Ethical Aspects

in the Practice of Clinical

Supervision

SYIFA MUSTIKA
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Presentation Goals

 To present an overview of clinical supervision and ethics to

supervision.
Perry C. Francis, Ed.D., NCC, LPC

 To present key ethical guidelines regarding client rights,

informed consent for the supervisee, multicultural issues,
and other current issues.

 To present information concerning the growing practice of

supervision in Indonesia
Perry C. Francis, Ed.D., NCC, LPC

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Perry C. Francis, Ed.D., NCC, LPC

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Why
ethics ???
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Ethical consideration means…

Refers to:
a) a non-legal or not solely legal norm, duty,
obligation or right; or b) consequences (well-
Perry C. Francis, Ed.D., NCC, LPC

being, happiness etc.) for some specifiable

person or groups of persons; or c) what kind of
person one ought to be or what virtues one
ought to have.
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Ethics in Clinical Supervision

 Supervisors who practice ethically make sure they

have the correct combination of education, practice,
and experience to help supervisees develop their
Perry C. Francis, Ed.D., NCC, LPC

skills and talents so that they (the supervisees) can

help people deal with the issues and problems they
bring into the counselor’s office.
Perry C. Francis, Ed.D., NCC, LPC

Principles of Medical Ethics

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Ethics & Supervision

The counseling supervisor:

 should have sufficient knowledge, skill, and judgment to use
efficacious interventions with the supervisee and the client the
supervisee is working with
Perry C. Francis, Ed.D., NCC, LPC

 respects the human dignity and freedom of the supervisee and

client
 uses the power of the supervisor’s role responsibly for both the
supervisee and client
 act in ways that promote confidence in the profession of
supervision and public confidence in the profession of
counseling.
 Sudah baik ….
tinggal perlu
Tanganmu
pengulangan biar
le.... lebih luwes
tanganmu !

DOSEN BADAL
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Ethical Issues in Supervision

Unique ethical issues can be separated into three

broad categories:
 Issues dealing with client welfare and rights;
Perry C. Francis, Ed.D., NCC, LPC

 Issues dealing with supervisor and supervisee

relationship;
 Issues dealing with administrative supervision.
 Issues Dealing With Client Welfare and Rights

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Client Welfare & Rights

 Triadic Relationship
Supervision appears to be a process that involves two
people: the supervisor and the supervisee. In actuality,
Perry C. Francis, Ed.D., NCC, LPC

there is a minimum of three or more people involved in

the supervisory relationship: the supervisor, the
supervisee, and the client(s). This has been referred to
as a triadic relationship (Kurpius et al., 1991;
Upchurch, 1985).
Perry C. Francis, Ed.D., NCC, LPC

Triadic Nature of Consultation

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 Issues Dealing With Client Welfare and Rights

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Making Ethical Decisions

The Supervisor’s Ethical Decision Tree:

 Relevant legal and ethical standards
 Client welfare
Perry C. Francis, Ed.D., NCC, LPC

 Supervisee welfare
 Supervisor welfare
 Program and/or agency service and administrative
needs.
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 Issues Dealing With Supervisor and Supervisee Relationship

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Education & Training

The Supervisor needs:

 Supervision & training in the process of supervision.
 Education & training in the population
Perry C. Francis, Ed.D., NCC, LPC

 Knowledge of one’s own strengths & limitations as a

supervior.
Perry C. Francis, Ed.D., NCC, LPC

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 Issues Dealing With Supervisor and Supervisee Relationship

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Dual Roles & Relationships

 The Supervisor understands:

 Dual Relationships are inevitable and are to be
managed properly.
Perry C. Francis, Ed.D., NCC, LPC

 That a power differential exists between the supervisor

and the supervisee.
 That a sexual relationship involves a power differential
that contaminates any perceived intimacy.
 Beware of
Sexual
Encounters
in Hospital
!!!
 Issues Dealing With Supervisor and Supervisee Relationship

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Counseling the Supervisee

 The Supervisor understands that:

 Supervision is a complex task of educational, professional,
ethical, informational, & therapeutic interactions.
 The power differential interferes with the counseling
Perry C. Francis, Ed.D., NCC, LPC

relationship.
 The supervisor can listen, empathize, & understand the
supervisee personal issues, but limits this activity because of
the evaluative role he or she has with the supervisee
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Avoid
unnecessary
Pressure on
Trainee !!!
 Issues Dealing With Supervisor and Supervisee Relationship

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Multicultural Issues

 The Supervisor shall:

 Take into account the effect individual differences
(gender, race, culture, etc…) has on the supervisory
relationship. This includes:
Perry C. Francis, Ed.D., NCC, LPC

Appropriate training and experience in cultural

differences.
Working with the CIT to understand how cultural
differences effect counseling/supervision process.
Issues of power surrounding differences.
 A Typology Of Ethical Challenges
Type of ethical issue Specific examples

Telling the truth • To patients and relatives about diagnosis

and prognosis
• To patients about lack of experience
• To consultants about tasks performed
Perry C. Francis, Ed.D., NCC, LPC

• To colleagues about a patient’s condition

when seeking tests

Respecting patients’ • Respecting patients’ wishes about

autonomy treatment, including at the end of life
• Maintaining confidentiality
• Seeking informed consent
 A Typology Of Ethical Challenges 2

Preventing harm • Dealing with potential harm to patients

associated with their treatment
• Avoiding harm to patients when involving
them in the educational Process
Perry C. Francis, Ed.D., NCC, LPC

• Coping with feeling inadequately prepared

Managing the limits of for their responsibilities
one’s competence • Negotiating lack of supervision/role modelling
by superiors
• Making mistakes
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 A Typology Of Ethical Challenges 3

Addressing the • Dealing with peers’ mistakes/ incompetence

inappropriate • Conflicts between views of junior doctors and
behaviour of others superiors –
• subjugating own opinions and values to superiors’
demands
• Observing the unethical behaviour of others
• Demeaning humour about patients
• Compromised superiors
Perry C. Francis, Ed.D., NCC, LPC

• Superiors handing risky tasks down the hierarchy

(‘passing the buck’)
• Dealing with verbal or physical abuse by patients or
superiors,
• including sexual harassment
 A Typology Of Ethical Challenges 4

Conflicts of interest • Ability to treat family and friends

• Offers of gifts or hospitality from
drug companies

Setting interpersonal boundaries with • Dealing with sexual advances or

patients romantic intentions
• Treating disliked, difficult, or
Perry C. Francis, Ed.D., NCC, LPC

dangerous patients

Impact of working conditions • Controlling compassion

• Dealing with transience
• Working long hours
• Feeling unsupported by hospital
administration
• Working when unwell or exhausted
• Lack of cover for absent colleagues
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How about Indonesia ?

1.Undang-undang Nomor 20 tahun 2003 tentang

Sistem Pendidikan nasional;
2. Undang-undang Nomor 36 Tahun 2009 tentang
Perry C. Francis, Ed.D., NCC, LPC

Kesehatan;
3. Peraturan Pemerintah Nomor 17 Tahun 2010
tentang Pengelolaan dan Penyelenggaraan
Pendidikan
4. UU no.20 th 2013 tentang Pendidikan Dokter
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Pendidikan Profesi Dokter

Pasal 18
(1)Untuk pembelajaran klinik dan pembelajaran
komunitas, Mahasiswa diberi kesempatan terlibat dalam
pelayanan kesehatan dengan bimbingan dan pengawasan
Perry C. Francis, Ed.D., NCC, LPC

Dosen.
(2)Mahasiswa sebagaimana dimaksud pada ayat (1), tetap
harus mematuhi kode etik Dokter atau Dokter Gigi,
dan/atau ketentuan Peraturan Perundang-undangan yang
mengatur keprofesian
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Aplikasi Dalam Pendidikan Profesi

• Langkah dan panduan praktis akan

tertuang pada tata tertib baik tata tertib
akademik, norma susila pergaulan dan
Perry C. Francis, Ed.D., NCC, LPC

lain lain

• Jika melanggar tata tertib maka berlaku

sanksi
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1

Buku Panduan
Teknis Peserta Didik
Perry C. Francis, Ed.D., NCC, LPC

Kedokteran dalam
Pelayanan Kesehatan
2015
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Challenges in Clinical Teaching

“The greatest challenge in

educating the medical student is
Perry C. Francis, Ed.D., NCC, LPC

to keep him awake”

Chevalier Jackson
Pioneer endoscopist, public advocate
 Do Provide Good Clinical 43
Teaching by Ethics
Perry C. Francis, Ed.D., NCC, LPC
Perry C. Francis, Ed.D., NCC, LPC

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 Questions-Cases

What are your

thoughts?
Perry C. Francis, Ed.D., NCC, LPC

Your cases for

Discussion.