Ethical Dilemmas and Decision Making in Behavioral Health: How to Practice in a Safe and Ethical Way

• Ethical decision-making model to resolve or alleviate ethical dilemmas
• Recognize and prevent problematic dual relationships and boundary transgressions
• Identify ethical issues concerning confidentiality, informed consent and self-determination, recognize their limits, and employ safeguards in practice
• Respond to subpoenas

As a mental health professional, you are confronted on a regular basis with the challenges of complex ethical and legal issues. Knowing and applying an ethical decision-making framework will provide you with tools to:

• manage ethical issues in a systematic way
• separate facts from assumptions and biases
• track the potential harms of each course of action
• formulate an ethical rationale for selecting the least harmful option
• decide on the most appropriate way to implement your choice
• assess what went wrong, or could go wrong, so you can prevent it from happening

During this program you will learn a unique decision-making model that does not tell you which ethical principle is most important (as do some other models), but provides you with options and raises critical questions to help you decide which principle trumps others. Learning this model will also help you to formulate reasons for choosing how to intervene with other professionals or clients in an ethical and safe way. This reflective model will enable you to be the proactive practitioner you want to be!

Through case examples, you will be able to apply the skills right away! Case examples will focus on the issues of confidentiality, informed consent, boundaries and dual relationships and self-determination.

OUTLINE

Common Ethical Issues

• Professional obligations vs clients’ rights
• Conflicting obligations and expectations
• Professional truth telling to clients
• Distribution of limited resources
• Professional adherence to regulations and policies that may harm clients

Ethical Codes

• Characteristics, functions, and limits
• The intersection of the law and ethical codes: congruence and conflict

Defensive and Safe Practice

• Practice according to the law
• Steps to reduce legal vulnerability
• Respond to subpoenas
• Four elements of malpractice
• Responding to impaired, incompetent, and/ or unethical behavior of professionals
• Duty to warn law

Practice Ethical Self-Reflection

• How demographic characteristics, values and beliefs influence ethical decision making
• Prioritization of ethical principles
• Ability to tolerate morally ambiguous situations

Apply a Model of Ethical Decision Making

• Discern the facts
• Assess ethical principles in conflict
• What may or did go wrong and why
• Short and long-term goals and their compatibility
• Assess the harms of choosing different options
• Develop strategies to prevent or rectify errors

Confidentiality and Informed Consent

• Distinguish confidentiality, privacy and privilege
• Confidentiality violations and consequences
• Limits to confidentiality
• Situations that require informed consent
• Limits of informed consent
• Case examples and small group discussion

Dual Relationship, Boundary Errors and Ethical Dilemmas

• Signs of possible problems
• Set clear, appropriate and culturally sensitive boundaries
• Case examples and small group discussions
• Prevention of harmful dual relationships or other boundary violations

Self-Determination

• Conditions for self-determination
• Limits or interference
• Case examples and small group discussion

OBJECTIVES

1. Identify ethical and legal responsibilities in practice.
2. Use an ethical decision making framework to recognize, analyze, resolve or prevent ethical problems and dilemmas.
3. Recognize common boundary and dual relationship issues/dilemmas that emerge in practice.
4. Identify common ethical issues and explain how they affect practice.
5. Identify conditions and limits for self-determination.
6. Recognize confidentiality and informed consent issues and their limits.
7. Respond effectively to subpoenas and duty to warn law.

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