NURSES & PHARMACISTS | COUNSELORS | LVNs | DENTAL

all courses | accreditation | help | resources | about us | home

 Ethical Dilemmas: choosing between two rights

Welcome to this 3-contact-hour Continuing Education  course with instant online processing and certification 24/7.  Study the course below, take the 12-question multiple-choice TEST, register and pay online. If you score 75% or above, you may print your CE certificate on your printer as soon as you finish. If you have difficulty printing your certificate, click here.

"What is usually the right thing to do?" Consider the following four opinions.

"We cannot afford that much help."............"The more we give, the more we get"

"People should forgive people" ............................................... "We can never forgive the Nazis"   

To deal with ethical dilemmas, you need to find the answers to these questions:

1. How do you define a dilemma?        
2. What values are at stake in the dilemma?        
3. What principles are at stake in the dilemma?    
4. What personal issues are at stake in the dilemma?          
5. How will you solve the given 10 dilemmas?

1. How do you define a dilemma?

Since a dilemma deals with two possible rights, these two right choices must be clearly stated. Then the dilemma can move to a solution, where one of the rights is preferred over the other one. 

Determine the two sides of the dilemma. (__v. __)  Write the dilemma as "a. one view" versus "b. another view."

Analyzing dilemmas: Ethical dilemmas are termed in the form of  _____v. ______, such as Equality of workers v. Integrity of organization.  Many dilemmas are also written as dealing with : 

1.1 Primacy of the interests of one party over the other (client or group)
1.2 Distribution in one way or other (merit or equal share)
1.3 Obligation of one to another (duty, custom, legal obligation)
1.4 Responsibility to client, colleague, profession, employer, society etc.

Some cases may be also deal with
* Permanency v. physical safety
* Best interest of client v. obligation to do no harm, etc (or v. rights of others, benefits)
* Quality of life v. prolonging of life
* Client self-determination v. obligation to prevent harm
* Right to confidentiality v. autonomy
* Effectiveness of service v. client privacy

2. What values are at stake?

Explore the relevant values in the authorities literature of the case. Individuals may validate their basic ethical values from such sources as laws, social science research, and the Bible.   

Some of the issues concerning values are: 
2.1 The right or wrong of an action.
2.2 The acceptance, reputation or embarrassment of an action.
2.3 Qualification and disqualification of a person, with reasons.
2.4 Virtues such as integrity, love,  forgiveness, respect, purity, trust, sanctity of life.

3. What principles are at stake?

Select the relevant principles that apply to the case and explain the reasoning process that you used to arrive at a tentative solution. Some of the terms presented in the dilemma definitions in Section 1. also suggest principles that may be at stake.

Some relevant principle may be:
3.1 Protection of life etc.
3.2 Conflict avoidance
3.3 Greatest good of group, etc.
3.4 Truth telling
3.5 Acceptance of Biblical command
3.6 Accountability

4. What personal issues are at stake?

Consider what personal issues of people or populations may effect the outcome of the case to such an extend that a particular ethical position is required. Reconsider your tentative solution in light of the personal issues involved and suggest a final solution.

In some cases, the loyalty for one group takes precedence over the loyalty to another group. Some groups include the:
4.1 victim
4.2 family
4.3 employer
4.4 profession
4.5 community 

 5. How will you deal with these 10 cases?

Use each of the above four steps to analyze the following cases, describe your reasoning, and reach a solution. For an example of using a case worksheet, see www.learnwell.org/reality.htm. 

Case Worksheet. 1. Definition: a._________________ v. b.__________________________

2. Values for a_________________________________ b____________________________

3. Principles for a______________________________ b____________________________

4. Personal issues for a________________________ b_____________________________

5. Reasoning and solution:____________________________________________ circle a   b 

4.0 Two orphans: Two sisters, Ann (age 6) and Bev (14), who live in foster care must leave the place. They have very different problems, Ann is physically handicapped, Bev is mentally handicapped. Should the sisters be placed together or separately? (Case 1.2)

4.1 Wanting to die: Mrs. Klimov (age 33) wants to stop her difficult cancer treatment and wants to die. She has a ten-year old son, who can be taken care of by her mother. Her mother says she is too young to die and considers it suicide. She was named her daughter's Advance Directive (medical decision maker) and refuses to let her daughter stop the treatment. (Case 1.3)

4.2 Adoption: Mary (age 15) was adapted 12 years ago and now wants to know who her birth-parents are. The records are sealed. Her adopted parents do not want her to meet her extremely poor birth-parents for they feel that it will upset her too much and that she may want to leave them.  (Case 1.7)

4.3 Computer Records: To be more efficient, Pastor Jones places his confidential home visitation records on his officer computer. That will make record-keeping easier and he could visit more homes. While at present he is the only one with access to that computer, it would be easy for anyone to access the information when he is not in the office, that is usually unlocked. It could compromise the records. (Case 3.2)

4.4 Cultural Differences:  Mr. Kim has immigrated from Korea some 3 years ago and joins the Washington Writer's Society. He speaks and writes very good English but has many problems adopting to the rules of the Society, which seem very strange to him. All his practices are acceptable in Korea, but not in Washington. The Society is considering if it can keep Mr. Kim as member because his presence disrupts the Society. (Case 3.3)

4.5 Organizational Mission: Joe, age 25, comes to a social worker at JKM, an organization that serves and supports homosexuals. He requests help in becoming heterosexual. JKM does not have a program for that and does not advocate sexual-orientation changes. (Case 3.4)

4.6 Suicide: Bill, age 45, has been abused as a child and has recently lost his wife. He is very depressed and visits his only friend, a male nurse. He threatens suicide. His friend things that he will get over it and tries to motivate him to living. He could also commit him to a clinic for treatment.  Next day Bill commits suicide. (Case 4.1)

4.7 Family: Henry, age 95, is keen of mind but feeble, lives alone and wants to stay living alone. He sometimes falls, but has not injured himself seriously. His daughter is concerned and wants him to come live with her. He refuses to move. (Case 4.4)

4.8  Rape Report: Jane, age 16, was raped by a neighbor and comes to tell her teacher she trusts. She asks the teacher not to tell anyone about that. The teacher feels that reporting it to the police and the investigation may be worse than the rape itself. Reporting may also place Jane's life in danger.  (Case 4.9)

4.9 Tasha's Baby:  Tasha, age 23, is single and 3 month pregnant. She uses drugs that endanger her fetus. Her mother tries to persuade her to give up drugs. She refuses. She also refuses to go see a doctor for she feels that the doctor will make her feel bad about her drug-use. (Case 5.3) 

The above cases were adapted from Juliet Cassuto Rothman's From the Front Lines: Case Studies in Social Work Ethics, Allyn and Bacon, 1997.

Further Reading

ERIC_NO: ED413544, A Practitioner's Guide to Ethical Decision Making. by Forester-Miller, Holly; Davis, Thomas E., 1995
ABSTRACT: Counselors must make sound ethical decisions but, often, determining the appropriate course to take when confronted with a difficult ethical dilemma can be a challenge. This guide assists counselors in ethical decision making; it is presented as a supplement, and is to be used in conjunction with, the American Counseling Association (ACA) Code of Ethics and Standards of Practice. This practitioner's guide addresses principles that are globally valuable in ethical decision making and provides a model for professionals to utilize in their practice. It opens with a review of the five moral principles that are viewed by many as the cornerstone of ethical guidelines: autonomy, nonmaleficence, beneficence, justice, and fidelity. These principles provide an absolute against which counselors can explore an ethical dilemma, thereby gaining a better understanding of conflicting issues. A sequential, seven-step, ethical, decision-making model is presented next and comprises the following: (1) identify the problem; (2) apply the ACA Code of Ethics; (3) determine the nature and dimensions of the dilemma; (4) generate potential courses of action; (5) consider the potential consequences of all options and then determine a course of action; (6) evaluate the selected course of action; (7) implement this action. www.askeric.org 

ERIC_NO: ED334468, Resolving Ethical Dilemmas in the Workplace: A New Focus for Career Development. ERIC Digest No. 112., by Lankard, Bettina A., 1991
ABSTRACT: The diverse, multicultural population that constitutes today's work force faces ethical dilemmas on the job that bring pressures to protect their own or their company's interests, at the risk of losing their personal integrity. Employers and vocational and career development personnel are recognizing the need for decision-making and problem-solving skills that will facilitate negotiation and conflict resolution in the workplace. Conflicts arise between two or more personally held values, between personal values and those of another person or the organization, between principles and the need to achieve a desired outcome, and between two or more persons or groups to whom one has an obligation. The resolution of conflicts requires interpersonal and negotiation skills; the application of "employability skills" such as honesty, cooperation, and integrity; and the participation of all stakeholders in a situation. Ethics training should help employees (1) recognize which decisions involve ethics; (2) understand the values of all stakeholders; and (3) weigh the potential impact of various options on those values. As part of a career development curriculum, discussions and analyses of case studies, use of ethics committees and resource people, and training in critical thinking, conflict resolution, communication, group processes, and mediation skills can prepare students for the ethical dilemmas they may face in the workplace. www.askeric.org 

Ethics Glossary  Classic Texts in Ethics Ethics Connection - What is Ethics?   

12 Point Quiz

Study this web-site for 3 hours for an approved (RN-CEP 11430, MFT- PCE 39) 3-hours Continuing Education Certificate (0.3 CEUs).  Click here for the self-correcting test & online payment, and 2) receive your certificate immediately online. All is online, nothing by post-mail. 

Consider taking another LearnWell course.