Ethical Decision Making

Introduction

Counsellors have a mandate to protect the welfare of their clients throughout their practice as part of their duty. Considering the level of confidential information that vulnerable consumers of counseling activities give to the counselors in despair and with hope of getting the anticipated help, it remains important for the counselor to ensure that such information is used only for the benefit of the patient. It is important for any counselor to ensure that the confidentiality is maintained in any dealings with the patient and that the therapy procession is of great benefit to the client. As such, a code of conduct and a code of ethics have been develop to provide guidance for counselors pertaining good practice, and to legally bind such counselors to their obligations to the client such that they can be legally held accountable if they fail to respect the provisions of the two sets of guidelines. The presented case of Mr. Berry is a unique case of incompetence and failure of the practitioner to observe the provisions of the Code of Conduct and the Code of Ethics and Practice. This paper is going to analyze Mr. Berry’s case using the Ethical decision making model to determine the ethical situation of his case and establish an intervention working plan that could be used in this case. 

Ethical Decision-Making Model

Assessment

The Issues

Several issues are presented in Mr. Berry’s case, which go against the moral principles of practice and the provisions of both the code of ethics and the code of conduct. To start with, it is clear from the investigation that Mr. Berry disregarded the safety of his clients as he proceeded to offer them therapeutic services beyond his scope and even during periods when he had been suspended for misconduct. In addition, while lacking the necessary skills and training to counsel general patients and to specifically handle children, Mr. Berry failed to take on any initiative towards improving his skills and knowledge in the field and continued to practice with such lack of skills, an aspect that undermined the health of his clients. Mr. Berry failed to establish boundaries between what he knew and what he did not know and thus continued to exercise therapy beyond his competence without realizing the need to refer patients to other health professionals in the field, who are more competent and with better skills necessary for handling the patents. 

Moreover, Mr. Berry also engaged in a sexual relationship with a client while providing therapeutic services to her, taking advantage of her vulnerability and even going ahead to leave her after he felt that he did not need her anymore, at a time when the client was solely dependent on her and highly vulnerable. Mr. Berry did not accurately document the processions with the clients and thus did not capture any contemporaneous or clinical information pertaining the clients that could be used by other medical practitioners to help the patients attain full recovery from their psychological problems and any other related conditions. On the other hand, the approach used in publicizing Mr. Berry’s prohibition from practice is an issue of significant concern as it jeopardizes the confidentiality of his client’s information, an aspect that may prove to be detrimental to the psychological and social health of the client if her private information is accessed by the public as it could easily point to her. 

Legal and Policy provisions

As highlighted by the NSW Health Care Complaints Commission, the code of conduct provides health practitioners with various guidelines that define their practice, with the view of safeguarding the interests of the client. As such, counselors are equally expected to identify and adhere to the various legal provisions that are included in the code. Mr. Berry’s case is responsive to sections of Clauses 3, 13, and 15 of the Code of Conduct. Clause 3(1) requires counselors to provide health services to their clients in a manner that is safe and ethical. As such, the consumers are expected to be well aware of their treatment regime and that the counselor is expected to adhere to the Code of Ethics throughout his or her practice. 

Clause 3(2) (a) requires all practitioners to ensure that they maintain the necessary competence within their field of practice by undergoing further training to improve their skills. Clauses 3(2) (b) and (c) requires health professionals to provide health services within their training and experience, and only the services within their scope of qualifications. Clause 3(2)(f) on the other hand requires health professionals to be cognizant of the limitations of the health care they can provide and to refer clients that were beyond their scope of practice to other health practitioners who are competent in the appropriate cases. Clause 13(1) and 13(2) prohibits counselors from engaging in any sexual relationships with their clients during or even shortly after providing them with therapeutic services. Lastly, clause 15 requires counselors to keep contemporaneous, legible, and accurate clinical records for all the legible client sessions. 

Various provisions under the code of ethics also offer a perspective to Mr. Berry’s case. Under subsection (a)(i) of competence section of the Code of Ethics, all counselors are require to attain a certain level of education prior to commencement of counselling, and they are required to maintain ongoing and regular supervision, as well as professional development. Subsection (a) (iv) of the Code also spells out that competence includes the ability of a counselor to acknowledge when to refer a client to other services or practitioners. On the other hand, subsection (a) (vi) and (vii) of the competence section of the Code requires counsellors to further their education in their areas of practice and to improve their competence levels through professional development and tracking best practices. Section 3.9 (a) and (b) define the boundaries between the counsellor and the client, noting that a counselor is not expected to engage in a sexual relationship with the client during treatment, or within the first two years after the treatment. The counsellors are also expected to ensure that the client is protected from any psychological, physical, or emotional harm under the safety provisions in section 3.2 (a) (i) of the code of ethics. In their responsibility to other counsellors, section 3.2(d) (i) requires counsellors not to conduct themselves in a manner that would undermine the confidence of public in the profession. When it comes to the confidentiality of the privacy of Mr. Berry’s information, section 3.7(f) of the code of ethics requires that counsellors pay utmost attention to the protection of the identity of the client. 

It is important to note that all these legal provisions influence the decision on whether the case against Mr. Berry should be upheld, and if so, whether publicizing the case in the chosen manner would undermine the confidentiality of the client’s identity and information. 

Analysis

Considering the legal and policy provisions, it is clear that Mr. Berry is way out of line in terms of professional practice in counseling as his conduct is wanting. He has dishonored every provision of the highlighted sections and clauses of the code of ethics and practice and the code of conduct respectively. Mr. Berry has failed to protect the interests of his clients by engaging them in therapeutic treatment while lacking the required skills and experience to guarantee their positive outcome. Mr. Berry also proves his incompetence and misconduct when he engages in a relationship with his client during treatment, thus preying on her vulnerability. This elevates the conflict of interest in the treatment regime and thus undermines achievement of positive treatment outcomes. It is important to note that there is an improper balance of power during counseling and that counsellors wield more power, an aspect that gives them more control over the client. As such, they are expected to exercise good use of such power in order to prevent any ethical dilemmas and professional misconduct. 

Nevertheless, Mr. Berry takes advantage of the power that he holds over his client to exploit her sexually. His client depends on him largely, given her psychological condition and thus presents a high level of vulnerability, which he explores and even leaves her on her own after being contented with her. In such a case, the client is left even more desperate and in bad psychological shape than he or she was prior treatment. Mr. Berry has also failed in terms of his responsibility to his fellow counsellors given that he has portrayed the profession negatively, an aspect that may influence the faith of the public in the field. 

It is thus clear that Mr. Berry’s conduct is wanting and warrants proper disciplinary and/or legal action with reference to both the code of conduct and the code of ethics. However, the decision made by the NSW Health Care Complaints Commission presents various challenges to the aspect of protecting the confidentiality of Mr. Berry’s client. Using the moral principles of practice, a clear analysis of the NSW Health Care Complaints Commission decision to make public Mr. Berry’s conduct may be conducted in order to have a clear understanding of any ethical impediments of the decision. To start with is the principle of autonomy, which requires that the client be given the freedom of choice and independence. It is important to note that the NSW Health Care Complaints Commission has not consulted the client to seek her consent owing to the publishing of information that infringes her rights to confidentiality. It is upon the Commission to ensure that the client is well aware of the procession and to make a choice on whether such information should be published owing to the impact that it will have on them.  

On the other hand is the principle of nonmalficence, which involves not causing harm to other persons. This principle involves upholding practices and actions that would not intentionally inflict harm on others, or expose them to increased risk of harm. Publicizing information that could reveal the identity of the client goes against this principle as the client may be exposed to further psychological problems, most of which may be catalyzed by social problems including social isolation by those who feel such a relationship is despicable. The principle of beneficence also comes into play, whereby three is a responsibility to contribute to the client’s welfare. This means that all efforts should be directed towards doing good towards the patient and preventing harm where necessary. As such, any decision made by the NSW Health Care Complaints Commission ought to be beneficial to the client as she was victimized in this case and thus should not be dragged in the mad alongside Mr. Berry. 

The principle of justice could also be consulted in this case as it asserts that equals should be treated as equals and unequals as unequals with regard to the proportion of their applicable divergences. As such, there is enough rationale to treat Mr. Berry unequally as the client since the latter is a victim of the former and thus any measures that are put in place should ensure that the client is treated fairly. Disclosing the client’s private information would prove to be an equal treatment as that of Mr. Berry due to the psychological harm that would be imposed on the client. The principle of fidelity refers to the notions of honoring commitments, loyalty, and faithfulness. It is important for the stakeholders from the counseling profession to ensure that they take adequate care in upholding the therapeutic relationship that exists between the client and the counselor profession. Publicizing the client information through the Mr. Berry’s prohibition report would undermine such a relationship.  

Plan and Implement

Considering that enough evidence has been established to substantiate claims of misconduct for Mr. Berry, the NSW Health Care Complaints Commission has grounds to initiate disciplinary action against him. The decision to make such proceedings public lies with the Commission. The circumstances under which the decision is made may determine whether it will be made public or not. In this case, there are two major options that the Commission may adopt. The first approach is the already proposed alternative in the case, where a public statement should be made about Mr. Berry, in which the public should be warned about his practices and be informed of a decision of his prohibition from participating in the field, whether voluntarily or on contractual terms. Nevertheless, it is important to note that this option proves disadvantageous to the client as it may expose vital client information to the public and risk exposure of the client’s identity, which is against the Ethical Code’s provisions for confidentiality. In addition, such exposure may be detrimental to the client’s psychosocial health. As such, this alternative proves to be less effective in the presented case. 

The second alternative would involve prosecuting Mr. Berry to the NSW Civil and Administrative Tribunal. On the other hand, such a case could also be pursued as an inquiry of the relevant council within the NSW health profession. A third option would be to prosecute Mr. Berry to a relevant Professional Standards Committees. Such approaches could be embraced with reduced public involvement and heightened confidentiality especially in terms of any information that may reveal the identity of the client. Public involvement would only come in in a publication that would list Mr. Berry as a prohibited practitioner on grounds of misconduct, without providing further details concerning his interaction with the client. This approach should be upheld by the council to safeguard the interest of not only the public and the council, but also of the client, who is the first-hand victim of Mr. Berry’s misconduct. 

Conclusion

It is evident that ethics is an integral party of any professional practice, and thus counselors are required to ensure that their practice is within conforms of the code of ethics and the code of conduct. Counselors could be held legally liable for failure to uphold the provisions of the code. Mr. Berry’s case presents a case of ethical misconduct with sufficient evidence suggesting the need to impose disciplinary measures. Nevertheless, the approach adopted by the NSW Health Care Complaints Commission is not efficient as it poses a risk to the psychosocial health of the client victimized by Mr. Berry. The ethical decision making model provides a clear approach through which the various aspects that make up the case can be analyzed to come up with an appropriate solution to the ethical dilemma presented. From an analysis of the presented case, it is clear that the most appropriate approach would be for the commission to prosecute Mr. Berry without making a public statement that may harm the psychological and social health of the client. Subjecting Mr. Berry to a hearing before an appropriate council would ensure that he is justly served in accordance with the moral principles, and that the relationship between the client and the counseling profession would be upheld, thus facilitating the intended client healing in the process. 

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May 14, 2019 in Psychology Essay Samples