child abuse.5 Step 5: Obtain consultation. This step is by far the easiest and most often followed step by students engaged in family practice. It is also the first step to go once a person is working full time in private practice or in agencies. Failure to seek consultation will almost always have negative results if an ethical decision is ever challenged within a professional association or in a court of law. Obtaining consultation can provide an opportunity to get feedback and recommendations regarding your decision-making process. The more uncomfortable you are in sharing your decision-making process in consultation, the more likely you are to be taking actions that you already know are not in your client’s best interest. It is often useful to seek out consultation from professionals who will provide a different frame of reference from your own. Legal consultation is vital for any family counselor when considering the aforementioned case.
6 Step 6: Consider possible courses of action. In this step, creative thinking is necessary. This is the time for reflective processes. You want to take enough time to complete this step with the confidence that you have explored solutions from many angles. Your solutions should also address the actions of all the people involved in a solution.You decide to tell the parents that your primary obligation is to their 14-year-old child because of the state’s interest in protecting children. You provide them with the option of either taking their child to a doctor or preparing to have the state remove their child from the home because you are required by law to call the child protection agency to advise them of the parents’ decision to avoid medical intervention. Your actions and words are firm and deliberate but friendly. What are your reactions to such a course of action? To what principles are you paying primary attention? Whose interests have been protected?Another option is to remain loyal to your clients’ religious beliefs. You understand the legal requirements placed on you and the legal context in which the family is embedded. Autonomy and cultural sensitivity inform your ethical reasoning; although the results of such actions may lead to harm for the child, you believe that promoting the family’s welfare is best served by promoting its autonomy. The idea that not all laws are ethical is central to your reasoning. In addition, you believe that the laws of the state are secondary to the larger laws set forth by the family’s religious higher power. Although this may not be what the majority of family practitioners would do in a similar situation, you believe that at times civil disobedience truly provides the best ethical action.What other ethical stances are possible, and what principles support these stances?
7 Step 7: Enumerate possible consequences of the various options. For the first option above, the child would probably receive the medical care indicated. The parents might be placed on probation and mandated to a parenting program, after which they might regain custody of their child. The parents themselves might be bitter and even more distrustful of both the government and family counseling or therapy. There is very little chance that they will ever consider therapeutic interventions of any kind again. Imagine this case for a moment. Given today’s world, the media will already have attended to this story, and thousands will now know your actions. These thousands will now take in this event and connect it to their attitudes toward the helping professions. Should an awareness of the public nature of your decision factor into your decision-making process?The second option above will invariably lead the parents to respect your ability to honor the family’s right to make decisions regarding their child. It is still uncertain as to whether your actions will lead to further involvement with the authorities—either for the parents or for you. It is quite likely that the child’s condition will worsen and may lead to death. How will you feel about your decision then? This action too will catch the attention of the public. How might the public view family practitioners if you pursue this option?
8 Step 8: Choose what appears to be the best course of action. Hopefully you see the two options described here as only two of many more options that might be available. The very application of this model based solely on principle ethics demonstrates how often no-win possibilities occur. Let us see if virtue ethics adds anything to our considerations.
A Virtue Ethics Model
Most professional codes are based on principle ethics. Except for a few aspirational statements in some codes, there is very little in the documents themselves that pertains to virtue ethics. As we have noted before, virtue ethics requires the professional to look inward and make space for a self-reflective process. Attending to oneself in ethical decision-making opens the door for the emotional experiences of empathy and compassion. Cohen and Cohen (1999) viewed the role of emotion in decision-making as a legitimate component of a “morally good motive” and noted that “moral action is no mere affair of rules but is instead infused with emotion, human relatedness, and sensitivity to the nuances of individual context” (p. 24). A decision-making process based on virtue ethics would include many of the following questions:
What is my gut telling me about the family’s situation?
If I were in the parents’ shoes, what might I feel or want to do? How would I answer the same question for the child, extended family members, family friends, or the community?
How important is my own spiritual or religious value system to me, and how hard might I fight to have it respected? Does this tell me anything about what the family is experiencing? How open am I to accepting that my view of the right choice might be different from the view of the right choice held by various family members?
How open am I to accepting that my view might be different from the state’s view? Am I willing to be courageous and stand up for my view or for the clients’ views if they are different from what the law requires?
Do I agree with what the codes suggest I do in this situation? Do the codes help me to be the preferred family practitioner I want to be?
Which possible courses of action best fit my preferred view of myself as a family practitioner? Which personal and professional values are activated in me as I face this dilemma: caring, compassion, judgment, courage, humility, connectedness? Other values or virtues?
Which choice am I willing to live with? How ready am I to make a choice and live with the uncertainty of its outcome?
When infusing your ethical decision-making with virtue ethics, you bring yourself deeply into the ethical decision-making process. How central to the decision-making process are you willing to place yourself as a family practitioner? Is it possible to be too central? What would that look like for you?
A Participatory Ethics Model
What might a model of ethical decision-making based on participatory ethics look like? The specific process we propose here is based on the model of feminist ethical decision-making constructed by Rave and Larsen (1995) and the model for the vulnerable therapist described by Coale (1998). Participatory ethics retains much of the structure of a rational-evaluative process and still requires the self-reflection of a feeling-intuitive process. But instead of leaving ethical decisions completely in the hands of the family practitioner, participatory ethics focuses on the relational, coconstructed knowledge that comes from active involvement of clients in the decision-making process. The model may be applied as follows:
1 Recognizing a problem. Problem recognition comes from a combination of perspectives. The family practitioner’s personal and professional knowledge, competence, and gut feelings are combined with the clients’ local knowledge and gut feelings in an effort to understand and clarify the ethical dilemma. The family practitioner’s task is to open space within the counseling or therapy sessions for the clients to inform the ethical process. They open space by actively encouraging input, feedback, and the sharing of client perspectives on the counseling process.
2 Defining the problem. Once the counselor and the
