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Ethical decision-making models propose a method for critical thinking and planning in the resolution of ethical quandaries (Beemsterboer, 2021). An ethical decision-making model is a tool that health care providers can use to help develop the ability to think through an ethical quandary and reach an ethical decision (Beemsterboer, 2021). The ethics literature contains a number of models, the majority of which are similar in design and content (Beemsterboer, 2021). Each model's goal is to provide a framework for making the best decision in a specific situation with which the health care provider is faced (Beemsterboer, 2021).
The majority of these models use principle-based reasoning, which is based on the work of philosophers Beauchamp and Childress(Beemsterboer, 2021). 7 These frameworks take into account ethics, duties, and values(Beemsterboer, 2021). They advocate for the use of resources in dentistry, such as published evidence, clinical data, and peer consultation(Beemsterboer, 2021). Some of these models include four, five, or seven steps for resolving problems, but they all encourage thorough reasoning through the structure of a decision model, whether in a solo private practice, a large clinical setting, or a dentistry advocacy organization(Beemsterboer, 2021).The majority of these models employ principle-based reasoning, which is based on the work of Beauchamp and Childress(Beemsterboer, 2021). 7 These frameworks take into account ethics, duties, and values(Beemsterboer, 2021). They advocate for the use of resources in dentistry, such as published evidence, clinical data, and peer consultation(Beemsterboer, 2021). Whether in a solitary private practice, a large clinical setting, or a dental advocacy group, all of these models encourage comprehensive thinking through the structure of a decision model(Beemsterboer, 2021).
Beemsterboer, P., 2021. Dental Continuing Education Author Phyllis Beemsterboer. [online] Dentalcare.com. Available at: <https://www.dentalcare.com/en-us/professional-education/phyllis-beemsterboer> [Accessed 9 August 2021].

Regards
Memory

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What stands out the most for you?

Ethical reasoning, like law, can be seen as black and white, but there is wiggle room in how we interpret these guidelines/rules. Common sense needs to be deployed, but that is also based on our own roadmap of the world.

What did you find interesting or surprising?

I have heard of a few instances where transference has happened between the counsellor/psychologist and their client. This can be disastrous to the career of the practitioner, but these are often swept under the carpet or rationalized. If I recall correctly there needs to be a 24 month gap in contact between both parties before a romantic relationship can be entered into. I believe this to be a good thing given that the delicate boundaries that come with a therapeutic relationship needs to be honoured, not only for the practitioner, but also the client. I feel it can do immense damage to the client if this is something that is allowed.

What seems like common sense?

I feel like the practicalities of ethics makes common sense. Things like not to engage in fraudulent behaviour. For example, non-rendered fees, false statements and excessive fees. Third party disclosure is also quite clearly a transgression taking into account common sense.

Thanks, Ilze van den Berg

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What stood out for me….
While reading through these I be couldn’t help but notice that some dilemmas seemed to be obvious no-no’s, others (such as the counsellor not using correct techniques) seemed less obvious. It made me think about a point in our reading this week which referred to the fact that the counsellor may not always be consciously acting/behaving unethically. Earlier this week there was the discussion around receiving gifts and how yes a diamond ring may be completely off the charts but what about a chocolate cake the client has baked? This was an interesting debate. I feel that if the rules/rules of conduct are outset properly at the outset of sessions, situations like these could be avoided.

What I found surprising….
The issue of fraudulent behavior in the part of the counsellor - very interesting!

What should be common sense…
I agree with an earlier comment where it was stated that what might be common sense for me, may not be common sense for you. I suppose it it about working within the cultural framework of where you practice and being aware of the norms and practices so that you can counsel in a culturally ethical way.

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The commonality and extent of unethical practice is a pertinent concern, and it is somewhat dissapointing to say the least, especially considering that it exists in the helping professions. Having said that, certain dilemas do exist whereby unethical practice is difficult to avoid, such as when acting ethical conduct is in conflict with the law.

I am surprised that romantic relationships are less common as a client in therapy is usually more vulnerable, thus there is high risk of them forming an attatchment to the therapist, for reasons such as feeling heard and understood. Naturally this creates a power dynamic in the theraputic relationship and it is up the the therapist to reframe from abuseing their position. The probability of the event occuring is more likely when the result is based on one out of two outcomes (therapist’s choice between doing and not doing), rather than one out of four outcomes (therapist and client’s independent choices)

The guidelines in the ethical code of conduct are crucial to follow, and it is common sense to avoid violation of any acts which are deemed unethical. As mentioned above, clients are very vulnerable when they enter therapy, and the therapist has a large degree of influence in their healing process, thus, they have the potential to severely harm the client.

I hope you all Have a Wonderfull week

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Hi All

I think what stood out to me the most was how obviously unethical most of the practices provided are and how frequently they occur! I was surprised that most of the health care practitioners after taking the oath were still able to go against it and were arrogant enough to think they could get away with it. I’m honestly just bewildered that those who we think we can trust could behave in such ways.

The things that make the most sense to me are forbidding sexual activities with a client, questionable financial arrangements and patient confidentiality. The first two I honestly find a bit repulsive that one could take advantage of someone they took a lawful oath to protect and help.

These readings left me feeling really unsettled :(.

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Hi Guys,

These acts indicate emotional detachment, malignance, and self-interest; they violate psychologists' ethical principles and code of conduct. I found this activity particularly interesting because I am interested in the dark triad, and most of the intentions behind these unethical acts overlap and can be associated with personality traits of narcissism, psychopathy, and Machiavellianism. These counselors/therapists have malevolent intentions and take advantage of their client's vulnerability and susceptibility.

The magnitude of consequences continually ran through my head as I read through these cases, and I refer to the harm and dire consequences that could befall the client, not the practitioner. These violations and misconducts seem like common sense; however, common sense might seem identical in time and space, but it takes numerous different forms, and we should not take anything as common sense because common sense prevents us from observing more significant systemic natures. People have the proclivity to focus their attention on their immediate environment, and consequently, we fall short of the ideal, and we should therefore be aware of our susceptibility as practitioners.

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Hi everyone,
What perhaps stood out to me the most is the prevalence of a counselor having sexual relations with a client and also fraudulent activities such as lying about your qualifications.
Although, as I think about it, it does make sense that sexual relationships could form due to the intimate nature of counselling, but it is clearly unethical since a well trained counselor cannot say that they did not see it coming since they are taught about setting boundaries during their education.

Unfortunately I find the sexual relationships unsurprising and nearly expected something like this to be a common issue. What I did find surprising is that counsellors would falsely advertise qualifications that they do not truly posses - one would think that there are better measures in place to prevent counsellors from falsely advertising their expertise.

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What stands out most to me?
A statement that stood out was about the misuse of ethics and use of ethics is nearly the same. That statement serves as a powerful reminder that just because someone has good intentions does not mean their actions serve the greater good.
What I thought would be obvious?
That critical thinking is needed to practice ethical principles in counselling.
What I found interesting?
That counsellors have to decide whether to break confidentiality over HIV transmission unless here is a law against it.
I thought there would be resources for counsellors to determine what to do in that situation so it was interesting to hear that in some places counsellors have to decide for themselves when the situation calls for it.
Here is an article on what South African counsellors should do in that situation for anyone whose interested.
https://www.medicalprotection.org/southafrica/advice-booklets/medical-records-in-south-africa-an-mps-guide/sharing-information-about-hiv-status

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What stood out for me the most?
Well reading through the padlets, I am shocked about the high stats of sexual relationships among client and counsellor.  Of course to be human you are going to be attracted to a person, but it's a choice to act on it and given you are in a helping profession, your main priority is what is the best for my client.

The breach of confidentiality seems very high as well and I have to ask a question here.....why would you want to discuss your clients personal issues with anyone.  Unless you feel they are going to be of harm to themselves or others, there is no need to talk about another person's personal issues with anyone.

What I found interesting/surprising?
Helping a client out financially.  What is done about this in a situation.  I would love to here others points of views.  What if they are in dire need of professional help, but cannot afford it, but you want to help them.  Can it be classified as Pro-Bono work?  What are the ethical codes in this?

Thanks everyone for your wonderful padlets to read through.

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Ethical reasoning and considerations: Waseem Omar

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Ethical reasoning and considerations: Waseem Omar

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Hello all

What stood out for me was the case of Tarasoff v. Board of Regents of the University of California which altered the concept of confidentiality in counselling as well as how it's interpreted in the practice of law. The client of the psychologist (Poddard) was on record stating that he threatened to kill a student on campus named Tatiana Tarastoff.

While she remained unnamed, the police claimed she was 'readily identifiable' or easy to recognise - whatever that means. The police then subsequently warned Poddar to stay away from Tarastoff and a formal evaluation to be conducted by a psychiatrist was put in motion. Unfortunately for Tarasoff, she was given no warning that Poddar had threatened her life and was killed by him shortly after. The duty to warn Tarastoff (the intended victim) and likely prevent her death fell upon Poddard's psychologist who somehow didn't think to notify Tarastoff or her family (third parties) of this threat.

This is interesting to me considering that the psychologist was perhaps attempting not to violate their client's confidentiality which is of course unethical. However, what is arguably more unethical was not reporting that his client threatened to kill someone who should have been warned and protected. This to me demonstrates a lack of moral commitment, sound professional judgement and common sense on the part of the psychologist as well as the police who also should have protected Tarastoff or at least warned her or her family of a possible imminent threat to her safety.

Hope you are all enjoying the weekend :) I thoroughly enjoyed this activity. Stay safe.

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What stands out for me
This list of transgressors is a very sad sate of affairs of some members of the HPCSA.
Two questions (maybe more) come to mind:
1- I am curious as to the reason that these professionals abandoned their ethical responsibilities?
2- What caused them to think/believe that they would get away with such unethical behaviour?

What I found interesting/surprising
Is the amount of suspended sentences, especially for overcharging or ghost charging and falsifying medical certificates.

Common sense
a-Do not overcharge or falsify any documents.
b-Do not become physically involved with your client.
c-Do not practice beyond your level of experience or expertise.
Finally, I am curious about the transition of these health professionals transition from (presumably) ethical graduates to unethical practitioners. It is of grave concern for me.
My final question, to myself:
How will I maintain ethical standards and no be lured by easy money or other unethical practices.

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What stands out most to you?

While going through the information what stood out most for me and I actually had to take some time out from continuing with the activity is that of fraudulent conduct but specifically compiling incorrect reports including allegations of sexual molestation without seeing a client. This literally blew my mind! Without sounding too judgemental I just thought what kind of person would actually do this and to what end? I think the implications of doing such a thing would be vast for all the parties involved.

What did you find interesting or surprising?

The concept of dual relationships leaves me scratching my head a bit. While I understand the theory behind it, I do believe that especially in South Africa within certain communities this would be a tricky situation to navigate. And yes, while you may disclose the dual relationships with your client, what happens when you are the only available mental health practitioner within the community? Or you grew up in the community, held various positions within the community and you are now ‘giving back’ in a way? Perhaps more research needs to be done on my part to figure this out.

What seems like common sense?

Not violating confidentiality

Sexual activity with a client

Charging exorbitant rates to clients or any fraudulent activity relating to money

Working out of ones scope of practice

Be Well
Tasneem
x

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What stood out most for me is sexual intimate relationship with clients. Sexual misconduct and unprofessionalism. Taken account from the video clip, it states that justice is fairness. Counsellors must be fair when they distribute care. Unethical behaviors must not be tolerated. Counsellors must not uphold any truth regarding clients, even if may lead to patient’s distress. What’s interesting or surprising for me was an unethical behaviors, where clients would actually accept gift (diamond ring) from the client. Ethical reasoning play an important role for each person to become ethical practitioners.

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Ethical reasoning :
What stands out most to you?

Violation of confidentiality. It should be a priority of a therapist to keep all information of every session confidential. This means storing all of the records after therapy in a secured and private place. Taking time to sort out your documents will ensure you don’t accidentally misplace records into the wrong folders. This includes not leaving documents lying around where they may be seen by a third party or leaving records on voicemail or text. A client goes to a therapist in a very vulnerable state, and therefore it’s important to portray the most secure, safe, and trustworthy environment. I’ve heard many professionals blab out confidential storylines in their social groups by keeping the client anonymous, but without the permission of the client even in an anonymous agreement. This should be against a therapist's policy. Also, blabbing out experiences of previous clients to current clients would affect the ability of your client to trust you. It is important to note and to notify clients when a therapist may indeed break confidentiality for example in case of threat towards themselves or others, planned future crimes or abuse, experiencing child abuse, etc.

What did you find interesting or surprising?

I find it interesting that some therapists would be prejudice against culture. Especially in South Africa, with our diverse rainbow nation, it should be important for a therapist to have it in their nature to find ongoing knowledge about cultures regarding society, history, religion, and even the government. In this particular topic, it would be important for a Therapist to practice Cultural humility. Cultural humility is the process in which a person in continuing to grow in areas such as your own identities and cultural beliefs. Self-awareness, valuing others, and continuous growth are important factors in cultural humility. After evaluating your cultural humility, then you can start to think of how you would respond to a culturally diverse client.

Be mindful of your client’s social and cultural identities and how those factors make them unique.

Consider how your client’s behavior may have been influenced by their cultural values.

Be aware that will be differences between you and your client by having tolerance.

To build rapport, it may be helpful to ask your client about how they have been holding up concerning something general (lockdown level 4), but keeping it brief so it doesn’t take over the real topic that needs to be focused on.

Show interest and ask appropriate questions.

What seems like common sense?

It seems like common sense to me to not anticipate or participate in any sexual behavior with your clients. Should there be a desire from you or your client, it might be best to redirect your client to another therapist. Getting involved sexually with a client may result in legal action since you’re supposed to offer a comfortable space for your client to feel free to open up, but if the therapist gets involved in sexual conduct with a client, the therapist may be blamed for taking advantage of the client at a vulnerable stage in their lives.

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What stood out most for me was how important ethical practice is and how easy it is to slip into saying or doing something that you believe is right or helpful, but which is not necessarily ethical.

I found interesting the idea that a romantic relationship between a therapist and ex-client is not ethical and I thought a lot about why this is the case. From the reading I did it has to do with avoiding harm and protecting the autonomy of the client. A therapist (who may be viewed as an authority figure by the client) has immense knowledge of a client’s history and vulnerabilities and can easily manipulate a client, especially a dependent client, into a romantic or sexual relationship. This is particularly dangerous for the client if they have been working on issues such as sexual exploitation.

It seems common sense that universal ethical principles should be followed to uphold the integrity of the counselling profession and that these concepts should be founded on universal human rights, not on religious doctrine, social norms or unethical laws. Violation of confidentiality seems the most obvious ethical standard to me as the whole therapeutic alliance is based on trust and on the client being able to be completely honest with the therapist which is not possible if the client fears that confidentiality can be violated. Also, it is common sense that therapists should not be compensated over and above what is fair and right or receive gifts from clients, as this blurs the boundaries between a professional and a personal relationship.

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What stands out most to you?

What stand out most to me is how often these ethical misconducts take place. Most ethical principles seem rather straightforward and relatively effortless to stick to. Another topic that stands out to me is dual relationships. It definitely seems wrong to counsel or help someone that you know and have an existing relationship with. However, I do see the appeal in being counselled by someone that I know (looking from the client's perspective). It may be more comfortable for a client to share with someone they already know, but inappropriate for the practitioner.

What did you find interesting or surprising?

I found it surprising that practitioners would go against these principles for selfish and personal gain. Such as getting into a sexual relationship with a client. Or having outrageous fees.

What seems like common sense?

For me, it is common sense to not counsel a family member, friend, or someone you have a preexisting relationship with. It is definitely common sense to not get into a sexual relationship with a client. It also makes sense to not exceed one's professional capabilities, going against veracity, fidelity and justice.

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What stood out most to me was that negligence happens on the regular and it can result in the death of the patient yet it is stated plainly as an occurance almost normalized.
I found it surprising the amount sexual misconduct cases presented which was also common sense to me as something not to be done. Another thing that was common sense to me was the fraudelent cases as to me that is something that is not only unethical but illegal so i assumed most professionals would know to steer clear.

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Hi Helen, Thank you for your post.  I agree with your sentiments about not accepting gifts but do you think that it becomes ambiguous if the gifts are not as valuable as a diamond ring yet more heartfelt?  What if the client baked you a cake for example, or knitted you a jersey?  I would almost feel obliged to accept based on the amount of time they had spent, yet I still think this opens a door for crossing the line in the relationship. Although I understand the theory, I would find this tricky to navigate.

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What stands out most to you?

·        Of all the examples on the Padlet, Professionals exceeding their level of competence, practising outside their scope, claiming expertise not possessed, being rude or demeaning, along with failure to communicate diagnosis or treatment with patient and/or family members stood out for me.

·        Overall, I think this speaks to professionals in a position of power (through title and/ or training, implying expertise) not practicing beneficence and nonmaleficence. Accordingly, this could directly or indirectly, harm those who are only seeing the professional because they need help. For me, the point that people rely on social media and electronic advances as a means of confidence to question the practices of some service providers, relates to the concept of the professional's power.

What did you find interesting or surprising?

·        I found the emphasis on sexual misconduct and engaging in relationships with clients surprising.

·        I found it interesting to read some of the cases currently occurring in South Africa noting that many relate to fraud.  An example is a case is related to an intentional false diagnosis, enabling a patient to receive a policy payout.  I also found the broad spectrum ranging over the medical profession from medical doctors, specialists, dentists and optometrists interesting, along with the fact that that even cases receiving a "not guilty" verdict still remain a matter of public record.

What seems like common sense?

·        It seems like common sense not to engage in fraudulent behaviour such as claims for non-rendered services, false medical statements and charging excessive fees.   I also feel that disclosure to a third party without consent seems like a clear transgression.

Looking forward to reading other posts. Regards, Janine

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What stands out most to you?

The amount of "professionals" found guilty on charges that seems "ridiculous/absurd". For example a doctor slapping a patient during a physical exam. I am completely speechless when I read some of these misconducts.

What did you find interesting or surprising?

I found it interesting that a lot (majority) of the incidents were related to fraud. It seems that money is a key driving force in these ethical malpractices. Which is quite surprising as I was under the impression that medical aid schemes are on top of their "processes" when it comes to claims.

What seems like common sense?

Not slapping a patient
Not having sexual relations with a patient
Not stealing a prescription pad and using it to obtain drugs
Not practicing as a physiotherapist when you are a Biokineticists.
Not falsifying your qualifications.
Not being rude to patients/clients
Not claiming money for consultations that did not occur
Not practicing outside of your scope (e.g. performing surgery)

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What stood out for me is that most of these statements have highlighted what I would have considered to be common sense however I think an important lesson I've learnt about "common sense" is that it is only common based on one's own worldview so what may seem like common sense to me is not necessarily seen as common sense by someone else so as a counsellor it is critical to be mindful of your own world view, what boundaries to put in place and what constitutes unethical behaviour and how to deal with it if you're faced with it eg. being gifted a diamond ring by a client or when your client becomes too familiar and expresses personal feelings towards you.  The other issue that stood out was how health professionals can continue with "treatment/therapy" in perpetuity. I know of people who've been in therapy for years with the same therapist and yet their situation has become worse. I would guess that it would be incumbent on the counsellors to be aware and honest about whether therapy is helping the client and communicate it. The other thing that stood out for me was the issue of the counsellor having a sexual and intimate relationship with a past client..... would this be unethical?  REgards NomsaK  

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What stood out for me is that most of these statements have highlighted what I would have considered to be common sense however I think an important lesson I've learnt about "common sense" is that it is only common based on one's own worldview so what may seem like common sense to me is not necessarily seen as common sense by someone else so as a counsellor it is critical to be mindful of your own world view, what boundaries to put in place and what constitutes unethical behaviour and how to deal with it if you're faced with it eg. being gifted a diamond ring by a client or when your client becomes too familiar and expresses personal feelings towards you.  The other issue that stood out was how health professionals can continue with "treatment/therapy" in perpetuity. I know of people who've been in therapy for years with the same therapist and yet their situation has become worse. I would guess that it would be incumbent on the counsellors to be aware and honest about whether therapy is helping the client and communicate it. The other thing that stood out for me was the issue of the counsellor having a sexual and intimate relationship with a past client..... would this be unethical?  REgards NomsaK  

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Hi Nomsa, I really enjoyed your post, Common sense may not be as common as we all think. It varies from person to person, as our knowledge and experiences are different. Thank you for sharing.
Regards, Mvusi

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What stands out most and seems like common sense:
How often the following seemed to appear in the posts and which one would have thought would be 'obvious' not to do, namely:
1.Not breaching confidentiality
2.Not engaging in sexual activities with a client
3.Not accepting gifts from clients (esp a diamond ring!)
4.Not compiling reports and diagnoses regarding clients which the counsellor has never seen
5.Submitting fraudulent claims
6.Using potentially dangerous techniques
7.Overcharging and entering into illegal, fraudulent third party referral practices
8.Improper advertising practices
9.Being rude, demeaning to clients
10.Claiming to have expertise one did not have

What was surprising (and alarming to think that healthcare practitioners had engaged in such practices) was:
1.Performing surgical procedures when they were not qualified to do so
2.Not communicating diagnoses to patients and their families
3.Failing to get consent for charging above medical aid fees (I have yet to have a medical professional get my consent for this!)
4.Not getting consent for intervention procedures

Looking forward to hearing from everyone what stood out for them and engaging with you all.
Regards
Helen

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Incompetence: inadequate knowledge and the absence of skills necessary for professional behaviour.
Lack of integrity, moral commitment and sound professional judgment to adhere to acceptable standards of right and wrong action.

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Unprofessional Conduct