In the selected scenario, a therapy patient is beginning to develop a trusting relationship with his therapist after spending a fir amount of time dealing with his depression. Under-employed and under-insured, it is clear that the patient still needs help but it is less clear that he has the necessary resources to continue paying for his therapy. Insurance payments could be guaranteed by embellishing his mental condition slightly, thus allowing the therapist to receive payment and providing the care needed, but is this proper? This paper will apply the fourteen steps in the ethical decision making process to derive an answer.
The basic situation of the ethical dilemma is whether or not it is ethically proper to report a more serious mental condition to the patient's insurance company in order to keep receiving payment for services he clearly needs. In other words, is it alright to lie in order to get help for someone; do the ends justify the mean?
Step 2: The effects of a decision in this case will be far more far-reaching than might initially be thought. In addition to affecting the patient, the therapist, and the insurance company, trends in the over-reporting of certain mental conditions simply for insurance purposes could lead to much larger if subtle problems for the insurance and mental health industries and society as a whole. On the other hand, consistently failing to provide necessary care due to lack of payment abilities will also have far-reaching consequences for all parties concerned.
Step 3: There are multiple clients in this scenario, which is part of the reason the ethical dilemma is so complex. The patient is clearly the primary client, however the insurance company is in some ways a client of the therapists as well -- they have a contract (explicit or implicit) in which the therapist is held to the honest performance of his duties in regards to making insurance claims/billing.
Step 4: Knowledge in this area likewise comes in several spheres, and thus the levels of expertise and the amounts of missing knowledge that impact the various areas of this dilemma vary considerably. It is without a doubt that continuing to receive treatment is in the best interests of the client and that continuing to be compensated for services is in the interest of the therapist, and it is likely that the funds from insurance can be disbursed without significant impact to the insurance company. More knowledge is needed in to the financial aspects of the case, but therapeutic knowledge and skills cannot be expanded much in a manner that would have a real impact on this scenario.
Step 5: Formal ethical standards also differ in their commentary on this case, sometimes in mutually exclusive manners. The tenets of a utilitarian ethical viewpoint would likely suggest embellishing the mental condition in order to keep providing services to the patient, as this would provide the greatest good without causing any noticeable harm (or arguably any harm at all) to the insurance company. Professional ethical standards, however, as well as other ethical systems, would insist that this type of dishonesty is never warranted, no matter what the outcome is expected to be.
Step 6: The relevant legal standards are fairly straightforward in this case: while therapists are bound to provide the best possible care they can for their patients, falsifying information regarding a mental condition is unquestionably illegal. No matter what the reasoning, the therapist would certainly be found guilty of an infraction if the "embellishment "came to be known by relevant parties.
Step 7: Research in this area exists, but is not necessarily especially relevant. The damage that can be done to individuals society by not treating depression is certainly extensive, but placing increased burdens on insurance companies and the health industry for services that are unnecessary or that cannot be paid for also creates problems (and the insurance company decides what is "necessary" based on what the patient can pay for the insurance). None of this impacts the decision of whether or not the ends justify the means in this case.
Step 8: There is a clear self-interest on the part of the therapist in both decisions that can be made in this scenario -- embellishing the condition has a direct monetary benefit for the therapist, allowing…