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ETH8385 - SECTION 4: THE STAGES OF ETHICAL DECISION MAKING

Stages of Ethical Decision Making

When you approach an ethical decision, there are several steps or stages involved in making a good decision. This chapter will be concerned with looking at these stages in some detail.

The following page shows, in diagram form, the different steps or stages in this process.

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


Stage One: The Knowledge Stage

The first stage is the knowledge stage. It begins before you are faced with the ethical decision.

As is implied by the name, this stage is concerned with knowing a number of things that are involved in the ethical decision making process.

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.

These codes are usually a very good starting point for the ethical decision making process, and may define good parameters for many, but not all, of the ethical dilemmas faced by mental health clinicians.

A surprising number of clinicians, however, are not fully familiar with the codes of ethics under which they are supposed to work.

The codes are evolving entities, incorporating changes in ethical thinking over time. Some clinicians do not know their codes because they have not kept up with the changes in thinking over the course of their professional career. It is important to know the present code or codes to help with making good ethical decisions.

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 codes of ethics are derived from a study of these principles and interests. However, because these principles and interests interact in complicated ways, the codes of ethics are not prepared to fully resolve all ethical decisions for the counselor.

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.

Because a detailed study of the principles and interests involved in ethical decision making is contained in the next chapter of this training, we will not discuss it further here.

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.

Apart from not fully understanding the code of ethics, this area is the most likely to cause the clinician to make poor ethical decisions.

Clinicians, like all other people, will at times be confronted by their own tendencies to engage in decision making based upon their emotional needs and impulses, instead of a full and clear reckoning of the issues involved.

The call of self-interests clouds good judgment, whether the call is set in motion by one's attraction to a client, the promise of improving one's financial situation, or fatigue and burn out.

Clinicians are intimately involved in the business of helping other people know themselves, bringing forth clarity out of the confusion.

This same process of seeking clarity must be turned on oneself if the counselor wishes to work at the highest level of ethical decision making.


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.

There will be more detailed study of these items in later chapters.
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.

This identification process is a necessary precursor to the next stage in which the clinician must evaluate which principles and interests carry the most weight in terms of reaching a good ethical decision for that 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. There may be a limited number of options available to the clinician, as is the case in many counseling situations.

In other cases, there may also be a great number of possible solutions to the ethical problem. The more options that are available, the more work is required of the clinician to evaluate each option fully.

However, it is also true that the more options the clinician examines, the wider is the range of possibilities for finding an option that offers the best balance of all the principles and interests at stake, including those which support and protect the interests of the clinician.

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.

In still other instances, it must be determined whether the client can and/or should be brought into the process of evaluating the ethical situation.

While this is not an invitation to transfer responsibility for these difficult decisions to the client, the client's input can often be helpful in keeping clear the real potential outcomes from some of the decisions to be made.

At this stage of any clinical intervention, the clinical and ethical components of the clinician’s actions will often overlap.

At times, there will be an easy convergence, and the clinical work will be fully compatible with the ethical considerations. However, this will not always be the case. There may be complicated instances in which the clinician may need to choose between following professionally defined ethical guidelines and doing what is best for the client.

This can be particularly complicated 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.

While professional codes of ethics make note of the need to consider cultural difference in clinical work, there are times when the clinician will be forced to choose between respecting the client’s cultural values and beliefs, and operating in a way that is consistent with their own profession’s code of ethics and the ethos from which that code arises.

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 sometime 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 made.

If the results or consequences of the selection have not led to the anticipated resolution of the problem, the clinician moves to the last stage or step of this process.


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.

This staged process will become clearer as we look at an analysis of the scenarios. With this section completed, we will now turn 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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