____________________________________________ Professional Ethics and Law in California, 2nd Edition
As of August 2023, eleven states recognize legal physician- assisted suicide (Death with Dignity, 2023). California’s law is called the End-of-Life Option Act (California Department of Public Health, 2020). Some individuals may support this right; others believe the act would be committing suicide, and therefore wrong. Tensions develop between a clinician’s religious beliefs and professional beliefs, as well as what that clinician would do if he or she were either “pro-life” or “pro-choice.” The tension in such an ethical dilemma may be seen as a conflict between the ethical concepts of beneficence and non- maleficence. The idea of beneficence is to promote good, and for a suffering patient, death may appear as a mercy, sparing the individual from chronic pain or some other form of suffer- ing. Nonmaleficence is best characterized using the sentence “First, do no harm,” which is often incorrectly ascribed to the Hippocratic Oath. Allowing a patient to commit suicide may be seen as bringing harm. (The principles of beneficence and nonmaleficence will be further discussed later in the course.) Also in play in this ethical dilemma is the concept of client self-determination. Another example of an issue that may lead to ethical dilemmas would be abortion. True dilemmas often involve issues that are controversial in our society as well. In these types of dilemmas, the cultural contexts of the community and the client are important factors to consider. It is important to remember that although each principle in a professional code of ethics has its own merits, the prin- ciples do not stand alone. They complement one another but at the same time often conflict with one another when ethical dilemmas occur. An ethical dilemma is a situation in which no best course of action exists; the person must choose between at least two options that have advantages and disadvantages. To solve ethical dilemmas, it is essential to identify which prin- ciples apply, how they conflict, and which ones take priority in a given scenario. Practitioners must also consider professional obligations and standards of care. Although professional codes of ethics are based on principlism, a basic understanding of consequentialism, deontology, and even virtue ethics can help in working through an ethical dilemma. ESTABLISHING ETHICAL CODES OF CONDUCT In addition to professional affiliation codes of ethics (such as established within national professional associations), state licensing laws and licensing board regulations identify basic competencies for mental health practice. Failure to follow the ethical codes of one’s profession may result in sanctions, fines, even expulsion from the profession, and can result, if sued, in a judgment against the practitioner. For example, Strom-Gottfried (2000) reviewed 894 ethics cases filed with the NASW between July 1, 1986, and Decem- ber 31, 1997. About 48% of the cases resulted in hearings, and of those, 62% concluded that violations had occurred, for a total of 781 different violations.
The study clustered those violations into 10 categories: • Violating boundaries
• Poor practice • Competence • Record keeping • Honesty • Confidentiality
• Informed consent • Collegial actions • Reimbursement • Conflicts of interest
Of the 267 individuals found to have violated ethical standards, 26% were found to have violated only one ethics category, while 74% had violated between one and eleven categories. Most of the cases (55%) involved boundary viola- tions such as those involving sexual relationships and dual relationships. Given the frequency of these violations (and, remember, this study only examined reported violations), we will be exploring these two violation types in more depth later. The findings reflected a variety of inappropriate behaviors that blurred the helping process and exploited clients, including: • The use of physical contact in treatment • The pursuit of sexual activity with clients, either during or immediately after treatment • Social relationships • Business relationships, and • Bartering UNINTENDED ACTIONS Some mental health professionals may argue that an action is ethical as long as you are not intending harm and/or are not knowingly violating an ethical standard or law. Or, what about those unique situations that don’t readily lend themselves to a reference in law or codes of conduct? What defines prudent practice? Grappling with questions about what is unethical and what isn’t ethical is a situation faced by any person in the helping professions. Pope and Vasquez (2016) discuss the tendency to rational- ize that an action is acceptable, as it relates to the practice of psychotherapy and counseling: This rationalization encompasses two principles: 1. Specific ignorance 2. Specific literalization Specific Ignorance The principle of specific ignorance states that even if there is a law prohibiting an action, what you do is not illegal as long as you are unaware of the law.
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