Ethical decision making in organizational contexts

Ethical Decision

Ethical Dilemma and Decision Making

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 him/her to continue receiving payment for services form this client. Getting caught doing this could be hugely detrimental to the therapists career, on the other hand, and avoiding such retribution would also be in the therapist's best interests.

Step 9: Cultural values will necessarily impact the ultimate decision made, and in some ways are directly causal in the creation of the dilemma -- modern society places an immense value on money and financial functions/actions, often at the expense of health/social unity/etc. The fact that payment for the treatment of depression is at issue is indicative of the cultural impact on this issue, yet this still does not address the question of whether or not the ends justify the means.

Step 10: Consultation should definitely be considered in this case, however there are certain complications and risks involved. The ethical dilemma then grows to encompass the person consulted -- they are now stuck in the same situation, as the advice they gives could have a direct impact on the decision made and the outcome of the situation, making the person consulted ethically responsible for the outcomes, as well. This also creates the potential risk of being reported for the embellishment, which would defeat the purpose and cause many practical issues for the therapist and all patients.

Step 11: The alternative courses of action in this scenario are very simple, assuming no additional information regarding the specifics of the case can be gathered/is needed: either no embellishment is made, in which case insurance stops paying and the therapist can either treat the patient for free or stop treating them altogether; or the embellishment is made and the therapist continues to treat the patient and collect payment for the services rendered, even though they will be billing for something slightly different.

Step 12: The best solution for parties not the therapist (i.e. The patient and the insurance company) would be for the therapist simply to treat the patient without any compensation, or with the minimal compensation the patient himself can provide. This has many practical and some ethical problems, however, and could lead to long-term complications and problems for the therapist. Refusing treatment without payment is not at all desirable, as it could create problems for all parties -- ongoing depression could lead to the client losing all employment and their insurance plan. Embellishment is best for the therapist and client, but is inherently and unavoidably dishonest even if it doesn't cause undue harm to the insurance company.

Step 13: As the client, I would simply hope to continue treatment with my now-trusted therapist until such time as I truly feel I have shifted my overall mental state and am no longer experiencing the symptoms of depression. As the insurance company, I would be hoping to maintain proper levels of premium collection and payouts for services so as to remain profitable while providing needed care to all insurance members. As the therapist, my primary goal would be to help patients overcome their mental issues and conditions in order to lead happier and more productive lives, while providing for myself and my family at the same time.