DIMENSIONS OF ETHICS
DIMENSIONS OF ETHICS
THE MODELS OF ETHICS
- One excellent model for ethical practice, discussed frequently in the literature, is particularly relevant. This model has its roots in medical ethics. The interaction and opposition of a set of principles is often used while considering the resolution of an ethical dilemma.
- The principles are beneficence, non-maleficence, autonomy, justice, and fidelity. In this application, beneficence is acting or reacting in a manner which is helpful and growth producing.
- The principle of non-maleficence indicates that the professional should not be a party to causing harm. In autonomy, the client’s right for independent decision making is to be protected. The principle of fidelity seek to remind us that promises made should be kept. The final principle of justice addresses the need to treat an individual fairly. DIMENSIONS OF ETHICS
- This model has been applied to a wide variety of settings and client situations. This model has been found usefully equally effective in intervention and treatment of adult survivors of incest. Using this model, decisions are made after consideration of how alternative solutions either support or oppose one or more of the relevant principles. This model is extremely helpful in justification of the alternative ultimately chosen.
- Another model took a more pragmatic approach to the ethical decision making process. It uses a broader perspective for the decision maker to consider. In addition, this model factors in all the organizations and systems that will in some way shape the decision being made.
The six basic areas or questions to be addressed by this model are:
- What are the potential ethical issues in the situation?
- Who are the stakeholders (individuals or groups impacted by the decision — e.g., the client family members, other individuals, employers, society, yourself?)
- Describe the environment in which this issue takes place (i.e., oppressive, supportive, etc.).
- List all possible choices of action.
- Which choice is the most ethically defensible?
- Make the decision.
- This model provides structure for the decision maker. Documentation of the issues, raised by the model, help to show exactly how the decision can best be made.
- A new approach suggested here utilizes three variables for consideration in decision making. This approach, with a working title of “Three-Dimensional Ethical Decision Making Model” considers the organizational needs and demands, the professional’s unique perspective, and the client’s viewpoint.
- All three dimensions contribute to problem solving from a distinct perspective. All three are active participants in the decision making process. The Three-Dimensional model includes the key elements of both models discussed above.
- The values and beliefs of the organization, professional, and client are always present to a greater or lesser degree in each and every decision made at the service provision level. These factors are especially salient when an ethical dilemma exists.
- First, the organization is likely to have a formally stated policy for responding to and/or solving certain types of problems. It may also have a history of either acting inconsistently or counter to that policy, or it may respond in a predictable manner. This variable will certainly contribute to successful forecasting of future decisions. The predictability, or lack of such, will influence the options perceived to be available by the professional and the client. DIMENSIONS OF ETHICS
- Second, the professional representing the organization in the in the decision making situation also brings a set of personal, professional, and cultural values and beliefs into contention. This person’s history in the organization, as well as prior experiences with the client, may also serve to define the decision making environment.
- The totality of these experiences on the part of the work adjustment professional help to determine the agenda brought to the decision making table. The third dimension in the process, the client, also has had experiences with the organization and the professional. Like the professional, the client possesses a set of personal, professional, and cultural values and beliefs. In addition the client brings specific needs and problems to the forefront.
- Once the problem has been defined and alternatives developed from the three dimensions, choices must be narrowed by measuring the impact of the alternatives through utilization of the principles of beneficence, non-maleficence, autonomy, justice, and fidelity. These principles are also useful in the determination of possible courses of action at each of the individual dimensional levels.
Six Steps of the Ethical Decision Making Model [DIMENSIONS OF ETHICS]
- Review the case situation and determine the two courses of action from which you must choose.
- List the factually based reasons supporting each course of action. These reasons will often be important consequences.
- Given the reasons supporting each course of action, identify the ethical principles that support each action.
- List the factually based reasons for not supporting each course of action. These reasons will often be important consequences. DIMENSIONS OF ETHICS
- Given the reasons for not supporting each course of action, identify the ethical principles that would be compromised if each action were taken.
- Formulate a justification for the superiority of one of the two courses actions by processing all information from the previous five steps. This means that an effective justification provides an analysis of the dilemma that includes:
- Factually based reason(s) supporting each of the actions. These reasons will often be important consequences.
- The ethical principle(s) supporting each of the actions, given the reasons in (a).
- The selected course of action and the reasons, why precedence should be given, in that situation, to the ethical principles supporting the selected course of action.
The Three-Dimensional Model encourages a careful examination of the problem, potential solutions, and the interaction of the three viewpoints. Examination of a problem from this perspective must surely provide opportunity for a higher quality decision to be made.
Even the use of one of the models discussed above, to determine which course of action will be chosen, there is no guarantee that the alternative chosen will prove to be the best decision possible. Each situation requires recognition of its uniqueness. DIMENSIONS OF ETHICS
- One way for increasing the possibility for making informed decisions is through the practice of day-to-day behaviour which stands the test of ethical analysis. The remainder of this discussion will consider the conduct or standards of individuals and groups who are charge with decision making with, or on behalf of, work adjustment clients.
- As stated above in the Three-Dimensional Model, three of the major variable which determine both attitudes and practice of appropriate ethical behaviour are the “organizational environment”, the “individual practitioner”, and the “client”. Each is important in determining outcome.
- The magnitude of importance may change concerning one of the dimensions as the interaction of the variables and situations change. The interaction of the dimensions is discussed below in terms of specific expectations and situations which occur in the field or rehabilitation.
THREE-DIMENSIONAL DECISION MAKING MODEL
|Identify options consistent||The professional will assist|
|with organizational||Identify options consistent||the client in determining|
|expectations, mission,||with the Code of Ethics||‘options that address client’s|
|funding sources, and||personal values, cultural||needs, history, personal|
|client groups served.||systems, knowledge, and||values, culture, attitudes,|
|experience similar||support systems, resources|
Choices from Each Dimension [DIMENSIONS OF ETHICS]
|All possible choices from the||All possible choices from the||All possible choices from|
|organization’s perspective||professional’s perspective||the client’s perspective|
|are screened through the||are screened through the||are screened through|
|ethical principles.||ethical principles.||the ethical principles.|
Choices Are Refined and Combined From All Dimensions [DIMENSIONS OF ETHICS]
Resolve ethical dilemmas from each dimension above by using these principles. Beneficence-Nonmaleficence-Autonomy-Justice-Fidelity
Resolve Remaining Alternatives
|Make final decision by resolving dilemmas which arise when choices have been determined from each dimension.
THE ORGANIZATION [DIMENSIONS OF ETHICS]
- An organizational system, either officially or by practice, tends to adopt an overall framework for dealing with situations thought to require consideration of ethical courses of action. In general these are policies and/or rules which attempt to define appropriate and inappropriate conduct or behaviour. DIMENSIONS OF ETHICS
- Personnel matters such as hiring, discipline, and termination are profiled as areas of concern because an inappropriate action often has long-term effects of lost time, energy and money. Three common positions exercised by organizations are:
A summary of these three approaches help to clarify how the organizational philosophy contributes to actions of individuals in the organization.
- An organization which follows the “utilitarian” view of ethics will make its decisions and complete its plans on the premise that the best response is based on a desired outcome. This approach primarily considers end result.
- Action is usually based on what is best for the largest number of individuals. The major problem in use of this model is that an individual, though right and able to justify an action, is in the minority. The end result may be that an appropriate action may still be punished in some way.
- The “rights” approach to organizational ethics concerns itself with the protection of the basic rights of individuals. The human and civil rights of the members of the organization are held to be the prime consideration in decision making and activity planning.
- On the surface this approach appears to be highly desirable. On closer inspection, vie often find that the organization is almost rendered unable to act due to the possibility of breach of individual rights.
- The third view of ethics is the “justice” approach. This approach provides close attention to treating each member of the organization in the same manner. The major concern is to enforce rules in a fair and impartial manner. While this seems faultless on first examination, think about some of the possibilities. Individuals in the organization may perceive the fairness motive as an opportunity to demand equal treatment whether or not it has been earned. DIMENSIONS OF ETHICS
- This approach has many negative implications for the work adjustment professional. In reality, organizations may actually apply their ethics in a way that utilizes two or all three of the above positions. It may also address some issues from one philosophical basis and resolve others by using another.
- The question may then become, which response is the organization likely to reward? In many “situations individuals in an organization are likely to be confused, not only about actions for specific situation, but about the attitude of an organization as it applies to unique situations which arise.
THE PROFESSIONAL AND THE CLIENT [DIMENSIONS OF ETHICS]
- As stated above, the other two dimensions in the decision making process are the rehabilitation professional and the client. In the rehabilitation profession, the decision making equation must include a shared responsibility for decisions and for resolving ethical dilemmas as they arise.
- In reality, most if not all issues will only be resolved by a significant contribution from each of these individuals. The relationship between the professional and client is critical because it sometimes places the professional into a position of power and influence. One description of the situation is that a fiduciary relationship has been established. DIMENSIONS OF ETHICS
- This relationship is described as:
- “special duties arise because of the trust or confidence reposed in the fiduciary;
- the fiduciary has special powers to dominate and influence the client because of the nature of the relationship; and,
- as a consequence, the fiduciary must act in the best interest of the client and
cannot take advantage of the client to promote the fiduciary’s own interests”.
- Clients come to the relationship with a wide variety of trust, mistrust, and other experiences. A large percentage grow to trust the profession as time facilitates a healthy nurturing relationship.
- The possibility of a fiduciary relationship and its potential for abuse become real factors. In any case, the nature of the relationship is cause for caution. In Tie fulfilment of the process of making decisions we must be sure they are ethically appropriate. This is especially of concern in the use of the “three-dimensional model” discussed above.
- Seven “human rights issues” relevant to the client-professional relationship discussion has been identified. Included in this discussion are voluntary versus involuntary services, due process, the right to services, the right to refuse services, least drastic or restrictive environment, confidential communication, and the duty to warm.
- While all of these are certainly important to the practice of the work adjustment profession, discussion here will be limited to issues most likely relevant to decision making between the client and the professional. Discussion includes voluntary versus involuntary services, the right to receive and to refuse services, and treatment in the least drastic or restrictive way.
Some clients are not willing applicants for services yet are required to participate. Those who are required may fall into two categories. First, the client’s participation may be required in order to receive another service or maintain eligibility for financial assistance. Clients may also be pressured to participate by parents, a spouse, or school officials. This concept can be discussed as “voluntary versus involuntary services”. This discussion identifies the differences in processing and treatment of these two client groups.
- In summary, the voluntary client is a partner in the relationship, sharing in making decisions and the determination for when and how services are rendered.
- On the other hand, the involuntary client is dependent on to others to make decisions, required to participate in treatment, and may lack motivation for participation. The client in the involuntary treatment category has little power for self determination and is certainly more dependent on the professional.
- Ethical decision making is typically much easier when both the professional and client are actively participating. When one person is more involved or has more power in the relationship the potential for ethical problems are multiplied. DIMENSIONS OF ETHICS
- In fact, as a general statement, it is easy to act in a professional manner when the relationship is positive and moving in a positive manner.
- It is much more difficult when problems are intensified with the nature of a relationship influenced by reluctance, lack of motivation, and goals that are divergent from requirements and expectations of the program. It is this situation that calls on the professional to be diligent in treating clients in a fair and appropriate manner.
- Another issue identified concerns the client’s right to have access to services, or be able to refuse services. These issues are particularly relevant institutions which clients are either confined or guardianship has been granted to an institution or individual professional. At issue here is the notion clients have the right to make decisions for themselves when possible. The professional must be careful not to make decision without consulting the client.
- A related issue, informed consent, should be added to this discussion of client’s right to require or refuse participation in a service. Informed consent figures prominently into the process of decision making. It is impossible for one to make a good decision without knowing both the positive and negative aspects of the available choices.
- Three concerns for meeting the requirements of informed consent has been identified. The rehabilitation professional should take steps to assure the client’s competence to understand the issues concerning the problem. Care should be taken to make sure the client is allowed to decide without being pressured by the professional. In addition, the client should be informed of the negative aspects as well as the positive outcomes which may result from the upcoming decision. DIMENSIONS OF ETHICS
- In the practice of the rehabilitation professional it is simply not enough to ask a client to sign a consent form. Work adjustment specialist must be sure the individual has the capacity and the necessary information to elect to participate or decide not to participate. In like manner, the client must have all necessary information when asked to be a participant in the resolution of an ethical dilemma.
- Another human rights issue identified is treatment of a client in the least drastic or restrictive environment. In discussion of this issue, it is important to remember each client has the right to be treated in an environment which affords, him or her, the right to determine their own level of participation. Self direction is encouraged to the degree of their ability to function.
- To facilitate this process, the concept of substituted judgment or guardianship may become an issue. It is important to remember the professional, in a substituted judgment situation, is responsible for representing the client in any and all decision. Substituted judgment is never the same as the client’s own decision making process.
- Care must be taken due to the overwhelming responsibility of making a decision that would be consistent with one the client would make if he or she were capable. Five basic issues common to the literature concerning guardianship can be discussed.
- These issues apply to a variety of circumstances. Each assumption is certainly relevant to the process of making decisions using models suggested by this discussion. A summary of these assumptions follows:
- persons with disability can benefit from a legally appointed substitute decision-maker to make appropriate choices for them; DIMENSIONS OF ETHICS
- a responsible guardian will make decisions which are consistent with the principles of autonomy, beneficence, and non-maleficence;
- parents and family members who are guardians should be held to the same standards as members of the rehabilitation profession. This is, in many cases, not always true
- codes of ethics will be used to help resolve ethical dilemmas as they arise;
- guardianship is fairly non restrictive concerning such things as power of attorney and control of financial resources.
In this process the professional is charged with two of the three dimensions discussed in the decision making model. The professional must represent, not only his or her own position, but must represent the client.
SUMMARY [ DIMENSIONS OF ETHICS]
- As discussed above, decision making and action of the client and the professional tends to be filtered through the organization’s influence. Each organization has a separate and unique culture and interpretation of how to make decisions.
- Each defines exactly how it will function in terms of ethical behaviour. Each individual’s value systems, a basic ingredient in the decision making process, is also different from others. Interpretation of societal rules, customs and expectations is processed in a highly individualized manner. Professional boundaries, personalities and environments are also pertinent to deciding a course of action.
- Any of these variables may influence one individual to act differently than another, given the same situation. In reality, all the above mentioned variables, as well as others not identified, are factored into the day-to-day practice of the work adjustment professional.
- The current economic and political reality adds to the complexity. It has become increasingly difficult to make decisions that will not be questioned in terms of their ethical appropriateness.
- When a situation arises which causes us to be torn between two or more actions or decisions, an ethical dilemma exists. Work adjustment professionals must move forward with their best effort to serve the client in an effective way.
- Certainly, successful accomplishment of effectiveness will be enhanced by remembering that the best decisions make use of all three dimensions, the client, the professional, and the organizational perspective. DIMENSIONS OF ETHICS