PHIL 216 Problems in Ethical Theory

Write from the perspective that you are a mental health professional in the field. Provide a thoughtful response to each of the following two sections, including specific, concrete examples to illustrate your ideas. Your final deliverable should be one cohesive paper addressing each section along with an introduction and conclusion. Use the section headings provided below to separate each section of your paper.

Section 1: Boundary Issues and Dual Relationships 

Part A – Decision-Making Model and Examples

How would you determine if a boundary-crossing or dual relationship is ethical and appropriate? What criteria would you consider when making your decision?

Present examples of how you would apply this criteria to at least two professional situations in which you believe the dual relationship issues are complex and ambiguous. One of your examples should address the issues of physical attraction between clients and professionals.

Part B-Ethical Issues and Dimensions in Ethical Decision-Making

Examine these issues in terms of encountering former clients. Address the following:

Do the ethical issues (and your opinion about appropriateness) change, depending on how long after the termination of services a dual relationship is initiated?

What are the key ethical dimensions that might change, after the termination of services?

Present an example of a situation that you believe would constitute a boundary violation with a current client but might be acceptable with a former client.

Section 2: Development of Your Thinking about Ethics

Clearly describe what you consider the most important developments in your thinking about ethical practice that have occurred so far during this course. This may include areas in which you have clarified your views and beliefs, modified your thinking on a given issue, gained new insights, or acquired a new perspective. It may include issues whose complexity you now appreciate more fully or difficult issues that you now understand you must grapple with, as a counselor. What have you most learned about yourself and/or about what constitutes becoming an ethical practitioner and how has your thinking about ethics and legal issues changed? Be sure to include specific examples to illustrate general statements.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Section 1: Boundary issues and dual relationship

Part A.

One of the most important ethical dilemmas experienced by mental health professional is to maintain appropriate professional boundary with patients. During the care of mentally ill patients, nurses often need to give emotional comfort to patients. However, understanding and maintaining professional relationship with patient is necessary to provide ethically safe care (Ehrlich et al., 2014). The criteria to understand ethical boundary crossing limits include the following:

• Ensuring the dignity and respect of patient
• Staying away from any personal attachment or communication with patients outside of shift
• Avoiding exchange of gifts
• Treating personal information of patient as confidential
• Engage in professional way of touching patients during care
• Abstain from dual relationship (Gabbard, 2016). 

If I came across a patient who is physically attracted towards me, then I would follow the criteria of abstaining from dual relationship to maintain professional boundary. Although it will be a complex situation, my strategy will be to engage in conversation that is related to health care needs of patients and avoiding any personal communication with patient.

Any boundary crossing that is for the purpose of achieving positive health outcome will be ethical action for me. For example, many patients requiring behavioral therapy endorse walking with clients to know their issues. Hence, this is safe and ethical boundary crossing because the activity is done to get information about patients that would facilitate identify client issues and planning care for them.

Part B.

1. The ethical issues surrounding dual relationship does not change on the basis of period of termination of service. Hence, a mental health care professional cannot initiate a dual relationship after passing certain time in service. This is extremely important as long as mental health care professional is part of the mental health care service (Manfrin-Ledet, Porche & Eymard, 2015).
2. After the termination of service, there is a responsibility for health care professionals to maintain confidentiality of client information. However, they do not have any other ethical obligations in relation to dual relationship, involvement in financial transactions and extending time beyond agreed time of engagement with client.
3. In mental health care setting, there is one patient with mood disorder and there is another medically non-compliant client with major depression receiving cognitive behavioral therapy. In case of the first patient, walking with them and touching them to provide physical support is unethical because inappropriate touch without any medical purpose is prohibited according to ethics of professional boundary crossing. Touching may also increase frustration and violence in such patients.  For the second patient, providing to comfort to patient by patting or touching hand is ethical because it is part of the counseling process and such behavior helps people to freely express their issues during the counseling process. However, the touch should be comforting and warm for patients instead of invasive and violating.

2.The most important development about ethical practice that I have learned so far in the course is that I am now aware about the ethical criteria to maintain and manage boundary violation issues in health care practice. With this knowledge, I will be more cautious in handling clients with complex illness. The course has also made me aware about the complexities surrounding boundary crossing. For example, I have learned that in some situation, the boundary crossing is ethical whereas in other situation, boundary is strictly violating ethical practice. However, I am now aware about the difference in situation or critical point where engaging in close relationship such as walking or visiting them is beneficial. These situations can be analyzed by critically thinking whether the action is done for the therapeutic benefit of patient or not (Blair et al., 2016). Hence, behaviors like walking with patient or touching them will be acceptable only when there is a clearly identified therapeutic need for such behavior.

 I have also learnt that in fear of any boundary violation issues, many mental health care staffs are under involved in care. This results in neglect of patients and poor satisfaction with care (Chiarella & Adrian, 2014). In the future, I will ensure that I keep my professional action within therapeutic relationship limits so that it neither leads to over involvement or under involvement in care. Campbell, Yonge & Austin, (2016) has also emphasized that therapeutic relationship is essential in psychotherapy to alleviate symptoms and foster character change in a client. However, while engaging in activities of hand shake or touch with patients, it is necessary to understand the complex relationship with culture, values and ethics in mental health care. Hence, for me developing cultural competence will also be important to manage therapeutic boundary, confidentiality and informed consent related issues in mental health care.

References

Blair, W., Kable, A., Courtney?Pratt, H., & Doran, E. (2016). Mixed method integrative review exploring nurses’ recognition and response to unsafe practice. Journal of advanced nursing, 72(3), 488-500.

Campbell, R. J., Yonge, O., & Austin, W. (2016). Intimacy boundaries: Between mental health nurses & psychiatric patients. Journal of psychosocial nursing and mental health services, 43(5), 32-39 

Chiarella, M., & Adrian, A. (2014). Boundary violations, gender and the nature of nursing work. Nursing ethics, 21(3), 267-277.

Ehrlich, C., Kendall, E., Frey, N., Kisely, S., Crowe, E., & Crompton, D. (2014). Improving the physical health of people with severe mental illness: Boundaries of care provision. International journal of mental health nursing, 23(3), 243-251.

Gabbard, G. O. (2016). Boundaries and boundary violations in psychoanalysis. American Psychiatric Pub.

Manfrin-Ledet, L., Porche, D. J., & Eymard, A. S. (2015). Professional boundary violations: A literature review. Home healthcare now, 33(6), 326-332.