Clinical intervention can support important change for clients. It can be a profoundly life-altering experience for clients, families and for the many community touchpoints in our clients’ lives. Clinical work brings many ethical challenges as we work to create a safe space for our clients to engage with when confronting issues and to find courageous solutions in often difficult circumstances. Resource limitations and limited numbers of trained staff contribute to these challenges.
This toolkit arose from discussions with clinicians working in adverse global contexts in complex and fragile settings. A shared need was expressed for a collegial environment to discuss and debate ethical issues to ensure that we provide the best service and support for our clients.
This toolkit emerged from those conversations and is designed to encourage thought-provoking conversations in the global community of clinicians.
Ethical challenges can arise at many points in the clinical journey from the point of referral (ie is this the right service for this client at this time?) through to addressing cultural differences between therapist and client (ie what is clinical judgement and what is cultural difference?), through to deciding how and when to end clinical contact. There are also legacy effects of clinical work that endure beyond the end of contact – have we ensured that these are positive lasting effects?
This toolkit has prioritised 10 points on the clinical journey to scaffold ethical reflection and action:
1. Culture of the clinical setting
2. Creating a therapeutic environment
3. Creating a therapeutic relationship
4. Case formulation
5. Therapy/ Clinical Intervention
6. Monitoring and adapting
7. Maintenance of relationship with client(s)
8. Relationship with other key stakeholders
9. Ending of the intervention – planned and unplanned
10. Legacy effects of intervention
The 4P's ethical challenges and solutions
At each stage of the clinical journey, we consider four influences on ethical practice – we call these the 4P’s – Place, People, Principles and Precedents.
Who we are, where we practice, who our clients are important considerations in defining ethical practice. Professional regulations are likely to reflect local values. Local precedents can guide us to find successful solutions as well as to avoid pitfalls.
We hope you will find this toolkit useful in navigating the ethical challenges that arise in your local context.
