Introduction

In the present-day healthcare setting, induced abortion is among common medical interventions. For instance, termination of unintended or unwanted pregnancies is legal in Hong Kong, given it is done within the legal requirements (Lo & Ho, 2015).  The legalisation of the procedure has minimised the ethical challenges by making it less morally problematic because it is becoming gradually acceptable in society. Women considering abortion seek information from different sources where some go direct to abortion clinics, others seek advice from primary care providers, gynaecologists and counsellors. The counselling process for abortion adheres to the legal and ethical policy of informed consent as it aims to ensure the patient comprehends the nature and purpose of the procedure, risks and acknowledgement of the consequences (Woodcock, 2011). Although the process is legal and considered ethical, it presents ethical dilemmas for counsellors as it collides with personal values of the services providers, especially when the involved parties do not have a consensus.

Personal Values

While in high school, I volunteered for social works activities that gave me opportunities to help the elderly, children and other helpless members of the community. Listening to the elderly and children during the volunteer period gave me a strong sense that they were suffering, and they needed support and encouragement to boost their will to live. After the volunteer program, I decided that I will become a counsellor as the profession is challenging, exciting and impacts people’s lives for the better. Besides the urge and enthusiasm to help those who are troubled, the job is aligned with my values of compassion, trust, honesty, fairness, generosity, equality and cooperation with others.

My religious and cultural background reinforces personal values. My culture believes in strong family ties because family is an essential pillar of society. In this sense, there is no tolerance for excessive individualism. I admit that everybody is important, but nobody is an isolated being because we are members of a nuclear and extended family, neighbourhood, community and state. Therefore, I hold that regardless of the circumstances, a person should consider the interests of others, be compassionate, care, honest and fair in whatever they do or say because I believe people who ignore such considerations are selfish.

Upon reflection of personal values, I realise the given case presents challenges as it is staged to collide with some of my values. The issue of abortion does not present an obstacle as it is not morally problematic from my standpoint because I believe human life starts at birth. A challenge emerges on the issue of the client taking an extreme individualism stance on the subject as she has no intention of sharing the information with her partner. The unwillingness to involve her partner in the pregnancy termination violates all my values because she is unfair to her partner, has no compassion for his feelings in case he feels otherwise and she is not honest too. Also, isolating herself shows that she does not value collaboration with others, does not trust her partner’s intentions and does not care about others; the unborn child included.

Moreover, the case is personally challenging because as a counsellor am only obligated to assist her in exploring emotional feelings, help her to gain a different perspective on the matter and cultivate trust to ensure successful counselling (D’Arrigo-Patrick, Hoff, Knudson-Martin & Tuttle, 2016). Since she is seeking the pregnancy termination from certified service providers, therefore the risk to life is minimised and as such am not obligated to disclose any information by law. Also, I feel that sharing my values with her on the issue can be interpreted as giving advice, attempting to solve relationship problems, getting emotionally engaged and being judgmental as I will be approaching her problem from my perspective.

Risks and Difficulties

Before becoming a counsellor, I was content with the reality of having clients that we can disagree on various aspects, and as such, it may result in distress to me. I have always depended on ACA Code of ethics guidelines in situations that I find challenging. ACA Code of ethics is supported by five principles of autonomy, non-maleficence, beneficence, justice, and fidelity (American Counselling Association, 2014). Autonomy states that an individual has liberty over the direction of their life, non-maleficence fosters not doing harm and beneficence holds that care providers must work for the good of their clients and society by promoting wellbeing (Leikas, Koivisto, & Gotcheva, 2019). The principle of justice fosters equality in service delivery while fidelity tasks counsellor to honour their commitment, keeping promises and fulfilling their responsibilities of trust in professional relationships.

In this case, if I let my values interfere with the interaction with the client, I threaten the indepedence of the client. By threatening the independence of the client, I risk causing harm to the client by devaluing her beliefs and values on the subject. Attempting to advise the client to involve her partner in the pregnancy termination I risk being deemed to have assumed a judgmental position, and this implies that I will not be working for the good of the client. As much as I feel she is unfair, uncaring and uncompassionate towards her partner, the best I can do is assist her to get a broader perspective on the issue.

Secondly, as a counsellor am obligated to be just to all clients regardless of their beliefs and values, in this sense, if a counsellor permits conflicts concerning personal values to affect service delivery will be unjust to the client and has failed to honour professional commitments as a counsellor. As such, it is difficult to be truthful to self during the sessions as the counsellor strives to work for the good of the client and ensure the client is not harmed while neglecting possible interests of the society as represented by her partner. The case presents a high risk of resigning to an advising position rather than assisting the client in exploring her emotional feelings as she contemplates the pregnancy termination.

As much as abortion is not morally problematic to me, I have personal considerations before the final decision to terminate the pregnancy. The requirements include consultation with family members or partners as everybody is a member of the family, community, and nobody exists in isolation. In this sense, there is a risk of encouraging the client to behave in a way that I would have handled the issue at hand besides attempting to resolve the problem for her. As such, the collision of my values and the professional values increases the volatility of the situation, especially when I have to be truthful to self and honour my professional commitments and responsibilities.

Practical Strategies

• Adhering to American Counsellors Association (ACA) Code of ethics guidelines

As a counsellor, the primary obligation is to assist clients through painful periods and digest the challenges of life. In this regard, counsellors have to respect the dignity and foster the welfare of clients by ensuring they are culturally sensitive and respectful to the diversity that clients bring into the counselling relationship (American Counselling Association, 2014). In the presented scenario, there is a risk of a counsellor imposing personal values, beliefs, attitudes and behaviours onto clients because the client’s goals are inconsistent with the counsellor’s value. The ACA Code of Ethics directly forbids counsellors against imposing own values, beliefs and attitudes upon clients.

• Being truthful to self

Since the situation has evoked an ethical dilemma, a counsellor must be honest to self and recognise personal triggers and indications that the client is no longer the central focus (American Counseling Association, 2014). Adopting this strategy will assist the counsellor in ensuring personal values do not muddle the therapeutic relationship besides safeguarding the client’s autonomy. Also, the approach will ensure the client is safe because the counsellor will be keen to ensure the client is the main focus and her beliefs and values are not devalued. Finally, being truthful to self will allow the counsellor to be willing to face challenges and situations outside personal comfort zones, thus enhancing the professional growth and cultural competence.

• Be empathetic

Empathy is the capacity to acknowledge and relate to the emotions and thoughts of other people. The ability if often characterised by the ability and willingness of a person to view a situation, problem or issue from the perspective of another person. In this case, being empathetic will assist the counsellor in understanding the client’s need and assertion that the decision to terminate the pregnancy is hers alone. Consequently, the client will understand the client’s feelings and thereby ask questions that lead the client to definite conclusions and gain a better perspective on the subject with feeling uncomfortable or judged.

• Consultation and research

The counsellor can overcome ethical conflicts through in-depth analysis on the issue, studying works that are relevant to the subject and consulting experts on the topic. A broader consultation will expose the counsellor to different perspectives and approach to the issue and support the client in making educated resolutions and delivering quality services (Brown, Byrnes & Fleenor, 2012). Delivery of quality services will help the counsellor in serving justice to the client, honouring professional commitments and adhering to established counselling code of ethics.

Conclusion

Counselling is a helping profession where counsellors employ their skills to assist others while remaining respectful to an individual’s autonomy. Subsequently, counsellors must respect the dignity and foster well-being of their clients by ensuring they are sensitive and respectful of diversity that clients might bring during the counselling sessions. As such, a counsellor must ensure that personal values do not hinder service delivery, especially when they threaten the client’s autonomy, risk devaluing the client’s values and beliefs. The counsellor can avert these challenges by adhering to ACA code of ethics, being truthful to self, being empathetic and engaging in consultations. Upholding the guidelines will assist the counsellor in maintain professionalism, serving justice, respecting the client’s autonomy and enhance the ‘helping’ image that the profession carries.

References

American Counseling Association. (2014). Ethical & Professional Standards. Retrieved 11 November 2019, from https://www.counseling.org/knowledge-center/ethics

Brown, K. M., Byrnes, E. K., & Fleenor, K. G. (2012). Maintaining the Counselor–Client Relationship: Ethical Decision-Making in Online Counseling and Social Networking.

D’Arrigo-Patrick, J., Hoff, C., Knudson-Martin, C., & Tuttle, A. (2016). Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy. Family Process, 56(3), 574-588. doi: 10.1111/famp.12236

Leikas, J., Koivisto, R., & Gotcheva, N. (2019). Ethical Framework for Designing Autonomous Intelligent Systems. Journal of Open Innovation: Technology, Market, And Complexity, 5(1), 18. doi: 10.3390/joitmc5010018

Lo, S., & Ho, P. (2015). First-trimester medical abortion service in Hong Kong. Hong Kong Medical Journal, 462-467. doi: 10.12809/hkmj154525

Woodcock, S. (2011). Abortion counselling and the informed consent dilemma. Bioethics, 25(9), 495-504.