____________________________________________ Professional Ethics and Law in California, 2nd Edition
PROFESSIONAL VALUES Professional values are the “guiding beliefs and principles that influence your work behaviour” and that are “usually an extension of your personal values,” and though your values may evolve over time, core beliefs should not (Birmingham Community Healthcare, n.d.). Examples of professional values are integrity, honesty, and a striving for social justice. Although professional values are based on personal values, which are based on such factors as culture and ethnicity, they are also acquired over time—from professional experts, col- leagues, the organization, and from actual situations in which an individual works. Values are also prioritized according to a person’s surrounding culture and other factors. Although professional values and ethics may overlap, they are not identical. An individual may feel that it is important to dress in a certain way that he or she regards as professional, even though his or her professional ethical code does not specifically cover this requirement. Professional values may even conflict with professional ethics, as might be the case when an individual believes in complete honesty and openness and a code of ethics emphasizes privacy and confidentiality (Reference.com, 2020). Because professional values are based on personal values that have their roots in culture and background, it is important in mental health practice to be aware of “beliefs, assumptions and norms, and how these affect practice situations” (Bogg, 2010). Also, because professional values are so varied with individuals, a framework of professional ethics is important for the professional and the practitioner alike. ETHICS AND MENTAL HEALTH PRACTICE Ethical issues are common in any profession. But mental health work, which relies heavily on relationship building and which can directly impact the health and welfare of its clients, poses even greater responsibilities and challenges. Mental health practitioners must rely on internal ethical guides through character and integrity, and external ethical guides such as laws and codes of conduct. Consider these two examples. Example 1: Mary, a mental health counselor, provided counseling services at a community mental health center. Most of her clients did not have insurance nor could afford to pay privately anywhere else. After several years of post-graduate full-time practice, Mary felt competent providing services for most issues. After three sessions with one of her clients, her client confessed that he wanted a sex-change operation and would need Mary’s support through the process. Mary had taken few graduate level courses in human sexuality and had no other specialized training in this specialized area. If there was another clinician available who specialized in gender reassignment issues, her client could not afford it.
frequency and intensity of their moral distress for each item. During analysis, the frequency and the intensity are multiplied for each item and then totaled. This provides a composite moral distress score of 0 to 432 (Latimer et al., 2021). Moral Distress Thermometer The Moral Distress Thermometer (MDT) was developed by Wocial and Weaver in 2013 to measure short-term episodes of moral distress. The participants are directed to reflect on their current level of moral distress as it relates to their prac- tice. The graphic representation of a thermometer has a scale of 0 to 10 with statements noted beside each degree. None is noted at 0 and worst possible noted at 10 (Powell et al., 2018). It has been found beneficial as an instrument to measure moral distress before and after an intervention to demonstrate effec- tiveness of the intervention (Epstein et al., 2020). CAUSES OF MORAL DISTRESS Jones-Bonofiglio (2020) described moral distress as “a lens that can reveal ethical issues present in healthcare environ- ments and the challenges of responding to these issues.” Moral distress can be caused by clinical situations such as futile care without considering relief of suffering, internal factors such as lack of confidence, and external factors such as the work environment and ethical climate (Jones-Bonofiglio, 2020). In practicing a profession, three interrelated but distinct areas come into play: professional values, ethics, and the law. Although all three areas are related to one another, sometimes they can conflict with one another. Sometimes, also, values can conflict with other values, as can ethics. When ethics conflict, an ethical dilemma results.
Self-Assessment Question
12. What is the main difference between moral distress and moral uncertainty? A) Moral distress occurs when ethical dilemmas are fully understood, while moral uncertainty arises from unmet professional accountabilities. B) Moral distress is characterized by the lack of trust in one’s own judgment, while moral uncertainty results from physical and emotional responses. C) Moral distress involves feelings of powerlessness, while moral uncertainty is associated with taking actions to mitigate the situation. D) Moral distress occurs when ones’ moral obligations are compromised, while moral uncertainty is not being certain how to proceed when confronted with an ethical dilemma.
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