Ethical Decisin Making in Cunseling: Applied Participatry Ethics Andrew Nay, PhD, CRC, CDMS Allisn Levine, MS.Ed., CRC, Cnnie Sung, PhD., CRC, LLPC 1
Part I: Ethical Decisin Making (EDM) in Cunseling: Basic Principles, Applicatins, and Client Invlvement Andrew Nay, PhD., CRC, CDMS Part II: Applied Participatry Ethics: Illustrate the Applicatin f Applied Participatry Ethics t Issues f Suicide in Rehabilitatin Practice Allisn Levine, MS.Ed., CRC, Cnnie Sung, PhD., CRC, LLPC 2
Agenda Fundamental Questins Regarding EDM General Framewrk fr EDM EDM Prcess in Clinical Cunseling Client Invlvement in the the EDM Prcess Applied Participatry Ethics Illustrate the Applicatin f Applied Participatry Ethics t Issues f Suicide in Rehabilitatin Practice 3
What are Ethics? Ethics is the study f and reslutin f cnflicting principles (Medicine). Ethics are the set f mral principles that guide a persn s behavir (Business). Ethics is a branch f philsphy that seeks t understand and t determine hw human actins can be judged as right r wrng (Educatin). Ethics are generally regarded as the standards that gvern the cnduct f a persn r human reflecting self cnsciusly n the act f being a mral being (Cunseling). At its simplest, ethics is a system f mral principles 4
Examples f Where Ethics May Cme Frm? Religin r religius scietal beliefs Human cnscience and intuitin A mral cst benefit analysis f actins and their effects The example f gd human beings A desire fr the best fr peple in each unique situatin 5
The Prevalence f Ethical Cnflict 6
The Prevalence f Ethical Cnflict: Imprtant Questins Hw prepared are mental health and rehabilitatin cunselrs t reslve ethical cnflict? What is yur philsphical basis fr making ethical judgments r decisins? What is yur style f dealing with cnflict? What type f mdel d yu subscribe t when presented with ethical dilemmas? 7
Five Questins that Impact Ethical Decisin Making 1. What benefit(s) and/r what harm(s) will each curse f actin prduce? 2. What are the ethical rights f each party r stakehlder? 3. Which curse f actin prmtes equality r equal treatment (i.e., fairness), except where there is a ethically justifiable reasn nt t (i.e., justice)?
Five Questins that Impact Ethical Decisin Making 4. Which curse f actin advances the cmmn gd? 5. Which curse f actin develps r supprts ethical principles within the cntext f clinical cunseling (e.g., prfessinal identity, client empwerment, mre???)
Primary Values Impacting EDM Respect human rights and dignity; Ensure the integrity f all prfessinal relatinships; Act t alleviate persnal distress and suffering; Enhance the quality f prfessinal knwledge and its applicatin t increase prfessinal and persnal effectiveness; Appreciate the diversity f human experience and culture; Advcate fr the fair and adequate prvisin f services. (CRC Cde f Ethics, 2016) 10
Six Principles Of Ethical Behavir Impacting EDM Autnmy: T respect the rights f the client t be selfgverning within their scial and cultural framewrk. Beneficence: T d gd t thers; t prmte the wellbeing f clients. Fidelity: T be faithful; t keep prmises and hnr the trust placed in rehabilitatin cunselrs. Justice: T be fair in the treatment f all clients; t prvide apprpriate services t all. Nnmaleficence: T d n harm t thers. Veracity: T be hnest. (CRC Cde f Ethics, 2016) 11
Autnmy Every human being f adult years and sund mind has a right t determine what shall be dne with his wn bdy." The ethical tenant r principal f autnmy is impacted by bth cmpetence and capacity f the client t make infrmed decisins. Wh is able t deem a client r patient cmpetent? Wh determines that a client r patient has the capacity t make infrmed decisins? 12
Autnmy In 1990 the Patient Self Determinatin Act was passed by the United States (US) Cngress, stating that cmpetent peple culd make their wishes knwn regarding what they wanted in their end f life experience, when they were pssibly nt cmpetent. Als included in this Act is the durable pwer f attrney, which designates a cmpetent persn t assist in making end f life decisins when the individual was n lnger cmpetent. Surces: Beauchamp, T. L., & Childress, J. F. (2009). Principles f bimedical ethics (6th ed., pp. 38 39). New Yrk, NY: Oxfrd University Press. & American Bar Assciatin. Health care advance directives. Retrieved frm http://www.abanet.rg/publiced/practical/patient_self_determinatin_act.htm 13
Which EDM Mdel d I Use? 14
General Framewrk fr Ethical Decisin Making Achieving ethical clarity thrugh dialgue By Dana Radcliffe (2006) 15
General Ethical Decisin Making Mdel Tarvydas (1998) & Crey et. al (2007) 1. Recgnizing prblem and interpret situatin 2. Review prblem r dilemma, and define the prblem(s) (cllabratin with client is essential at this stage) 3. Determine standards that apply t dilemma (if applicable) and develp slutins (with client) 4. Generate pssible and prbable curses f actin
General Ethical Decisin Making Mdel Tarvydas (1998) & Crey et. al (2007) 5. Cnsider cnsequences fr each curse f actin 6. Cnsult with supervisr r peers 7. Chsing a slutin 8. Plan and execute that selected actin 9. Evaluate curse f actin What if I need help interpreting a situatin r in making a decisin?
Ethical Decisin Making: Cnsultatin within the Prfessin NASW Members: The Office f Ethics and Prfessinal Review (OEPR) prvides individual ethics cnsultatins as a benefit f NASW membership. Cnsultatin services are intended t guide members thrugh the applicable standards in the Cde alng with ther pertinent cnsideratins and resurces that address their cncerns and allws them t make reasned ethical decisins. While we can discuss ethical issues, we cannt prvide definitive answers fr a particular situatin r make decisins fr members. http://www.scialwrkers.rg/nasw/ethics/cnsultatin.asp 18
Ethical Decisin Making: Cnsultatin within the Prfessin Certified Rehabilitatin Cunselrs: The CRCC Ethics Cmmittee prvides advisry pinins n select situatins having ethical implicatins. CRCC's Ethics Cmmittee rutinely respnds t requests fr advisry pinins related t the applicatin f CRC/CCRC Cde f Ethics. CRCC advisry pinins shuld be regarded nly as general educatinal assistance, and nt as specific directin in any particular instance. https://www.crccertificatin.cm/filebin/pdf/advisryopinins_2017 03.pdf 19
Client Invlvement in EDM Hw much f the EDM prcess typically invlves the client f cunseling service(s)? Primary r Secndary Participants? Individual (internal) vs Cllective Deliberatin? Frmal vs Infrmal Prcesses? Are there sufficient avenues r mechanisms available t the client fr EDM invlvement? Mre recent infusin f Scial Justice cncept int EDM mdeling.
Part II: Applied Participatry Ethics: Illustrate the Applicatin f Applied Participatry Ethics t Issues f Suicide in Rehabilitatin Practice Allisn Levine, MS.Ed., CRC Cnnie Sung, PhD., CRC, LLPC 21
Participatry Ethics: An Overview 1. ETHICAL DECISION MAKING MODEL Cmbines the ideal f client cunselr cllabratin embdied in the ntin f the therapeutic alliance with actual ethical prblem slving behavirs exhibited by cunselrs 2. PARTICIPATORY APPROACH Restrictive vs. Participatry: Invlve client as stakehlders in ethical decisin making mdel (Prilleltensky, Rssiter, & Walsh Bwers, 1996)
Participatry Ethics: An Overview 3. APPLIED PARTICIPATORY ETHICS Tw levels f rientatin tward applied prfessinal ethics frm Prilleltensky et al s wrk + The assumptin that behavirs maybe seen as existing alng a cntinuum between fully restrictive and fully participatry (Tarvydas, Vazquez Rams, & Estrada Hernandez, 2015) 23
WORKING ALLIANCE APPLIED PARTICIPATORY ETHICS CONSUMER DIRECTED THEORY OF EMPOWERMENT (CDTE) 24
CONSUMER DIRECTED THEORY OF EMPOWERMENT (CDTE)...increased CD (cnsumer directin) in disability plicy frmulatin and rehabilitatin service delivery will lead t increased cmmunity integratin, empwerment, and QOL amng peple with disabilities (Ksciulek, 1999, p.198) 25
ACTION ORIENTED MODEL OF PARTICIPATORY ETHICS (Tarvydas, Vazquez Rams, & Estrada Hernandez, 2015) Ethical Knwledge & Orientatin Therapeutic Alliance Relatinship Client Invlvement Empwerment 26
Case Example Client 42 years ld Male White, nn Hispanic Histry f ccupatinal knee arthrplasty Histry On disability since knee surgery Lives with wife & 2 children Past alchl, tbacc, and illicit drug use Spent 3 mnths in medical rehab, transitined frm piids t ibuprfen Presenting Prblem One mnth int general cunseling, disclses that he takes wife s OxyCntin when needed Appears unfcused, lethargic and withdrawn After 20 minutes, he infrms yu that he s nt feeling well and gets up t leave
PRACTICE OF ETHICAL ANALYSIS: Using PES CONSIDER... What is the level t which the client is invlved in a nn harmful and meaningful ethical discurse related t the service in which he/she participates in? Ethical Knwledge & Orientatin Therapeutic Alliance Client Invlvement Is the client invlved in a therapeutic alliance that is inclusively driven by using a client centered apprach? Hw t ensure that the client has adequate decisin making skills, nt just the right t decide? Hw t invlve the client in jint gal setting and decisin making? Client Empwerment 28
IMPLEMENTING CDTE STRATEGIES: Prtecting withut Disempwering PRINCIPLES 1) Participants with disabilities are experts n their individual needs, 2) Chice and cntrl can be intrduced int any setting, 3) Cnsumer directin shuld be available t all persns with disabilities. ACTIONS 1) Use ageapprpriate language, 2) Assume cmpetence and self awareness n the part f participants CAUTIONS 1) Participatry mdels d nt necessarily dictate equal distributin f pwer 2) Balance cmpeting interests f prtectin and self determinatin 29
REFERENCES Crey, G., Crey, M. S., & Callanan, P. (2007). Issues and ethics in the helping prfessins (7 th ed.). Belmnt, CA: Thmsn Learning, Inc. Cttne, R. R. (2001). A scial cnstructivism mdel f ethical decisin making in cunseling. Jurnal f Cunseling Develpment, 79, 39 45. Frd, G. (2006). Ethical reasning fr mental health prfessinals. Thusand Oaks, CA: Sage Publicatins. Garcia, J., Cartwright, B., Winstn, S., & Brchukwska, B. (2003). A transcultural integrative ethical decisin making mdel in cunseling. Jurnal f Cunseling and Develpment, 81, 268 276. Herlihy, B. & Watsn, Z. E. (2007). Scial justice and cunseling ethics. In C.C. Lee (Ed.), Cunseling fr scial justice (2 nd ed., pp. 181 199). Alexandria, VA: American Cunseling Assciatin. 30
REFERENCES Prilleltensky, I., Rssiter, A., & Walsh Bwers, R. (1996). Preventing harm and prmting ethical discurse in the helping prfessins: Cnceptual, research, analytical, and actin framewrks. Ethics & Behavir, 6, 287 306. Radcliffe, D. (2006). Achieving ethical clarity thrugh dialgue. Crnell Center, available at http://www.jhnsn.crnell.edu/alumni/enterprise/fall2006/vantagepint.html. Tarvydas, V. M., Estrada Hernandez, N., Vazquez Rams, R. A., & Saunders, J. L. (2016). Develpment and initial psychmetric prperties f the participatry ethics scale. Rehabilitatin Cunseling Bulletin, 1 8. Tarvydas, V. M., Vazquez Rams, R., & Estrada Hernandez, N. (2015). Applied participatry ethics: Bridging the scial justice chasm between cunselr and client. Cunseling and Values, 60, 218 233. Tarvydas, V.M. (1998). Ethical decisin making prcesses. In R.R. Cttne & V.M. Tarvydas (Eds.), Ethical and Prfessinal Issues in Cunseling (pp. 144 154). Upper Saddle River, NJ: Prentice Hall. 31