March 2013 Ethics Newsletter

“ETHICS!” she cried

March 2013

Have you ever been at a gathering where you did not know all the proper etiquette? I have, and I find my actions drop to the minimum as I stumble through trying not to break rules. Everywhere we go; there are written and unwritten rules of behavior. The goal of these rules is usually so that everyone knows how to behave. Those people in the know can choose to help others learn them, or we can use the rules to exclude others. This is a way that etiquette can be used to hurt others, instead of help act as a guide.

We have codes of ethics in order to help guide us in situations. It is less perfect than the rules that tell us which fork to use at the table, and alas, there are bigger consequences for unethical practice. But the greater weight carried by ethics and the gray areas create more room for the use of ethics as a tool to get what we want, or as a weapon to attack another. Let’s look at some examples. I am basing these on real life events that I have seen over the last 20 years.

An organization might be going through a change in services. In the past it offered group therapy for a certain population, but that therapy is no longer financially viable due to rate changes. The non-clinical management decides to end groups, and concentrate more on individual and family therapy, where the numbers still work. Marsha is one of the therapists that enjoyed group and is sorry to lose it. She goes to her boss and says that it is unethical to end the groups because the clients really benefited from the groups. “Ethics!” she cried, against the change.

Now, Marsha may feel that the best possible treatment for the clients is having group as part of the services offered to the clients. She may be very distressed that the clients will no longer get this service. The question is: “Is it ethical to stop providing a service that it costs the organization money to provide?” I think most of us would answer “no”. For instance, not all hospitals provide all types of surgeries, and they do not all have an ER. Marsha could always offer group on her own time if she feels strongly enough about it.

Another way ethics can be used is to attack a colleague. Dan and Joe have never gotten along well. They have different approaches to work, and they both get under each other’s skin. Joe struggles with his documentation, and has a tendency stay late to finish up. This includes assessments. Dan decides that Joe is actually unethically completing assessments without the client present and just filling in lines The first thing Dan does is goes to their boss to complain Joe is being unethical.

Our guidelines clearly tell us we should first go to the other person and discuss the issue with them. Dan skipped this part, and went straight to his boss crying “Ethics!” under the guise of helping, but really to get Joe in trouble. Here we see ethics used as a weapon against a coworker. Dan may care about the integrity of the note, but his first stop should have been Joe. The fact that it was not, means Dan is not following the very ethics he seems so worried about with Joe.

Crying “Ethics!” in these ways is to be against the very point of a code of ethics in the first place. We want to prevent harm to the client, and harm to ourselves. Trying to use ethics to manipulate a situation or as a weapon against a peer is damages our credibility as a therapist and the credibility of all therapists. We need to reserve the call for those situations where there is a real issue.