WEEK 7 READING (2) - Ethical Principles in Practice (Textbook) (INFORMED…
WEEK 7 READING (2) - Ethical Principles in Practice (Textbook)
Prerequisite for autonomy = must have rationality
- the capacity to act intentionally and to reason through the consequences of actions.
In order for clients to determine their own choices (self-determination), they must both
Liberty - independence from controlling influences
Agency - the capacity for intentional action.
Once our client has both agency and liberty, it's our role to actively seek to enable them to make informed decisions on their own behalf.
Autonomy comes with restrictions:
The making of choices cannot harm self or others, and needs to be within acceptable societal standards.
To be competent to make decisions, an individual must be able to understand the relevant consequences of that choice, both on themselves and on others.
All engagement with clients/patients must begin with presumption that individuals are competent to self-determine.
Acting without someone's consent or overriding their wishes, wants or actions, in order to benefit them, or at least protect them from harm.
It's hard to resist the urge to 'know best'
Involves putting a higher ethical priority on doing good for someone and protecting them from harm, rather than respecting their autonomy.
Strong paternalism -
overrides the wishes of a competent person
Weak paternalism -
overrides the wishes of an incompetent person, with the hope to restore the person to competence.
INFORMED CONSENT: A legal obligation
The process of ensuring a client's right to autonomy is met prior to any intervention.
Establishing informed consent involves both an info component and consent component
It must be given voluntarily
We must present the info so that the client can understand it. Therefore we must avoid jargon and unfamiliar terms.
Conditions of informed consent:
The patient must be competent and able to understand consequences of the consent, so that there is no undue coercion to consent (voluntariness)
All necessary info must be provided to allow the patient to give fully informed consent.
Practitioners must discuss with clients their rights and responsibilities and provide them with accurate info that outlines:
The service being offered
Who will have access to recorded info about them
The purpose, nature, extent and known implications of the options open to them
The potential risks and benefits involved in the course of action
Their rights to obtain second opinions
their avenues of complaint
If a client is unable to give consent, we may be required by law to gain consent from a substitute or surrogate who can act on their behalf. If you can't find one, the court may appoint one.
When we are working with clients who are unable to give consent, it is vital to ensure that a diminished capacity to consent to treatment in no way reduces the respect that a client must be afforded as an individual.
Privacy vs Confidentiality:
They are both informed by ethical principles of respect for persons and beneficence.
Concerned with being in control of the access that others have to personal info and the capacity to protect oneself from unwelcome intrusion.
It has been situated as one of the human rights that people should be afforded.
Without the right to privacy, many clients would be hesitant to consent to sharing personal aspects of themselves.
Concerns the treatment of identifiable, private info that has been disclosed to others, usually in a relationship of trust and with the expectation that it will not be divulged, except in ways that have been previously agreed on.
Code of Ethics of social, health and human service professions:
Provides info on what is meant by privacy, and guidance on how to achieve it, including:
The requirement not to share client confidences, clarifying in which situations this may be overriden, such as legal prerogative or duty of care considerations.
the need to disclose client confidences, if required, in such as way that a client's rights to privacy are respected.
The requirement to exercise caution when keeping client records, to ensure that a client's privacy is privileged.
Info is not limited to that actually communicated by the client to the profession - it can include opinion derived from observation as well as the exercise of professional judgement.
The duration of the obligation extends beyond the period when a person has ceased to be a client.
The obligation can be overridden in some circumstances by other ethical considerations.
The obligation is subject to compliance with the law, at least when the specific law in question is ethically defensible.
CODES OF ETHICS:
They require us to ensure that clients:
Consent the use of their professional codes of their private info prior to such info being divulged
Know to whom their info shall be given and in what detail
Know from whom info about themselves may be requested
Are fully informed of their right to confidentiality and the limits of confidentiality, from the start of the professional relationship.
Circumstances in which it's appropriate to breach confidentiality:
When there's a legal or ethical obligation to do so
When there's an immediate and specified risk of harm to an identifiable person or persons that can be averted only by disclosing the info.
Process to follow when breaking confidentiality:
Involving the client in reporting the incident
Discussing with the client why a report needs to be made, what the benefits and risks are to the client of making a report, what procedures will be followed once the report is made and what some possible outcomes might be
Inviting the client to ask any questions they may have
Ensuring the client has support throughout the process.
When working with Indigenous clients or those from non-Western cultural contexts, it is particularly important to be be sensitive to alternative world-views that place a higher priority on the family or community as a whole.
Family members may not understand why we cannot share info with them about their relative, and they may believe that our withholding of such info is inappropriate.
Complexities that arise in rural practice:
Clients provide personal info in informal settings such as community festival or school event
Practitioners in the community hold dual and multiple roles, such as acting both ass a member of a community safety committee and a volunteer suicide-prevention counsellor.
Being clear and consistent regarding boundaries
Strictly following agency procedures
Ensuring that clients are only acknolwedged in public with their prior agreement
Locating services in another town if clients would prefer
We can seek guidance from:
Our professional codes of ethics
The requirements of our employer organisation
Our own 'practice wisdom' (knowledge built up over time from our experience - our intrinsic knowing of what works and what doesn't)
DOCUMENTATION AND CLIENT RECORDS:
Ways to record client info while ensuring we respect their right to confidentiality:
Only record essential info
Share records appropriately, with prior client consent for sharing of info that relates to them
Store client records in a safe location for the required period (this is sometimes determined by law).
Destroy both electronic and paper records appropriately when required
Types of documentation and writing in professional practice:
Critical incident recording
Case notes and case records
Specified court reports
Minutes of meetings