Problems Of Ethics

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Not all of the areas discussed below are covered by a specific legal or ethical code for every profession or community service, but are nonetheless related to ethical behavior for just about any program or organization. All should at least be considered as you define ethics for yourself and your program. Probably the most familiar of ethical issues -- perhaps because it's the one most often violated -- is the expectation that communications and information from participants in the course of a community intervention or program including conversations, written or taped records, notes, test results, etc.

Programs' legal responsibilities in this area may vary, but as a general rule, confidentiality is the best policy. It protects both participants and the organization from invasion of privacy, and establishes a bond of trust between the participant and the program.

Depending upon the program, the staff member's position, and the participant's needs, confidentiality may encompass a range of possibilities:. Most programs not required by law or professional ethics to keep all information confidential do so anyway, both out of moral scruples and to establish trust with their participants. There are, however, specific exceptions to complete confidentiality. Many mental health and other professionals will share clients' records usually leaving out the client's name with a colleague for the purpose of consultation and supervision.

If the program staff member is a mandated reporter for child abuse and neglect, if the participant presents a threat to himself or others, or if the staff member is subpoenaed in a legal case, both the law and ethical codes generally require that the staff person put her responsibilities to the law or to the safety of others above her promise of confidentiality.

Some program staff may consider their relationship with participants to be ethically more important than legal considerations. They may either not take or periodically destroy notes from meetings with participants; refuse to testify in court cases and risk being fined or incarcerated for contempt of court ; or simply "not remember " the relevant information.

The ethics in this type of situation are complex, and it's best for both an organization and its individual staff members to discuss the possibilities before they come up in reality. Having clear policy on these matters makes everyone's course of action clearer as well, and reduces anxiety all around.

Some Basic Problems in Ethics |

What are the obligations of that youth worker at the beginning of this section? Exceptions to confidentiality should be made clear to participants at the beginning of their involvement in the program see "Disclosure" below. This type of sharing is consistent with the rules of the Family Educational Right to Privacy Act, popularly known as the Buckley Amendment, which protects academic records.

This act was meant to assure both that student records were not distributed to non-school recipients without the permission of the student or her family, and that students and their families would have free access to copies of their records. It also gives those students and their families the right to question any elements of those records, and to negotiate corrections where necessary.

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The stakes become higher if some participants are illegal aliens. The funders' guarantee that it will neither check on nor turn in anyone in that situation is seldom enough for people who have been conditioned to fear reprisals for being in the wrong place at the wrong time. In all circumstances, ethical treatment of participants demands that they be informed about the program's confidentiality policies.

In most cases, they then have the choice of not participating if they are unhappy with those policies; in the case of court-mandated participation, at least they'll know what to expect. All of which brings us to the next two issues, which may intertwine with confidentiality and each other: consent and disclosure. There are really three faces of consent: program participants giving program staff consent to share their records or information with others for purposes of service provision; participants giving informed consent to submit to particular medical or other services, treatment, research, or program conditions; and community members consenting to the location or operation of an intervention in their neighborhood.

In the case of any major medical treatment surgery, for example , doctors and hospitals generally require an informed consent form as a matter of course. Patients have a right to be told exactly what their diagnosis is, what treatment is being recommended and why, what its risks and advantages are, possible outcomes, etc. They also have right to a second opinion, and to refuse treatment.

In the case of most other services or treatment, participants' rights are similar, unless their participation is mandated by the court or in some other way. In the case of research, people have a right to know what the research is about, who will see and tabulate the results, what the results will be used for and how, what will happen to their personal records, how their anonymity will be protected, etc. They also have a right to refuse to be part of the study i. In practice, it almost always makes sense to let people know what you plan to do, and to negotiate with them if they have concerns about it.

But what if that neighborhood is unalterably opposed to a homeless shelter being located in the area, and you've already bought the property? Legally, you may have every right to put any facility you want to there, but what is your ethical obligation assuming you can't persuade the neighbors to change their minds? Furthermore, what is your ethical obligation to the homeless people you plan to serve?

Handling these issues in a community is seldom easy or clear-cut. In general, the best course is to be honest about your intentions and to try to attend to people's objections or concerns. There's usually a way to find a solution that both sides can live with if you keep communication channels open.

Both confidentiality and consent bring up the issue of privacy, one that has been much discussed in the past 20 years or so. Technology has made information far more accessible to far more people, and individual privacy has consequently become far more threatened. Much of what is discussed above and below has been the subject of legal wrangling or legislation as in the case of the Buckley Amendment. While the question of the right to privacy, constitutional or otherwise, is much too broad to go into here in any detail, it is always lurking behind any decision about releasing information.

Many programs have a grievance procedure for participants who feel they have been unfairly denied services, or that they have been in some way harmed in the course of their contact with a community program. Participants should know such a grievance procedure exists, receive a copy of it, and have it explained to them so they can file a grievance if they need to. They should also have a copy of any specific conditions they're agreeing to by enrolling in the program: to remain drug-free, for instance, or to keep a journal. Many states and the federal government require such disclosure as part of any contract with or grant to an organization.

Depending upon the controlling laws, the public funder usually specifies what constitutes conflict of interest, so that the program can report accurately and police itself properly. By offering services of any kind, an organization is essentially making a contract with participants to do the job it says it will do.

Implied in that contract is that those actually doing the work, and the organization as a whole, are competent to accomplish their goals under reasonable circumstances. Participants may be unready -- think about the long-term failure rates of many substance abuse treatment programs -- or resistant.

Some community interventions may succeed less than half the time, and that may be the best anyone can do. But whatever the success rate, participants and the community have a right to expect that the program knows what it's doing and will make its best faith effort to provide effective services. That means that community services need to be offered by folks who are competent at what they do. Competence means more than simply having the appropriate training and experience. A competent organization hires competent staff members, provides supervision and staff development, and does everything it can to assure that the services it offers are the best available.

If service appears to be ineffective or harmful, it is the ethical responsibility of the program to seek out or develop and try more effective methods. If a staff member, even with help from supervisors and others, isn't able to do the job, that should be documented and she should be dismissed. There are legal implications here as well. As explained earlier in this section, in some cases, service providers can lose their licenses or be sued for malpractice if they are found to be incompetent.

It is up to a program to make sure that no one on its staff places himself in that position. A conflict of interest is a situation in which someone's personal financial, political, professional, social, sexual, family, etc.

Framework for resolving ethical problems

In community interventions, conflicts of interest may change -- to the community's disadvantage -- how a program is run or how its money is spent. Conflicts can also affect an organization, especially where a Board of Directors is involved. If a staff member is also a Board member, she should not take part in Board decisions about staff salaries, for instance, although it may in fact be helpful for her to contribute to the discussion of that issue.

It is usually considered a conflict of interest for programs to pay Board members for services e. Conflicts of interest are virtually always unethical, to the point where the mere appearance of a conflict needs to be avoided. Even if decisions or actions are not actually influenced by personal interest, people in conflict of interest situations in their public or professional lives should do everything possible to resolve them.

Another type of conflict of interest is subtler, and arises when pressures from a funding source force a program into a certain kind of behavior that shortchanges some participants. Some job training programs, for instance, are only paid for their work with trainees after those trainees have reached certain goals.

A program may get part of its payment once a trainee has completed a vocational assessment; another part after he has finished a job training course; and the last and usually largest part once he has found employment. It isn't hard to see that if too many people drop out before completing their goals, the program will lose money. Therefore, programs are less likely to recruit participants who might drop out -- the very people who need the service most -- and more likely to seek trainees who already have skills and who can easily complete the program and find jobs.

There is a clear conflict here between the program's obligation to serve those who can benefit, and its need to bring in enough funding to stay in operation. While the example given involves employment training, the numbers game that puts programs in this bind can be played in any number of situations: adult literacy, youth programs, even community health, where -- as in HMOs -- the number of patients that must be seen can reduce the effectiveness of care. There are ways to avoid this kind of conflict, but often they create as many problems as they solve.

One is to refuse funding which places pressures on the program to ignore the needs of part of the target population. If there's no other source of funding available, the program then runs the risk of closing, and thereby eliminating services for everyone. Another way out is to try to negotiate with the funder: perhaps the program can be paid to serve a certain number of "high-risk, high-reward" participants, those who are at high risk of dropping out, but for whom success constitutes a high reward for the program and the community.

A third possibility one which can and should be pursued no matter what else happens is to educate funders and policy makers to the unintended consequences of tying funding to participant numbers and particular outcomes. This last, unfortunately, takes a long time and a lot of effort: it's more than worth it in the long run, but a program may simply not have the long run in which to operate.

Ethically and practically, trying to negotiate with the funder is probably the best solution. If it doesn't work, however, you may find yourself in a very difficult position. The more different funding sources you can tap, the less likely you are to find yourself in this bind, and that may in fact be the best solution: spread your funding out as much as possible, so that losing or refusing one funder doesn't put you in the situation of having to choose between ethical behavior and survival. This is behavior far beyond the bounds of the normally accepted ethical standards of society.

In some cases, grossly unethical behavior may stem from taking advantage of a conflict of interest situation. In others, it may be a simple case of dishonesty or lack of moral scruples. Both individuals and organizations can be guilty of some instances of it, and in both cases it is often a result of someone managing to justify the unjustifiable. Community programs need to be clear about their own ethical standards, and to hold individuals to them and to any other standards their professions demand.

In most cases, staff members guilty of grossly unethical behavior should be dismissed as quickly as possible, and prosecuted where that is appropriate. Some of the more familiar types of grossly unethical behavior include:. Discrimination may not be unethical if an intervention is established to serve a particular group for a particular purpose. A women's shelter for victims of domestic violence would not be expected to house men as well, for instance. A support service for members of the Vietnamese community would not be obligated to provide translation for other groups.

ICAEW framework - how to resolve ethical problems

Ethical behavior for a community intervention is more than simply following particular professional codes and keeping your nose clean. It means actively striving to do what is right for participants and for the community, and treating everyone -- participants, staff members, funders, the community at large -- in an ethical way. By doing what you do in the community, you take on a number of responsibilities:.

Responsibility to funders. You are responsible for being fiscally accountable, for using funds properly, and for trying to do what you promised to do when you took the money. If a funder is asking for something you're not willing to provide or promise, either don't take or apply for the money, or try to negotiate a compromise. Be honest, both to yourself and the funder, about what you're willing to do. Don't violate your own ethics just to get funding. Responsibility to staff members.

You are also responsible for protecting staff from harm to the extent possible, and for warning and training them if some physical or other danger is part of their jobs. You owe it to a youth gang outreach worker, for instance, to train him in such areas as the boundaries of different gang territories, colors or clothing that send particular signals, conflict resolution techniques, how to talk to gang members without creating problems, etc.

You also owe him a clear explanation of the risks of the job and of how much and what kind of support he can expect from the program. Responsibility to participants. You are responsible for trying, throughout the life of the program, to provide the best and most effective services possible.

This means constantly searching for better methods and ideas; paying attention to participant feedback; building on program successes; and acknowledging, learning from, and correcting program weaknesses. You are also responsible for respecting participants' rights, and for treating all with the respect due them, not only as program participants, but also as human beings. The issue of participant rights can be a sticky one.

A mentally ill -- but intelligent and reasonably functional -- woman living in a group house went to the hospital for a simple surgical procedure.

Solving ethical problems

In the course of the surgery, the operating doctor, who was the woman's primary care physician, decide to sterilize her without her consultation or permission. When she found out, she was devastated, but refused to file a complaint because of her fear of doctors and their power over her. The ethics committee of the organization that ran the group home then had to decide if the woman's right to decide whether or not to protest -- regardless of how irrational her reasons -- overrode her right to compensation for inappropriate medical treatment.

The offense was serious enough that the physician could have lost his license if it had been brought to light. The committee ultimately decided that the woman's right to let the matter lie was more important than her right to some restitution from the doctor, and no complaint was ever filed. Was the committee right? It's extremely difficult to say, which is exactly the point. Most ethical decisions are far from cut and dried. There is no such list within moral philosophy. Not all problems that are discussed in ethics are equally important.

The Nonidentity Problem #1 - Ethics - WIRELESS PHILOSOPHY

What would the equivalent list look like for moral philosophy? For more explanation of why, see my previous two posts on high impact philosophy, here and here. Development charities? Animal welfare charities? Extinction risk mitigation charities? Or investing the money and donating later? What are the highest leverage political policies? Libertarian paternalism? Prediction markets? Cruelty taxes, such as taxes on caged hens; luxury taxes?

What are the highest value areas of research? Tropical medicine? Artificial intelligence? Economic cost-effectiveness analysis? Moral philosophy? Should we maximise expected value when it comes to small probabilities of huge amounts of value? If not, what should we do instead?

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How should we respond to the possibility of creating infinite value or disvalue? Should that consideration swamp all others? If not, why not? How should we respond to the possibility that the universe actually has infinite value?

Problems Of Ethics
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