Ethical Dilemma: A Case Study Analysis

The presence of ethical dilemmas in the provision of human services is commonplace. These often emerge in the context of direct services professionals both clinical and nonclinical in the course of their operational practices. Though such professionals exercise their own discretionary powers to act appropriately in resolving such dilemmas, there is an oversight responsibility on the agencies that deploy them to offer guidance in all situations that are ethically dilemmatic (American Psychological Association, 2002). This responsibility is shouldered in order to both protect client interests as well as ensure that all practice is averse of violations in ethical, legal and professional dimensions. Examples of ethical underpinnings that such bodies take note of include confidentiality of client information, obtaining informed consent for various actions, maintaining fidelity and beneficence among others (Zur, 2011). The therapeutic-fiduciary relationships of direct services professionals and their clients are however complex and suffice scenarios that violate/cross boundaries, create dual relationships and other unique situations that can only be assessed on an ad hoc basis away from the general application of ethical principles (Barnett, 2008). This paper analyzes such a case in which a housekeeper has repeatedly overstepped on their mandate to offer “counseling” services to members of their Native American tribe. Apart from being unqualified to offer such services, the housekeeper has in most occasions contradicted the advice of the certified counselors in the agency and has in extension declined to stop the behavior even after warnings. On their part, the clientele have threatened to withdraw if he was fired. This is besides him accessing client information irregularly and also acting as an elder in their tribal setup.

Ethical Issues Emerging in the Scenario

            There are several ethical issues that result from the above scenario. First, the housekeeper is in a dual relationship with the clientele. The dual relationship is communal in nature, given that they belong to the same tribe and he is also an elder in that setting. Therefore, assuming his de facto position as a counselor, he would also be acting as an elder to the clients. While this is ethically problematic, it is not automatically wrong (American Psychological Association, 2002). Dual relationships of communal nature are unavoidable, given that they emerge from inescapable social factors. There was nothing the housekeeper could do about their tribal identity or better yet, their elder status in the community. Even if he was to step down as an elder, this would not guarantee an erasure of the duality of the relationship due to the tribal factor and the previous history as an elder. Given that the dual relationship was concurrent, it was however prudent to assess its implications on therapy and the individual’s judgment.

            Also emerging from the situation is the ethical component of competence. Counselors are required to only offer services that they are duly trained for and mandated to, beyond which is unethical (Zur, 2011). The housekeeper lacked any training in counseling at least by the virtue of the case reading and was clearly not mandated to offer any related services. They were thus incompetent and posed various dangers to the clients by trying to offer counseling. This may have been the reason why they were contradicting the advice that was being issued by the agency’s counseling team. Granted, he was an elder in the tribe and perhaps had been accustomed to resolving disputes and counseling individuals within their cultural context, but that does not amount to the professional competency of a counselor. There should be formal training and certification for one to be termed as competent, and even so, their practice would be constrained within their areas of expertise. There are various services a certified counselor can still not offer due to transcending their boundaries of expertise. Therefore, there is no contradiction that the housekeeper was incompetent in the given scenario.

            Another issue evident in the case scenario was confidentiality. Clients released their information to counselors and the agency at large hoping that it would not be accessed irregularly as was with the case of the housekeeper. First, the latter was not mandated to access such information given that he was part of the non-clinical staff. In addition, he was not supposed to use such information in any way without the consent of the clientele, which was clearly never obtained (Zur, 2011). There was an appalling breach of confidentiality in the agency, which was likely to reduce client confidence in the entity. Also important was the fact that the “counseling” sessions held against the advice of the institution bequeathed the housekeeper with private information about the clientele, and given that he was neither qualified nor mandated to handle such information, this amounted to another breach of confidentiality. There was no assurance that he would not misuse the information and probably even transfer it for use in their tribal setting where he sits as an elder. There was confidentiality breach in both access and receiving of information in the case scenario.

            Above all, there was need for an ethical risk assessment in the scenario. This was brought about by the client cultural factors, namely sharing a tribal identity with the housekeeper. He was not only a member of their community but also an elder that they clearly respected and adored. No wonder, the housekeeper failed to heed advice on stopping to offer the counseling services against the law and the framework set out by the agency. He certainly counted on the support and respect he held on the clientele to shield him from any disciplinary action. True to his expectations, the community threatened to withdraw any cooperation if he was fired. There was thus need to evaluated the ethical risk posed by the actions of the housekeeper vis a vis firing him anyway. The latter was a vain choice as it would be against beneficence and non- malfeasance (Welfel, 2015). This is because if he was fired and the community declined counseling services, the agency would have not benefited them. Elsewhere, Native Americans value collectivism and separating their elder from the counseling services may appear as maleficent. These risks needed to be assessed properly in order to come up with a fitting decision.

Decision Tree & Influence of Personal Values

The decision tree in fig 1 below shows the possible options and their consequences.

Fig 1: Decision Tree

Personal beliefs and values may exert certain influences in decision making. One of the influences include an accommodative approach to the housekeeper’s actions due to collectivist orientation. The actions of the housekeeper warranted disciplinary action given that he was neither qualified nor allowed to offer counseling services. In addition, he had failed to heed warning and was openly defiant towards the administration. However, as someone who understands collectivist societies and the allure of being involved in the affairs of others within, such behavior may be excused and hence seek other solutions. Elsewhere, the personal belief that elders are important in the society and have a unique insight into any issues may fuel the integration of the housekeeper into the counseling framework. This shall be on the premise that he was culturally aware of the challenges of the clientele and may hence offer valuable advice on the best courses of action to take.

Decision and Recommendations

The best course of action in the given case scenario was to integrate the housekeeper into the counseling regimes as a bit part consultant who shall help to offer cultural context to the clientele’s problems. As an elder in the Native American tribe, he was uniquely qualified to understand any contextual and historical issues that some of the clients may be battling with. It was also no secret that he was adored and loved by the clients, and therefore would be a valuable addition to the agency’s counseling activities. His endorsement to any counsel would mean that it would be taken seriously and in cases where there were contradictions, he would harmonize the same with the counselors in charge. Therefore, there was need to:

• Make the housekeeper part of the counseling framework for Native Americans
• Form a sustainable and useful cooperation with the housekeeper in the offering of counseling services to leverage on his favorable relationship with the locals.
• Carefully monitor and moderate the contributions of the housekeeper in the counseling process.

Risk Management

Notably, there is a risk involved in the integration of the housekeeper into the counseling framework as demonstrated by the decision tree in Fig. 1. His entry into the team may lead to further contradictions in the advice given, institutionalization of unethical practices and further infringement of the ethical code. This will happen if there is no proper risk management in place. However, in mitigation, there can be careful management of his contributions, with such input only limited to the presence of a certified counselor. Any contradictions with the counsel offered by agency counselors must also be resolved prior to client contact and the whole process carried out formally (Barnett, 2008). In addition, his role should be more cultural oriented, rather than professional. These measures shall ensure that the relationship of the agency, the housekeeper and the community is collectively favorable and fruitful.

Conclusion

            In the end, the complexity of ethical dilemmas facing direct services professionals in the provision of human services is apparent in the given case study. The administration has a role in offering guidance in such cases to protect client interests and promote professionalism. It was proposed that the housekeeper in the case scenario be integrated into the counseling regime for the beneficence of the community and in recognition of his cultural value as an elder. However, the arrangement needed to be closely monitored as the move was capable of causing further unethical practices and contradictions. Accordingly, there was need to apply risk management in the situation to ensure that the inclusion of the housekeeper does not end up causing more ethical deviance rather than compliance.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American psychologist, 57(12), 1060-1073.

Barnett, J. E. (2008). The ethical practice of psychotherapy: easily within our reach. Journal of clinical psychology, 64(5), 569-575.

Welfel, E. R.(2015). Ethics in counseling & psychotherapy. Cengage Learning.

Zur, O. (2011). Dual relationships, multiple relationships & boundaries in psychotherapy, counseling & mental health. Zur Institute 45(3) 11-34