Case of a psychologist who is facing an ethical dilemma of client confidentiality

Abstract

This paper analyzes the case of a psychologist who is facing an ethical dilemma of client confidentiality versus duty to the organization. It uses three models of ethical reasoning- utilitarianism, Wallace’s Ethical Contextualism, and Kant’s Formalist Theory. The ethical dilemma of the psychologist can be solved by preserving the principle of privacy and confidentiality and by recommending expert support for the worker. The results are greater good for society, context-based solutions, treating employees as ends themselves, and making a decision that can be universalized. If the worker gets the support he needs, it is possible to improve his performance and life conditions, which are aligned to the principles of psychologists and personal and organizational goals of concerned stakeholders.

Introduction

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            This paper analyzes the case of a psychologist who is facing an ethical dilemma of client confidentiality versus duty to the organization. The ethical questions are: What should the consultant psychologist advise to the forklift operator? Should she report his admission of his alcohol problems to the company, even if it might risk him his job? This paper uses three models of ethical reasoning- utilitarianism, Wallace’s Ethical Contextualism, and Kant’s Formalist Theory. It argues that based on utilitarianism, ethical Contextualism, and formalist theory, the psychologist should put greater value on client confidentiality and should not inform the organization about the forklift worker’s problem. The psychologist should deal with the situation independently by offering advice to the worker that can help him solve his personal problems.

Utilitarianism

            For act utilitarianism, the primary question is: What are the effects of a certain set of actions on the general balance of good over evil? (Velasquez et al., 1989). Before proceeding to answer this question, the first step is identifying various courses of action that the psychologist can do (Velasquez et al., 1989).  The first option is that the psychologist will not value client confidentiality and she will inform the company about the alcohol problems of the forklift operator. The second option is that the psychologist will value confidentiality more and ask the worker to seek for psychological help also, so that he can gain additional support and guidance in coping with his personal problems.

The next step is to assess the harms and benefits of each option (Velasquez et al., 1989).  For the first option, the harms are that the company will no longer trust the worker and fire him, or demote him. Either way, the utility of the worker will be decreased, because as he told the psychologist, he is happy with his job, considering the pay and nature of work. If he is fired, he would suffer more emotional, and additionally, financially, as well. This can also add up to his family problems, because his wife will get angrier at him. It is assumed that he already has a family, based on his admission of his age. Losing his job can lead to marital problems and economic stress that can also pave the way for divorce and an unhappy family. If he is demoted, he is still in the same economic and emotional position as being fired. Having lost the job he loves and needs, he will be less happy than before.

In addition, the psychologist will also not be that happy, because she has violated the American Psychological Association’s (APA) (2010) Ethical principles of psychologists and code of conduct. The principle of privacy and confidentiality is violated by informing others of the client’s problems. Standard 4.01 Maintaining Confidentiality says:

Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. (italics added, cited from APA, 2010).

It is the primary responsibility of psychologists to protect confidential information. What the worker told her is completely confidential, and informing other people about his problem breaches the principle of confidentiality. Another consequence is that employees will no longer trust their psychologists, since they will feel that the latter will reveal their secrets to the company anyway. When this happens, the integrity of psychology as a profession will also be injured.

            Despite these negative impacts on several stakeholders, the organization may be better off, because they can replace the worker with another employee with no alcoholic problems. This can reduce accidents and improve efficiency. However, if the worker has been with the organization for a long time, then terminating him because of his health and emotional problems would depress worker morale. They would think that the loyalty of an employee means nothing to the organization, and that the organization would not extend a helping hand to employees facing similar problems. The negative consequences will be that more employees will no longer seek help and problems would be hidden for fear of termination, which will lead to lower productivity in the future.

            For the second option, the psychologist will put greater positive value on client confidentiality more and ask the worker to seek for psychological help also, so that he can gain additional support and guidance in coping with his personal problems. This is a better option because the result will be higher net good for the society. For the worker, he can still keep his job and having psychological help will support his strategies to stop drinking and to lessen his withdrawal symptoms. The worker’s family will also benefit because the psychologist can help him handle his problems more properly and that they will no longer have further financial problems. The organization will also be better off, because a valued employee will be maintained and the costs of hiring and training another employee will be reduced. The psychologist will also be better off because she preserves the integrity of her profession and she also upholds the principle of confidentiality. Thus, based on utilitarianism, the best choice is to allow the worker to handle his problem with sufficient expert help.

Wallace’s Ethical Contextualism

            Wallace believed that there are no universally applicable or acceptable ethical values for all cases (Ford, 2000, p.77). He stressed that context impacts the relevance of issues and the true ethical conflict (Ford, 2000, p.78). In this case, in order to solve the ethical dilemma, the psychologist should assess relevant conditions (Ford, 2000, p.78). The relevant principle is client confidentiality because it applies more to the case than organizational loyalty. The psychologist has a primary role in preserving confidentiality, especially when disclosing the worker’s problem can lead to losing his job. Losing his job can present greater psychological and financial problems for him.  The psychologist is also put at a good position, contrary to thinking that she should rationalize using conflict as a negative value (Ford, 2000, p.78). The psychologist can help an individual overcome his personal problems, which would result to better performance. She can “shoot two birds” in one stone, so to speak, by helping the client privately and helping the organization attain its objective of increasing worker productivity. After all, once the worker solves his alcoholic and emotional problems, he would be fitter to work and he can also enhance his performance.

Wallace also asked why these decisions are important to the people involved. This decision will be important to the psychologist because this is aligned with the Code of Ethics of her profession (Ford, 2000, p.78). This decision will also be important to the employee, because he can get the expert help that he needs. This decision will also be significant to the organization because the means provide for the end of improving workplace performance. Hence, Contextualism also supports the recommendation that the psychologist would privately help the employee seek medical attention.

Kant’s Formalist Theory

            Kant argued that an action is right if it can be applied a priori as a universal law (Ford, 2000, p.62). If all psychologists also choose to help the worker confidentially, will it still be right? This paper argues that it will still be right, because the code of ethics of psychologists will be promoted. In addition, the worker will have a chance to redeem himself and his organization will benefit from a better performance. The worker’s family will also have a chance of their lives not being more ruined that it was. If the worker solves his personal and alcohol problems, his family will definitely benefit from these positive consequences also.

            Kant also argues that people should be treated as an end and not as means to their ends (Ford, 2000, p.62). If the psychologist informs the company about the worker’s problems, she will be using the worker as the means to her end, wherein her end or goal is to help the company improve its performance. This would not be right because every human being should be treated as an end, not as means alone (Ford, 2000, p.62). Thus, using Kant’s theory, it will also not be right for the psychologist to disclose the worker’s problem to the organization.

Conclusion

            The ethical dilemma of the psychologist can be solved by upholding the principle of privacy and confidentiality and by recommending further help for the worker. The consequences are greater good for society, relevance of assessment based on the context, treating employees as ends themselves, and application of a decision that can be universalized. As long as the worker gets the support he needs, it is possible to turn his performance and life around, for the benefit of numerous stakeholders.

References

American Psychological Association (APA).(2010). Ethical principles of psychologists and code of conduct. Retrieved May 30, 2010, from http://www.apa.org/ethics/code/index.aspx

Ford, G.G. (2000). Ethical reasoning in the mental health professions. Boca Raton, Florida: CRC Press.

Velasquez, M., Andre, C., Shanks, T., & Meyer, M.J. (1989). Calculating consequences: The utilitarian approach to ethics. Markkula Center for Applied Ethics at Santa Clara University. Retrieved May 30, 2010, from http://www.scu.edu/ethics/practicing/decision/calculating.html

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