Question

based on infant and child ethics: give your insight on mothering, foundation of trust, universal vaccination, global problem of poverty and infectious diseases, abuse and neglected children and surrogate decisions making....write a summary of your understanding about these aspect contecting ethics to caring for children.

Answer 1

Ans) Identify the clinical issues: When an ethical issue arises, the provider should review the larger picture in her work with the client or system. Identifying the clinical issues is the first step. What are the clinical needs of the client? How does the ethical dilemma relate to what the client presented with initially? It is important to assess the clinical issues so that pertinent information is not missed. For example, if a client with advanced AIDS is asking for help in ending his life, the provider would review the client's previous mental health history and current emotional issues, look for any significant changes in the client's support system, and determine if the client is experiencing social or psychological issues that might influence his decision. Until this is done, it is impossible for the clinician to address the ethical issue regarding end of life.

Identify the legal issues:

There can be significant legal issues to consider. Has the clinician reviewed the State and local laws regarding the issue? If necessary, has the clinician checked with an attorney for consultation or informed his supervisor of possible liability questions?

Identify the system issues: What are the policies and procedures of the clinician's agency regarding the ethical question? In some agencies, the answers may be hard to find, but they can shed light on any restrictions the clinician may face or make the choices clear. For example, if it is against policy to accept a gift from a client, the clinician can avoid a personal rejection by referring to the policy. Agency policy also can help a clinician in a legal challenge. For example, if the clinician followed agency policy, it is less likely that the clinician can be challenged legally for actions pertaining to that policy (although the agency can still be challenged).

Identify the cultural issues: Cultural issues often are glossed over in the midst of a dilemma or crisis. Yet cultural issues are significant for understanding the client's motivation and whether or not the client will act according to the proposed treatment plan. For example, a gay, African American client may have difficulty dealing with his homosexuality and as a result may be having anonymous unprotected sex impulsively. In the African American culture it can be especially difficult for men to acknowledge their homosexuality. If the client is HIV positive, there is an ethical need to educate him about protecting others. If the clinician does not acknowledge the client's discomfort on a cultural level, the education process will be limited and the clinician will miss the "larger picture."

Identify the ethical issues: What is the clinician's reaction to the situation? Ethical issues often are revealed when there is a "gut instinct" that something is not right. Confusion, anxiety, or uncertainty about what to do next with the client are indicators that an ethical issue is at stake. If basic principles seem to be compromised, the clinician should stop and evaluate further. A significant step is for the clinician to examine her own feelings about the situation. The clinician needs to identify any countertransference issues regarding the situation to ensure that the issue can be viewed objectively.

Review what principles are at stake: What is the true dilemma? Is there a dilemma at all? So much can be occurring with a client that it is difficult to see the real issue, or whether the issue is significant. Is harm being done either by the client or to the client? Can the client make her own decisions, and is she not being allowed to do so? Is the client being treated fairly regardless of race, culture, or lifestyle? Is there a threat to the client's confidentiality? These are the questions relating to basic ethical principles.
What are the possible options? By this point, the clinician's next step may be clear already. Or, there may be choices of possible options. It is useful to simply list all of the possible options and then examine them.

Review the pros and cons of each option: List the pros and cons of each possible option, noting the impact of the options on the welfare of the client, the clinician, the agency, and others involved in the situation, such as the client's support system.

Act: At this point, the clinician should be ready to make a decision. Sometimes the decision may not be one that everyone is comfortable with, but it may be the least objectionable plan. The client should understand the rationale for the clinician's decision, and there should be evidence of the clinician's thought process in the documentation of consultations, discussions with the client, and supervisory meetings.

Follow up and evaluate: An ethical decision should be evaluated and the impact to the client monitored. For example, if the clinician decided to breach confidentiality for the protection of the client, how has this affected the clinical work with the client? These issues should be considered once an initial crisis has passed.