Fulfilling Legal and Ethical Responsibilities

Health administrators can be faced with a range of legal and ethical issues throughout their practice. In the case of legal issues, the health administrators’ course of action is usually clear – they are required to comply with their legal requirements. However, in the case of ethical requirements, the ‘right’ course of action isn’t always as clear because there can be conflicts between different ethical principles and/or practices. While there are a wide range of potential ethical dilemmas that an allied health worker might face throughout their career, we will explore a few of the most common within the context of health administration. 

Managing Conflicts Between Different Responsibilities and Client Rights

One common ethical dilemma occurs when there is a conflict between a health administrator’s duty of care to prevent harm from occurring to the client or another person and their responsibility to protect client confidentiality. For example, what should a health administrator or allied health professional do if a client tells them that they intend on harming another person? What about if the client says that they intend to harm themselves? In these situations, should the health administrator protect the client’s confidentiality and autonomy, or should they take action to warn the person the client intends on harming or take action to prevent the client from harming themselves? These are considered ethical dilemmas because in these situations the health administrator has conflicting ethical responsibilities. While these are extreme examples, that occur more often in professions such as counselling and social work, they should still be considered as any contact with individuals in a confidential manner can produce such dilemmas. 

Health administrators may face a similar ethical dilemma if clients were to tell them that they intend on engaging in risky behaviours like drug use. In these situations, do health administrators have a duty of care to prevent harm to the client? Does this responsibility override the client’s right to autonomy? The concept of duty of care is often tied up with the concept of dignity of risk. Dignity of risk is often used in disability services and the mental health sector, and it essentially refers to the concept that clients have a right to make their own decisions regarding risk to allow them to experience life fully. The goal of this principle is to emphasise personal choice and self-determination. This corresponds to the general ethical consideration of promoting client autonomy. However, the question then arises as to at what point a health administrator’s duty to prevent harm necessitates intervention. This is where ethical decision making comes in. 

While there are several different approaches to ethical decision making, they all involve the worker fully considering various options in line with legal, ethical, and organisational responsibilities, before selecting the most appropriate course of action to take. Proctor proposes a simple four-step model of ethical decision making:

Corey, Corey, Corey, and Callanan (2015) suggest this process for ethical decision-making:

1. Identify the problem or dilemma: Gather all relevant information, clarify the nature of the issue, and look at it from multiple perspectives.
2. Identify the potential issues involved: Fully consider the context, including the rights, responsibilities, and welfare of all involved.
3. Review relevant ethical codes: Consult the codes and standards of the organisation and the profession to determine whether they offer guidance and what that guidance is.
4. Know the applicable laws and regulations: Consider all relevant legislation and organi-sational policies; determine whether they guide actions to be taken in such a situation.
5. Obtain consultation: Consult with colleagues and supervisors to gain the benefit of their perspectives, experience, and expertise, and to extend your understanding of relevant factors.
6. Consider possible and probable courses of action: Brainstorm as many potentially viable solutions to the dilemma as you can.
7. Enumerate the consequences of various decisions: Consider the probable outcomes, risks, and benefits of the various solutions. It is important to consider your legal and ethical responsibilities as you do so.
8. Determine what appears to be the best course of action: Carefully review everything, select a course of action (in consultation with your supervisor), and enact it.

As you read through each of these models, take some time to reflect upon what they have in common – the concept of the importance of carefully considering a full range of information before deciding how to proceed. This is fundamental to effective ethical decision making. Health administrators should not make ‘snap decisions’ when faced with an ethical dilemma. Additionally, they should not make their decisions alone. Health administrators should discuss all ethical dilemmas with a supervisor, always refer to the allied health professional, and obtain guidance when determining the most appropriate course of action. 

Managing Boundaries

In the previous section of this module you learned about the importance of maintaining appropriate practitioner-client boundaries. Boundaries are another common source of ethical dilemmas. For example, what should an allied health assistant do if a client were to give them a small gift and the allied health assistant believes that turning this down could damage the clients trust or relationship with the allied health organisation, individual, or team? What about a long-term client inviting an allied health assistant to an award n ceremony because they feel that the progress they made in physiotherapy, for instance, was instrumental in their achievement? ? What about an allied health assistant in a small town who is likely to see their clients about town and, as a result, be exposed to relationships that blur the strictly professional line (often referred to as dual relationships)?

Health administrators need to engage in ethical decision-making processes to decide upon appropriate actions to manage potential boundary issues. They should consider the following sorts of questions used in counselling practice where dual boundaries are a much more prevalent concern as part of the ethical decision-making process. They also need to discuss these issues during supervision, to make sure the issue is considered thoroughly.

• Is the dual relationship necessary? While you should ideally choose to avoid dual-role relationships, such a relationship may be necessary in some cases.
• Is the dual relationship exploitive? If the relationship would in any way exploit the client, then it is unethical and should not be entered into.
• Who does this dual relationship benefit? Dual relationships may be appropriate if they benefit the client but are generally unethical if they only benefit the professional.
• Is there a risk that the dual relationship could harm the client? As part of their decision-making processes, you should consider if such a relationship could harm the client.
• Is there a risk that the dual relationship could disrupt the therapeutic alliance? Similarly, you must consider if the dual relationship would damage the existing therapeutic alliance and take all reasonable steps to minimise harm.
• Am I being objective in my evaluation of this matter? You should be objective in your evaluation and decision-making. Conferring with professional supervisors is a common way to promote objective decision making.
• Does the client give informed consent regarding the risks in engaging in the dual relationship? It is vital to discuss the possible consequences of dual-role relationships with the client and gain informed consent.

^{(Younggren, 2002)}

Conflicts of Interest

Another common ethical dilemma that can arise in allied health practice is conflicts of interest. According to the AAPM Code of Ethical Conduct, a conflict of interest occurs when “a member’s personal interests’ conflict with their responsibility to act in the best interests of AAPM, clients, colleagues, and other professionals”. Furthermore, they explain that personal interest, they are referring to “family, friends, or other organisations a person may be involved with (for example, as a consultant).” They also specify that a conflict of interest can arise between a member’s responsibilities to AAPM and another duty they may have at another organisation, for example. 

Conflicts of interest can occur when an allied health worker engages in dual relationships and boundary violations. For example, it would be a conflict of interest for a health administrator to accept a disgruntled ex-client, or an ex-partner, as a client. Another type of conflict of interest that can arise occurs when a health administrator is in a position to receive personal or financial benefits based upon decisions made in treatment.  

A conflict of interest can be actual, potential, or perceived and could result in risks to reputation, transparency, accountability, governance, and law. Health administrators should always be mindful of the potential for conflicts of interest to occur. Health administrators should tread carefully when determining whether something would be considered a conflict of interest or dual relationship because, even if you may be clear on where the boundaries are within that relationship, it may not be clear to others. This is where favouritism and power differences, whether perceived or actual can come into play. When a conflict of interest does arise, health administrators will need to discuss the issue with their supervisor to determine the most appropriate actions to take. If a health administrator is ever unsure if something is a conflict of interest, they should discuss the situation with a supervisor or allied health professional to allow an independent third party to make a decision.

 It is essential that when a conflict of interest is identified, steps are taken to address the situation promptly and in accordance with all relevant ethical and organisational requirements. In many cases, organisations have specific policies and procedures in place to manage conflicts of interest. These typically involve the same general requirements, including:
•    Conflicts of interest should be avoided wherever they are foreseeable. 
•    If a conflict does occur, then it must be disclosed immediately. This typically involves raising the matter with their supervisor or manager, who decides upon the next steps based on the specific situation and the organisation’s policies and procedures. 
•    The supervisor or manager will provide guidance about how the conflict or situation should be handled; these instructions must be actioned by the health administrator.
•    All decisions and actions are documented. 

These steps promote the appropriate handling of conflicts of interest and that the decision making surrounding them is documented. This helps protect the health administrator and the organisation in the event of future legal or ethical complaints. 

Managing Values Conflict

Another area of ethical practice involves the health administrator managing their own personal values and engaging in non-judgemental practice.

Every individual has their own personal values that they hold dear. These values help shape the decisions people make, the way in which they do their work, and their interactions with clients. However, health administrators, and anyone working in allied health and helping professions, are required to minimise the impact that their personal values have on the treatment process and provide non-judgemental practice. This is not as simple as it sounds. Health administrators need to develop their self-awareness and monitor their attitudes throughout practice. It is important for health administrators to continually monitor themselves and become adept at reading their own emotional reactions in order to prevent these from impacting on the practitioner-client relationship. 

If, as a health administrator, you ever identify that you are imposing your own values on a client or judging a client from your own frame of reference then you will need to address this. Some of the steps that you can take include:
•    As soon as you are aware of issue take a mental step back and seek to better understand and work within the client’s own value system rather than your own.
•    Consciously consider the professional values of allied health practice and carefully frame your interactions around these values.
•    Continually monitor interactions with the client: maintain a non-judgemental approach, foster self-determination, be respectful, and prioritise the client’s interests.
•    Discuss the situation with your supervisor so that they can also carefully monitor your practice.  
•    If you find that you are not able to be respectful and objective or if you find yourself imposing your own values upon your client, then you should consider making arrangements to refer the client to another health administrator – it will be important to discuss this with your supervisor. If your supervisor agrees that this is the most appropriate action to take, then they will also help you decide upon the most appropriate way to discuss this with the client. 

Ultimately, health administrators have an ethical responsibility to take all appropriate steps to manage any values conflicts that occur. 

Recognising and Addressing Legal and Ethical Breaches

So far, we have discussed how to avoid unethical conduct and how to handle potential ethical di-lemmas that a health administrator might face. While each health administrator has a responsibility to conform to their legal and ethical requirements, they also have a responsibility to recognise and appropriately address any breaches that they observe. If a health administrator becomes aware of any unethical conduct, they have a responsibility to act on this information by following their organisation’s policies and procedures for such situations. In most cases this will involve reporting the matter immediately to the supervisor or manager (either verbally or in writing). From there it will be important to accurately document what has occurred (e.g., what was observed or heard) and to cooperate with management as they investigate the matter.  

In some cases, health administrators may also identify improvements that can be made to organisational policies and procedures to support legal and ethical compliance. In such cases, they should pro-actively share their thoughts with their colleagues and supervisors. 

Organisational policies and procedures should be regularly reviewed and updated to reflect current legislation and standards of practice. Typically, organisational management should ensure that policies and procedures are reviewed:
•    When there is a change in legal or ethical requirements (e.g., updates to acts, codes of conduct, ethics or practice, standards of practice).
•    As new guidelines and evidence on best practice emerge.
•    When incidents are occurring that indicate the policy is not working. For example, clients are submitting complaints about confidentiality violations created by a particular service process.  
•    Regularly as part of the organisation’s annual review and planning.

Most organisations will have committees made up of management representatives and workers to regularly review policies and procedures. However, it is every worker’s responsibility to contribute to this process. You can do this by:
•    Being familiar with current policies and procedures and being willing to make suggestions and contribute to the discussion. 
•    Pro-actively sharing feedback with colleagues and supervisors. When you have dealt with a legal or ethical issue, share your experience and lessons learned with colleagues and super-visors. You can also work with the organisation’s management to review and improve their protocols and procedures to reflect legal and ethical responsibilities. 
•    Keeping up to date with current best practice through continuing professional education and sharing your knowledge with management and work colleagues. 
•    Involving clients and other stakeholders in the consultation process. 
•    Participating in committees and meetings set up to review policies and protocols. 
•    Completing employee feedback forms.

If a health administrator ever observed a situation in which policies, procedures, or work practices could be improved to better meet legal and ethical requirements, it is their responsibility to share this information. This might involve discussing the matter directly with a colleague, raising the issue with a super-visor/manager, or completing an employee feedback form.

Let’s look at an example of how a health administrator can identify a problematic work practice and contribute to the review of policies and procedures to help improve their organisation’s compliance.

A Note on An Allied Health Administrator's Rights

Throughout this Study Guide the focus has been on the rights of clients and the responsibilities that a health administrator has to their clients. However, it is important to note that health administrators also have rights that should be protected by their organisations. For example, you briefly learned about an organisation’s responsibility to provide a safe working environment when you learned about WHS requirements. As a health administrator, if you are ever concerned about your own, your colleagues’, or your client’s safety, you should raise this issue with management and take appropriate steps to contribute to the improvement of WHS policies and procedures.  

A key piece of industrial relations legislation that is designed to protect workers in Australia is the Fair Work Act 2009. This act sets out national statutory requirements and obligations related to areas such as workplace rights, discrimination and unfair dismissal, and employee entitlements. As a health administrator, you should be aware of your rights under this legislation and promote compliance within your workplace. If you identify any breaches of your own or your colleagues’ rights, you should raise this matter with your organisation’s management or discuss the matter with the Fair Work Ombudsman. Protecting your own rights as an employee helps to contribute to overall organisational compliance and to safe, effective, and professional allied health services.

Health administrators have other rights too, even if they aren’t clearly stated in the Fair Work Act or WHS legislation and regulations. Some of these rights are protected by legislation; some are not but are generally agreed upon within the professional community. Some require others to do (or not do) something; for others, health administrators will have to organise for themselves. These rights include:
•    The right to be treated with respect by employers and co-workers.
•    The right to being free from violence and abuse from any source, including clients.
•    The right to be protected from discrimination.
•    The right to ‘leave work at work’ (e.g., not being expected to answer calls or do other work outside of stated working hours).
•    The right to regular breaks in work, such as snack and meal breaks.
•    The right to take time off for personal care, family reasons, and holidays.
•    The right to support in their professional lives (e.g., supervision, debriefing).
•    The right to support in their personal lives (e.g., personal counselling, health care).

Remember, as a human being, you have all the same rights as everyone else, and your wellbeing is just as important as anyone else’s. 

Throughout this module you have learned about the key legal and ethical requirements of effective health administration. However, it is important to understand that this module has only provided you with a broad overview of the legal and ethical requirements of a health administrator. As you progress in your career as a health administrator you must continue to develop your skills and knowledge to maintain effective, professional, and compliant service delivery.

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Australian Association of Practice Management Ltd (AAPM). (2022). Code of Ethical Conduct. 2nd Ed. https://www.aapm.org.au/Portals/1/AAPM%20Code%20of%20Ethical%20Conduct_FINAL_12OCT22.pdf 

Corey, G., Corey. M., Corey, C., & Callanan. P. (2015). Issues and ethics in the helping professions (9th ed.). Boston, MA: Thomson Brooks/Cole.

Manatova. M., & Metcalfe, N. H. (2022). Professional boundary violations in primary care. Sage Journals. 15(5), pp. 301-306. https://doi.org/10.1177/17557380221080187 

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Proctor, G. (2014). Values and ethics in counselling and psychotherapy. London, UK: Sage.

Younggren, J. (2002). Ethical decision-making and dual relationships. Retrieved from http://www.kspope.com/dual/younggren.php