Ethical issues in the health professional client relationship

ProfessionalEthics: The Professional-Client Relationship

ethical issues in the health professional client relationship

The central issue in the professional-client relationship is the allocation of the moral worth of patients but only work to advance their health. The practitioner-client relationship is an extremely important, influential, and legal and ethical obligations are acquired by practi- “A central issue in the professional-client relation- ship is the .. Washington, DC: National Register of Health. of the practitioner-patient/client relationship is effective communication. skills and professional behaviour are core aspects of good practice. Teaching This Code is not an exhaustive study of professional ethics or an ethics guide. It does .

Client Relationships and Ethical Boundaries for Social Workers in Child Welfare

In addition, the clinical issues of managing dual relationships and management of transference and countertransference are factors that cannot be ignored in this discussion. Workers in child welfare are often found in dual client relationships.

Inside our respective roles and responsibilities, to move a client forward, we must engage a client in the process of change. This is an integral part of the client engagement strategy, which must be established in the early phase of the relationship. Unfortunately, many professionals in our field have difficulties in the area of client rapport building. Throughout our profession, thousands of men and women work with vulnerable families and children.

Many of our clients have been subjected to abuse, neglect, or other forms of violence or maltreatment. Some report stories of abandonment, domestic violence, emotional abuse, or other wrenching experiences.

Some even report having difficulty with intimacy as a result of their reported pain. Subsequently, instead of helping, the social worker may start the path of hurting the client while disclosing or sharing his or her own personal experiences. In child welfare, immediate supervisors must play a vital role in modeling, coaching, and engaging in frequent discussions with workers on topical issues of client engagement, rapport-building, and assurance of proper boundaries in the worker and client relationship.

Social work schools, child welfare training, and other continuing education programs also have a responsibility in providing education and information on the management of client relationships and examination of ongoing ethical issues.

In some instances, it may be a labor relations matter, or a training or coaching issue between the worker and supervisor. Why might a caseworker risk contamination of the client engagement process or actual working relationship? There is no definitive or even easy answer. From others, it may be suggested there are always persons in any given profession who will violate the code of conduct rules and standards, despite any degree of training, supervision, or administrative oversight.

As social workers, we have a responsibility to examine the issues of client relationships and ethical boundaries. This conversation merits discussion among our peers and other related professionals. In the age of increased litigation and constituent complaints, it is not a topic to be ignored. The personal and corporate costs and liabilities associated with claims of unethical behaviors have long lasting impact to those in the profession and for those who are served.

Fortunately, ethics training for social workers must be taken in accordance with state licensure standards. This provides an opportunity to be mindful of our ethical obligations and boundaries in serving others throughout the field. Non-licensed employees are not exempt from the risk of assumed liabilities in child welfare or other social work settings. Professionals must also be ethically free and responsible persons. For their own freedom and the protection of others, they should not abdicate authority and responsibility in decision making.

The strongest possible claim of supremacy has been suggested, namely, that, like the common law doctrine of the merging of the identity of the husband and wife, the attorney and client are similarly merged in the identity of the client.

Second, a client is concerned about some basic value-personal health, legal status, or financial status-whereas a professional is not as concerned about the subject matter of their relationship. The client usually has more at stake. Third, a professional often has a freedom to enter the relationship that a client lacks.

A professional is often able to obtain other clients more easily than a client can obtain another professional. Especially if a potential client has an acute illness or has just been charged with a crime, he or she is not free to shop around for another professional.

From this point of view, the bargaining situation is more like that between an individual and a public utility. These considerations are not as important for the usual situation in architecture, accounting, and engineering. The clients of these professionals are often better informed about the subject matter of the transaction than are clients of lawyers and physicians. For example, businesses and corporations have accountants working for them who can give advice about auditors.

Often firms hiring consulting engineers have had previous experience working with engineers in that field. Governments, even local ones, frequently have one or two engineers working for them who can advise and help. Moreover, they are freer than the professional to conclude an arrangement with another firm. Thus, in these situations the factual basis for the contract model is most nearly present.

However, the consulting engineer or architect has some special knowledge and ability the client lacks, or else a professional would probably not be hired, so the contract model's empirical assumptions do not quite hold even in these cases.

One does not relate to a professional as one does to a grocer or public utility. The personal element is most closely captured by viewing the relationship as one of pals or friends. According to this view, professional and client have a close relationship of mutual trust and cooperation; they are involved in a mutual venture, a partnership.

Perhaps the most sophisticated version of this conception is that proposed by Charles Fried. Fried seeks to justify professionals devoting special attention and care to clients and sometimes seeking ends and using means that they would not seek or use for themselves.

Friends are permitted, even expected, to take each others' interests seriously and to give them more weight than they do those of other persons. Fried suggests that the attorney-client relationship is analogous to a one-way limited friendship in which the lawyer helps the client secure legal rights. The lawyer helps the client assert his autonomy or freedom within the bounds society permits. Others have suggested that the physician-patient relationship should similarly be viewed as a cooperative effort of friends or pals to deal with the patient's illness or injury.

The many dissimilarities between friendship and the professional-client relationship, however, destroy the analogy. First, as Fried recognizes, the professional-client relationship is chiefly in one direction; the professional has a concern for the client's interests but not vice versa.

Second, friendship is usually between equals. Even in friendships between employer and employee, the employer's superiority in the office is changed to a position of equality in the bar for a drink. As the above discussion of the contract model indicates, professionals and clients are not equals. Third, the affective commitment of friendship is usually lacking.

Thus, one commentator concludes that "Fried has described the classical notion, not of friendship, but of prostitution. The friendship analogy is not needed to justify a professional paying special attention to a client's interests.

The role of a professional is to provide services to clients, and the acceptance of a client is sufficient to justify the special attention. A barber who accepts a customer pays special attention to a customer's hair over that of others who need a haircut more. One need not postulate the barber as friend to justify this attention. It is presupposed by any system of services for a fee. Parents have knowledge and experience that children lack, and it is often ethically appropriate for them to exercise their judgment on behalf of their children.

Similarly, as a professional has knowledge and experience a client lacks and is hired to further the client's interests, perhaps the relationship should be viewed as one of paternalism. Paternalism is a difficult concept to analyze. A person's conduct is paternalistic to the extent his or her reasons are to do something to or in behalf of another person for that person's well-being.

What is done can be any of a number of things, from removing an appendix to preventing the person from taking drugs. One can also have a paternalistic reason for acting in behalf of a person-for ex- ample, filing a counterclaim or asserting a legal defense.

The key element of paternalism derives from the agent, X, acting regardless of the person's, Y's, completely voluntary and informed consent. X's reason is that he or she judges the action to be for Y's well-being regardless of Y's consent to it.

ethical issues in the health professional client relationship

Conduct can be paternalistic even when y in fact consents. The key element is that X would have done the action, if he could, even if y had not consented. Such claims are difficult to establish, but this difficulty is a practical problem and does not affect the conceptual matter.

In manufacturing consent, information can be withheld, false information provided, or more emphasis placed on some facts than others.

Professionals sometimes manufacture consent when action cannot legally be taken without client consent, such as accepting a settlement or performing an operation. The concept of doing something to or in behalf of someone includes failure to do something.

Suppose y requests X to do something for him, but X refuses because she thinks it would be detrimental to Y's well-being; for example, a physician refuses to prescribe a tranquilizer for a patient.

This also counts as doing something to or in behalf of a person without his consent; y does not consent to the tranquilizers being withheld. A voluminous literature exists concerning the justification of paternalism. The brief discussion here will outline only the major arguments. Paternalism requires justification because it involves doing something to or in behalf of another person regardless of that person's consent. It thus denies people the freedom to make choices affecting their lives.

They lack the freedom of self-determination. The loss of control over their own lives, especially to professionals, is one reason for people's concern about professional ethics.

Thus, paternalism is of central importance in professional ethics. Three arguments are often offered to justify paternalism. The agent has superior knowledge as to what is in a person's best interest. Because the agent knows better than the person what is best, the agent is justified in acting to avoid significant harm to, or to procure a significant benefit for, the person. This argument is perhaps the central one in favor of paternalism by professionals. As noted before, a professional possesses a relevant knowledge the client lacks, so he or she is better able to perceive the advantages and disadvantages of alternative actions.

Consequently, the professional rather than the client should have primary authority and responsibility for decisions. The client is incapable of giving a fully free and informed consent. By "fully free" is meant without duress, psychological compulsion, or other emotional or psychological disturbance.

By "informed" is meant with appreciation of the consequences of a course of conduct and its alternatives. If people cannot give such consent, then their decisions will not adequately reflect their reasonable desires and will not be expressions of their "true selves.

It is often claimed that people who are ill have a strong feeling of dependency, are worried by their illness, and are in a weakened state, and so lack their usual mental command.

A somewhat similar argument can be made about lawyers' clients. If charged with a criminal offense, a person is fearful and disturbed. Even in civil suits, a client's emotions might be aroused, preventing an objective view of the situation.

A person will later come to agree that the decision was correct.

ethical issues in the health professional client relationship

Although the person does not now consent, he will later. For example, an unconscious accident victim with a broken limb will agree that a physician was correct to set the bone. Parents often require their children to do things, such as take music lessons, on the ground that later the children will be glad they did-"You'll thank me later! She might make the change in the belief that the client will agree when he sees the completed design.

To decide whether these justifications support viewing the professional-client relationship as paternalistic, it is useful to consider when reasonable people would allow others to make decisions for them. First, a person might not wish to bother making decisions because the differences involved are trivial. For example, an executive authorizes a secretary to order any needed office supplies, be- cause the differences between brands of paper clips and so forth are not important.

Second, the decisions might require knowledge or expertise a per- son does not possess. For example, an automobile mechanic knows whether a car's oil filter needs changing. One goes to a mechanic for knowledge and service. Third, a person might allow others to make judgments if he or she is or will be mentally incompetent. Some people voluntarily enter mental hospitals. The first of these reasons does not directly relate to the arguments for paternalism, but the second and third do relate to the first two arguments for paternalism.

Reasonable persons would allow others to make decisions for them when they lack the capacity to make reasonable judgments. However, most clients do not have sufficiently impaired judgment to reasonably allow others to make important decisions for them.

Client Relationships and Ethical Boundaries for Social Workers in Child Welfare -

This incapacity argument has little or no plausibility for the common clients of architects, engineers, and accountants. Business and corporate clients of lawyers are unlikely to have significantly impaired judgment, even if they are biased. Moreover, even with individuals, the view is not plausible for the common legal and medical cases.

A person who wants to purchase a house or make a will, or who has the flu or an infection, is rarely so distraught as to be unable to make reasonable decisions. Consequently, the argument from incapacity does not support adopting a paternalistic conception of the professional-client relationship for most cases, although it supports using that conception in special cases. The first argument for paternalism, that from superior knowledge, fits with reasonable persons allowing others to make decisions when they lack knowledge.

Moreover, clients go to professionals for their superior knowledge and skills; such knowledge and skill is a defining feature of a profession. Howevermany decisions require balancing legal or health concerns against other client interests.

Webinar Creating & Maintaining Ethical Boundaries in Client Relationships

As many authors have noted, crucial professional decisions involve value choices. Professionals have not had training in value choices. Even if they had, they might not know a client's value scheme sufficiently to determine what is best for him when everything is considered.

An attorney might advise a client that he or she need not agree to such large alimony or child support payments, but the client might decide that for personal relations with the former spouse or the welfare of the children, the larger payments are best. Similarly, a physician can advise bed rest, but because of business interests a client can decide her overall interests are best promoted by continuing to work on certain matters.

The client might especially need the income or be on the verge of completing a business deal that will earn a promotion. Physicians sometimes fail to realize that a patient's other concerns, even a vacation trip with the family, can precede health. They write and speak of the problem of patient noncompliance just as parents speak of noncompliance by children. Yet, one does not have everything when one has health. Similarly, a client might want an engineering or architectural design to use one type of construction rather than another because its subsidiary supplies such materials.

Although a professional and client are not equals, sufficient client competence exists to undermine the paternalistic model as appropriate for their usual relationship. Clients can exercise judgment over many aspects of professional services. If they lack information to make decisions, professionals can provide it. Sometimes professionals argue that clients can never have the information they have.

ethical issues in the health professional client relationship

This is true, but not directly to the point. Much of the information professionals have is irrelevant to decisions that significantly affect client values. The precise name of a disease and its manner of action are not relevant to deciding between two alternative drug therapies, but the fact that one drug reduces alertness is. Similarly, clients of engineers do not need to know the full weight a structure will bear, only that it is more than sufficient for all anticipated stress.

To deny clients authority and responsibility by adopting the paternalistic model is to deny them the freedom to direct their own lives. Clients are not capable of determining the precise nature of their problem, or of knowing the alternative courses of action and predicting their consequences or carrying them out on their own. They need and want the technical expertise of a professional to do so.

However, they are capable of making reasonable choices among options on the basis of their total values. They need professionals' information in order to make wise choices to accomplish their purposes.