8.2  Practitioner–client relationship

In the previous study session you learnt about the core ethical concepts of autonomy, beneficence, nonmaleficence and justice. These basic principles should always form the basis for your working relationships. In addition to the above principles there are issues like confidentiality, privacy and trust that you also have to think about at all times.

The following case study will help you to explore some ethical conflicts and ways it might be possible to resolve these conflicts.

Case Study 8.1  Difficult patients

Lemlem, a Health Extension Practitioner at Laelay Michew kebele, Central Zone, Tigray Regional State, is approached by Hailemariam, the son of Ato Gebregziabher, a well known Gena player in his locality. Hailemariam asks Lemlem to provide him with some paracetamol tablets because of pain in his knees. In fact Hailemariam doesn’t have any pain, but he is trying to accumulate enough tablets to commit suicide. He has also bought additional tablets at a market and asked another Health Extension Practitioner for even more tablets. Sometime later Hailemariam swallowed all the tablets at one time and for a while he was very ill, near to death. Hailemariam didn’t die and when he recovered he didn’t want others in the community to discover that he had attempted suicide. He began to spread rumours that Lemlem, the Health Extension Practitioner, was incompetent and had prescribed medication that she does not know how to use and that she had harmed him.

Although this is quite a complicated situation, and hopefully you will never be faced with such a difficult case, people in the community may make false accusations against you. For poor Lemlem the dilemma is something like this: she has done nothing wrong at all. She has prescribed some painkilling tablets with the best of intentions when Hailemariam pretended to have some pains. It is Hailemariam who has deceived her, but then gone on to accuse her, falsely, of being an incompetent practitioner. If she does not defend herself then her position in the community may be damaged. People might believe Hailemariam and start to think that she is not very good at her job. But how can she defend herself while still being professional and ethical in relation to her relationship with her patient Hailemariam?

Can Lemlem’s ethical principles help her in this situation? Perhaps there are principles of justice involved? Lemlem is certainly in the right and should have the opportunity to defend herself against these charges. But defending herself might harm her patient. If she successfully wins her struggle against Hailemariam he might lose face in the community and feel that he has to try to commit suicide again. He does sound as though he is very troubled. He has deep psychological problems and has already tried to kill himself - and now he’s making trouble for Lemlem. Lemlem doesn’t want to harm him (nonmaleficence), but she also feels that she should keep her job and continue to help lots of people in the community (beneficence).

  • Which of the following actions do you think that it would be ethical and appropriate for Health Extension Practitioner Lemlem to do? Explain your reasons.

    • a.Nothing, but let the accusations pass without further comment.
    • b.Attack Hailemariam publicly and make sure that everyone knows about his psychological troubles.
    • c.Ask for help from an experienced healthworker at the hospital or health centre.
  • It would be a really good idea for Health Extension Practitioner Lemlem to get some help from an experienced practitioner. They will be able to help clarify her ideas and support her in any action she takes in the future to clear her name. If she responds to her patient in any public way then this could be considered to be a breach of confidentiality and may bring about a complaint against her that would be hard to defend.

8.1  Ethical dilemmas and conflicts

8.3  Privacy and confidentiality