Today’s blog post is the third in our series on ethics, written by Dana Katz, who holds the ethics portfolio on SAISI’s board.

What is an Ethical Dilemma?

At one time or another, we will all find ourselves in a bit of a pickle, having to make a difficult decision about a client or a situation that arises. This can be with regards to resources, therapy, colleagues, billing or any number of issues. We find ourselves stuck and not knowing what to do. How do we what is right, what isthe right thing to do?

An ethical dilemma exists when no single good solution can be found. It may be a conflict of “goods”. It may be a situation in which there are often a few solutions, none of which appear to be the ideal solution though. So what do we do?

An ethical dilemma can be characterized by:

  • Uncertainty – which moral or ethical principles do we apply
  • Distress – Knowing the right action but feeling constrained to act
  • Dilemma – Facing two or more alternatives, i.e. having two possible ethical principles that are in conflict with one another

An ethical dilemma may occur in practice in any of (but not limited to) the following instances:

  • Where a conflict of interests exists:

A conflict of interest occurs when a therapist’s personal interests or concerns are inconsistent with the best interests of the child/client. If a therapist receives any unearned benefit, a conflict of interest may be suspected.

It is important to be aware of personal relationships with clients or parents of clients. It can be rather challenging to identify conflicts of interests in these instances as we can become emotionally involved with the family or the child. In these instances or when family or friends are treated, one needs to be very aware of a personal bias influencing one’s actions, clinical reasoning or decision making.

Any time that a pattern of preference emerges that cannot be ethically explained, a conflict of interest may exist.

Conflict of interest can also include:

  • Giving or receiving any compensation, gift, reward, or gratuity from any source other than payment made for professional services provided to clients
  • Disclosing confidential information gained because of the therapist’s position, or otherwise using confidential information for personal gain or benefit.
  • When deciding whether to withhold / withdraw treatment.
  • When an invasion of privacy/breach of confidentiality occurs in team information sharing, especially in the school setting. Confidentiality and informed consent are of the utmost importance here.
  • Where resource allocation is challenging / limited or resources are shared – more specifically noted in a hospital or clinic setting – who gets what?
  • When a therapist’s personal views, morals or values are in conflict with their professional obligation/commitments.
  • When there is conflict between a client’s / parents’ request and what you believe to be required/best practice in the therapeutic process.
  • When there is conflict in deciding which treatment methodology/approach is best for a child.

How do we solve an ethical dilemma if it arises?

In order to solve an ethical dilemma one has to look at the problem systematically and objectively. It is often valuable to get someone who is not personally or emotionally involved in the situation to help with the process. There are various ethical approaches that represent ways in which we can evaluate situations, make decisions and ensure that we follow the most ethical course of action. Some of the more common approaches are described below.

The Utilitarian Approach

When using this approach, the consequences of the therapist’s actions are carefully weighed up. It is based on the principle of common good – “what is best for the majority?” This is observed to be one of the most common approaches to ethical decision making. The best action here will be the one that does the most good and the least harm.

The Rights Approach

This notes that the best ethical action is one that protects the rights of the individual/s affected by the action. “Does the action respect or violate the moral rights of the client?”

In order to ensure that we are protecting the rights of a child or their family, we can review the following documents:

  • UN convention on the Rights of the Child
  • Human Rights Charters
  • Patients’ Rights Charters

The Deontological Approach

This approach is non-consequential /duty based, i.e. it is about doing(or not doing)or basing your decision, on what is universally believed to be right and not about the consequences of our actions.  It states that is our duty to do good – having the correct intention when performing the action is what counts in this approach. Here the ethical action is taken because it is our obligation to perform the action based on rules or principles that apply. It follows rules of behaviour that are not contradicted by reason.

The Virtue Based Approach

This approach is agent centered, it asks the question “What kind of person should I be? It is concerned with one’s whole life and states that ethical actions should be consistent with human virtues. It emphasizes people of good character / virtuous people –it upholds honesty, faithfulness, courage, integrity etc. This approach values role models to support our understanding of ethical deliberation.


Models of Decision Making

There are a number of models that can be found to help us to think clearly about the process of making an ethical decision. We need to ensure that we have all the relevant information, clinical facts, wishes of the client etc. clearly stated. We need to ensure that we understand the legal perspective if required. We need to ensure that all stakeholders’ views are represented. We need to explore alternatives and look critically at the outcomes of our actions, evaluate the impact and only then make a decision that we can comfortably stand by.



Attached is a worksheet that will help you work through this process when you are faced with an ethical dilemma.  Take it slowly, step by step, then put it aside and have another look at a later stage with a clear head.  Click here to access the pdf.