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It is obvious from the case that the year-long therapy has no significant positive effect on the patients mental health. Moreover, the addition of a previously unknown therapist and thus untreated eating disorder also poses an acute issue. As the patients case manager, I would advise them to consult with several other therapists who use different methods than the one they are currently working with and choose a new specialist from them. This relates to the principles of beneficence and honesty, as the methods of the current therapist the client is visiting obviously are not effective, and they cost the client their time and money. Juujärvi et al. (2019) add that the ethic of care nurtures good patienthealthcare professional relationships, while the ethic of justice is needed to address the fair delivery of care . As an honest and autonomous professional, I have the ethical duty to explain this to the client and refer them to another therapist.
Despite the clients condition, the decision to change their therapist will still be up to them, as perhaps they may not feel comfortable enough to go to other professionals. In this case, the principle of nonmaleficence should be applied: I cannot pressure the client into a situation that would be harmful to their mental state, especially in their vulnerable condition. However, I must also apply the principle of justice and educate the client on every treatment option they have. Additionally, I may not imply in any way that their current therapist lacks the skill or knowledge to help them. I should merely explain to the patient that, perhaps, the therapists methods are not suitable for them and that it is not there or the professionals fault they are getting worse. There, the ethical principles of fidelity and honesty apply.
It is understandable that people may react inadequately while exposed to a multitude of stress factors for long periods of time. I think that it is my ethical duty of fidelity to express empathy toward the client and work with her on improving the situation. According to Schuchter and Heller (2017), this implies the consistent consideration of the affected persons view, as well as the search for a level of communication which does not put anyone in an inferior position . It would be my legal duty to report the case of abuse to the child protection authorities. However, I do not think it would be ethical to do so after only one incident, as it would breach the principles of justice and non-maleficence.
Seeing as I know that she is a good mother under a lot of stress and that she has very little financial support, I understand that she did not abuse her son with malicious intent. Thus, I can conclude that if child protection authorities were to take her son from the client, it would bring more harm to both the client and her child than good. Still, as an autonomous professional, I would ask her to discuss the issue with a professional therapist to work out a peaceful solution to it, as it is still not normal to abuse a child. This decision applies to the principles of honesty, beneficence, and fidelity. I should truthfully explain to the client the possible consequences if she abuses her son again in the future. I should also tell her that it would be beneficial for her to attend therapy to learn how to cope with stress healthily. This will also help me resolve my inner conflict with the situation, where I am legally obliged to report abuse but cannot do it ethically. If the client agrees to go to therapy, I will know that the situation will have little chance of repeating itself in the future. Thus, I will be able to trust my client with her treatment of her son.
References
Juujärvi, S., Ronkainen, K., & Silvennoinen, P. (2019). The ethics of care and justice in primary nursing of older patients. Clinical Ethics, 14(4), 187194. Web.
Schuchter, P., & Heller, A. (2017). The care dialog: The ethics of care approach and its importance for clinical ethics consultation. Medicine, Health Care and Philosophy, 21(1), 5162. Web.
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