example, there is the customer–mechanic relationship, the family counselor–client relationship, the family counselor–other family member relationship, and the family member–family member relationship.
Let us see what help various codes of ethics may provide. The ACA Code of Ethics (American Counseling Association [ACA], 2014) encourages counselors to avoid nonprofessional relationships when “the interaction is potentially harmful to the client” (Standard A.6.e.). Similarly, the IAMFC Code of Ethics (International Association of Marriage and Family Counselors [IAMFC], 2017) encourages family counselors to “avoid multiple relationships with clients, including but not limited to, business, social, or educational relationships” (p. 2). The AAMFT Code of Ethics (American Association for Marriage and Family Therapy [AAMFT], 2015) requires that therapists
make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Such relationships include, but are not limited to, business or close personal relationships with a client or the client’s immediate family. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists document the appropriate precautions taken. (Principle 1.3)
So now what? Let us say you are a family counselor and a member of both IAMFC and ACA. IAMFC strongly asserts that family counselors should avoid business relationships, whereas ACA’s code would allow such a relationship if it were not harmful and maybe even beneficial to the client. To which code are you bound: the one for a division of ACA that represents your counseling specialty or the one for the entire counseling profession? Another difficult question is how you would determine what might be a harmful or beneficial relationship. That is apparently not so easy to answer.
AAMFT (2015) lists two highly problematic concerns that could result from dual relationships: impaired professional judgment and client exploitation. Okay, so that is easy. If I think that a dual relationship with my mechanic could impair my professional judgment or result in exploitation, I just do not take that person or family on as a client: That is nice and clear. But what if I do not live in a big city? What if I live in a small town in a rural state or up in the northern territories of Canada? What if I am the only therapist for miles around? How can I avoid dual relationships then? Well, if I cannot, I am directed to take appropriate precautions. I wonder what those are.
If it all comes down to my professional judgment, what will motivate my actions: a duty to respectfully follow perhaps multiple codes of ethics; a desire to avoid legal problems; or a desire to do what I think is best, based on my personal virtue, morality, and character? Welcome to the world of ethics in family practice.
We began this chapter by noting that professional ethics provide not only guidance but also opportunity for personal learning and growth. Ethical decision-making—especially when dealing with conflicting professional ethics codes—moves you into the realm of ambiguity and uncertainty. It becomes the practitioner’s responsibility, hopefully with consultation from experienced professionals, to make clinical choices that promote the well-being of clients. So what do “beneficial” or “promote” or “well-being” really mean in action? How are these terms defined? Who has a role in defining them? Even though these are difficult questions to address, some of your most meaningful moments as a family practitioner may occur in the uncertain struggles with professional ethics.
Any consideration of professional ethics is fuzzy, and the phrase “It depends” will emerge more often than a definitive answer. A dilemma is a dilemma because it is not easily solved, and wrestling with it often raises more questions than it answers.
Perspectives on Ethics
There are multiple ways to address ethics, moral action, and professional practice. In this section, we discuss two of the most salient and familiar perspectives on ethics as they apply to our work with families: principle ethics and virtue ethics. We then discuss an emergent perspective on ethics firmly grounded in postmodern thought called participatory ethics (McCarthy, 2001).
Principle Ethics
Principle ethics can be seen as preexisting obligations a family practitioner embraces prior to any interaction with clients. The most commonly mentioned principles in the fields of counseling and family therapy reflect the Western values and themes first articulated by Plato, Aristotle, and Cicero: autonomy, beneficence, nonmaleficence, fidelity, justice, and veracity (Remley & Herlihy, 2020).
Autonomy is the principle underlying the individual’s freedom of choice. There are many ways in which the principle of autonomy can play out in family practice. At the outset of family consultation, you will describe to your client your preferred approach or model as part of what is called informed consent. Families have the right to say “no” to the services you offer if those services do not fit them. The principle of autonomy also favors the individual over the family or the group. In many Asian and Hispanic cultures, however, what is best for the individual is never considered above what is best for the family. It is important to keep in mind that autonomy is a decidedly Western value. Even in Western cultures, the principle of autonomy forces relational practitioners to articulate who they see as their client: Is it each individual in the couple or family, or is it the relationship or system as a whole? Will the practitioner support the needs and development of individuals or of the couple or family or attempt to do both? And how will conflicts in these areas be resolved? The ACA Code of Ethics (ACA, 2014) states that in couples and family counseling
counselors clearly define who is considered “the client” and discuss expectations and limitations of confidentiality. Counselors seek agreement and document in writing such agreement among all involved parties regarding the confidentiality of information. In the absence of an agreement to the contrary, the couple or family is considered to be the client [emphasis added]. (Standard B.4.b.)
The default position is that the relational system is the client when counselors do not indicate otherwise.
Beneficence is the promotion of the client’s welfare and well-being. Family practitioners take steps to consciously and consistently work toward the betterment of the couples and families with whom they work. Sounds simple, does it not?
Let us imagine a family that has come to you for support and guidance. (We use this family throughout the rest of this chapter to consider other ethical questions and concerns.) The family has recently been charged with child neglect. The specific charge of neglect involves the family’s 14-year-old child, who is suffering from leukemia. The parents hold religious beliefs that do not allow medical intervention to be given for any illness, even cancer. The parents want to gain your support for their freedom to choose the health care interventions they deem appropriate within their religious system. Prayer is their preferred form of intervention.
Supporting their freedom sounds like the right thing to do, but there in front of you is their 14-year-old child, suffering—and most likely dying—from cancer. So what actions do you take that would be seen as promoting the client’s welfare? And who exactly is your client: the parents, the child, the family as a whole? The answer to this question will be central to every move you make.
If promoting the 14-year-old child’s welfare seems clear to you, then you are viewing the child’s problem from the perspective of what is possible using Western medical procedures, a perspective clearly outside of the religious values that are informing the parents’ actions. As it turns out, even the child espouses the same religious convictions. If you support the family’s perspective, are you prepared to watch this young person die when everything within your own value system tells you the child has a chance with what you might deem proper medical care?
Nonmaleficence
