Ethics condundrum #1

This is taken from my Ethics formal assignment, Semester 1, 2015.

Context

I believe my client has reached the end of fruitful counselling and has been using me as a crutch rather than take responsibility for their own life. I believe I should terminate the relationship but my supervisor believes we should keep the relationship going as the client pays the full fee and on time.

Meta-ethical perspective

The author’s meta-ethical perspective is one of ethical non-naturalism (Wikipedia, n.d.). That is to say, ‘right’ and ‘wrong’ are self-evident and reached by either ‘common sense’ or rational, non-empirical, non-sensory processes, or by special revelation by a deity (Miner, 2006).

Ethical dilemma

Do I continue seeing a client just because they pay the full fee and on time? What of their needs?

Consequentialism

Drawing on a long heritage that goes back to ancient Greece and Aristotle, early Enlightenment philosophers John Locke and David Hume[1] laid the foundation for writer Jeremy Bentham in 1789 to propose a ‘calculus’ for determining right from wrong. The system was simple: do whatever is best.

This is simple—all one needs to do is to determine which action will bring about the best consequences and do it (King, 2008). There is a beguiling logic to this; after all, as John Stuart Mill asked in the Greatest Happiness Principle, how could anybody want anything but the best consequences?

There are, of course, some minor problems with such a system. For example, comparing what people want is fraught with difficulty: who is to say that one of my needs—to keep a full-fee paying client for the practice or agency—outweighs one of the client’s needs to move forward with their life?

Doing whatever brings about ‘the best consequence’ doesn’t offer any clear rules for behaviour. If I look for moral certainty with this calculus, I cannot find it. So at times, ‘seek the best consequence’ seems like a very empty sort of advice (King, 2008).

In addition, my intentions—as distinct from the outcomes from my act—may be deleterious to my client. I may intend to keep my client coming to see me for as long as I can in order to pay my rent, irrespective of the benefit to them of continuing therapy.

Deontological

Deontology places its emphasis on doing one’s duty, which is obedience to some predetermined higher moral absolute. It is in the following of predetermined ethical duties that the deontological decision can be reached.

To bring deontological principles to bear on the case study, I would only be acting ethically if I were following the prescribed rules for handling such situations, rules embedded either in workplace codes of conduct or the codes of any relevant professional bodies—in this instance, Christian Counsellors Association of Australia (CCAA) and Psychotherapy and Counselling Federation of Australia (PACFA).

The PACFA Code of Ethics (PACFA, 2014) doesn’t have any specific rules that dictate what to do in our current situation; but the CCAA Code of Ethics (CCAA, 2014) does. Code 2.6.3 states:

2.6 Counsellors shall not:-

2.6.3 Unnecessarily prolong therapy or continue counselling with high fee clients.

However, PACFA do have in their code some general principles that should guide ethical behaviour:

2.2.4 Non-maleficence: a commitment to avoiding harm to the client

Non-maleficence involves: avoiding sexual, financial, emotional or any other form of client exploitation;

Clearly here there is an imperative to not exploit the client financially by insisting on them continuing with their therapy. But there is a big gulf between ‘insisting’ and agreeing to see the client when they renew their appointment at the end of each session. One is coercive; the other is allowing the client freedom and agency. In considering the CCAA directives, the client may be still deriving benefit from the sessions (have we asked them?). The therapy room may be the only place they have where they can ‘vent’, or talk through decisions they need to make.

The CCAA have something further to say:

3.8 Counsellors should not abruptly cut off or end services without giving notice and adequately preparing the client for termination or referral. Termination or referral is indicated when:-

· 3.8.1 objectives have largely been achieved;

· 3.8.2 the client declines further counselling; and/or

· 3.8.3 the client no longer benefits from counselling.

Clearly, deontological principles can impact on our end decision about what to do in this instance, but a strictly rule-based approach doesn’t take into account the client’s views—we may think we have reached the end of the road with them, but the client may not agree. So a purely deontological approach to our case study is not sufficient in this instance.

What I would do

Both consequentialism and deontology have been examined and individually found wanting. So, bearing in mind Miner’s (2006) reminder that the goal of ethical decision-making is a fully-informed decision, I would take both approaches into account. I would firstly ask the client what they wanted to do, pointing out why I thought they had gone as far as they could with me as their counsellor. Armed with the knowledge of what the client felt was best for them, I would do my best to meet their needs. If they requested further counselling sessions, I would acquiesce.

And document everything.


[1] I can’t think of David Hume without thinking of Monty Python’s ‘The Philosophers Song’ [https://www.youtube.com/watch?v=xQycQ8DABvc]