Ethical reasoning in medicine has drawn on a range of theories in moral philosophy. There is obviously a close relationship between medical ethics and the utilitarianism of Jeremy Bentham and John Stuart Mill, namely that the doctor should act in such a way as to bring about the best medical consequences for the greatest number of people, or act in such a way as to minimise harmful consequences for the greatest number of people. Although it may seem unarguable that doctors should always do what is best for their patient’s welfare, it is not always clear how the assessment of welfare is to be done, and from whose perspective.
Many questionable acts will not be repeated once the colleague understands or receives insight into why an act was wrong. However, when a colleague willfully and knowingly engages in professionally irresponsible or unethical behavior, intervention becomes more demanding, uncomfortable, and worrisome. This takes personal courage; we will attempt to assist you with the process at the end of this lesson.
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Most therapists who are themselves recovering from sexaddiction use the Twelve Steps in their recovery, and many continue to attend12-step meetings. Such therapists routinely recommend 12-step meetingattendance to their recovering clients. Unless they live in one of the major citiesin the ,most sex addicts do not have a wide choice of “S” meetings to attend. How dorecovering therapists feel about attending the same meetings as theirclients?We posed this question to sexaddiction professionals on an e-mail discussion group. Twelve experiencedclinicians responded: ten said no, and two said maybe or it depends. Becausethis is such an important and recurrent issue, we have quoted some of therespondents. Here are several responses from the first group:
Ethical Dilemmas Related to Disclosure Issues: Sex Addiction
We have argued consistently that therapists usually serve the consumers of their services best when they hold to appropriate professional roles. However, behavioral emergencies and crises may call for temporary exceptions to this advice. The most ethical response under conditions of possible calamity – especially those involving matters of life and death – might conceivably involve ministering to distraught family members, breaking a confidence that would have remained secure under usual circumstances, showing more patience or engaging in more than the usual non-erotic touching, or even actively searching for the whereabouts of clients or their significant others. The case of the child about to run away from home provides an example of those rare occasions when the therapist might consider jumping in his car and driving to the family home in the hopes of finding that the girl has not yet left home.
Schneider and Barbara Levinson
As both cases demonstrate, an incident requiring a decision that is bound to have ethical ramifications occur most often when an element of ongoing harm or immediate danger appears to be present. As seasoned clinicians know, uncommonly flat affect in a client at risk for suicide could indicate that the client has made a decision to resolve his pain by exercising the “ultimate solution.” As for the midnight wake-up, clients who stalk their therapists are not uncommon, and an estimate of the risk of such stalkers becoming aggressive is as high as 25% (Kaplan, 2006).
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Mental health providers rank high among the professionals vulnerable to ethical and legal quandaries when making decisions and acting under behavioral emergency conditions (Hanson, Kerkhoff, & Bush, 2005). These conditions pertain when therapists are concerned about a client’s condition (especially if information is incomplete), or when the best course of action is unclear, or when the situation is emotionally charged, when time is of the essence, and when stakes are high should a negative outcome result (Kleespies, 2014). Both coping and decision-making skills must be brought to bear (Sweeny, 2008).