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Ethical Moral Principles and Values

Professional Mental Health Ethics

A Training Resource

By James J Messina, Ph.D., CCMHC, NCC, DCMHS-T
Levels of Ethical Practice

Mandatory Ethics: level of ethical functioning wherein counselors comply with minimal standards, acknowledging the basic “musts” and “must nots”

Example: providing for informed consent in professional relationships 


Principle Ethics: focuses on moral issues with the goal of solving a particular dilemma  and establishing a framework to guide future ethical thinking and behavior.

Example: asks “Is this situation unethical?” 


Virtue Ethics: focuses on character traits of the counselor and non-obligatory ideals

Example: asks “Am I doing what is best for my client?”


Aspirational Ethics: refer to the highest professional standards of conduct to which counselors can aspire

Example: providing services pro bono for those in the community who cannot afford needed services 


For the purposes of this website, Aspiraitonal Ethics will be the model of ethical behavior which is advocated for Mental Health Professionals to attain in their clinical practices.

Karen Kitchener’s Moral Development for Mental Health Professionals

Karen Kitchener stated that the foundation of Critical-evaluative level of ethical reasoning are Moral Ethical Principles which she based on: Beauchamp, T.L. & Childress, J.F. (1979). Principles of Bio-medical Ethics.Oxford: Oxford University Press. The Ethical Principles she identified are autonomy, beneficence, nonmaleficence, fidelity and justice.Her article on Inutition, critical evaluation and ethical principles in 1984 is considered a seminal document when talking about Ethical Principles.

Reference: Kitchener, K.S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. The Counseling Psychologist, 12(3), 43-55.

 

Two levels of Moral Reasoning:

Immediate-intuitive level – this level is based on the “ought and ought not” to do which comes from Mandatory Ethical Thinking based solely on beliefs, knowledge and assumptions based on their Professions’ Ethical Codes. This results in professionals having an immediate, automatic response to most ethical situations based on their prior ethical knowledge and experience. This immediate response forms the basis of their ethical actions.

Intuitive level immediate judgments and actions are based on:

  1. Empirical facts of the case
  2. Our ordinary moral sense-BUT when our ordinary moral judgment fails us or when we are called to evaluate or justify our ordinary moral judgments, then we must move to the Critical-Evaluative Level.

 

Critical-evaluative level – is used to sharpen our moral judgment and to redefine the bases for our actions, which sharpens our critical thinking to build up an improved set of ethical rules and principles which become part of our redefined intuitive sense.

The Critical-Evaluative Level is composed of three tiers of general and abstract forms of justification:

  1. First line of justification-Ethical or Moral rules, such as stated in Ethical Codes-they are grounded in ethical principles, which are ground in ethical theories.
  2. Second line of justification-Ethical Principles which provide a more consistent framework within which cases may be considered and provide a rationale for the choice of items in the codes themselves.
  3. Third line of justification is Ethical Theory
Figure 1: Model of Ethical Thinking according Kitchener (1984)

Moral Principles

Autonomy: Encouraging clients’ personal responsibility for their own behaviors with a freedom of choice and making decisions thus giving clients the freedom to choose their own course of action.

  1. Right to act as an autonomous agents, to make their own decisions and to develop their own values
  2. That they must treat others in the same way as autonomous agents and respecting the rights of others to make autonomous choices, even when they believe they are mistaken, as long as their choices do not infringe on the rights of others. 

Autonomy is based on the concept of competence and based on the assumption that an individual has the ability to make competent or rational decisions.

Clients for whom autonomy is restricted because they do not have the ability to make competent and rational decisions or act on those decisions are:

  1. Children infants to 10 years of age and individuals with intellectual disorders have limited competence
  2. Adults with dementia or Alzheimer’s has intermittent competence
  3. Clients who are incarcerated cannot act upon theirrational and competent decisions due to their status

Exception to Autonomy – If a counselor becomes aware that an individual is planning on infringing on the rights of others, by causing harm or depriving them of their autonmy, the counselor is held to the “Duty to Warn” and must warn these others of the impending danger.

 

Nonmaleficence – not causing harm to others, based on the field of medicine’s goal “above all do no harm.” This means not inflicting intentional harm nor engaging in actions which risk harming others.

  • Many ethicists according to Kitchener have suggested that, all other things being equal, not harming others is generally a stronger ethical obligation the benefiting them.
  • The goal of mental health professionals is to promote human welfare, so in harming others would result in not achieving this goal, and would in reality prevent this goal.
  • Nonmaleficence strongly pushes we professionals to protect our clients from harm which may arise from negligent or faulty practice, thus it is incumbent on us to intervene when we see a fellow profession who is negligent or inappropriate in the provision of services to others
  • The issue of diagnosing clients enters into the discussion of nonmaleficence since there are diagnoses which label people as different from the norm and thus are exclusionary in nature. It is imperative that the use of diagnosis lead to the benefit of clients by identifying appropriate treatment choices for them.

 

Beneficence – Doing good for other, which “contributes to the health and welfare” of our clients. This implies that we mental health helping professionals must use our knowledge and skills to promote human welfare and benefit our clients.

  • Mental Health professional incompetence in the provision of our clinical services is intended to benefit our clients and failure to benefit our clients based on our incompetence in the provision of these services is unethical and undermines the public trust in the mental health professions. 

 

Justice – Aristotle believed that justice consist of treating equals equally and unequals unequally but in proportion to their relevant differences (Aristotle). In other words equal people have the right to be treated equally and nonequal people have the right to be treated differently if the inequality is irrelevant to the issue at hand then the treatment must be equal.

  • Ethical concerns with just require we mental health professionals to be equally aware of fair treatment for all who are involved in mental health services and it is important that we advocate for these rights to be insured, protected and encouraged
  • Justice is a mutual give and take, if we expect others to be fair and respect our interests, we must treat other fairly and justly in return
  • It is this give and take of fairness to one another in a requirement in our mental health professional society which assumes societal cooperation.
  • We mental health professionals must commit to promote the worth and dignity of each individual and thus be concerned with equal treatment for all individuals which leads to our need to promote and advocate for multicultural acceptance and respects for all no matter their gender, race, color, creed, nationality, religion, sexual orientation etc.

 

Fidelity – involves the question of “faithfulness,” promise keeping, and loyalty. This comes into play when individuals enter into a voluntary relationship such as counselor to client. The fact that two individuals freely consent to participate in this relationship an ethical commitment involving certain obligations of bother parties is implied.

  • Lying is disrespectful of another’s right to choose freely based on accurate information so it is imperative that we are open, transparent and honest with our clients to maintain fidelity
  • Not maintaining confidentiality is not fulfilling a contract and disregards the other individual’s choice to enter into a relationship which has set boundaries.
  • Fidelity is the basis of the development of trust between the helper and client and is dependent on honest communications and trust is built  based on the assumption that the contract on which the relationship was initiated will be followed
  • Informed Consent explicitly establishes the nature of the therapeutic relationship and delineates the requirements for both parties to sustain these obligations. 

Steps in Making Ethical Decisions to work through Ethical Dilemmas as they arise

In thinking through ethical dilemmas:

1. Identify the problem or dilemma

2. Identify the potential issues involved

3. Review the relevant ethics codes

4. Know the applicable laws and regulations

5. Obtain consultation

6. Consider possible and probable courses of action

7. Enumerate the consequences of various decisions

8. Choose what appears to be the best course of action
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