Addressing Ethical Dilemmas in a Domestic Case Study: Confidentiality, Truth-Telling, and Protection

In this ppt slide we will discuss about ethical dilemmas and below are the summaries point:- Mary, a victim of spousal violence, attempted suicide multiple times and her eldest child, Esther, confided in a school counselor. Child Protection Services (CPS) intervened, returning the children to Mary after her discharge, and proposed that Esther leave the marriage. Ethical dilemmas include confidentiality, truth-telling, and protecting Esther from harm while professionals aim for a permanent resolution.

Ethical Dilemmas
Presentation

The case study
 Mary aged 29 has 3 children, suffers from spousal violence.
She had contemplated divorce but never succeeded.
 Mary attempted to commit suicide many times last year.
 However, Esther, her eldest child gained confidence and
shared the situation with her school counselor.

The case study continuation
 The child protection service called Esther's mother for referral.
After Mary was discharged, she was given back the children.
 The CPS proposed to Esther that she came out of the marriage
since she already planed to divorce her husband who was a
drug addict and she agreed.
 When the CPS shared the information with the mother and
suggested they meet her husband, she denied and demanded
to know where the CPS has got the information

The dilemma
The picture below shows a family faced with a
domestic problem, however, the family also faces
dilemma issues in solving the problem.

Range of ethical dilemmas faced by health and social
health care professions
1. Confidentiality
 Everyone has the right to privacy, however, health professions
sometimes need to bypass the right to help the client.
 For example, in the above case study, the school counselor had
to know everything from Mary’s family to find a way of helping
the family.
 Mary is disappointed on how these people got the information.
The social workers always have the challenge whether to make
the information confident yet they have not solved the situation.

2. Truth telling
 In this dilemma, the health workers find it challenging to
tell the client the truth for them to resolve the situation.
 In the case of Mary, her child Esther had told the school
counselor the truth about the situation but the challenging
issue is that, they have to confirm the statement from the
mother to get a way of solving it.
 However, Mary denies the information and demand to
know the source of the information.

3. Protection from harm
• Esther who is one of the children to Mary have revealed
crucial information about their situation in the family to the
school counselor, however, the counselor need to protect
her from harm because their mother do not want situation
to be known by everyone. As the nurses confront the
mother they also have the duty to protect Esther from the
harm (Mullen, Morris and Lord, 2017:p.50).

Two different course of action to the professionals
• What I think about the situation is that the proffesionals must
protect the children’s right in every situation. Considering the
above case study, the children are the most affected people in
this situation.
• The second thing is that the professionals must aim at bringing a
permanent resolution concerning the matter (Balcom, Kotzer,
Waltman,Kemppainen and Thomas, 2016:p.840). Even if it is a
matter of bypassing the confidentiality but they have arrived at a
conclusion that will save the lives of the family members of
Mary.

Analyzing the dilemmas and bad practice
 Various situation put nurses in dilemma, these situation
may lead to bad practice.
 It is important to ensure respect to everyone and the
privacy of that individual.
 It would be a bad practice for the school counselor to start
leaking information they got from Esther to third party.
 There is also the risk of more abuse is the professionals tell
Esther’s mother that Esther was the one who told them
everything concerning the family situation.

Ethical justification
 Integrity is the best way to justify that one has certain level of ethics.
 Mary had risked taking her life and that of the children. What the
counsellor should ensure is to tell Mary the truth, that it is high time
for her to save the family.
 All the children are suffering because of depression and threats that
she constantly give.
 Another important step is to try and connect the family with the
husband without informing him everything that Esther had told the
counsellor. The step will save the family from future quarrels (Alku
and Varmus, 2018: p.28).

continuation
 Professionals handle crucial cases from different families.
However what will prove one’s ethics is how he or she can
maintain confidentiality and integrity in his or her role.
 There is challenge of approaching the victims with the truth
but it is crucial.
 The case of Mary’s family, she may have killed all the
children but the role of the counsellor have help to save the
life. The counsellor should not reveal to Mary that Esther is
the source of the information.

References
• Alku, D. and Varmus, H., 2018. Ethical Dilemmas of Precision
Medicine.
• Balcom, J.R., Kotzer, K.E., Waltman, L.A., Kemppainen, J.L.
and Thomas, B.C., 2016. The genetic counselor’s role in
managing ethical dilemmas arising in the laboratory
setting. Journal of genetic counseling, 25(5), pp.838-854
• Mullen, P.R., Morris, C. and Lord, M., 2017. The experience
of ethical dilemmas, burnout, and stress among practicing
counselors. Counseling and Values, 62(1), pp.37-56.