Ethical dilemmas are circumstances in which there is a decision to be taken between two choices, also known as moral dilemmas, none of which fixes the problem in an ethically appropriate manner. For all healthcare workers, ethical principles are important. Ethical practice is the basis for professionals who struggle with ethical challenges regularly. When a health care worker works for patients, ethical dilemmas emerge (Rainer et al., 2018). These dilemmas can clash with the Code of Ethics, or with the ethical principles of the healthcare, at times. Counselors are patient supporters who must strike a balance when offering health care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence (Jill Day et al., 2018). Healthcare staff is obligated to refrain from maltreatment, reduce damage, and allow patients to benefit. Within their discipline, they should know the Code of Ethics and be mindful of their honesty and moral character to accept them. A simple and consistent knowledge of core ethical values should be accessible to nurses. The nursing career must stay loyal to patient safety while fighting for self-identifying interests and societal expectations for patient rights. Though daunting, ethical issues in nursing reflect a genuine synthesis in the practice of health care (Mullen et al., 2017).
What do I know?
A male client named Aaron with mental health problems was admitted. In the sessions, he claimed that due to extreme remorse about certain unspecified acts, he had developed urges to injure or destroy himself. He is unemployed and homeless, looks lonely, and has not made eye contact with me. Aaron was given stress treatment by the resident GP and prescribed medicines which he promised to take as planned by the GP. This appears to have alleviated his urges to kill himself and within 24 hours he is expected to be discharged.
In my last session with him I asked him to explain what he meant by 'intense remorse'. Aaron reminded me of the confidentiality obligations and said he had abused and raped women at and near the University of Adelaide. Furthermore, I was asked if I was comfortable to be with him alone in the space, he said he felt so bad that he will never do it again, and that's why he tried to kill himself. I inform him of the secrecy restrictions and that he signed a consent agreement specifying the terms under which I could breach secrecy. He recalled signing something, Aaron said, but he was so angry that he couldn't recall what it said, telling me not to tell anybody about his revelation.
What don't I know?
I don't know whether or not Mr. Aaron is telling the truth. Perhaps, as they constantly hallucinate about objects that are not actual. Many a times people with impaired mental health disorders make up the narrative (Ebert et al., 2017). I am still unclear if he is the one charged with the rape cases. Although the rapes of the University of Adelaide were in the headlines at the time, it might be likely that he may have heard the news from the other mental health institution inmates. The mental illness client regularly depicts themself as abusive, murderous, volatile, and accountable for his disease, gross exaggerations and misrepresentations of fact, and entirely false (Miller, 2020). So, it may be likely that Aaron is going through the same circumstances. The pessimistic opinions of mentally disturbed people are directly related to the hours spent viewing or listening to the bad news of this nature (MacLeod, 2017). As a mental health specialist, it is my job to listen to the experiences of patients, but whether an instant inference is drawn by the consumer experiences, it is not rational and out of practice.
I could find out what I don't know by:
The reality can be learned by conducting some studies into the frequency of rape incidents at Adelaide University. The first way to get information about the perpetrator in the rape incidents is to contact the police. The defendant's identification given in the police reports may be extensively investigated. It is possible to fit the profile of the accused with that of Aaron. It is possible to schedule additional sessions with Aaron and discover the truth about the confession he made. If the client is stable and adamant with the argument, he provides a straightforward image of the whole event that can be gained in the session regarding the event.
What ethical principles conflict?
My responsibility is to tell about the next steps I will take concerning his situation is to respect Mr. Aaron's autonomy. I would also look after the other ethical concept of beneficence that does not damage the individual (Sullivan, 2016). To help the patient in each case, this theory states that health care providers must do whatever they can. The prescribed therapies and medications must be designed to do the patient the most benefit. In any situation, he could be brought into detention if Aaron is the actual accused of the rape cases at the university. And after taking care of the mental health hospital, Aaron's condition is improved, but any form of regression of mental disease will be a danger to the public.
It is doubtful that a patient who does not trust the counselor would be frank about their emotions and concerns because he or she will never get the appropriate support to deal with these problems. Therefore, the counsellor is needed to bring that trust with the client. The counsellor and the client sign a confidentiality agreement in which no client information may be exchanged with others without informed written permission (Brooks et al., 2020). To protect the patient or the public from significant injury, counselors can reveal private information without permission, which is why confidentiality is so crucial to make therapy successful. In the case of Aaron, if he is found guilty in the rape proceedings, their condition could be where secrecy needs to be compromised.
Mr. Aaron's caring and concern will see me trying to fix it immediately and tell no one during the sessions about the revelation he made. Mr. Aaron showed faith and told me the most secret item that, under legal responsibilities, could hurt him. At a certain point in time, it is my job to take care of the client and provide security and safety. The ethics of treatment still needs me to be committed to the well-being of the client in any case, including after the facts he has discovered about his grim and violent past.
According to virtue ethics, counselors behave and think in ways that in all cases are morally and ethically acceptable, while ethical standards recommend that counselors should demonstrate proper ethical actions when faced with a dilemma (Tsoukas, 2018). Since speaking to a client, it is very difficult for a counselor to get out of the legal dilemma and come to a right conclusion. In the case study given, Mr. Aaron admitted that he raped university females. There's a major possibility he's regretting his actions when he told me he's ashamed of his actions with shame. In this case, I am in an ethical debate that it should not be possible for a person with a negative history to be a decent person. Without careful thought, these things can cause me to behave precipitously. Having people in pain is not something I can readily handle emotionally, but I need to be cautious not to presume that this means that people's suffering may be of no value.
Mr. Aaron's rights and wants: He has a right to be given a second chance to make his life better. Also, he should be informed by the counselor about the steps taken if the confidentiality obligations are broken keeping his actions of past in mind.
My duties: To honor and follow the values laid out in the PACFA(Psychotherapy and Counselling Federation of Australia) Code of Ethics 2017 where it is my ultimate responsibility to provide the customer with treatment to strengthen the circumstance, I also should try the best possible solution in such a situation, keeping the ethical dilemmas in mind ( PACFA, 2017). Counseling is no different, with a robust code of ethics that must be upheld by those in the profession (Jungers & Gregoire, 2016). Given the sometimes fragile and intensely intimate contact with the customer, confidentiality with Mr. Aaron is important. Yet the legal issues hardly stop there for me. Perhaps the most serious legal issues derive from the client-counselor relationship. The Australian counselling association (ACA) states, above all, that it is "the main duty of counselors to uphold the integrity and encourage the wellbeing of patients." This is the fundamental concept in the principles of counseling partnerships (ACA, 2019). Ethical dictums, for example, such as preventing harm, controlling territories, ensuring cultural awareness, getting informed consent, and becoming part of a support network, are both directed at protecting and supporting consumers(Davis‐McCabe, Di Mattia, & Logan, 2019).
Choice 1: Doing what Mr. Aaron says.
Pros: I asked him to explain what he meant by 'intense remorse' in my last session with Aaron. Aaron told you of your confidentiality responsibilities and said that he was abusing and raping people at and near the University of Adelaide. He then proceeded to beg me not to tell anyone about his exposure. A chance to come out of the dark past should be offered to any person. Practicing forgiveness and offering second chances would allow Mr. Aaron to become a better guy, as difficult as it is. The expectations of confidentiality, care ethics and autonomy make me wonder about giving Mr. Aaron a more chance for the client to have a happy and fulfilling life. In this situation, my spiritual principles ask me to be a skilled goddess and obey the treatment of ethics and the theory of beneficence so that the individual would benefit from the uncertainty since his poor mental health was responsible for what he did in the past.
Cons: And if Mr. Aaron is not a rapist, breaking my moral standards, which should be to violate confidentiality commitments and promptly tell the police, will be to do nothing. But if he is the rapist, it will damage the public if I do not notify the police and maintain confidentiality with the client. He can go out of the hospital for mental wellbeing and continue to do the crimes. And if it did happen, it could be handled professionally-although he had once been a criminal, he had handled to give that up with help already, then it seems likely that he might do so again.
Choice 2: Not doing what Mr. Aaron says
Pros: Many girls who are at risk from him could be spared in the future if the confidentiality agreement is violated with Mr. Aaron. I follow my standards of justice and I will live with myself. The public who is at risk because of the client's past should be protected from the abuse. It is likely that in the future he will have a mental health problem and might damage girls at university. Informing the police will help deter such an atrocious occurrence in society in the future.
Cons: He won't get the treatment he wants from me. The confidence bond between the psychologist and the patient is also affected. This can result in the client not discussing with the psychologist their history. It would be Mr. Aaron's wasted chance to make his life easier. He will believe like he made a mistake in asking the psychologist about the past and may have a sense of hate for humanity when his trust is lost. In the future, this will affect his mental health.
Weighing up and deciding.
The consequences of not doing anything about Mr. Aaron means placing the community at risk from the patient. Except for his care and safety, on the other hand, to see his rights violated and see me involved in acts that contradict my moral code of ethics and my partnership as a counselor with my clients (Anderson, 2016). The perfect outcome will be the results of doing anything to guarantee that he has the necessary treatment and opportunity to will not hurt others until leaving the mental health care center. So, with guidance, I will speak with the supervisor and realize what the best possible approach we should make with Mr. Aaron is. I will prolong his stay in the facility for some more time so that it can make a good decision for him. More consultations with psychologists and other members of the multidisciplinary team should be planned in the interim to ensure that he is in good health and mental well-being and does not endanger people outside.
Action and follow up:
I'd begin with a knowledgeable dialogue with multidisciplinary team members such as psychiatrists, general practitioners, occupational therapists, physiotherapists, and social workers that may have a deeper perspective on the entire scenario. I can also speak to my team members about the moral dilemma and my spiritual responsibilities this brings to me. I will also speak to Mr. Aaron, though, and make him understand that in this situation it is important for me to breach the terms of the trust. I'm going to try to convince Mr. Aaron that I'll try my hardest to provide him with treatment to security. All this will be done to do what I can to prove the love he has for him and the importance of this friendship as he trusted me with a lot of faith in his history. In a collegial, not confrontational manner, I could incorporate some of the latest studies just to let him understand that the measures I take are subject to legal and ethical obligations. I would also provide the customer with an identical case analysis so that he can provide a clear view of the whole situation. In his extended stay, I will follow up on the situation regularly and will support Mr. Aaron so that he will be physically and emotionally strong to consider the repercussions if at all is against him (ACA, 2013).
Routine outcome testing has been suggested by the Australian Psychological Association to be part of reliable psychological treatment since such monitoring approaches have been shown to increase client outcomes. Feedback progress reviews and warnings should be analysed not as a measure of one's competence as a mental wellbeing provider, but as critical indicators of medical progress. I'm going to check to see if Mr. Aaron gets sufficient medicine and care. If he is not, with their recommendations, I will meet with my boss or other counselors, but lean towards telling senior management that I do not accept this course of action and will go to a higher authority. I will continue to check in on his changes with Mr. Aaron. I'm going to keep track of any decisions are made on his situation.
ACA. (2019). Codes of ethics in practice. Retrieved from https://www.theaca.net.au/documents/ACA%20Code%20of%20Ethics%20and%20Practice%20Ver15.pdf
ACA. (2013). Suicidal clients – ACA (INC) guidelines. Retrieved fromhttps://www.theaca.net.au/documents/ACA%20Suicidal%20Client%20Guidelines%20Ver%203.pdf
Anderson, C. (2016). Workforce Innovation and Opportunity Act Implementation: Ethical Considerations for Counseling Practice. Retrieved from https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1869&context=gradreports
Brooks, J., Bratley, R., Jones, L., King, N., & Lucock, M. (2020). Expectations and experiences of psychological therapy from the client perspective: A qualitative study. British Journal of Guidance & Counselling, 1-11.
Davis‐McCabe, C., Di Mattia, M., & Logan, E. (2019). Challenges facing Australian counselling psychologists: A qualitative analysis. Australian Psychologist, 54(6), 513-525.
Ebert, D. D., Cuijpers, P., Muñoz, R. F., & Baumeister, H. (2017). Prevention of mental health disorders using internet-and mobile-based interventions: a narrative review and recommendations for future research. Frontiers in Psychiatry, 8, 116.
Jill Day, B. G. S., LDA, R., & Sarah Stream, B. A. (2018). Ethics in the dental office: Autonomy, beneficence, non-maleficence, and justice should guide your decisions. Dental Assistant, 87(4), 8-9.
Jungers, C. M., & Gregoire, J. (2016). Authenticity in ethical decision making: Reflections for professional counselors. The Journal of Humanistic Counseling, 55(2), 99-110.
MacLeod, A. (2017). Prospection, well-being, and mental health. Oxford University Press.
Miller, L. (2020). The Psychology of Police Deadly Force Encounters: Science, Practice, and Policy. Charles C Thomas Publisher.
Mullen, P. R., Morris, C., & Lord, M. (2017). The experience of ethical dilemmas, burnout, and stress among practicing counselors. Counseling and Values, 62(1), 37-56.
PACFA. (2017). Code of ethics. Retrieved from https://www.pacfa.org.au/practitioner-resources/ethical-standards/
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461.
Sullivan, M. (2016). The patient as agent of health and health care: Autonomy in patient-centered care for chronic conditions. Oxford University Press.
Tsoukas, H. (2018). Strategy and virtue: Developing strategy-as-practice through virtue ethics. Strategic Organization, 16(3), 323-351.
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