Ethical Principles of Health and Disease - Essay Example

Running head: Contemporary Ethical Concerns in Psychology Contemporary Ethical Concerns in Psychology By _____________________ Ethical principles of health and disease refer to those physical problems that are entirely the result of direct physiological processes in the body such as chemical changes, infections or injuries. According to this view which is still held by a portion of the medical establishment today, the mind is seem to have little or no role to play in the physical health of the body. In contrast the health psychology perspective sees the mind and the body as being closely linked and in constant communication. (Rapee M. Ronald, 2001) In this way the mind has a major role to play in influencing the health of the body. An even stronger view sees no difference between mental and physical processes, and the body and brain are seen to be in constant interplay. As a result, one important method of improving health is to work through behavioral and psychological changes. Fighting AIDS As part of the psychological concerns to research upon the principles to fight AIDS, the blurring of distinctions between basic and applied research has characterized the emergence of health psychology, community psychology, and other newer areas of behavioral science. This work typically has aspects of both psychological concerns, i.e., basic psychosocial and psycho physiological functioning, as well as provide a basis for intervention, care, and prevention. Studying AIDS processes and treatment upholds many psychological concerns behind it. (Baum & Temoshok, 1990, p. 13) While establishing the psychological impact of HIV, new psychological issues arise as treatment strategies evolve and the clinical picture and prognosis of the infection change. This change has given rise to hope that seems easy at the moment, but sustaining it over the longer term may prove more difficult. It is early days and we have only limited evidence of what the impact of the new anti-HIV treatments is on the psychological status of people living with HIV, and no doubt new research will become available in the near future, mapping out what is expected to be a more optimistic picture of the way people with HIV cope with their predicament. (Catalan, 1999, p. 21) HIV infection can lead to a wide range of mental health problems in individuals living with the infection, and in their partners, relatives and carers. Apart from the treatment of HIV and its complications by means of medical treatments, a variety of mental health interventions can be used to prevent or minimize mental health problems. Such interventions may include the use of medication with effects on mood or behaviour and the use of psychological approaches, from counselling to different forms of psychotherapy. Psychological and psychopharmacological interventions are not mutually exclusive, and they can usefully be given at the same time. Psychological and psychopharmacological interventions can be extremely effective and, contrary to popular but misguided opinion can contribute to the empowerment and increase in quality of life of people with HIV. Attitudes are changing, though, and it is good to see that publications aimed at people living with HIV promote a positive view of the need to recognize mental health problems, such as depression, and to seek effective help. Dual Relationships Several assumptions states that there is a continuation of myriad of views on many difficult ethical decisions; that is, that there are often reasonable arguments for and against different courses of action. This perspective can be lost in the trend toward more rigid ethical rules that attempt to simplify relationships through legislating the avoidance of dual relationships. Although the current code of ethics does not implement any ban on dual relationships in recognition of the diversity of social work practice. But still it emphasizes on social workers’ to avoid at their utmost not to indulge in any harmful secondary relationships with clients. As a result social workers bear the burden of proof that clients have not been harmed. If in this respect the code considers sexual relationships with clients or former clients to be unethical, it would not be wrong to say that the right decision has been imposed upon workers which includes the addition of a sexual relationship after a person which has been a client and treating current or former sexual partners. (Anderson & Boland, 2005) Treatment of Domestic Violence Domestic violence may occur between any of a family’s constituent elements, despite methodological difficulties in reporting and surveying, it is estimated to be most common between husbands and wives, and parents and children. Most often, victims are women or children. The psychological impact of domestic violence has been found to have parallels with the impact of torture and imprisonment on hostages. Experts in the field of domestic abuse and healthcare provision, generally agree that one of the challenges to improving the response to clients is the continued use by the professionals of a medical model of care framework. The violence and abuse are frequently reduced by the professional to a physical, psychological or mental health diagnosis and treatment, without due consideration given to the social and political location of violence. In effect, such an approach locates the ‘problem’ in the individuals sustaining the injuries or presenting with the ill-health aftermath of years of abuse. The clients are ‘treated’ according to their signs and symptoms and often left feeling as though either the problem is theirs, or alternatively that she or he is the problem. (Shipway, 2004, p. 92) Research has demonstrated conclusively that some women who have been abused later present with long-term physical health problems. Therefore, it is crucial that all health assessments recognize this important factor. Staff must recognize that a client who is, or has been, abused might currently be misusing alcohol or drugs. Consequently, this may further compromise their physical and psychological health, which is already being endangered by the partner abuse. Where staff have no readily available assessment instrument, it may be necessary to seek assistance in assessing the mental health status of the client. To ignore this situation could be to jeopardize the client’s current and future well-being. Risk of Self-Harm Research has shown that as a last resort some clients in abusive relationships attempt and often succeed in committing suicide. (Shipway, 2004, p. 92) Where the client appears to be depressed or suicidal or in any way mentally dysfunctional, the health professional must consider referral to a member of the mental health team for risk assessment. Risk to Children The potential harm that can occur to children in an abusive home can later take them towards different mental disorders like personality, anxiety, schizophrenia etc. Where the health professional has reasons to be concerned, the child health services should be made aware of the situation. Health organizations should have in place comprehensive practice guidelines related to the safety of children in homes where an adult is being abused. In addition, the American Medical Association (1995b) identifies the following common mental health disorders associated with family violence that can affect any member of the family: 1. Self-neglect, malnutrition, dehydration; failure-to-thrive in babies 2. Sleep disorders 3. Aggression towards self and others 4. Dissociate states 5. Repeated self-injury 6. Eating disorders 7. Compulsive sexual behaviours, sexual dysfunction 8. Poor adherence to medical recommendations. (Shipway, 2004, p. 92) Screening Mental Health Clients Mezey’s study (2001), in which she was establishing the existence and use of screening protocols for domestic violence in several healthcare settings, noticed that: ‘Reviewing the notes, the authors found that psychiatric patients or patients with a psychiatric history were significantly less likely to be screened than non-psychiatric patients, even though this group is arguably at particularly high risk’. (Mezey, 2001) This occurs despite the fact that it is known that victims of domestic violence have increased rates of depression, anxiety, post-traumatic stress disorder, and alcohol and substance misuse, as a consequence of the violence. Arguably, failure to undertake routine screening or carry out an appropriate risk assessment in mental health areas could be construed as negligence. Managed Mental Health Care Although it is clear that the new era in health care has had a powerful impact on professional psychology, not all of it has been negative. In what follows we identify some of the positive aspects of managed care. Managed care has forced mental health practitioners to examine the way they practice their profession. Although we expect that most psychologists act for the good of their patients, it is clear that the old fee-for-service system had incentives that were geared toward the provision of unnecessary services. The new system of care demands that providers be accountable for their treatment. Within today’s managed care environment, the psychologist’s decision to utilize psychological assessment and evaluation in clinical practice is predicated on at least two practical considerations: (a) Will the use of evaluation and testing lead to demonstrable differences in the length and effectiveness of treatment? (b) Will the MCO pay for it? Obviously, for the practicing psychologist, these questions are interrelated and can be viewed within the framework of cost-benefit analysis. Can the benefits of psychological testing and evaluation be shown empirically to outweigh the costs of these procedures? (Hersen & Kent, 2000, p. 10) Until the value of testing can be shown unequivocally, support and reimbursement for evaluation and testing will be uneven within MCOs and frequently based on the psychologist’s personal credibility and competence in justifying such expenditures. In the interim, it is incumbent on each psychologist to be aware of the goals and philosophy of the managed care industry, and to understand how the use of evaluation and testing with his or her patients not only is consistent with, but also helps to further, those goals. To the extent that these procedures can be shown to enhance the value of the managed care product by ensuring quality care and positive treatment outcome, to reduce treatment length without sacrificing that quality, to prevent over utilization of limited resources and services, and to enhance patient satisfaction with care, psychologists can expect to gain greater support for their unique testing skills from the managed care industry. (Hersen & Kent, 2000, p. 25) To survive and thrive in the managed care environment of the future, psychologists will need to locate new settings for practice, where the clinical need and demand for services is high, and where penetration by other qualified mental health providers is low. Technology The analysis of the use of both paper and screen-based records during the medical consultation also points to the ways in which video-based field studies of work and interaction may contribute to the design and development of new technologies. Although the original analyses of medical consultations were funded by the research councils and were not concerned with system design, but still there is a need for collaboration with system designers who are concerned with developing novel forms of support for workplace activities. The medical consultation is a particularly demanding case to consider the potential of various kinds of technology to support real-time, co present activities and interaction, the project involving the development of preliminary designs, assessment of potential solutions and the evaluation of particular prototype devices. (Luff, 2000, p. 87) The critical issues, which rise from this aspect, were: Firstly, the ways in which relevant medical information is entered and retrieved from the system resonates with the ways in which the information is used by practitioners during the consultation. Secondly doctors should be able to use the system during the consultation, and in particular in the course of listening to and talking with, the patient. The original study identified a number of problems with current technology and suggested ways in which these might be dealt with. (Luff, 2000, p. 87) The suggestions included the following: 1. The length of particular entries should be left to the doctor and not constrained by the system. It should be possible for doctors not only to provide discursive entries, but also to employ descriptive economics, even leaving out particular classes, when appropriate. 2. Diagnosis and treatment information should be presented together as a single entry and there should be no division between information concerning treatment for chronic and acute problems. 3. By presenting classes together it should be possible to omit classes of items within an entry, facilitating reading the entry as a whole. 4. It should be possible to scan or read an entry in relation to a series of entries and thereby formulate the career of particular illness. When made appropriate by the contents of related items, particular classes in an entry can be omitted. 5. The entries should be maintained in relation to a potential course of a treatment, i.e. in chronological order. It should be possible to easily read both a single entry, and a collection of entries, as a whole. Mapping these and other devices against the requirements led us to a more straightforward solution, utilising a mobile technology, a notepad computer, which preserved the general format of the medical record card whilst augmenting this with various computational capabilities. (Luff, 2000, p. 87) The principal focus of the technology, therefore, is not so much on maintaining a formally consistent document for various bureaucratic and financial purposes, but rather on giving doctors greater textual flexibility so that they can tailor the documents with regard to diagnostic and prognostic practicalities. Diagnostic and treatment information could be presented together and chronological entries could be read together, allowing doctors, where appropriate, to write concise entries and elide classes of items within entries. Conclusion Health psychology is a relatively new branch of psychology that aims to study different ways in which psychological factors can influence physical health. While studying AIDS and other related disorders we have analysed how our psychological and behavioural processes can have a direct and major impact on our physical health and how our physical health can sometimes influence our mental processes. References Anderson C. Sandra & Boland Kim, (2005) Teaching Ethical Decision Making Using Dual Relationship Principles as a Case Example’ in Journal of Social Work Education. 41(3) Baum Andrew & Temoshok Lydia, (1990) Psychosocial Perspectives on AIDS: Etiology, Prevention, and Treatment: Lawrence Erlbaum Associates: Hillsdale, NJ. Catalan Jose, (1999) Mental Health and HIV Infection: Psychological and Psychiatric Aspects UCL Press: London. Hersen Michel & Kent J. Alan, (2000) A Psychologist’s Proactive Guide to Managed Mental Health Care: Lawrence Erlbaum Associates: Mahwah, NJ. Luff Paul, (2000) Technology in Action: Cambridge University Press: Cambridge, England. Mezey, G., (2001) Domestic Violence in Health Settings in Current Opinion in Psychiatry, 14(6), pp. 543-7, Lippincott, Williams & Wilkins, London November 2001. Rapee M. Ronald, (2001). Health Psychology: Bond McConkey Shipway Lyn, (2004) Domestic Violence: A Handbook for Health Professionals: Routledge. New York. Read More