While philosophers can argue at length about a definition, there is widespread agreement on what constitutes an ethical dilemma. The Oxford English Dictionary defines it as: “a situation in which a difficult choice has to be made between two courses of action, either of which entails transgressing a moral principle.” The vast majority of what people claim to be ethical dilemmas are not, because one of the choices of action is either overwhelmingly significant, or the choice is really dictated by common sense rather than any ethical conflict.
Some examples might help make it clear.
I have a client who I find sexually attractive. Should I enter into a relationship with them and have sex (almost certainly jeopardising their mental wellbeing) or simply continue to work with them? This isn’t an ethical dilemma. Regardless of what our codes etc say, sheer professional common sense says that it is wrong to enter into a sexual relationship with a client who is almost certainly vulnerable and so unable to make clear decisions. Equally, though, simply continuing to work with them is not an acceptable answer. Normal professional practice is that the first step is to take my feelings, and what they might represent, to supervision, and possibly personal therapy as well, while continuing to work with the client. This is my stuff, so to dump the client would not be ethical.
Another client bores me. I find myself drifting off as soon as they sit down. They could talk forever about subjects that have little bearing on their long-term well-being. What choices do I have? (1) Tell them that I don’t feel that I can help them and suggest that they find someone else. (2) Take my tendency to find them boring to supervision etc. (3) Challenge them on their behaviour? Personally, it would be (2) and (3). Surely this is common sense? If they are creating a smokescreen (whether consciously or unconsciously) then I am doing them the best service by making them aware of it and asking (subtly, of course) what they would like to do about it. I’ve had this happen a few times, and the clients have always thanked me for pointing it out, acknowledged that it is [or ‘might be’] a defence mechanism, and we’ve made far better progress from then onwards. Is there an ethical element to this? Well, yes, I must always do my best for my clients, but not really because the course of action is pretty clearly common sense.
So, can I think of ANY truly ethical dilemmas in counselling? Frankly, not many. There are plenty of examples of ‘ethical issues’ but very few ethical dilemmas. West (2002) puts forward several examples of ethical issues, though mainly concerned with the teaching/development of therapy rather than issues arising spontaneously in the relationship between the client and therapist.
REFERENCES
West, W. (2002). Some ethical dilemmas in counselling and counselling research. British Journal of Guidance & Counselling, 30(3), 261–268. https://doi.org/10.1080/0306988021000002308