|
Article Excerpt
The authors examined the impact of substance abuse counselor (SAC) recovery status and education level on (a) SACs' sensitivity to ethical dilemmas and (b) extent to which training might help resolve dilemmas. Results revealed a significant difference between SACs with a graduate degree and SACs with an associate's degree/high school diploma regarding sensitivity to ethical dilemmas, with the latter being more sensitive. This study could be used to develop educational materials to improve SAC competency in resolving ethical dilemmas.
The norm for human service professions over the past 45 years has been to establish codes of ethics. The American Psychological Association adopted its first code of ethics in 1953, and the American Counseling Association espoused its code of ethics in 1961. Rehabilitation counselors, under the auspices of the National Rehabilitation Counseling Association (NRCA), adopted a code in 1972. By 1987, a joint committee representing NRCA, the American Rehabilitation Counseling Association, and the Commission on Rehabilitation Counseling Certification revised the code for rehabilitation counselors. Other professions or disciplines that have adopted ethical codes include social workers, forensic psychologists, vocational experts, and rehabilitation administrators (Blackwell, Martin, & Scalia, 1994).
In fact, substance abuse counseling ethical codes have been adopted nationally by the National Association of Alcoholism and Drug Abuse Counselors (NAADAC, 1995) and also at the state level by bodies such as the Illinois Alcohol and Other Drug Abuse Professional Certification Association (IAODAPCA, 1992). A study conducted in 1997 (St. Germaine, 1997) found that 14 of 40 state credentialing boards require substance abuse counselors to follow the NAADAC code of ethics, so no one code takes precedent. Consequently, counselors can refer to several codes that may have conflicting rules or canons.
Ethics Education
Most accrediting and certification bodies for the human service professions (e.g., Council on Rehabilitation Education [CORE], IAODAPCA) now require training in ethics, including 33 of 40 state certification boards for substance abuse counselors (St. Germaine, 1997). Generally, the training covers issues corresponding to six major areas of professional ethics: confidentiality, dual relationships, informed consent and business practices, competence, sensitivity to differences, and interventions (Bednar, Bednar, Lambert, & Waite, 1991; Blackwell et al., 1994; Byington, Fischer, Walker, & Freedman, 1997; Carroll & Schneider, 1985; Claiborn, Berberoglu, Nerison, & Somberg, 1994; Corey, Corey, & Callahan, 1993; Keith-Spiegel & Koocher, 1985; Matkin, 1982; Mucowski, 1992; Pedersen, 1989, 1997; Pope, Tabachnick, & Keith-Spiegel, 1987, 1988; Pope & Vasquez, 1991; Rhodes, 1986).
A code of ethics provides general principles to guide and direct professional behavior. Ethical codes, however, may possess limits (Ibrahim & Arredondo, 1990; Pedersen, 1989; Pope & Vasquez, 1991). Ethical codes alone cannot resolve some ethical issues; guidelines within a code may conflict with laws, statements of practices, or regulations. Also, there may be a conflict because of the counselor's personal values or agency policy and practices. To be understood in a cultural context, codes may need to be adapted to specific cultures. And, because of the diverse makeup of the profession, all of its members might not agree on all standards. Therefore, ethical codes, although necessary, may be insufficient for exercising ethical responsibility (Corey et al., 1993; Kitchener, 1984; Millard & Rubin, 1992; Wilson, Rubin, & Millard, 1990).
Ethical Decision Making
Ethical Principles and Dilemmas
The gaps and contradictions in ethical codes require the counselor to have a deeper understanding of the fundamental basis for dealing with ethical dilemmas (Kitchener, 1984). In essence, when a code fails to provide clear guidance, the professional must make reasonable ethical decisions using the principles upon which critical ethical reasoning is founded: autonomy, beneficence, nonmaleficence, fidelity, and justice (Blackwell et al., 1994; Corey et al., 1993; Howie, Gatens-Robinson, & Rubin, 1992; Kerkhoff, Hanson, Guenther, & Ashkanazi, 1997; Kitchener, 1984; Langford, 1994; Millard & Rubin, 1992; Tarvydas, 1987; Thomas, 1994; Wilson et al., 1990; Wong, 1990).
The five principles, adopted from medical ethics (Beauchamp & Childress, 1994), are defined as follows with minimal variation. Autonomy refers to self-rule (Beauchamp & Childress, 1994) and respecting the freedom of a client to make choices and decisions without constraints imposed by others (Wilson et al., 1990; Wong, 1990). Beneficence refers to "promoting the client's growth and well being" (Wilson et al., 1990, p. 30) or holding the client's interests as primary (Howie et al., 1992). Nonmaleficence means "avoiding or preventing harm to clients" (Wilson et al., 1990, p. 30), a duty not to cause harm to others (Kitchener, 1984). Fidelity refers to honoring promises and commitments made explicitly and implicitly (Howie et al., 1992; Wilson et al., 1990; Wong, 1990). Justice refers to treating clients equally or fairly (Wong, 1990, p. 28) in relation to the allocation of services (Howie et al., 1992).
A counseling professional encounters an ethical dilemma when faced with a situation requiring a choice between two reasonable courses of action, both of which can be supported by ethical principles, and both of which may have significant consequences (Blackwell et al., 1994; Corey et al., 1993; Rhodes, 1986; Wilson et al., 1990; Wong, 1990). Rubin, Wilson, Fischer, and Vaughn (1992) delineated the four characteristics of an ethical dilemma:
1. A choice must be made between two courses of action.
2. There are significant consequences for taking either course of action.
3. Each of the two courses of action can be supported by one or more ethical principle.
4. The ethical principles supporting the unchosen course of action will be compromised. (p. 42)
To resolve ethical dilemmas, counselors need to be able to recognize ethical dilemmas (via understanding of ethical principles) and possess skills for reaching reasonable resolutions to those dilemmas (Millard & Rubin, 1992).
Decision-Making Models
A systematic approach for reaching ethical resolutions is necessary for human service professionals when they encounter ethical dilemmas (Perkins, Hudson, Gray, & Stewart, 1998; Wilson et al., 1990). Several systems or ethical decision models have been offered (Corey et al., 1993; Ivey, Ivey, & Simek-Morgan, 1993; Kottler & Brown, 1992; Rubin et al., 1992), all of which offer some variation on the following steps: (a) identifying the dilemma and all possible options, (b) identifying consequences of those options, (c) reviewing ethical guidelines and the principles involved, and (d) deciding on the apparent best course of action.
However, codes of ethics may be lacking or provide insufficient guidance for dealing with ethical dilemmas. The limits of a code and its inherent gaps and contradictions revolve around the complexities related to the professional, the agency, and the client--what is known as the "complex environment." Some of the ethical dilemmas encountered in a complex environment are irresolvable when relying solely on a code. Hence, to offer quality and ethically accountable services, it is essential that the counselor understand the...
|
