Steps for handling ethical dilemmas

Ethical Decision-Making

Abstract

Ethical dilemmas require a series of decision-making considerations through the evaluation of the potential outcomes. Counsellors find themselves with the need to consult different avenues in orders to make ethical decisions which adhere to moral principles.  Different parameters dictate the course of action taken by the counsellor with the focus of legality, ethicality, and professionalism with the main goal being to protect the client from any potential harm. The step by step decision-making process in handling ethical dilemmas includes its identification in relation to the ACA Code of Ethics to categorize it and determine the suitable course of action. Amy, a private practice intern taking her PhD in counselling advertizes the Live Healthy Industries’ products in her office and professional website where her clients can see the promotions and inquire about the products. The ethicality of such a decision can be determined by analyzing the parameters along which it affects the clients, the profession and Amy. Analyzing such situations, rooting the ethical values, principles and standards helps counsellors navigate the complex decision making parameters to ensure credibility.

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Identification of the problem

Amy is a PhD student struggling to make her ends meet, which makes her consider advertising Live Healthy Industries’ line of multivitamins and homoeopathic remedies in her office as well as in her professional web page. She uses the opportunity to sell the products to her clients through the inquiries attained form the information she displayed. This decision is fueled by the need to supplement her income to support the postgraduate program and not the specific benefits that the product has on its patients. With the main focus being the profits, there are various points of concern that Amy and the company she is advertizing can overlook concerning the state and welfare of the clients who are the consumers of the adverts.

One of the assumptions of the scenario is that the products Amy advertises are fit for human consumption and have been approved by the Food and Drug Administration (FDA) and other consumption regulators. According to Miller (2019), drugs and other medical products, approval must be sanctioned by the FDA with the test results, manufacturing capabilities and the labelling indicating its uses and the possible associated risks. This is one of the assumptions that Amy might not have considered about the company before advertizing the products on her website. Her clients bear the same assumption on the products as patients trust their care providers and this could be the reason that Amy’s patients buy the products from her assuming that her endorsement means that they are safe. Another situation arising from the scenario is that some of her clients might not be able to make their own decisions and only choose to buy the products because their counsellor endorses them. Another consideration that can be picked from this situation is that the company Amy works for allows advertising products which are not related to their practice.

From the above considerations, the problem can be classified as ethical, professional and legal depending on how the products affect the patients. In terms of ethicality, the scenario raises the questions of whether Amy or the company knows the full details of the products she is advertizing to her clients. Professionally, Amy should be allowed by her company to include outside products into her website, and if her profession allows or endorses the type of products. The situation spreads to legal avenues if the products end up harming one of the clients even after following the directions which can place Amy or the manufacturing company liable for the outcome. The scenario is about self if the company does not allow for external products and covers the institution if the firm sanctions the advertizing. It would extend to the client if the products bought end up affecting or producing undesired results to the consumers.

Application of ACA Code of Ethics

There are different purposes of the ACA Code of Ethics including establishing the basis for the modelling of professional practice and articulation of responsibilities, promotion of values and the procession of ethical complaints (American Counseling Association, 2005). The codes are meant to assist counsellors in ensuring a succinct decision making when faced with ethical dilemmas that require an effective model. Depending on the nature of the decision, several codes can be involved in addressing the various areas that the scenario covers.

Amy’s case covers several Codes of Ethics highlighted by the ACA. According to the scenario, Amy’s reasons for advertising the products id because she attends Live Healthy Industries’ seminar, which made her believe in their benefits. She, in turn, imposes her beliefs about the benefits of the multivitamins on the clients which cover the code A.4.b on personal values. The Code states that counsellors should avoid imposing values that are inconsistent with counselling goals. The use of multivitamins does not affect the mental health of the clients, which is why it is a value fronted to the customers by Amy. The code A.12.h requires counsellors to provide electronic links to licensures and certification boards to protect consumer rights. This is one of the aspects not mentioned in the scenario as she ought to have linked the adverts to FDA or the Live Healthy website for further clarification.  According to the ACA Code of Ethics section A.12.h.8, the counsellors should help the clients in the verification of the reliability and validity of the information published on their websites. It is also Amy’s responsibility to ensure that the information relayed on the advertisements is accurate and adequate to help the clients in making informed decisions according to the requirements of section C.3.e of the ACA Code of Ethics. As Amy used the advertising posture on her consulting room, this is against the code C.3.f, which bars counsellors from promoting to customers in a manner that influences the vulnerable individuals. This may be applicable if the products negatively affect the customers through instances like addiction or other health complications. If the products are confirmed to affect the clients’ health, the Code under section H.1.b directs the case to legal and regulatory control.

Dimensions of the Dilemma

            The various moral principles and the professional regulations determine the nature of the dilemma and show the areas which a counsellor overlooked during a scenario. Identifying the dimensions of the dilemma also help the counsellor in formulating ways to resolve the issue. In Amy’s case, the first principle that is affected by her decision to advertise on her website is respect for autonomy. According to Lofstrom (2019), the autonomy principle is affected when the supervisor’s, Amy, in this case, views intrude the clients’ by pushing values to them, therefore, affecting their independence of choice. This mainly affects the mentally challenged who may not understand the full details of the products before buying on the website when they have no supervision because it allows them to make decisions on their own. The other principle that Amy’s actions affected is non-maleficence. The main focus of the regulation is the avoidance of actions that would, either intentionally or unintentionally, cause harm to the client (Byrd and Winkelstein, 2014). By advertising the products, Amy subjected her clients to potential harm as a result of using them. Amy also violated the beneficence principle by not preventing her customers from using the Live Healthy’s products.

The issue of medical supplements is a common discussion to medical professionals, especially in terms of their applicability and effects to the clients.  According to healthline.com, the FDA does not always review and approve most herbs and supplements, increasing their probability of being unsafe or ineffective (Holland, 2016). This increases the responsibility of the counsellor in ensuring that the drugs they advertise are effective and safe for the customers. The untested supplements may have adverse effects on pregnancy, children or other underlying conditions in addition to negative interaction with other drugs (National Center for Complementary and Integrative Health, NCCIH, 2019). Tello (2018) described the sale or promotion of supplements as unethical and a cause of conflict of interest and has the potential of problems both medically and legally. FDA regulations require manufacturing and marketing companies to present evidence about their product safety. According to NCCIH (2019), advertisers are required by the FTC to ensure that the content of their advertisements is accurate and objective. Consulting thee two bodies, FTC and FDA can help practitioners in deciding the course of action concerning advertising other companies’ products.

Potential courses of Action

In the above case, there are different courses of action that Amy can take depending on how the supplements react with the patients or as a preventative measure. The first step that Amy can take concerning the products is contacting the Living Healthy to ask about the effectiveness and truthfulness of the description on the label. She can ensure their safety by asking for the FDA approval reports about the products from the company. She can also report the drugs directly to the Health and Human Services Safety Reporting Portal with any safety concerns about the vitamins or homoeopathic medicines as a consumer and distributor (NCCIH, 2019).  If the products have already affected some of her clients and received complaints, the FDA can take legal action against the company and order the drugs to be removed from stores. The reporting to the FDA is the practitioner’s responsibility as required by the ACA codes and the FTC to ensure that the advertised products are safe. This can mean that her practice is terminated or she sets the advertising business aside. The online adverts can also be changed or removed to limit the decision making authority of purchasing the products by the mentally challenged and children in order to boost privacy as she does not know who visits their websites.

Consequences of the options and the suitable course of action

            Asking the manufacturing company about their FDA reports would ensure an easy answer to the safety of the supplements, their interaction with other drugs and vulnerable individuals. It would also guarantee that Amy has a healthy working relationship with the company in their products to meet the standards. The second involves directly going to the FDA for the review of the products to check if the company adhered to the requirements. This option would put the counsellor at odds with the company as it indicates she does not trust its products which can lead to the termination of her deal to sell the supplements. The last option happens when the practitioner and the company do not adhere to the regulation until a consumer reports the products as harmful to the FDA. This can lead to the termination of both the company and Amy’s practice as it is also her duty to ensure that the promoted products are up to par with the organizational requirements. Although the second serves her customers well by ensuring that they receive quality products and Amy servers her responsibility, it is costly in terms of money and time as she needs to present samples, and allow for a testing period which should be done by the manufacturing company. The termination due negligence is also not viable as it ends her career. Thus, ensuring that the products are safe, and contain an adequate description for informed decision making by the clients before stocking them is the viable option. This is because it covers the clients’ safety and the consultants’ and agency protection against legal liability.

Evaluating the selected course of action

            Relying solely on the manufacturing company for product information may have some biasness in the reports as its main objective is profitability. However, making sure that the company provides the FDA approvals of the products before taking up the advertisement removes her from liability in case the products are detrimental to the users. This would ensure that both the supplier and consumer are catered for by the decision providing the latter with quality products and shielding the former from legal liability.

Jiggins and Asempapa (2016) explain justice as treating individuals equitably through exhibiting fair treatment to all clients. The classification and categorization of the products in terms of compatible drugs and medical conditions ensure fair treatment of the clients as each can choose products that are beneficial to their health. The decision not only caters for the company by ensuring that its products meet the regulations. Measuring the appropriateness of the decision can also be determined by the publicity test, which requires practitioners to choose actions they are comfortable with airing to the press (Forester-Miller and Davis, 1996). This explanation shows that Amy can be satisfied with the information about her selling the products of a certified company to the public. The decision also sits the universality test as it is recommendable to other consultants to ensure the quality and authentication of their products.

Implementing the Course of Action

Ensuring that the company delivers the FDA authorization before receiving and including any batch in the advertisements is the best way to ensure that all the commodities are consumer safe. This should be done continually to ensure that any new products introduced are safe for use. It can also be achieved by the company endorsing or partnering with the consultancy to structure a collaboration that ensures all the products and services are reviewed. Ensuring close collaboration between the two entities will ensure transparency and value as they combine their objectives to cater to their shared client.

References

America Counseling Association (2005) ACA Code of Ethics

Byrd, G.D. and Winkelstein, P. (2014) A comparative analysis of moral principles and behavioural norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions.  Journal of Medical Library Association, 102(4). DOI: 10.3163/1536-5050.102.4.006

Forester-Miller, H. and Davis, T. (1996) A practitioner’s Guide to Ethical Decision Making

Holland, K. (2016) Herbs, Vitamins, and supplements for Depression. Retrieved from  https://www.healthline.com/health/depression/herbs-vitamins-supplements

Jiggins, K.C. and Asempapa, B. (2016) Values in the Counseling Profession vs Non-Maleficence. Ideas and Research You Can Use: VISTAS 2016, ACA Knowledge Center.  

Lofstrom, E. (2019). The Ethics of Doctoral Supervision. Researcher Identity development. University of Helsinki

Miller, E. (2019). FDA Approval Process. Retrieved from https://www.drugwatch.com/fda/approval-process/

Tello, M. (2018) What patients – and doctors- need to know about vitamins and supplements, Harvard Health Publishing. Retrieved from edu/blog/patients-doctors-know-vitamins-supplements-2018“>https://www.health.harvard.edu/blog/patients-doctors-know-vitamins-supplements-2018

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