____________________________________________ Professional Ethics and Law in California, 2nd Edition
3. Identify the individuals, groups, and organizations that are likely to be affected by the decision. 4. Tentatively identify all possible courses of action and the participants involved in each, along with possible benefits and risks for each. 5. Thoroughly examine the reasons in favor of and opposed to each possible course of action, consider- ing relevant: a. Ethical theories b. Codes of ethics c. Constitutional provisions, statutes, regulations, court decisions, and executive orders d. Personal values (including religious, cultural, and ethnic values) 6. Consult with colleagues and appropriate experts. 7. Make and implement the decision and document the decision-making process. 8. Monitor and evaluate the decision. APPLYING THE MODEL We can use this model to critically examine the last scenario, that of David and his dilemma regarding placement of a child. ● David, a licensed marriage and family therapist, believes a child’s right to permanency would be bet- ter served by placement with an affluent, Caucasian, Christian family versus a middle - class family of the same race as the child. He believes they are a very nice couple who have been waiting far too long for a child to adopt. David’s obligation is to the best interests of the child, so it is clear to whom he is committed. Therefore, the length of time one couple has spent waiting to adopt a child should not be a consideration. Finding the best family for the child is the primary consideration. In addition, standards regarding competence and social diversity require David to be knowledgeable about the child’s culture and the importance it will play in the child’s life. He also needs to consider the overall strengths offered by both families as well as any potential barriers to placement. One family has unlimited resources, while the other family has enough resources to afford a lifestyle typical of most families in the community. The person most affected by the decision will be the child. The prospective adoptive families will be impacted as well. To a lesser degree, so will the two adoption agencies. For example, they will wonder if one family may become disenchanted by the wait for an adoptive child and choose to go to another provider. There may be macro-level issues involved as well,
given the debate at the national level concerning interracial adoptions. Again, these should not be a consideration, because the primary responsibility is to find the best family for the child, not to find a child for a family. David will ultimately keep this in mind when he makes his recommendation to the court. ETHICS AND TELEHEALTH In light of public health measures, such as physical dis- tancing during the COVID-19 pandemic, the adoption of telemental health services, including videoconferencing, has become imperative to ensure ongoing clinical care for psychi- atric outpatients. These technological tools are not only used for treatment but also for assessment and monitoring, serving as a crucial component of psychological first aid for COVID-19 (Liem et al., 2020). Telemental health also serves as a means to bridge the global mental health treatment gap, particularly in low- and middle-income countries. However, despite the growing interest in telemental health, the pandemic forced a sudden shift from in-person to online modalities, challenging clinicians to rapidly adapt to meet their patients’ needs. For instance, in high-income countries like the United States, over two-thirds of psychologists had never used videoconferencing for therapeutic services. This percentage is even higher in low and middle-income Asian countries, with approximately 85% of clinicians in Bangladesh lacking prior experience in provid- ing telemental health services. In Iran, early career clinicians began offering digital support groups through messaging apps and social media, many of whom had no prior experience with this form of remote support (Ransing et al., 2020). These novice online clinicians may not be fully aware of the ethical and privacy concerns associated with technology use in their practice. Furthermore, telemental health services may not yet be adequately regulated in health law, particularly in Asian countries (Liem et al, 2020). Before engaging in telemental health, clinicians should be aware of five key ethical concerns (Liem et al., 2020). First, they must ensure the confidentiality of online treatment, includ- ing implementing end-to-end encryption to safeguard against third-party access. Second, clinicians should possess practical competence in delivering online interventions and assisting patients with logistical issues. Third, staying updated on the latest regulations related to online interventions is crucial. Fourth, clinicians should seek informed consent from patients before the intervention, discussing the risks and benefits, especially in light of privacy concerns. Fifth, clinicians need to have contingency plans for emergency situations, such as suicidal intent, by pre-emptively determining the patient’s physical location in case of technical malfunctions. A concise checklist outlining these five ethical standards for telemental health is provided in Table 1, serving as a valuable resource during the COVID-19 pandemic.
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