amy@amymadson.org

As a licensed marriage and family therapist, wife and mother of three kids, church goer, supervisor of therapists, and even as a pet owner, I face issues around living ethically from lots of different perspectives all the time. For me, living ethically is simultaneously instinctive, intimidating, important, and occasionally overwhelming. (What is the best ethical decision when faced with school calling about a sick kid, client who is probably getting in the car to come to an appointment, a dog who needs to be let out or else she will soil the rug we paid too much for, husband who has recently rescheduled a meeting to care for kids during the polar vortex school cancellations, and a toddler who just wants to run and play??)

I recently prepared for a supervision group where I was facilitating a discussion about ethics with marriage and family therapy trainees. In attempt to make the training a rich discussion, I incorporated The Ethical Brain by Michael Gazzaniga along with some ethical decision making models and of course our code of ethics and relevant statutes. Pairing this discussion with recent work I’ve been doing with parts of families like couples or one parent and one child caused me to look at ways to consider whether or not I am living ethically. Although my example does not draw upon the Gazzaniga book, that book did offer some great insights, particularly into considerations from neuroscience around ethics regarding decisions concerning pre-birth and dementia as well as insights into the impact one’s emotions have on decisions even when facts may demand new considerations on those decisions.

Below, I will share how I have adapted an ethical decision making model from the American Counseling Association to help me make a recent difficult ethical decision in my family. I hope this discussion will help give you a framework to apply when you want to make an ethical decision around a difficult topic in your life.

Here is my example:

One of my children recently was diagnosed with a vomiting syndrome called Cyclical Vomiting Syndrome that could last for a short time or could be a life-long condition. This condition resulted in her getting into cycles of vomiting and missing a lot of school. My child wanted one of us to comfort her when she was having a vomiting episode, and also needed someone to pick her up from school if an episode began while she was there. As a result, my husband and I had to make some difficult decisions in order to figure out how to manage this unpredictable factor that affected our work lives, family life, etc.

1.  Figure out what your problem is. Where is your pull? Is it a a pull about competing commitments or values, such as a pull between responsibilities at home or work? Is it a conflict between balancing your needs versus your partner’s or family’s? Are you struggling with what you feel you should do versus the demands of your reality (such as untrue messages about what would make you a “good daughter, mom, spouse etc.” vs. a more true and relevant message.)

My pull was about how to be a good mom to my sick child, good mom to my two healthy children, practice healthy self-care, including continuing my work where I have a sense of purpose and also maintain some connection with my support system. I also had guilt when I needed to reschedule clients.

2. Name any guiding spiritual or religious viewpoints, policies (such as work/school policies), etc that fit for you, and identify how your personal and/or family values can guide you in a decision.

Being a mother is very important to me. This was a huge value. While trust in God did not inform my decision, it helped me gain a sense of perspective which was really helpful for me.

Investigating school policies also helped guide my decision. Initially, I was worried that I would have to home school her, but I learned that there was a policy in place through the school district where she would be entitled to an in-home tutor if her syndrome continued to cause her to miss enough school. This information came out of learning more about school policy and it helped me let go of the prospect that I would need to find a way to home school my daughter.

3. Figure out what is at the crux of your problem. Gather facts about the size of the problem and figure out if you can put any systems into place that might help minimize this problem should it return in the future.

At first, this problem felt huge. How can I have a successful private practice if I am not reliable? (Note, I also had some exceedingly high messages about reliability. It was as if there was no room for people in my family to be sick.)

I ended up finding some substitute therapists for my clients to see in times of flare ups. I also redefined my schedule so that I had space to reschedule each week.

Finally, we put a plan into place where a care figure is available at all times in case my child has a flare up. This involved some delegating.

I’ll let you read the final steps and consider how they would best serve you in determining your dilemma:

4. List out potential courses of action and gather facts about them.

5. Figure out the implications of various courses of action for yourself, your family, and for the situation.

6. Evaluate the course of action. This can be a great place for collaboration with affected parties who share power such as a spouse, siblings, etc.

7. Go forth! Put your plan into action.

I wish you the best with whatever decisions you are currently faced! I commend you for taking the time and creating the intention of making the best decision you can. Your family/partner/future self will thank you for it!