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Ethical Dilemmas in Mental Health

An ethical dilemma is a situation in which ethical principles conflict or when there is no one clear course of action in a gven sinuation. For example, the client who refuses medica- ton or treatment is allowed to do so on the basis of the prin- iple of autonomy. If the client presents an imminent threat of danger to him or herself or others, however, the principle of nommaleficence (do no harm) is at risk. To protect the client others from harm, the client may be involuntarily com- mited to a hospital, even though some may argue that this a violates his or her right to autonomy. In this example, de utilitarian theory of doing the greatest good for the great- of number (involuntary commitment) overrides the indi hal client's autonomy (right to refuse treatment). Ethical lientas are often complicated and charged with emotion.

git dificult to arrive at fair or "right" decisions The legal aspect of an action is behavior that is allowed required by law there is almost always a clear "answer" to question about the legality of an action. The ethical pe of an action involves what is "right," or what a person o do. The answer is not always clear, and there is often Yean one possible course of action. Ethical points of

Many dilemmas in mental health involve the client's are influenced by values, opinions, and beliefs. gto self-determination and independence (autonomy)

and concern for the "public good" (utilitarianism). Exam- ples include the following:

Once a client is stabilized on psychotropic medication, should the client be forced to remain on medication through the use of enforced depot injections or through outpatient commitment?

Are psychotic clients necessarily incompetent, or do they still have the right to refuse hospitalization and medication?

Can consumers of mental health care truly be empow- ered if health care professionals "step in" to make deci- sions for them "for their own good?"

Should physicians break confidentiality to report clients who drive cars at high speeds and recklessly? Should a client who is loud and intrusive to other

clients on a hospital unit be secluded from the others? A health care worker has an established relation-

ship with a person who later becomes a client in the agency where the health care worker practices. Can the health care worker continue the relationship with

the person who is now a client? To protect the public, can clients with a history of violence toward others be detained after their symptoms are stable?

When a therapeutic relationship has ended, can a

health care professional ever have a social or intimate relationship with someone he or she met as a client? Is it possible to maintain strict professional boundaries (i.e., no previous, current, or future personal relation-

ships with clients) in small communities and rural areas, where all people in the community know one another? The nurse will confront some of these dilemmas di- rectly, and he or she will have to make decisions about a course of action. For example, the nurse may observe be- havior between another health care worker and a client that seems flirtatious or inappropriate. Another dilemma might represent the policies or common practice of the agency where the nurse is employed; the nurse may have to de- cide whether he or she can support those practices or seek a position elsewhere. An example would be an agency that takes clients with a history of medication noncompliance only if they are scheduled for depot injections or remain on an outpatient commitment status. Additional dilemmas are in the larger social arena; the nurse's decision is whether to support current practice or to advocate for change on behalf of clients, such as laws permitting people to be detained after treatment is completed when there is a potential of fu- ture risk for violence.