The Doctrine of the Mean 中庸

Translated by A. Charles Muller

Consideration of any culturally relevant variables becomes important. If such factors as the degree of expected confidentiality, gift-giving traditions, bartering practices, geographic locale, placement of professional boundaries, gender, age, ethnicity, or culturally based expressive behaviors exhibited during therapy sessions play a part in an ethical matter, an inappropriate decision might result if culturally-based variables are not considered in the mix. Many proscribed acts are unethical no matter what the culturally relevant variables may be, but other instances can be influenced one way or the other depending on the cultural context. It is helpful to learn the fundamental values of cultures and religious orientations other than one’s own (see Houser, Wilczenski and Ham,2006) while avoiding the assumption that a specific client is going to reflect the same world view. Unwarranted and possibly poor decisions could follow from believing everyone from a certain culture or group is pretty much alike.

[Updated: 2016-02-24T18:10:28.118+09:00]

Because ethical decision-making involves a complicated process influenced by our own perceptions and values, we can usually benefit by seeking input from others. We suggest choosing consultants known in advance to have a strong commitment to the profession and a keen sensitivity to ethical matters. Choose a confidant with a forthright manner, and not an individual over whom you have advantaged status; otherwise, you may hear only what she thinks you want to hear. If you doubt a confidant's advice, seek a second opinion.

Except in those instances when the issues appear clear-cut, salient, and specifically defined by established guidelines, mental health professionals may well have differing opinions regarding the decision. Personality styles and primary guiding moral or religious principles can significantly influence the ethical decision-making process. Other personal characteristics influencing decisions include criteria used to assign innocence, blame, and responsibility; personal goals (including level of emotional involvement); a need to avoid censure; a need to control or for power; and the level of risk one is willing to undertake to get involved. Divergent decisions could also be reflected in judgments about the reprehensibility of a particular act. For example, no bright line demarcates the appropriate level of personal involvement with clients. Indeed, we have observed marked discrepancies about the seriousness of an alleged violation in actual ethics committee deliberations.


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Confidentiality rights must be assessed and protected throughout the decision-making process. In some cases, confidentiality issues may preclude taking any further steps.

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Early in the process you should also collect information from other involved parties as appropriate. Sometimes this step reveals a simple misunderstanding that led to an improper interpretation. Or, the new data may reveal the matter to be more grave than first suspected.

5. Confucius said: “What a pity! The way is not followed.”

Whenever relevant, attempt to identify the potential consequences of a decision. These include psychological and social costs; short-term, ongoing, and long-term effects; the time and effort necessary to implement the decision; any resource limitations; other risks, including the violation of individual rights; and any benefits. Consider any evidence that the various consequences or benefits resulting from each decision will actually occur. The ability to document this phase may also prove useful should others later question the rationale for your final decision and resulting action.

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Even after collecting data, the solution still may not become clear, and uncovered contradictions can sometimes cause more confusion than before the decision-making process started. Nevertheless, collecting relevant information constitutes a critical step that must be taken conscientiously. A disregard for extant policy or relevant ethical obligations may result in unwanted consequences for you or for a colleague.

(1) Treating my father as I expect my son to treat me.

If the above phases have been completed conscientiously – perhaps with the ongoing support of a consultant – a full informational display should now be available. Happily, a decision that also feels like the right thing to do may well become obvious at this point. Even so, many moral and just decisions do not always protect every involved person from some form of injury. Therefore, if anyone could suffer harm, pause to consider any actions that could minimize the damage. For example, if a therapist suspects that an out-of-control adult client might harm his child, the therapist may be legally required to file a report with the state’s child protection agency. Sometimes, a more positive outcome can occur with parental engagement rather than alienation, as depicted in the next case.