Counseling Ethics: Navigating Controversial Issues With Thoughtful Consideration - Essay Sample

Introduction

The field of counseling is often filled with ethical dilemmas. Such issues are controversial, which demands thoughtful consideration. Furthermore, ethics align closely with one's cultural, moral, personal, professional, and spiritual values (Francis, 2015). While many ethical dilemmas may appear to have definite solutions, the context of the situation may add a level of complexity that needs the counselor to consider an alternative ethical course of action that may have a significant effect on the client (Ling & Hauck, 2016). However, this does not mean that people cannot reason about ethical issues. Instead, they can use various moral theories to identify resolutions to any ethical dilemma faced (Francis, 2015). In this paper, Kant's and relativist theories are considered to defend and criticize Dr. Susan Lim's moral position, a surgeon who was suspended for overcharging a patient for medical services. Thus, the purpose of this paper is to apply Kant's and relativism theories to Dr. Susan Lim's case and make the most ethically correct resolution.

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Summary of Case

Dr. Susan Lim is a general surgeon based in Singapore. In 2001, Dr. Lim started treating Pengiran Anak Hajah Damit, a woman member of Brunei's royal family, for breast cancer. She remained the patient's principal physician from 2001 to August 2007 when the victim died (Ching, 2011). During the treatment period, Dr. Lim's Clinics addressed all invoices that totaled $40 million to the Brunei High Commission in Singapore. Although the patient's family paid all the bills up to March 2007, they alerted the Ministry of Health (MOH) of very high bills that Dr. Lim charged for the patient's treatment between January and June 2007. This charge amounted to around $24 million (Cheah, 2013). The MOH alerted Dr. Lim of the complaint, which she tried to resolve by annulling and discounting some of the invoices. She described these cases as inadvertent mistakes made by her clinics. However, the MOH still found the charges as unacceptably high. Hence, to avoid further confrontation, Dr. Lim indirectly threatened Brunei's family of disclosing their personal information, which would affect their reputation adversely.

On 3 December 2007, the MOH addressed a letter of complaint to the Singapore Medical Council (SMC) arguing that Dr. Lim exceeded her ethical obligation to charge a reasonable fee considering the medical services rendered (Ching, 2011). The SMC had to investigate if Dr. Lim's conduct amounted to professional misconduct. On 20 July 2009, the SMC issued the doctor with a Notice of Inquiry stating 94 charges of professional misconduct against her regarding the medical fees charged to Brunei's family (Ching, 2011). In August 2012, the SMC ruled a three-year suspension and a fine of $10,000 against Dr. Lim (Yamadak, n.d). The Council also censured the doctor in writing and forced her to undertake never to overcharge again.

Moral Theories

Various moral theories can apply to Dr. Lim's case. However, the ethical theory that one uses for decision-making emphasizes the features of the ethical dilemma faced, which facilitates making the most ethically correct resolution. This paper centers on Kant and relativism theories to defend and criticize Dr. Lim's moral position.

Kant's Theory

In Kant's moral theory, people's dignity and their right to respect is grounded in their ability to subordinate their particular desires and inclinations to the universal law of morality (Herman, 2016). Whether an action is right or wrong under this theory depends on whether it fulfills a given duty. In particular, goodwill is a will that chooses a certain action because it is the action dictated by duty. Kant defines duty as a categorical imperative or the commands of morality that simply dictate what people ought to do, and he holds that there is just one; acting on that maxim through which one can at the same time will that it should become a universal law. One's maxim is the reason for pursuing an action (Herman, 2016). Further, the theory argues that the rightness or wrongness of acting from a particular maxim depends on the type of maxim that it is. For example, if lying is sometimes forbidden, then it is always morally forbidden. In addition to the formula of universal law, Kant gave the formula of humanity that argues that one should treat others as they would want to be treated.

Based on this theory, one would argue that Dr. Lim's actions were wrong. Certainly, all medical professionals must charge reasonable fees for services rendered. This duty holds universally regardless of the patient's standing in society or their level of income. Therefore, overcharging Brunei's family as determined by the SMC was morally forbidden. Similarly, one would opine that if Dr. Lim were in Brunei family's position, she would not want to be overcharged nor harassed in any way.

Kant's theory has various limitations. First, it fails to consider that in real life, every situation is unique, and thus morality should be relative (Ward, 2019). In particular, Kant's theory articulates what morality forbids one from doing. However, it does not dictate what one ought to do in every case. Hence, some actions might be morally right even though not doing them would not be contrary to the formula of universal law, and thus not morally forbidden. Therefore, these actions are neither morally required nor morally forbidden. According to Ward (2019), another limitation is that the theory is inflexible and sometimes it is necessary to break an unhelpful rule if the situation allows it.

In Dr. Lim's issue, Kant's theory would be limited because it is difficult to determine which maxim to follow. For example, Dr. Lim's maxim for invoicing some bills was the fact that scheduling appointments with the patient sometimes resulted in her failing to attend some other avenues such as seminars from which she made extra income. From her point of view, she was right. However, from SMC's maxim, her actions were deemed wrong. Therefore, it remains unclear how broad either party's application of categorical imperative should be.

Relativism

Relativism can help one understand between right and wrong actions. In this theory, morality is relative to different perspectives. It argues that actions can be classified as either moral or immoral, depending on the point of view (Arrington, 2019). In particular, the appropriateness of action is always relative to the individual, culture, location, or time. For instance, some people may consider an act necessary while others may regard it as unnecessary depending on their view. Similarly, one culture may hold values that differ significantly from another culture. Hence, moral standards and beliefs can be different across cultures, groups, and time, which means that there are no universal sets of ethical principles or standards.

Based on this theory, whether Dr. Lim's actions were right or wrong is also relative. On one side, one would consider her actions wrong because she went against ethical standards of practice by overcharging the Brunei family for medical services offered to their patient. This would be proven by the fact that she termed the invoices as inadvertent mistakes made by her clinics, and even went to the extent of discounting and annulling some charges. Conversely, another person would regard her actions as right because a set limit for charging patients for medical services did not exist. Even the SMC ethics did not specify the extent of a reasonable fee. Besides, the $26 million would be a reasonable and affordable amount for a royal family.

Although relativism has its strengths, it also exhibits some limitations. First, it argues that the truth, right and wrong are all relative. This reduces ethics either to personal preferences or to social conventions (Baghramian & Coliva, 2019). For instance, if social convention and morality were similar, anything done by a dominant group of people would be seen as ethical if that is how the group defines morality. However, something is not right just because a group of people thinks it is. Additionally, the lack of universal ethical standards set by the theory can lead to everyone's perspectives being equal, which creates a problem when measuring the morality behind people's actions.

In Dr. Lim's case, the application of relativism is limited because her actions would not be deemed right or wrong just because different groups of people think they are. Moreover, the authoritative position of Brunei's family would have influenced MOH or SMC's determinations that Dr. Lim did overcharge for the service rendered. Hence, a problem would arise when assessing the morality behind Dr. Lim's actions.

The 8-Step Model

Figar and Dordevic (2016) define an ethical dilemma as a situation of choosing between two or more alternatives. A person is in a difficult situation because he or she often needs to choose between ethical and unethical alternatives. In the context of this paper, Dr. Lim's assumed ethical dilemma was whether she should reveal sensitive information regarding Brunei's family relations to the Brunei government to defend her situation and end the legal suit against her. Certainly, revealing such confidential information would affect the family negatively. Schwartz (2016) asserts that, while confronted with any ethical dilemma, it is essential to follow certain guidelines while deciding to minimize the negative effect on stakeholders. This paper proposes the 8-step model to help Dr. Lim in making the best decision.

Step 1: Gather the Facts

In this step, one should gather as much information as possible that illuminates the situation (Pope & Vasquez, 2016). Moreover, it is crucial not to jump into conclusions without the facts. Therefore, Dr. Lim should examine all possible alternatives to her dilemma and their effect on the stakeholders. She should remain specific and objective. It is also vital to clarify any assumptions she makes around the ethical issue.

Step 2: Define the Ethical Issue

This stage involves the identification of the ethical issue in the situation. One should define the ethical basis for the issue. In Dr. Lim's case, the ethical dilemma pertains to whether she should reveal confidential information regarding the relations between the Brunei family and the Brunei Government. If she reveals the information, it can harm the family. Besides, breaching confidentiality is against professional integrity. However, failure to reveal this information raises her chance of being prosecuted.

Step 3: Identify the Affected Parties

These refer to the identification of primary and secondary stakeholders in the issue. In the present case, the primary stakeholders are Dr. Lim, SMC, and the royal family of Brunei while the Brunei government is the secondary stakeholder.

Step 4: Identify the Consequences

In this phase, one thinks about the potential positive and negative consequences of the decision for the stakeholders. This also involves determining the magnitude of the consequences and the likelihood that they will happen (Pope & Vasquez, 2016). In Dr. Lim's case, revealing the sensitive information may prompt the Brunei family to drop the charges against her. However, this may destroy the family and Brunei government's reputation.

Step 5: Identify Obligations

In this step, an individual should consider obligations in terms of principles and rights involved. That is the ethical principles and specific rights of the stakeholders. In the present case, Dr. Lim has an obligation towards the Brunei family and the SMC. Moreover, professional ethics of physician-patient confidentiality stipulated by SMC require medical professionals not to reveal their clients' sensitive information. Thus, if she reveals this information, then she will breach th...