No abstract

Until recent times many nursing authors have relied on rather narrow interpretations of selected aspects from the broader discourse of ethics and moral philosophy in their writing on ethics in nursing. As a consequence, discourse in nursing ethics has been limited in its vision and far from comprehensive in its content. This can be seen in the large number of texts and journals which discuss issues in nursing ethics. Particularly in many of the nursing textbooks up to and including the 1960s, 1970s and, to a lesser extent, the early 1980s, ethics content is commonly framed in terms of the dilemmas of practice. Moreover, overall there is a preoccupation with either deontological or teleological positions and the application of corresponding analytical frameworks consistent with the particular view taken. In most texts the preferred view is deontological, with a predominating emphasis on principle and duty. Recently in nursing ethics there has been a focus towards the deconstruction of the dominant views in ethics encompassed by the more traditional perspectives. Consequently, as in other areas of applied and theoretical ethics, there has been a re-awakening of interest in the 'virtues', and in processes which encourage the articulation of ethical dimensions of practice in ways other than applying principles, rules and formulae to situations of clinical dilemma.

The moral status of professional boundaries and the ethical nature of dual and multiple overlapping human relationships in contemporary clinical practice remain enduring problems in all health care disciplines. In this paper I explore the ethics of dual or multiple overlapping relationship and apply a virtue ethics framework to the case of psychotherapy. After clarifying the context and meaning of commonly used terminology, and considering what some of the key Australian codes of ethics relevant to psychotherapy advise about dual relationships, I identify some commonly occurring situations where overlapping relationships are unavoidable. A case study from a rural context where size, isolation, and community expectations profoundly impact on the capacity of a psychotherapist to maintain clearly defined professional therapeutic relationship boundaries is analysed. The rural example is pertinent. A virtue ethics approach goes some way toward alleviating perceptions about the nature of dual relationships that contribute to an enduring reticence amongst psychotherapists (and other professionals) to practice in rural settings. Clearly, if a dual relationship involves exploitation then that relationship is a boundary crossing that should rightly be categorised as a boundary violation. Boundary violations are exploitative and unethical. However, some dual relationships may involve boundary crossings that are not necessarily boundary violations. Despite their general prohibition by Australian (and many other countries') codes of ethics relevant to psychotherapy, I argue that in certain situations, if a psychotherapist (who crosses a professional relationship boundary) acts with professional integrity from the distinct professional role-related virtues and/or regulative ideals that ensure the goals of psychotherapy (to increase autonomy and psychological wellbeing) are met, then a dual or multiple overlapping relationship in psychotherapy will be ethical.