Applying Ethical Principles
Learner’s Full Name
Capella University of Health and Sciences
FPX4000: Developing a Healthcare Perspective
Professor’s Name
Month Year
Most of the ethical issues faced by clinical psychologists involve scenarios, which entail several ethical code provisions compromising clinical practice. Such circumstances require the best approach to be determined in order to ensure that everyone’s safety is maintained as well as upholding the principles of the profession. The purpose of this case analysis is to review how communication processes and decisions in addressing such ethical dilemmas be identified and thus provide the information that supports the recommendation of a viable solution that is anchored in ethical principles.
Summary of the case study
The case, “Confidentiality and Mental Health” involves Dr. Laura Simmons, a licensed clinical psychologist who is in a tricky ethical position in the course of treating her patient, Mr. Alex Turner, a 35-year-old software engineer who is struggling with depression and anxiety disorder. Of course, Alex is able to trust Dr. Simmons and, during six months of treatment, shares his most crucial thoughts and worries. During the course of the race, Alex confides with another participant that he has constantly been thinking about how to injure another worker with whom he has had a professional rivalry and present day disputes. About these thoughts, he writes extensively and clearly states his intent to implement them.
For Dr. Simmons there are two problems: on the one hand, she is bound to keep the secret of her patient, which is the founding of trust between both parties, on the other hand, she has to follow her ethical duties for saving Alex and other people’s lives. Fidelity is encompassed with confidentiality; however, Dr. Simmons has to ensure other three principles, namely beneficence, non-maleficence where she has to act in the best interest of her patient and persons involved in the case, and cannot harm them. It forces her to make a decision based on the implications that it may
have on the therapeutic relationship on one hand and the possible harm to Alex’s colleague on the other hand which presents her with one of the most daunting ethical dilemmas need to be solved.
The facts of the case study
In order to support my analysis of Dr. Laura Simmons and Mr. Alex Turner case study, it is appropriate to cite the current peer-reviewed journal articles to get more understanding of the ethical issues in clinical psychology such as confidentiality, duty to warn and risk assessment. These sources will contribute to the understanding process regarding the unethical decision made by Dr. Simmons that will be further justified when evaluating decisions which are to be made.
The first article shows that ethical duty to protect potential victims outweighs the patient’s right to confidentiality. Thus, this article provides evidence base for the given idea that, though confidentiality is crucial in the therapeutic process, there are times when their breach is unavoidable to protect other people (Hansson & Fröding, 2020). This directly relates to Dr. Simmons situation where Alex threatened to harm a colleague making the patient’s confidentiality be breached so that others may be protected.
Another important article of the selection focuses on the effects on the therapeutic relationship after communicating breach of confidentiality. Article show that violation of privacy can substantially undermine patient’s confidence and commitment to therapy (Kafka et al. , 2024). This supports the analysis by pointing out what may happen after the shot information was given by Alex implying that the authors wanted to stress on the fact that much as the case of Dr. Simmons, much consideration should be taken in order to come up with the right decision for managing the disclosure.
Reason
Through such choices of articles, the rationale of the analysis is grounded on literature that looks at practices and ethical dilemmas on the case. This approach will only foster the ethical practice of medicine by guaranteeing that all the actions made by Dr. Simmons are both ethical and for the benefit of her patient and possibly all who can be affected. Moreover, such approach helps Dr. Simmons to work through the real-life dilemma of reporting patient’s information to others and ensuring patient’s confidentiality to the maximum extent allowed by law and professionalism. It offers a good framework for arriving at some of the more challenging clinical choices, which are always between the best interest of the patient and the interest of the public.
Effective Communication Approaches
To solve ethical problem in the case, there is a need to consider essential communication actions that Dr. Laura Simmons takes when dealing with Mr. Alex Turner. The first approach is the empathetic communication where one listens to Alex, assures him that what he feels is okay and allows him to speak about what is wrong without passing judgment. Most importantly, it nurtures the working alliance, and in addition to that the doctor gets to learn more about some of the factors that may be triggering Alex’s negative thoughts and behaviors. As a result of the research, it was revealed that empathetic communication can increase trust and openness that indicates that Alex will recommend himself for further sessions even if some any issue like violation of confidentiality will be raised by the therapist (Zhang et al., 2023).
The other strategy is the use of communication that is open and truthful regarding the aspects of information sharing that can or should not involve confidentiality (Zucker et al., 2019). This is one of the key ethics in therapy, therefore Dr. Simmons should make it very clear to Alex that there are circumstances when she might be compelled legally and or ethically to disclose the
information to the third party such as when there is a danger that other people may be harmed. Being truthful about these limitations can prevent patients’ misunderstanding and give them something that can make them understand why some action was taken for example in the case were Alex’ s doctor took his medical records from the hospital showing him that it is normal for such tests to be done without informing patients.
Last but not least, a key component of communication is problem-solving (Brommelsiek et al., 2019). During these interviews, Dr. Simmons can engage Alex in a process whereby they can jointly decide on the actions that can be taken so that his thoughts can be controlled so that harm is not occasioned. This could include coming up with a safety plan to prevent harm to himself, coming up with other ways that the person can channel their energy other than being angry most of the time or, in some extreme cases that the patient is willing, having the patient agree to have her or himself hospitalized if and when all other methods do not seem to have any positive impact. In involving Alex in those discussions, Dr. Simmons also eases the situation and gives him a perceived control which is important for the patient’s engagement hence his treatment.
By means of these effective communication approaches, Dr. Simmons will be able to discuss the ethical issues of the presented case and simultaneously work on the development of therapeutic rapport and safety of the patient and other individuals.
Effectiveness of the Approach in Relation to the Ethical Decision-Making Model
The process by which Dr. Laura Simmons has made a decision in the case study can be analyzed in the context of the ethical decision making model; which comprises of the following steps: recognizing the ethical dilemma, highly relevant ethical principles, assessing the possible ethical decision/option and finally making the right ethical decision which conforms to ethical standards. In this case, Dr. Simmons is able to pinpoint the main dilemma of respecting patient
privacy and one’s responsibility of safeguarding other people’s lives (Tariq & Hackert, 2023). In this case, she manages to tackle this dilemma in a way that honors both her commitment to her patient, including Alex Turner’s intentions and the gravity of his threats, and her commitment to the well-being of others. Her honesty in explaining the details of the case and her understanding of when confidentiality cannot be maintained; Her approach to handling Alex’s self-harming thoughts by involving him in the process also demonstrate compliance with the ethical decision-making process. This method enables her protect professional ethic and reduce loss to all the affected individuals.
Consequences of Using Effective and Non-Effective Approaches
The outcomes for implementing a best practice, exemplified by Dr. Simmons, include protecting the working alliance, patient allegiance, as well as guaranteeing that Alex gets the help he needs to address his pathologic thinking. Thus, believing in the threats and being able to address them within the ethical decision making, Dr. Simmons will be able to avoid harm on Alex’s colleague and avoid the legal and ethical consequences.
On the other hand, an ineffective course of action, for example, not commenting on imminent danger that Alex poses, or not informing clients about restrictions of privacy can be life-threatening (Surmiak, 2019). The consequence of such an approach might be a rupture in the therapeutic rapport which will compel Alex to disengage himself from the therapeutic process altogether. This could lead to Alex enacting the lethal plans towards his colleague leading to massive legal and ethical repercussions for Dr. Simmons. Furthermore, lack of an appropriate procedure regarding the extent of confidentiality and the responsibility to inform other people may erode the ethical foundation of the profession as well as endanger the lives of others.
Ethical Principles Applied to a Proposed Solution in the Case Study
In an effort to solve the ethical concern in the case study effective and feasible recommendations include the following The first step that Dr. Laura Simmons needs to consider if she is going to maintain the therapeutic relation while insisting on the protection of Alex Turner’s colleague, is that she needs to offer the colleague a new venue she has selected. This solution would entail Dr. Simmons opening up to Alex and discussing his thoughts seriously and then explaining to Alex the ethical duty she has to interfere in case a threat to the lives of other people is real. She can suggest the plan that involves creating a safety plan which may comprise of a willing committal to a hospital or contact the authorities if the threat is imminent.
Beneficence and non-maleficence are the ethical principles that underpin this solution strongly (Cheraghi et al., 2023). In preventing the potential victim from being harmed, Dr. Simmons is performing a service to all the involved parties thus meeting her obit of care. Advertisers also follow the principle of autonomy as Alex is involved in the decision making process where he at least has some level of control over the outcome of the situation. Last but not least, justice entails considering all the involved individuals’ rights, and safety, in order to come up with fair solutions.
Hence, the proposed solution is ethical because it understands that one cannot avoid ethical dilemmas and tries to solve such a dilemma in a proper way. Thus, following this approach, Dr. Simmons will be able to act ethically and at the same time ensure that the safety of the public is assured without compromising the therapeutic relationship.
Conclusion
Performing the ethical analysis of the case, it can be concluded that Dr. Laura Simmons’ approach to the dilemma is a clear portrayal of the conflict between patient confidentiality and the subsequent obligation to safeguard others. A good example is demonstrated in her interaction with Alex Turner where, despite the dangers of losing touch with the core therapeutic relationship, she is able to navigate a well-articulated ethic decision making model and thus manage the identified risk factors whilst balancing the same objectives with the maintenance of the therapeutic rapport. With the ethical principles of beneficence, non-maleficence, autonomy, and Justice Dr. Simmons is able to perform her duties ethically and for the benefits of all the parties involved.
References
Brommelsiek, M., Graybill, T. L., & Gotham, H. J. (2019). Improving communication, teamwork and situation awareness in nurse-led Primary care clinics of a rural healthcare system. Journal of Interprofessional Education & Practice, 16(16), 100268. https://doi.org/10.1016/j.xjep.2019.100268
Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. BMC Nursing, 22(89). https://doi.org/10.1186/s12912-023-01246-4
Hansson, S. O., & Fröding, B. (2020). Ethical conflicts in patient-centered care. Clinical Ethics, 16(2), 55–66. https://journals.sagepub.com /doi/full/10.1177/1477750920962356
Kafka, J. X., Kothgassner, O. D., & Felnhofer, A. (2024). A matter of trust: Confidentiality in therapeutic relationships during psychological and medical treatment in children and adolescents with mental disorders. Journal of Clinical Medicine, 13(6), 1752–1752. https://doi.org/10.3390/jcm13061752
Surmiak, A. (2019). Should we maintain or break confidentiality? The choices made by social researchers in the context of law violation and harm. Journal of Academic Ethics, 18, 229–247.
Tariq, R. A., & Hackert, P. B. (2023). Patient Confidentiality. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519540/
Zhang, X., Li, L., Zhang, Q., Long Hoang Le, & Wu, Y. (2023). Physician empathy in doctor-patient communication: A systematic review. Health Communication, 39(5), 1–11. https://doi.org/10.1080/10410236.2023.2201735
Zucker, N. A., Schmitt, C., DeJonckheere, M. J., Nichols, L. P., Plegue, M. A., & Chang, T. (2019). Confidentiality in the doctor-patient relationship: perspectives of youth ages 14-24 years. The Journal of Pediatrics, 213, 196–202. https://doi.org/10.1016/j.jpeds.2019.05.056
