Ethics and Ethical Decision Making D. Shane Koch Rh.D, CRC, CADC Professor Rehabilitation Institute Southern Illinois University at Carbondale
GOALS • Examine how the constructs that we use to define ethics can significantly impact the lives of our consumers.
• Examine the nature, strengths and limitations of those constructs. • Develop ethical approaches that are based on objective evaluation and examination.
• Consider how we may act ethically in all of our roles and funtions as addictions professionals.
Exactly what do we mean by Ethics anyway?
Ethical Constructs • Teleology • Consequences are all important • Independent of “goodness or badness” of an action • Utilitarianism
• Deontology • “goodness or badness” is NOT exclusive function of consequences
• Places limits on the consideration of consequences
Ross’s Theory of Duty • • • • • • •
Fidelity Reparation Gratitude Beneficence Non-Maleficence Justice Self-Improvement
Beauchamp and Childress (more on this later) • • • • •
Justice Autonomy Beneficence Fidelity Non-Maleficence
Know Thyself “An unexamined life is not worth living…”
ABVB • Attitudes • Beliefs • Values • Behaviors
Context and Constructs • How do we know what we know? • How do we know “the facts”? • What about clinical “intuition”? • Reification and Pygmalion Effects
Sources of ABVB • Composites • Culture of Origin • Family Systems • Community
• • • • •
Recovery Experience Lack of Recovery Experience Education Practice HOW OUR THINKING/WORLDVIEW/CONSTRUCTS BECOME REALITY
How does this affect me? Is any of this stuff really applicable and practical in my profesisonal life….
Ethics • • • • •
Rules Roles Standards of Practice Expectations: Clients and other Professionals Professional Identity • ABVB • “Integrity” and “Congruence” • Value driven-Principle drive
What are Ethical Principles? How do Values and Morality differ from Ethics?
Ethics • • • •
Principles vs. Values? Values and Subjectivity / Culture / Constructivism Covey’s Law of the Farm Codes of Ethics are grounded in Ethical Principles but the Codes themselves are insufficient to guide our practice-due to ethical conflict and dilemmas
What are the ethical Principles that guide our profession? • Justice • Autonomy • Beneficence • Fidelity • Non-Maleficence
Justice • • • • • • •
Fairness Distribution of Resources Access to Services Rights to Services Fair Opportunity Rule-Discrimination Movement of clients through levels of care “One Size Fits All”
Autonomy • • • • •
Client Choice Client Involvement Informed Consent Consent to Treat / Consent to Release Individualized Treatment as opposed to “One Size Fits All Models”
Beneficence • Promotion of well being of others through actions • • • • •
that provide positive benefits and actions that prevent harm Are treatments and services helpful? Quality of Services Program Evaluation: Process, Outcome, Progress Adhering to National Minimum Standards of Practice Utilizing the current research and best practices
Beneficence • Act to prevent harm • Duty to help
Fidelity • • • •
Maintenance of Trust Confidentiality Relationship Building Informed part of informed consent
Non Maleficence • Do No Harm • Do not encourage participation of clients in
therapies or other interventions that could result in harm to the client
• Do not harm through inaction
What are Ethical Dilemmas?
Ethical Dilemmas • A choice must be made between two courses of action
• Significant consequences are associated with taking either course of action
• Each of the two courses of action can be supported by one or more ethical principles
• Ethical principles supporting the unchosen course of action will be compromised
Ethical Dilemma Decision Making Process (Roessler & Rubin, 1998) • Review the case situation and determine the two courses of action from which one must choose
• List the factually based reasons supporting each course of action-these reasons will often be important consequences
• Identify the ethical principles that support each action given the reasons for support
Ethical Dilemma Decision Making Process • List the factually based reasons for not supporting
each course of action. These reasons will often be important consequences
• Given the reasons for not supporting each course of action, identify the ethical principles that would be compromised if each action were taken
Justification Formulate a justification for the superiority of one of the two courses of action by processing all information from the previous five steps. This means that an effective justification provides an analysis of the dilemma that includes: Reasons with ethical principles and why precedence should be given to the your choice.
Dewey I had to get around to him eventually… 41
Are Constructs REAL? • We treat our ideas as if they are permanent, independent, and singular
• We constantly reify by labeling, categorizing, and generalizing
• We are not “mindful of our process” • We are not aware that we are “creating” the reality rather than actually apprehending it in most cases
Dewey • Challenges us to lose our need to be “rule bound” • Challenges us to take on the idea of looking at each situation individually and contextually
• Challenges us to use the community to guide us
Dewey • Challenges us to be as objective as we can be by relying on complex analysis of the situations
• Challenges us not to get trapped by our ideas and approaches
• Challenges us to learn from our environment and adapt. To be open and fresh.
Professional Practice Challenges: Assessement
Problems with the “Medical Model?” • Labeling Effects • • • •
Reification Pygmalion Effects Spread of Effect Stigmatization
• “Analysis Paralysis?” • Failure to focus on the solution • Ethics of Neuroscience
Assessment Issues • Do we assess for strengths? • Do we follow “modern” or “traditional” assessment methodologies?
• Ethics in practice: Does our treatment plan really reflect our assessment or are we doing the famous OSFA shuffle?
How do we evaluate our plans? • Does the client understand them? • Have we really achieved “informed consent?” • Are they individualized…..are they do-able?
Ethical Issues in Treatment Planning • How is the power relationship “playing out” during the planning process?
• How do our personal and professional values shape the plan?
• How do our personal and professional values shape our expectations?
What is case management? • Everything is case management? • What are some of the risk factors in case management of our clients? • Referral to appropriate resources • Referral to effective resources • Referral to accessible resources
Risk Factors in Case Management • Are we really helping the client with the services rendered or are we letting the “model” drive the process?
• How are we utilizing levels of care? • • • •
Least Restrictive Environment Access to Treatment Most appropriate Fair Opportunity Rule
Case Management and Professional Culture • What barriers exist when using interdisciplinary / multidisciplinary systems?
• What ethical issues arise when doing
consultation/referral/case management across professional cultures?
• How do professional cultures (ABVB’s) affect service delivery?
Contacting Me [email protected]