Ethical issues in guidance and counselling

Ethical Issues in

Guidance and

CounselingUnit Six: Ethics and Scientific Issues

Tanecia Stevens BA G&C International University of the Caribbean 1

What is Ethics?

• The basic

concepts and

fundamental

principles of

decent human

conduct.


Ethics cont.

• It includes study of universal values such as

the essential equality of all men and women,

human or natural rights, obedience to the law

of land, concern for health and safety and,

increasingly, also for the natural environment.


What is Science?

• Science is the concerted human

effort to understand, or to

understand better, the history of

the natural world and how the

natural world works, with

observable physical evidence as the

basis of that understanding.


Science

• It is done through

observation of

natural phenomena,

and/or through

experimentation that

tries to simulate

natural processes

under controlled

conditions.Tanecia Stevens BA G&C International University of the Caribbean 5

What are Issues?• A point or matter of discussion,

debate, or dispute: What legal and

moral issues should we consider?

• A matter of public concern:

debated economic issues.

• A misgiving, objection, or

complaint: had issues with the plan

to change the curriculum.

• A problem.Tanecia Stevens BA G&C International University of the Caribbean 6

What are Medical Issues?

• The field of ethics studies principles of right and wrong. There is hardly an area in medicine that doesn't have an ethical aspect. For example, there are ethical issues relating to:

• End of life care: Should a patient receive nutrition? What about advance directives and resuscitation orders?

• Abortion: When does life begin? Is it ethical to terminate a pregnancy with a birth defect?


• Genetic and prenatal testing: What happens if you are a

carrier of a defect? What if testing shows that your unborn

baby has a defect?

• Birth control: Should it be available to minors?

• Is it ethical to harvest embryonic stem cells to treat diseases?


Medical Issues cont.

• Organ donation: Must a relative donate an organ to a

sick relative?

• Your personal health information: who has access to

your records?

• Patient rights: Do you have the right to refuse

treatment?

• When you talk with your doctor, is it ethical for her to

withhold information from you or your family?Tanecia Stevens BA G&C International University of the Caribbean 9

Bio-ethics

• Bioethics is the study of

the typically controversial

ethical issues emerging

from new situations and

possibilities brought

about by advances in

biology and medicine.


Bio-ethics cont.

• It is also moral discernment as it relates to medical

policy, practice, and research. Bioethicists are

concerned with the ethical questions that arise in the

relationships among life sciences, biotechnology,

medicine, politics, law, and philosophy. It also

includes the study of the more commonplace

questions of values ("the ethics of the ordinary")

which arise in primary care and other branches.


Medical ethics and Bio-ethics

• Medical ethics tends to be

understood narrowly as an

applied professional ethics,

whereas bioethics appears to

have worked more expansive

concerns, touching upon the

philosophy of science and

issues of biotechnology.


Medical and Bio ethics cont.

• Still, the two fields often overlap and the distinction

is more a matter of style than professional

consensus. Medical ethics shares many principles

with other branches of healthcare ethics, such as

nursing ethics. A bioethicist assists the health care

and research community in examining moral issues

involved in our understanding of life and death, and

resolving ethical dilemmas in medicine and science.


What do they have to do with

counseling?

• The integration of health care services has created a

new ethical landscape for all parties, including the

counselor who participates in the health care system.

Ethical, political, and social norms create a new

complexity within the environment for counseling

practice. Counselors who work in a health care

setting are expected to operate within the prevailing

biomedical model.


Counseling

• Bioethical areas that are influential in the lives of counseling clients:

• Genetics

• Abortion

• HIV/AIDS

• Euthanasia

• Cancer

• Fertility

• Alternative

medicine


Fertility Issues

• Fertility is the ability to reproduce; men who

are fertile are able to father children and

fertile women are able to get pregnant and

carry their baby to full term, with a live birth

nine months after conception. This all

happens naturally as a result of sexual

intercourse.


Fertility Issues• You may have

fertility problems

if you haven't

been able to get

pregnant after

trying for at least

1 year.


Genetic Engineering

• Genetic engineering is the process of using

technology to change the genetic makeup of

an organism - be it an animal, plant or a

bacterium. The goal is to add one or more

new traits that are not already found in that

organism.


Genetic engineering questions

• Does the search for a cure for specific disabilities for

individuals who

may be diagnosed

in the future

have a negative

impact on those

currently living

with a disability?Tanecia Stevens BA G&C International University of the Caribbean 19

Genetic question for Counselors

• What is “normal” an what constitutes a disability, and who is to make this decision?

• What are diseases, or disabilities, and should they be prevented or cured?

• How can we meet the financial needs of individuals who desire gene therapy, which is beyond that many individuals can afford?

• Who should obtain these services and at what cost?


Abortion

• Counselors who work in a variety of

environments, including school,

rehabilitation, and marriage and family

practice settings, may be confronted with the

issue of abortion. Abortion is a value-laden

issue in society at large and also within the

counseling setting. Without a massive shift in

public opinion, abortion will remain one of

the most divisive health care policy issues.Tanecia Stevens BA G&C International University of the Caribbean 21

Abortion


Abortion Cont.

• Because of the value-laden and emotional nature of the

abortion issue, counselors must examine their own

values and understand their clients’ value systems. They

must carefully analyze all relevant empirical research to

ensure that all involved parties in the debate

appropriately characterize the scientific knowledge base.

They should encourage health care policy and

institutional policy that are based upon evidence rather

than assumption alone.Tanecia Stevens BA G&C International University of the Caribbean 23

Euthanasia

• Euthanasia (from Greek: εὐθανασία; "good death": εὖ, eu; "well" or "good" – θάνατος, thanatos; "death") is the practice of intentionally ending a life in order to relieve pain and suffering.

• There are different euthanasia laws in each country. The British House of Lords Select Committee on Medical Ethics defines euthanasia as "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering". In the Netherlands and Flanders, euthanasia is understood as "termination of life by a doctor at the request of a patient".


Euthanasia: Think about this


Ethics in Euthanasia

• Physician-assisted suicide and euthanasia are distinguished and discussed in the context of the counselor's role in helping terminal clients. An aging population coupled with the proposed legislation in many states to legalize physician assisted suicide could mean these issues will become more paramount to the counseling profession. Potential ethical dilemmas are discussed using the bio-psychosocial model, five pillars of ethics, and an existing health-care model as guidance.


Terms used with Euthanasia

• Hastened death

• Passive Euthanasia

• Active Euthanasia

• Double Effect

• Living will

• DPA: Dual Power of Attorney for heath care


Elements of Ethical Procedural

Safeguards for Euthanasia

1. Requests should be made by a competent person on several occasions and in writing.

2. A through examination should be made to rule out or treat any prevailing psychological condition.

3. The act of assistance should be restricted to certified physicians who will receive compensation for their work.

4. Careful documentation with reference to alternative treatments should be offered to the person.

5. All cases should be reported to an official body.


Counseling Implication for

Euthanasia.

1. Keep current on developing legal, social, and ethical information related to euthanasia.

2. Determine what culturally influenced moral theory, personal biases, and persona perspectives guide tour practice. Clarify personal beliefs and values.

3. Become adept at the skill of self-reflection. Assess your decision making process, understand it, and use it to deal consistently with issues.


Implication cont.

1. Examine, understand, and reconcile institutional protocols, legal precedent, and liabilities.

2. Obtain differing professional perspectives.

3. Be knowledgeable about the potential course, prognosis, and all treatment alternatives related to a client’s illness.

4. Be familiar with all contextual factors that may be influencing client. Their perspective.


Implication cont.

• Try to understand client by exploring their world.

• Act as a resource person and empathic listener.

• Help clients understand the importance of various

personal and formal documents associated with the

end of life.

• Be available to comfort significant others after a

death has occurred.


Counseling persons with STI (Aids)

The HIV/AIDS epidemic has presented

counselors with new ethical decision-making

dilemmas. This uncharted territory has required

counselors to carefully examine and consider

prudent action on resolved ethical issues. Legal

and professional norms of practice have

remained difficult to negotiate.


STI’s Counseling

• As counselors struggles to resolve these emerging ethical issues; they must have a working knowledge

of the basic issues

related to working

with individuals

with touched by

HIV/AIDS and

other STIs


Limitation of Confidentiality

• Counselor who receive information from clients who may have a communicable disease known to be fatal must disclose information to relevant third parties if, and only if, the counselors have reason to believe that:

a) there is medical evidence.

b) The client bears specific relation eg. Sex

c) The client have not or plan to inform third party.


Limitation cont.

• In cases wherein the above conditions are met, counselors’ general obligation to third parties is defined by:

Within the counseling context, before disclosure, counselors make all reasonable efforts to educate the clients about the disease and to provide the clients with the support, understanding, encouragement, and opportunity to disclose the information to third parties on their own.


Limitation cont.

The counselor must make third party disclosure in a timely

fashion.

Before disclosure, counselors must inform clients of their

intention.

Counselors must disclose information only to the parties at risk

or to legal guardian.

Counselors must limit the third party disclosure to general

medical information, in earnest, communicate to the third party a

willingness to provide support in the form of counselling or to

make an appropriate referral.Tanecia Stevens BA G&C International University of the Caribbean 36

Counselor Implications

• Become familiar and continually update medical

information regarding HIV & STI

• Be familiar with short and long-term issues that may arise.

• Be aware of one’s own attitudes, biases, and prejudices as

they relate to individuals with HIV.

• Seek to inform and encourage all clients in high risk

groups to consider safe methods of having sex and using

drugs.


Implications cont.

• Be prepared to refer clients to legal resources if warranted to protect their right to nondiscrimination.

• Keep current regarding existing state and federal laws concerning the caregiver role in the spread of communicable diseases.

• Articulate early in the therapeutic relationship the limitations of confidentiality, including the possible use of written formats to facilitate the informed consent process.


Implications cont

• Determine mutual goals with client as part of ongoing assessment.

• Remember that your principal duty is to your client.

• Exercise your prerogative to refer or consult with other professional as needed.

• Maintain appropriate case notes that document confidentiality issues, understandings with your client, treatment goals and progress, and usual events.


References

• http://www.businessdictionary.com/definition/ethics.html#ixzz3SVbOeFcI

• http://www.gly.uga.edu/railsback/1122science2.html

• http://www.thefreedictionary.com/issue

• http://www.nlm.nih.gov/medlineplus/medicalethics.html

• http://www.counseling.org/knowledge-center/vistas/by-subject2/vistas-professional-development/docs/default-source/vistas/article_53#sthash.YMe4FCQE.dpuf

• Counseling Ethics and Decision Making. R. Rocco Cottone


http://www.businessdictionary.com/definition/ethics.html

http://www.gly.uga.edu/railsback/1122science2.html

http://www.thefreedictionary.com/issue

http://www.nlm.nih.gov/medlineplus/medicalethics.html

http://www.counseling.org/knowledge-center/vistas/by-subject2/vistas-professional-development/docs/default-source/vistas/article_53#sthash.YMe4FCQE.dpuf

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Ethical issues in guidance and counselling