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Introduction

This paper seeks to study in depth ethical dilemmas of a psychologist, if faced with situations that require tactics and decisions. It seeks to describe an ethical dilemma scenario and an ethical problem solving model. This paper will attempt to follow this model in order to solve the dilemma at hand.

Dilemma Scenario

A 13 year old girl came to my office in the morning and asked to see me. She explained me that she was pregnant and wanted to go and get an abortion. I tried to interrupt her attributing that abortion was not the only solution, but this teenager insisted that she would have to get an abortion. She explained that if she did not get an abortion, her life and that of her parents would drastically change. She also added that if her community found out about her pregnancy she and her family would be discommunicated from the community. This was because in her culture it was not only forbidden, but it was a crime to have any relationship with the opposite sex before marriage. She confessed that she had come to me that I could help her to get the abortion. At firs,t I sat there staring at this girl thinking and analyzing the kind of ethical dilemma she had just put me into and I wondered how I would solve this particular dilemma (Bernard, 2009). 

Ethnical Problem Solving Model

This particular ethical dilemma was very complex in nature. This is because it involved a conflict between moral imperatives and moral philosophies. As a psychologist, I realized that in my ethical problem solving model, I will have to choose the greater good and the lesser evil. In other words, the first step would be to determine the value theory of the dilemma. The question in this case is, if it would be a greater good to prevent this girl from having the abortion or if it would be a lesser evil to allow the girl and her family to be excommunicated from the community. In this case, I took time to measure the value of these attributes through the value theory. On the other hand I have to consider the legal attributes of the law in regards to abortion. Is abortion legal? Does the infant disserve to die because of the cultural believes of a certain community? (Van, 1980)

In this default position, the common sense view is evident. The girl’s cultural views are something that needs and should be respected, and in this sense the cultural views are respected. However, I have acknowledged that human life is of a pre eminent value that should not be taken for granted. Asserting and accepting the cultural values would mean the death of an innocent infant who is not aware of the cultural beliefs of this community. The dilemma is, should I bite the bullet and close my eyes to consider the cultures of this community or should I consider the innocent life of the infant not to mention the life of the girl. This is because an abortion could go wrong and both the girl and the infant may loose their lives. I was also aware that the decision that I made would form the precedence for other similar cases in the future. Would the decision encourage more girls from the community get abortions? In this case, a careless behavior in the community would be encouraged and more lives would be lost. My ethical obligation did not allow me to disclose this information to the girl’s parents. (Fenster, 1986)

In my ethical problem solving model I choose to follow the principals that govern ethical principals. These principals include value of life, goodness and rightness, justice and fairness, truth telling and honesty, and individual freedom. According to these principals, life should always be greatly valued. Goodness and rightness should be considered; justice and fairness should be observed. Truth telling and honesty should always come first and the client should always be allowed the freedom to choose. In this sense, the decisions made would not only be sound, but also entail all the important and necessary attributes and principals.

Value of Life

‘’It is always wrong to act in a way which directly intends to harm or kill an innocent human person’’ (Goodwin, 1985, p. 7) In this case, human life is very important and has an inviolable sanctity. This simply meant that I first had to consider the girl’s life and the life of the infant in comparison to the repercussions of the cultural believes and cultural conflicts for that matter. An abortion could harm and put both the girl’s life and the life of her infant in danger. This would also mean killing or taking away the life of the infant which was not fair plus was also dangerous. My dilemma was that I could not consult or share this information with the girl’s parents. This is because it was my ethical responsibility to keep the respect for the wishes of the patients. However, in this case, my patient was still a minor and thus she was not of the age to make decisions. On the other hand, telling her parents about the pregnancy would jeopardize my relationship with my patient and she would eventually end up in the back street hospitals to get the abortion. This would have even greater consequences. In this case, I decided to respect her wishes, but to try every strategy to convince her to value the life of her unborn child. I also tried to explain to her all the dangers that were involved in abortion processes. I placed before her an option to choose between committing a greater good as compared to facing a lesser evil. This simply meant that she had to choose whether to value and spare the life of the infant inside her and face the community and her parents which would mean facing a lesser evil. In this strategy, I shared the dilemma with her. This was because she was also responsible for the pregnancy and had to face the consequences. I explained to her that to commit a greater wrong was like adding a wrong on the top of a wrong.

Goodness and Rightness

When faced with ethical dilemmas, the ethical decision should involve the principal of goodness. This principal entails doing well and refraining from doing evil. Doing good will not only be for the good of the girl and her child, but will also be for the good of her family and the community at large. Doing evil to correct a wrong only causes and attracts more consequences which may affect not only the teenager, but also her parents and the community. The consequences may be great as compared to the consequences from doing what is right. This principal simply meant that it would have been a right decision to have the baby and not to abort it. On the other hand, an abortion would cause and attract greater consequences for the teenager and the community at large. For example, if the abortion went wrong or had other negative effects then the teenager and her parents would suffer and face the consequences. If I had to go by or follow this principal, I would decide to refrain from getting the girl an abortion, but have her face the consequences of her mistake by facing her parents and community. In both instances, she would have to face consequences. The question is would she rather face the consequences of her first wrong or face the consequences of both her first wrong and the second wrong?

Many people naturally think that it is wasteful to optimize value. However, it is a very important aspect in choosing between goodness and rightness. Is it the right to abort? Is it good to deny this teenage girl the ability to carry on with her life?

Justice and Fairness

This principal involves and encompasses the equality of treatment and the fair distribution of advantages and burdens in the community and amongst the members of the society. If I had to make a decision based on this principal then I would consider the distribution of burdens and benefits in the situation. It is important to note that justice means giving to each person what they deserve. I have to determine what each person deserves. Does the girl deserve to have an abortion to prevent the consequences of having a sexual relationship between marriages? On the other hand, does the girl deserve to go through such harsh judgment for having sexual relationships before marriage? This is a real dilemma. In my attributes, I considered that justice and fairness are closely related and can be used interchangeably. If I used the justice principal, I would have to consider the standard of rightness; on the other hand, if I used the principal of fairness, I would have to consider the ability to judge without reference to one’s feeling or interests for that matter.

The second consideration is whether the client has the ability to make sound decisions. In this case, I have to review autonomy, justice, fidelity, nonmaleficence and beneficence.

The Autonomy addresses the concept of independence. The main question is whether this teenager has the freedom of choice and action. Should I encourage the teenager to act on her own values and make her own decisions? The first thing that I need to do is to help the teenager understand that her decisions may not be well received in the context of the society around her. A thirteen year old does not have the ability to make rational and sound decisions. In this case, the teenager should not be allowed to make such decisions. Nonmaleficence means not causing harm to others (Kitchener, 1984. P. 12). This principal clearly suggests that it is my moral responsibility not to engage in activities that could harm others.

Advocating and encouraging for an abortion will be putting the lives of two people in danger. Thus it was my moral responsibility not to encourage abortion, as it is an activity that could cause harm to the teenager and to her unborn child. Beneficence reflects on my responsibility to look into the welfare of my client. This means that I have an obligation to do well and prevent harm (Forester, 1992, p. 17). Additionally, the fidelity principal clearly states that I must be loyal, faithful and committed to my client. This is because bad faith could threaten the relationship between me and my client. Bad faith could also affect the future relationship between me and my clients.

Telling the Truth or Honesty

This particular principal is based on the truth. However, it is sometimes complicated by many issues which are related to who is right and whether it is appropriate to withhold the right. The idea is to have all the facts and determine whether the facts are true. Confidentiality poses a set of complications in withholding what is right. The big question is ‘what do you do when human conflict and confidentiality hit the peak point? Do you break a contract?

 Some researchers have indicated that families of clients and patients have a right to know clients’ position and condition. Thus, health care professionals have ethical obligations to disclose the truth to the family members of the client or patient. Failure to provide such information makes the life choices inconsistent with the wishes of the family. The main issues surrounding telling the truth in ethical situations are the adverse effects or the outcome of activities carried out without the consent of the family. In my case, the teenage girl specifically asked me not to tell her parents. In addition, she explained why she did not want her parents to find out. Her reasons were because the knowledge of the same would have or cause serious consequences for her and for her family as well. This was because her culture did not allow sexual relationships before marriage. (Stadler, 1986) In the event that a girl had sexual relationships before marriage, she had to face consequences such as being punished for her immorality. This posed an ethical dilemma for me in the sense that I had an obligation to disclose this information to the teenager’s parents. On the other hand, I had an obligation to maintain the relationship between me and my client. I had an obligation of sworn secrecy and therefore could not tell her parents about the pregnancy. I also had an obligation as a psychiatrist of ensuring the safety of my client and not exposing her or her unborn child to any harm or danger. Abortion is risky and it can harm both the girl and the child. In this case, I searched for other similar cases and researched on the rulings and decisions made in such situations. From the research that I carried out, I decided not to disclose the information to the client’s parents, but withhold the information as per the instructions of my client. In this way, I would maintain secrecy which is a very important obligation in this field. If I disclose this information to her parents, it would drastically affect my relationship with my client. On the other hand, it would negatively affect my reputation as a psychologist.

Individual Freedom

This principal is based on self determination which treats human beings as the ends in themselves. It relates to the standards which one should follow if faced with complexities. Everyone has a right to have their life respected. In this case, I had an obligation to respect the life of the unborn child. My ethical responsibility for privacy was not reasonable enough for me to encourage and attribute for an abortion. In this regard, I endeavored to advice my client to consider other options apart from the abortion. (Fenster, 1986)  I suggested other ways in which she would deal with the problem apart from having an abortion. I encouraged her to let her parents know if she intended to have an abortion. This is because I had an obligation to protect the life of the unborn child. I also had a responsibility not to put the life of the teenager or the child in danger. It was her individual freedom to make her choice after listening to my advice and suggestions. I realize that any simple mistake would have diverse effects.

According to Sheena, we are in the midst of choices and we are still trying to figure out where the ethical boundaries should be. Many people would disagree bitterly when it comes to abortion. This is because many different people have their own personal views about the abortion. The abortion subject has attracted many suggestions, attributes and criticism. These attributes and suggestions largely depend on the location, country and place of resident. This has made room for all kinds of choices which give a woman the option and freedom to choose. For many years, many doctors refused to set the ethical boundaries in the abortion cases. This is because of the controversy that surrounds the abortion. In the recent days, however, ethical demarcation has come up and the doctors have been faced with ethical dilemmas on the same. The main question in the case at hand is what rights the girl ha. (Norman, 1996) Well, abortion is legal in some countries, but not in others.  I encouraged this thirteen year old girl to look at all the consequences, options and alternatives before making a final decision. However, in this case this girl was determined to have an abortion. Her decision was driven by fear of the unknown and of the known. This simply means that she was afraid of the consequences that she would face if her parents found out and she was afraid of the consequences she would face from the abortion.

I considered letting the girl’s parents know many times, but I know that it was my ethical responsibility to keep the case confidential. Some of the cases related to ethical dilemma in regards to disclosure of secrets are when client disclosed illegal behavior to the police. The psychologist had to face the consequences of his actions. However, ethical responsibility of every psychologist is to maintain privacy and secrecy in the disclosure of the same.

Another similar case involved an 18 year old girl who went to the bathroom and delivered a boy. She left him there dead. The young woman attributed this to the fact that she had conceived unexpectedly. In telling her parents she faced social and personal challenges that she was not ready to face. The emotion responsibilities and consequences of unwanted pregnancy may affect the teenagers’ life for a long time or even change the course of their life. Adolescence is very vulnerable to early pregnancy (Kleining, 2005 p.341). And with early pregnancy they have to face the adverse social and cultural position from their families and society at large. In this particular case, many statistics showed that teenage pregnancies are more likely prone to premature or could be a threat to both mother and child. In other cases, there have been a high percentage of birth defects. Most of the children delivered from teenage pregnancies are often given out for abortion. In the consideration of the above and in the interest of the social welfare of the teenagers, the psychiatric association:

  • Opposed the constitutional legislation and regulation that relates to abortion and family planning segments
  •  They stood firmly on the position that abortion was a medical procedure and the physicians involved should respect the rights and freedom of choice of the teenagers or persons involved. In this case, the psychiatrists should give a consultancy to the patients and appreciate the motivation and consequences of the case or the intentions of the person concerned.
  • They also stood firm on the fact that freedom to act or interrupt pregnancy because of mental health and other social and mental health implications should be considered and adopted where need to.

This position was approved by the psychiatric association and given the red card.

In 1998, a case involved legislation in regards to abortion in individual states. The studies showed that in individual countries women aged 15 and below were reported to have the highest rate of abortion. The case had to follow the precedent of the first case. (Frankel, 2005)

Steps of Solving the Problem

The first step in solving this dilemma will be a pro-abortion counseling. In this session an assessment will be conducted on the 13 year old girl. She has to undergo a careful medial checkup. The medical checkup is to focus on the complications or complications that may cause damage during or after the abortion. The second step is to give the girl a psychiatric diagnosis. This is to determine her mental state. The next step will be to assess the social network. This will involve considering if she needs any family support during this period. However, I have to be careful not to overrun my ethical obligation of secrecy. My next step is to provide the necessary information in regards to abortion and the dangers of abortion. The next step will be to give her time to consider other options. However, the time should be limited because of the abortion time factor. This means that abortion is only safe in a certain amount of weeks. In this regard, an advanced pregnancy cannot be terminated. The next thing is to look for the best clinic where she can have the abortion as per her instructions. However, this will largely depend on her financial capabilities. I will then introduce her to the medical practitioners at the clinic and explain her case. After the abortion, I will encourage her to come for a few sessions in order to deal with the emotional and psychiatric effects of undergoing the procedure (Miller, 2009).

Many people would choose to differ with my ethical decisions on the same. However, based on the ethical problem at hand and the similar cases before, I had to come to this conclusion. The young girl was a teenager and had rights to choose and freedom of choice. The young teenager also was stable in mind and thus could make a decision on what they truly wanted. I also considered different principals in solving the ethical problems. These principals included individual freedom, telling the truth and honesty, justice and fairness, goodness and justice and value of life. Some of the principal rested more in favor of the unborn child, and other principals rested on the teenagers attributes. In my decision, I had to consider past cases that had similar attributes and the resolutions that were made from these cases (Hoose, 1980).  In my personal view, I would have considered if the girl had not gone through the abortion. However, basing on my ethical responsibility, I had to consider all the factors that were involved in the case. Many critics may point a figure of blame citing personal reasons. The recent time of abortion is viewed differently, personal and emotional values can not measure up to the principals that have been set forth to deal with such cases. In the wake of these facts, I was forced to follow all my clients’ requests to the later. Additionally I took the responsibility of ensuring that she was in good hands and that the procedure was fair and just. This way the teenage girl was able to exercise her teenage rights. She was also able to prevent emotional, social and cultural consequences that she would have suffered from her community and the society. In my personal view, parents should be more engaging with their teenagers and not set too high rules to reach. This is because if the teenager’s parents had been engaging with her, she would have gone to them for help. However, because she could not connect to her parents to resulted to coming to me for help. This was a wise choice. On the contrary, sometimes the teenage girls may end up in the wrong hands and suffer more consequences. In this way parents should be involved in the teenager’s life (Kleining, 2005).  They should also develop ways to protect them from the society, in case of an incident, such as this particular case. In this case, I faced many ethical dilemmas in relation to the case at hand. However, I was guided by ethical principles, similar situations and many other attributes on the same. These principals are very important in solving problems related to ethical problems as a psychiatrist. Any mistake or misconduct as a psychiatrist would have diverse effects on the career as a psychologist and my reputation. Mistakes may also cause loss of life or cause harm to the client in this case. Many people may not agree fully with the decisions I made in this instance. However, it was my responsibility to do what is deemed as right in such a situation. (Hass, 1989)

Kitchener’s model on choice

This model is one of the ways that one can view the process of ethical dilemma in order to have a reflective and critical analysis of the case and compare the responses. This model provides a level of moral reasoning into the intuitive and crucial evaluation and ethical principals of nonmaleficence, beneficence, justice and anatomy. In other words, in a case where the ethical guidelines and codes give conflicting advice, this model comes to the rescue and helps to provide moral reasoning on most of the aspects related to ethnic dilemmas. It is important to note that every individual has morals and ideas which may affect their emotional responses and believes. In the view of this fact, ethical beliefs can impact ethical choices in the professional field. In this regard, principals should be put in place to help professionals in the process of decision making especially in critical decision making levels. Professional culture can also contribute largely to making ethical decisions by professionals. In this case, ethical acculturation helps to substitute the cultures of the professional.

Conclusion

This paper has examined an ethical dilemma that a psychologist would experience in dealing with specific case. This particular case involves a thirteen year old girl. The thirteen year old girl is pregnant and is afraid to face her family because of personal, social, economic and cultural issues. In this paper, as the psychiatrist, I try to explain and describe the ethical problem. Additionally, the paper describes a step by step problem solving model.

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