Working through ethical dilemmas Once the dilemma is identified, the following strategies can be used to address them: ● Be sure to know all standards, ethics codes, state requirements, agency policy, and professional obligations and responsibilities prior to practice. When/if an issue arises, the therapist must review the elements of the situation against these to effectively address the conflict. The practitioner must know the standards of ethical conduct to make ethical decisions in practice. This is assuming that the practitioner acted in accordance with these criteria. ● The practitioner must be able to objectively and honestly observe and analyze the client behavior, as well as their own, to determine what contributed to the ethical issue. ● The practitioner must identify areas where boundary crossing may have occurred, determine the source, and take action to remediate the situation. ● The therapist must identify their triggers, and the client’s triggers, that may lead to ethical dilemmas. ● Though the roles and perceptions of the client and practitioner may not align, the responses of each may shed some light on the causation, time of origin or progression of the ethical issue. ● As soon as a warning sign of conflict appears, stop treatment and address the issue. One a problem develops effective treatment cannot be achieved and the conflict could escalate. ● It may take time to determine the root of the problem through careful investigation. This underscores the importance of accurate, contemporaneous documentation. ● Always speak truthfully and guard against appearing offensive or defensive ● Institute a decision making model and collaborate with appropriate resources. Contact legal counsel if indicated.
● When the issue is resolved, be sure to take steps to establish clear boundaries roles and expectations with the client ● The practitioner must reflect on personal attitudes, values, and beliefs that influence behavior and ethical decision making. ● The practitioner should understand that personal morals, bias, and professional principles are intertwined. They must learn to separate personal values, beliefs and feelings from professional ethical standards when reaching an ethical decision. Separating personal beliefs and values from professionally ethical choices clarifies decisions. Over time, experience will help the practitioner to feel more confident and capable to identify the early warning signs of ethical conflict to communicate with the client, stop inappropriate actions and solve the issue before it becomes an ethical dilemma. Fitch (2015) concludes: ● When therapists have a strong internalized code of ethics, they are able to maintain a clear sense of purpose, professional role, and internal sense of power regardless of the circumstances. ● These therapists use inappropriate behavior as an opportunity to instruct the client and clarify what is acceptable. ● Therapists must learn how to “practice professionally, independent of personal beliefs.” ● Therapists must differentiate between personal and professional beliefs and explain how the client’s behavior must change. ● Regardless of how a client behaves, the answer always lies in choosing the professional role over personal impulses. ● A professional response, delivered empathically, can usually address whatever issues arise from client behaviors.
DECISION-MAKING MODELS FOR CLIENT CARE
along with patient decision support tools. The NIH article describes the model as follows: Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, a model of how to achieve shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences. The guiding principles of SDM are aligned with those of the massage and body professional standards which promote individual self-determination, autonomy, is a critical goal and professionals have an obligation to support patients to achieve this goal. Self-determination in the context of SDM does not mean that clients are left alone to make decisions for which they have inadequate knowledge and experience. It is also not the goal of the model to place the responsibility for decisions solely on the client to relieve the practitioner of liability or blame if a negative outcome results.
There are many decision making models that have been used successfully in medical and clinical setting to assist clients in building autonomy in the therapeutic process. Supporting patients in this way correlates with standards of professional conduct as well as ethical guidelines. Most decision-making models involve collaboration with other colleagues or authorities in the profession to provide additional information for decision making within professional practice. The nature of this type of process precludes a collaborative relationship between client and practitioner. A shared decision making process with the client is a way to build the therapeutic relationship from the beginning, set a tone of collaboration, build client autonomy, and help balance the power differential in the relationship. The NIH has researched a different model of decision making which involves the client in the process and it is referred to as a shared decision making (SDM) process (Elwyn et al, 2012). This model is gaining acceptance and is being reflected in health care policy since 2012. Shared decision making (SDM) has been defined as: ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’ (Elwyn et al, 2012). The three-step model was developed to be practical for clinicians and integrates good communication skills
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