ABSTRACT
Ethical principles clearly should inform all therapeutic practice. However, some situations and contexts present unique and especially challenging ethical problems for the practitioner. This is especially the case in working with patients with medical problems. Here, dilemmas can be related to the nature of the medical problems encountered. For example, in infectious diseases such as viral hepatitis or HIV where there is a risk of transmission, the therapist may have to deal with issues of secrecy, denial and the risk of possible harm to others. Furthermore, in conditions where the patient’s mental state may be altered, the therapist may have to assess the patient’s decision-making capabilities. Other challenges to ethical practice can occur where there is a requirement to work within multidisciplinary teams and where varying definitions of confidentiality apply or where there are different philosophies of and approaches to patient care. In medical settings, therapists are therefore required to address a wide range of ethical concerns, adding considerable complexity to their work but also adding an interesting challenge to the therapeutic task. In this chapter, we describe some of the main therapeutic challenges to working with medically ill patients and in healthcare settings, and offer some guidance to the practitioner for addressing some of these issues.
