This paper looks into the legal and physiological as well as a counselors best measures to take incase of an emergency relating to an abused woman who has a baby that could suffer if the woman is further exposed to the harm she has been undergoing.
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Ethical dilemmas are offset by conflict of ethical codes and a patient’s interest. According to Hill, Glaser and Harden, an ethical dilemma is a result of ‘no appropriate course of action, since each course of action conflicts with a set code of ethics all which expose the decision makers to uncertain risks (18-19). As such, the clinician or therapist has to assess the best course of action, help and recommendations to resolve a case without exposing both himself and the patient to risks.
In this case, Jean is faced by an ethical dilemma in which she has to weigh her options without destroying her therapeutic relationship with Mary and her work. Jean has to assess her professional codes, the possible legal implications and the client’s needs before embarking on finding resolve.
Though Mary is now absorbed in the counseling, it’s not clear how committed she is to the therapy, secondly, Mary is possibly too emotionally impaired that, she is confused about positive resolve. Mary’s from the onset doesn’t want her problem to be exposed, and also, she is afraid her decisions might result to further complexion of her life, endanger her little boy and subsequently expose her to risks. She has confided in Jean and Jean has, through professional ethics, to seek a proper methodology of arresting Mary’s problem.
According to Hill, Glaser and Harden, ethical consideration which covers intuitive and cognitive levels of reasoning and concrete models for ethical decision making, and comments is seen to arise as Mary does not want to be known that she is attending counseling lessons most definitely by her husband. Issues of regarding the information and situation of the victim confidential is conflicting with a set of procedures which would help resolve Mary’s case. As such some ethical considerations on the side of Jean are necessary so as to find a solution and to more appropriately help Mary and the boy.
Jean has an obligation to safeguard respect for persons. This translates to respecting the autonomy and self-determination of the victim. The context of confidentiality arises as the foremost problem Jean is facing. Mary is seeking redress however; she is still rigid about eventualities which she has to face in the event of complete separation with her husband. Most accurately, she is fiscally unable hence would rather tolerate further abuse than starve in the streets. From this perspective, Jean is facing a profound ethical dilemma since she has to evaluate the need for assisting this woman while at the same time; she remains silent about her problem.
This is a result of Mary’s anxiety about the destructive social, physical, psychological and legal consequences of disclosing her experience. Her situation is characterized by instability, insecurity, fear, dependence and loss of autonomy.
Jean has a duty to protect those who lack autonomy, including providing security from harm or abuse. Any legal action aimed at Mary’s husband will certainly invoke an impasse which will further affect Mary. Mary has confided in Jean and Jean’s responsibility is to weigh and assess the options best suited to help Mary without further infringing her physiological well being. However, Jean has a more profound role in her capacity; she is now entrusted with the welfare of Mary and the child involved (Nama & Schwartz 2002). She has a role which includes minimizing risks and assuring that benefits which Mary will get outweigh risks and eventualities which would harm Mary and her child.
The child is another issue which Jean has to ethically consider. The child has suffered and is still exposed to both physical and physiological dangers. Jean has a duty to ensure that, the child is protected and that she evenly distributes the benefits of child protection without infringing Mary’s physiological well being (Brasseur 2001).On this child issue, research has shown that both maternal depression and social adversity lead to compromised social, cognitive, and emotional outcomes for infants (Murray & Cooper, 1997), as such Jean has a huge responsibility to help the child as well.
However; Jean has to weigh the liability incurable if she helps the victim. Her decisions and involvement in implementing the most effective and concise decisions might result to drastic legal repercussions on her side (WHO 2007). According to Nama and Schwartz, as a social worker, Jean might find herself going beyond her employer code of ethics (6).
The context of confidentiality comes up when Mary confesses her traumatic life and the sensitive issue of the boy’s harassment. Jean has been privileged by Mary as a confidant regardless of her position as a social worker. Secondly, Mary has testified that the boy is in great risk if the father continues to be near him. The need for confiding is to edge nearer to the truth about both Mary’s and the baby’s condition and if the father had in any way molested or even sexually assaulted the baby.
This is based on the fact that Mary wants the issue of the baby and the father kept secret. Jean has a duty to warn the patient of the impending dangers of going back to her husband and the subsequent eventualities on the baby (143). The husband might be more violent and as he is used to, beat her and abuse the child. Jean should, assess and document Mary’s problems and inform the liable authorities.
This way, the principles of the practice of informed consent won’t put Jean at a risk of prosecutions since if ‘the clients' safety is jeopardized, Mary risked with her consent fully aware of the implications as advised by Jean (Bednar et al., 1991). According to Hill, Glaser and Harden, ‘the protection of Mary takes precedence over Mary agreeing to treatment in this emergency situation (143).
Addressing the issues
From the onset, Jean should document Mary’s case and inform the facilitator of the impeding problem. This way she will be able to present credible evidence about Mary’s case to any referral or during counseling. Documenting Mary’s case is the initial step to address the problem. This, she should do in a manner that wont risk the confidentiality of the victims. She should make available the basic care Mary and the child need. This she should do at the earliest convenience even before Mary tells away any further problems she is facing.
Jean has already assessed the immediate consequences of foregoing treatment and since Mary’s behavioral reaction to the current situation is potentially harmful to herself and the baby. If help is not offered immediately, she has to take whatever steps are necessary to ensure no harm comes to Mary and the baby (Bednar et al). As such, Jean has to protect the confidentiality to ensure the baby and the mothers are safe as well as herself (WHO, 2001).
Jean should take into consideration that the victim’s physical safety is the most important step; as such she should not allow Mary to leave the facility whatsoever until a resolve is found. Also, she should make sure the confidentiality of the victim remains prioritized. Each resolve she uses should be aimed at reducing any possible caused to Mary. The baby should be given all necessary child protection amenities and kept safe. This should be prioritized to avert Mary’s irrationality from taking unprecedented emotional toll on the baby. These actions will safeguard both the mother and baby.
There is an urgent need for Jean to consult with relevant authorities about the issue of the husband. This is based on an intuitive and the critical evaluative levels of moral reasoning as argued by Kitchener (1984). This will help Jean have a background and a foreword on what Mary needs in therapy and if, she Jean, is capable or cannot, based on a cognitive evaluation of the confidence aspect of the case, continue to counsel Mary. This will promptly lead to consulting with another counselor to help Mary.
Jean has to account if the cognitive and rational respites are good for both the subjects and herself, and if, in her perspective, would they befit her (Hill, Glaser and Harden, 12).
Through consultation Jean can be able to identify a better treatment.
She and the colleague can re-examine the data Jean has collected about the patient and come up with a more decisive resolve. The new resolve might affect Mary and breach the ethics of confidentiality, but they are effective and would result to helping Mary once and for all. Not to honor the client's choice without compelling reasons would constitute a paternalistic response from the Jean (Hill, Glaser and Harden, 25).
The considerations here should aim at making sure more benefits and less harm came to Mary conceptually regardless of her perception. Jean will continue to evaluate and consult about the case to find more appropriate resolves in principal. To consult with someone and document the consultation when in doubt is a mandatory practice which Jean should not ignore. Consultation is mandatory since the situation involves physical harm to both Mary and the baby and threats and circumstances in which abuse is susceptible (Hill, Glaser and Harden, 25).
Jean Is now bound in principal as the guardian to Mary. She has to follow up the case and make sure that Mary’s therapy continues so as to have her empowered to become independent and have the ability to have autonomy and an emotional balance so as to make rational decisions. Her commitment to Mary is to ensure Mary recovers and regains her autonomy
Jean should assess if the potential risk of Mary and the boy coming to harm and if all suggestions made to clients were meant to ensure clients' safety.
She should make sure Interventions initiated to decrease the risk of the baby coming to harm. On the case of the mother, she should consult clinical opinions regarding clients' capacity so that she can assess if the mother’s ability to determine right from wrong. Consultation with other professionals and supervisors so as to have Mary watched and advised incase she is not within proximity of the facility.
- Brasseur. D (2001) Ethical considerations in clinical trials;(CPMP)
- Hill, M., Glaser, K., & Harden, J, () A feminist model for ethical decision making
- Murray, L., & Cooper, P. (Eds). (1997). Postpartum depression and child development. New York: The Guilford Press.
- Nama.N., & Swartz.L., (2002): Ethical and Social Dilemmas in Community-based Controlled Trials in Situations of Poverty: A View from a South African Project : Journal of Community & Applied Social Psychology 12: 286–297
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