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ETH8283 - SECTION 5: THE STAGES OF ETHICAL DECISION MAKING: A BRIEF REVIEW

Stages of Ethical Decision Making


In yourceus.com's introductory course on ethical decision making: Ethical Decision Making: A Primer for Mental Health Clinicians, a considerable amount of time was spent examining the six stages of ethical decision making.

Because the focus of this course is concerned with leadership issues and ethical decision making, we will not cover this section in complete detail. We will, rather, summarize the important points, and then focus on issues of leadership and authority. Let's begin by looking at the six stages the clinician uses in making a complicated ethical decision.

The Steps or Stages of the Ethical Decision Making Process

The Knowledge Stage

The Identification Stage

The Evaluation Stage

The Selection Stage

The Assessment Stage 

The Adaptation Stage 

 

This process is very similar in nature to the multi-stage assessment/intervention process utilized in good clinical work. For the mental health clinician who wishes to operate from a position of leadership, the most important of these stages may be the first: the knowledge stage.

There are many things that experts and leaders must know in the field of mental health. In an earlier section, we discussed some of the leadership and clinical skills that an expert mental health clinician must understand.  On the next pages, we'll present some of the other important things that each mental health clinician must know and understand.

  

Stage One: The Knowledge Stage

 

The first thing to know, not surprisingly, is the ethical code or codes for your profession. Most mental health clinicians are familiar with both the code developed by the national organization for their profession, and a state code associated with the licensure or certification board. The next thing that the clinician must know is the collection of principles and interests that are involved in the ethical decision making process.

The clinician must have his or her own understanding of these principles and interests over and above the codes in order to answer some of the more complicated ethical dilemmas he or she might face in the course of a professional career.

The third item a clinician must know in the ethical decision making process is oneself: one's biases and prejudices, one's blind spots and trouble spots, and situations in which self-interest will make it hard to make the right ethical choices.

There are also some more practical items that the clinician must know from his/her position of leadership. These are shown below.

 

- Legal codes related to privacy and confidentiality, such as Federal Law 42 CFR part 2, and HIPAA regulations

- State statutes related to reporting responsibilities for suicidality, homicidality, and child and elder abuse

 - Statutes and guidelines related to clinical work with minors and multiple (versus primary) clients

  

Stage Two: The Identification Stage

The second step or stage is the identification stage. There are three important things to identify in this stage: 1) who the client is; 2) the various ethical principles and interests in operation within the actual situation that is before the clinician; 3) potential options for solving the problem.

 It is important to identify all the principles and interests at stake in every aspect of the situation, as well as in each of the potential options for resolving the situation.

Leaders will do the extra work of looking at a wide range of possible solutions, searching for the one that creates the best balance of all the competing forces in operation. The willingness to engage in this extra work - at one's own expense of time and energy - is one of the defining characteristics of leadership.

The leader will also do the extra work in terms of looking at how his or her personal self-interests, biases, emotional reactions and blind spots are being factored into whatever options are being considered. Where clarity does not exist, a leader will - with great humility - seek consultation from another trusted professional, one who can lend an objective perspective on the situation.

 

Stage Three: The Evaluation Stage 

The evaluation stage is next. It is concerned with taking the principles and interests that have been identified as being at stake in the situation, and evaluating which are the most important to consider. This will incorporate knowledge of the codes of ethics, and understanding of the principles and interests themselves. 

The evaluation stage is also concerned with evaluating the options for resolving the situation. The more options that are available, the more work is required of the clinician to evaluate each option fully.

In the evaluation stage, it is important that the clinician be completely clear about how his or her personal self-interests, biases, emotional reactions and blind spots are being factored into whatever options are being considered.

Where such clarity does not exist, it is often helpful for the clinician to seek a consultation from another trusted professional, who can lend an objective perspective on the situation, as well as feedback from the client about his or her evaluation of the situation. This willingness to seek outside views and opinions is in keeping with the concept of humility that was discussed earlier in this training.

The willingness to invite clients into the evaluation process is particularly important in situations in which the client comes from a culture other than the dominant culture. Ethical codes, which are connected to legal and moral systems of belief in complex ways, have arisen from ideas and beliefs that hold sway in Western culture. 

In working with clients whose cultural values and beliefs are different, there may be instances in which those predominately Western beliefs may be both culturally insensitive and incompatible with the client's deeply held system of values. The process of evaluation, in such instances, will be a deeply collaborative process requiring great sensitivity and flexibility.

This issue represents one of the most difficult areas within the arena of ethical decision making and cannot be covered in full detail here. For clinicians who wish to engage in a fuller examination of this subject, we recommend yourceus.com’s course entitled, “Cultural Diversity, Value Conflict and Complex Ethical Decision Making for More Senior Clinicians”. This course should be available in 2005.

  

Stage Four: The Selection Stage

The fourth stage or step is the selection of the best option or solution, and the putting of the option or solution into effect. This is the point at which the world of the abstract and theoretical meet the world of real life consequences and effects. If the clinician has selected well, the choice will hopefully operate effectively in the real world. To assure that this is the case, the clinician will continue this process with the two final stages.

  

Stage Five: The Assessment Stage

The fifth stage is the assessment stage, in which the clinician assesses the real life effects of the selection that has been made to solve the ethical dilemma. The real life effects must be evaluated both from the perspective of the clinician and the ethical obligations the clinician holds, and from the perspective of the client, whose life will be affected by the ethical choice that has been selected.

  

Stage Six: The Adaptation Stage

The last stage of this process is the adaptation stage. In this stage, the clinician will look to adapt the selection or solution of the ethical dilemma by refining it, or by returning to the evaluation and selection stages to find and choose a better solution. The adaptation stage is essential to aligning the ethical choices with the real world of the client. 

With this quick review of the stages of ethical decision making completed, we will next be turning to an examination of the principles and interests at stake in the decision making process.

 

Post-test Preparation: Review questions

At this point in the training, the trainee should be able to answer the following questions: 

What are the six stages of ethical decision making?

In the examination of the knowledge stage, there were three important things noted as being essential for the clinician to know. What are these three things?

In the examination of the identification stage, there were three important things noted as being essential for the clinician to identify. What are these three things?

Whom should the clinician consider involving in the ethical decision making process beside him/herself? 

What conflicts may arise from the code of ethics being derived from a predominately Western ethos?

What purpose does the adaptation stage serve in terms of ethical decision making?

 

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