At various times I’ve heard some wisenheimer or another say that “everything good is either illegal, immoral or fattening.” I’m not going to contest that (cause I know what good was in those instances and, yeah, those things were those – more or less.) No, what I’m talking about here is the accusations leveled at practitioners by patients (though never at me, of course,) sometimes by practitioners at patients, and other times by patients and/or practitioners at insurers or other third party payers. Confused yet? Don’t worry. It’s like what Bohr said of quantum mechanics. If you’re not getting a headache you don’t understand it. Wait, there’s more. Most of the time people are using those words incorrectly! Often when someone says something is “unethical” he really means “unprofessional” or “illegal” (maybe even “immoral” but rarely, if ever “fattening.”) Often “unprofessional” is used to mean “I don’t agree with or like what you’re doing,” which may be illegal or unethical (by some set of standards somewhere) or may just be that you believe you were treated “unfairly,” which probably has nothing to do with “unethical, unprofessional” or “illegal.” What’s the difference between unethical, illegal, and unprofessional? That’s where I’m going. I’ll leave immoral and fattening up to those better qualified. Ready? Deep breath and here we go.
Unethical: thorny issue to start off with because, some will say, it depends on whose view of ethics you espouse: Aristotle’s or Kant’s. Kant takes a more utilitarian view to arrive at ethical decisions that Aristotle, but let’s leave that aside for now. Maybe for this whole post. For a working definition let’s describe ethics as values put into action. It’s about doing that which is right because it’s right, not because the law says so or some written code of behavior says so. Ethical behavior may be congruent with the law or the code, but it might not. Let’s leave the definition there.
Unprofessional: this means that a practitioner is not behaving according to his or her profession’s code of conduct, which is often referred to as a “code of ethics.” See where the confusion begins? An example of this is the National Association of Social Workers’ “Code of Ethics.” It’s not. It’s a written codex that describes the minimum expected behavior by a member of the Association. By being a member the practitioner has said that he/she subscribes (underwrites, agrees to be bound by) this code and will conduct him/herself accordingly. Violating this code isn’t necessarily “unethical” but it is “unprofessional.” An example would be showing up for work in an impaired state. The NASW code of ethics says this is a no-no. We can agree that this is bad form. Is it “unethical?” Probably, maybe, I don’t know, I’m not going to make that statement. What I will say is that it is “unprofessional” because it goes against the agreed upon code of conduct. An example of what’s not unprofessional is charging a patient for a missed session, which I spoke about in an earlier post (see how I did that?), or not extending a session because the patient arrived late and still charging the full fee to the patient (that’s also neither illegal nor unethical behavior,) yet these are two of the things that a patient is talking about when he says that the practitioner behaved “unprofessionally.”
“Illegal.” When I’d say that something was “illegal” my father would always respond “that’s a sick bird. You mean unlawful.” He might still say that, for all I know. I haven’t said anything was illegal around him in a while. The New Oxford American Dictionary that came with my Amazon Kindle ™ says that illegal is an “adj. contrary to or forbidden by law, esp. criminal law: illegal drugs,” whereas unlawful is also an adjective but means “not conforming to, permitted by, or recognized by law or rules: the use of unlawful violence; they claimed the ban was unlawful.” Seems like we’re splitting a blond hair here and it doesn’t matter for our purposes. Illegal or unlawful would be doing something that is not allowed, such as having a phone session with a client who is in another state in which the practitioner has no license and/or using claim code 90806 (45-50 minutes face-to-face psychotherapy) to charge the session to the insurance company. That’s where this gets thorny because:
It’s not necessarily unprofessional or unethical to have the phone session with the patient who is out of state if the patient has moved and is seeking other help, is in transition and still wants psychotherapy. To say that I can’t help her is abandoning her, even though the law says, depending on the state, I have to have a license in the state in which the service is delivered. I can’t ethically abandon a patient who is “in pain.” Some states say it’s OK, most don’t. What do I do? Act ethically or obey the law. My “code of ethics,” the code of professional behavior doesn’t necessarily help because it will tell me to do both or to follow the nobler path (which is exactly what?) No matter which I do I’m being “unprofessional.”
This is getting long & I’m forgetting where we came in. Oh yeah: the things that patients claim we are when they are unhappy with what we’ve done. No matter what we do, someone is liable to be unhappy about it and use some word to say that what we’ve done is a violation of some principle or other. Maybe it was. Most likely it wasn’t. If it was he or she is probably using the wrong word or principle. It’s more important to me to know why the claim is made than to put the claim into the right category. What’s behind it. What does my patient perceive, not is the perception in the right realm. Repair, not correct (at least for now.) As long as my patient is still in the room there’s still the possibility of treatment going on, right? If he leaves he may not come back.
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