After working with patients for a long period, psychologists develop some form of relationship with the patients that make it hard to report ethical issues by breaking the concept of privacy and confidentiality.
In the ethical case above, the psychologist in question is wondering whether to report his patient or not. The patient is suffering from PTSD because of some traumatic incident in the recent past. However, she is making progress and wants to be in control of her life again. Her recent confession that she has been abusive to the children has left the psychologist in a weird position. The psychologist is confident that the patient is making progress, but he is not confident enough that the progress will stop her from being abusive to her children. The psychologist is torn between the responsibility towards the patient and doing the right thing.
The APA Code of Ethics has a list of general standards and specific ethical issues to guide psychologists in their work. Each provision of the Code of Ethics provides a guideline to address ethical issues. The general standards are made up of five principles: beneficence and nonmaleficence, fidelity and responsibility, integrity, justice and respect for people’s rights and dignity (APA, 2010). The above ethical dilemma can be addressed through some of the general ethical standards. For instance, the psychologist is guided by the principle of beneficence and nonmaleficence, in their actions they should seek to look out for the welfare of the patient. However, the principle of beneficence extends to affected persons, hence, in this case the psychologist should also consider the children of the patient in question. The principle of beneficence states that psychologists should resolve conflicts in a fashion that avoid or minimizes harm, a reasoning which can be used by the psychologist to avoid reporting the patient to the relevant authorities.
The second principle is the principle of fidelity and responsibility, which encourages psychologists to establish a relationship based on trust with whom they work with. However, the relationship is guided by responsibility, hence, the psychologist must inform the patient of the roles and obligations as per the professional code of standard. A relationship of trust is important as it encourages patients to open up and share their problems.
Some of the specific ethical standards that are related to the ethical case are: standard 1 and standard 4 (APA, 2010). Standard 1 focuses on resolving ethical issues, it is made up of eight guidelines to guide psychologists in resolving ethical issues. According to the first guideline, psychologists must take the necessary steps to minimize conflicts. The second guideline is related to the ethical case, a psychologist has an ethical responsibility to comply with the law, regulations of the legal authority, Ethics Code and organizational demands. The psychologist facing the ethical dilemma is mandated by the law and the Ethics Code to report child abuse. On the other hand, Standard 4 deals with privacy and confidentiality. Psychologists have the primary obligation to protect confidential information, however, the concept of confidentiality also has limits. Confidentiality among minors is a gray area, as there are states that allow psychologists to share information with parents. Regardless, the psychologist has a responsibility to disclose private information to protect others from harm (APA, 2010)
Legal and other Professional Practice Issues
According to APA (2003) ethics and laws are quite different; ethics are standards that govern the conduct of the members of a certain profession. On the other hand, law is a body of rules that govern the conduct of individuals within a community, state or a country. A violation of an ethical standard does not necessarily result in a violation of law. Nonetheless, there are legal provisions that guide the work of psychologists and how they handle certain cases (Fisher, 2016). The legal provisions compliment the code of ethics.
The law gives patients a privilege, which is the right to bar the use of confidential information in a court proceeding. While confidentiality is considered an ethical concept, psychologists have a legal duty to protect information about clients. Client consent is considered the only basis for disclosing confidential information, however there are legal exceptions. According to Behnke (2004), there are legal mandates that ask psychologists to disclose confidential information without the consent of the patient. The legal mandates come in various forms, for instance, the mandatory reporting laws. The child abuse reporting law is a result of legislation passed to protect children. In the ethical dilemma involving the abusive patient, the psychologist will not be at fault for disclosing information without patient consent because of the child abuse reporting law.
Apart from the APA Code of Ethics, individual organizations come up with their own code of standards to guide how practitioners operate. Most professional organizations support disclosure of certain information, for instance, abuse of minors. The organizational code of conducts are borrowed from APA’s general principles and the specific ethical standards, and they guide individuals in their practice. Psychologists are not just guided by APA’s codes of ethics and the law, but they are also guided by organizational guidelines.
Ethical Decision Making Steps
When faced with an ethical dilemma, making the right decision is a hectic process that involves weighing different options. APA Code of Ethics provides the guidelines for making an ethical decisions. Before addressing any ethical dilemma, the psychologist must have made a commitment to doing what is ethically appropriate. APA Code of Ethics are the standards that guide practice and they must be observed always, not just in the case of ethical dilemmas. A psychologist who does not follow the code of ethics on a daily basis, might not follow it in case of an ethical dilemma. However, those who are familiar with the code of ethics have an upper hand in solving a dilemma.
The ethical decision making steps are: Familiarizing oneself with the APA ethical code, consulting any law or professional guidelines, understanding the perspectives of various parties, generate and evaluate alternatives, selecting and implementing the most ethically appropriate alternatives, monitoring the course of action (APA, 2007).
The first step is to analyze the ethical dilemma using the various provisions of the APA ethical code (Fisher, 2016). The ethical code has various provisions within the general principles and the specific ethical standards to guide the psychologist. For instance, the first principle of beneficence and nonmaleficence advises the psychologist not to do any harm to the patient and other involved parties.
The second step is consulting any law or professional guidelines. APA has a professional guideline for psychologists in its code of ethics. There are legal mandates that affect the work of psychologists, in this dilemma, the psychologist is supposed to report child abuse by his patient. The third step is understanding the perspectives of the various parties involved, the psychologist owes it to the patient to listen to her before reporting. The patient has made progress and appears remorseful of her actions, the psychologist can ask the patient to bring in her children so that he can get their perspective on abuse. If the children appear traumatized from the long years of abuse, the psychologist can decide to report the patient. However, if the abuse only went on for a short while when the patient was sick, and the situation has approved, the psychologist can choose not to report and monitor the progress of the patient closely. The psychologist will choose an alternative based on his assessments of all the parties involved instead of making a quick judgment after learning that the patient was abusive. PTSD is a serious condition that can impair one’s functionality, and they tend to act aggressively. If the patient is making significant progress and is in control of her aggression, the psychologist might not feel the need to report the incident.
The last step is one of the most important steps, the psychologist must monitor the patient keenly to evaluate the effectiveness of the course of action. Ethical dilemmas present impossible options, and monitoring the course of action to ensure it produces positive results is the only way to confirm that the course of action was the right decision. To monitor the course of action, the psychologist will carry out regular sessions with the patient, the children and their father or another responsible adult who will monitor the patient’s progress at home and be in charge of the children’s welfare.
Appraisal
a. The ways in which self-awareness of your personal life experiences, including their emotional influence on perceptions of legal issues and professional ethics, could affect your work with this case.
Self-awareness is an important concept in the ethical decision making process. Self-awareness is the process of identifying traits, behaviors, and feelings that make up an individual. According to Rochat (2003) self-awareness is one of the most fundamental issues in psychology developed from early childhood. As children grow, they reach a period where their sense of self become permanent, and it is no longer tied to temporal simultaneity. Self-awareness of personal life experiences is necessary for the individual to identify the patterns of decision making and the ethical theory that one ascribes to. Individuals do not make decisions out of spontaneity, rather they tend to make decisions based on certain principles.
According to Evans et al. (2012) some of the factors to consider when conceptualizing self-awareness includes individual experiences, professional development and the system in which an individual exist. Self-awareness is developed from individuals past experiences, the psychologist will have to carefully analyze the past experiences and self-growth experiences to identify permanent changes that form personal values. Professional development also affects one’s sense of self awareness. For instance, psychologists recognize the importance of values in their profession, and they make an effort to explore their individual values and adjust them to suit the profession.
Self-awareness also involves knowledge of one’s emotion, and its potential effects on professional decision making. Emotions such as anger, fear and frustration can get in the way of rational thinking, and they have influenced my decision making in the past. Effective self-awareness has enabled me to gain control of negative emotions.
Personal experiences, including emotional influence, affect one’s approach towards professional ethics and legal issues. Despite the code of ethics and other professional regulations, psychologists also apply individual judgment in resolving ethical dilemmas. Individual interpretation of the code of ethics, values, knowledge and world view will play a role in ethical decision making (Evans et al., 2012). For instance, a psychologist who ascribes to relativist ethics will pay less attention to code of ethics, and might not report the abusive patient to the relevant authority. On the other hand, a psychologist who ascribes to Kantian deontology is more likely to follow everything in the code of ethics, and will take the issue seriously, and will probably report the patient.
b. The ways your personal ethical perspectives could affect ethical decision-making specifically in this case. Provide a rationale for what you have determined in this regard.
Personal ethics guide an individual’s interaction and ethical decision making process. Personal ethics are an individual’s sense of right and wrong, and it affects all areas of an individual’s life including the professional life. Unfortunately, personal ethics sometimes overlap with professional ethics.
Personal ethics are created from a plethora of sources such as childhood upbringing, life experiences, and influences from others, code of ethics, religion and ethical theories. Childhood upbringing forms the foundation for an individual’s ethical framework. Children learn from observing parents, guardians and siblings. For instance, I grew up with a strict father who expected us to always follow the rules, even if they did not make sense. Eventually, obeying rules became a part of my personal ethics. As I became an adult I realized that there are gray areas in life, those who do not obey rules are not necessarily wrong. As a student of psychology I understand that rules and code of ethics exist to guide behavior, however, they do not apply to all cases. However, I will carefully monitor whatever decision I make since it involves children, and I will not hesitate to report the patient in case of any red flag. I consider myself a utilitarianist, I believe that it is our duty to minimize harm by all means (Fischer, 2016). Psychologists should do whatever they can to help their patients to do better in life, even if it means failing to report past involvement in child abuse if the treatment worked.
My personal ethics are guided by the need to do greater good and minimize harm, and it will definitely affect how I react to the ethical dilemma. A careful analysis of the situation is necessary to determine what “greater good” means in this particular case. If the patient is making genuine progress, I will verify that in an extensive session with the children to show that the patient is no longer posing any danger to the children. After a careful evaluation, and if the patient’s control over her PTSD is improving, I will postpone reporting the incident because reporting it will affect the whole family. However, if the patient is not improving, I will not hesitate to report her in order to protect the children. My personal ethical perspective is not based on rigid rules, rather on the need to evaluate each situation as it is to determine the option that carries the most benefits. Utilitarianism is not about defying the rules, but looking out for the best interests for the most in each situation.
c. The development of your moral and ethical framework throughout the course including a discussion of how you might have responded to this case at the beginning of the course compared to your present responses.
Throughout the course I have learnt that an individual’s moral and ethical framework play an important role in psychology. While the APA code of ethics, legal provisions and professional ethics are supposed to guide an individual, each situation is different, and sometimes the ethical and legal provisions are not enough. At the beginning of the course, I would have immediately reported the patient for confessing to have abused her children in the past because of her PTSD. In the beginning, I believed that psychologists must follow all rules because rules are created to check the behavior of the psychologists and for the greater good of everyone.
According to Fisher (2016) ethical decision making in psychology requires flexibility and sensitivity to context. Each case is unique, and it is the responsibility of the psychologist to apply the necessary competencies, knowledge of APA’s code of conduct and legal knowledge to analyze the situation well. The primary responsibility of the psychology is towards the patient, and when dealing with patients who have gone through traumatic experiences, a lot of care and trust is necessary. Fisher (2016) states that psychologists must implement various reasonable actions to solve an ethical issue as long as they are not violating human rights. However, when their actions are not resolving the conflict, psychologists are permitted to make a conscientious decision to comply with the legal and authority.
References
American Psychological Association (APA). (2010). Ethical Principles for Psychologists and Code of Conduct. Retrieved from: http://www.apa.org/ethics/code/
Behnke, S. H. (2004). Informed consent and APA's new Ethics Code: Enhancing client autonomy, improving client care. Monitor on Psychology , 35 , 80-81.
Evans, A. M., Levitt, D. H., & Henning, S. (2012). The Application of Ethical Decision-Making and Self-Awareness in the Counselor Education Classroom. Journal of Counselor Preparation and Supervision , 4 (2).
Fisher, C. B. (2016). Decoding the ethics code: A practical guide for psychologists . Sage Publications.
Rochat, P. (2003). Five levels of self-awareness as they unfold early in life. Consciousness and cognition , 12 (4), 717-731.
