Moral Good Versus Moral and Ethical Duty in Mental Health Practice: Shoulds, Shalls, and What-Ifs

This text-based course is an edited transcript of the webinar, Moral Good Versus Moral and Ethical Duty in Mental Health Practice: Shoulds, Shalls, and What-Ifs, presented by Alan Barksy, JD, MSW, PhD, on February 19, 2025.

Introduction: Rationale

Ethical decision-making in mental health practice often presents complex challenges, requiring professionals to navigate a landscape where various obligations and desired outcomes may conflict. This article, based on a webinar presented by Dr. Allan Barsky, aims to delineate the critical distinctions between "moral good" and "moral duty" within the context of mental health practice. Understanding this differentiation is paramount for prioritizing actions, especially when conflicting obligations arise. While the desire to "do good" is a fundamental motivator for many entering helping professions, it is crucial to recognize when actions are merely commendable versus when they are mandated by professional, legal, or ethical standards. The discussion emphasizes that ethical issues are best managed through relational engagement and constructive conversations with clients, colleagues, supervisors, and supervisees. It also acknowledges that ethical and legal obligations can vary across regions and cultures, underscoring the need for practitioners to consult their specific codes of ethics, local laws, and seek supervision.

The core objective is to equip mental health professionals with the ability to:

1. Differentiate between moral goods and moral duties when making ethical decisions in practice.
2. Analyze ethical issues in practice situations through the lenses of moral goods and moral duties.
3. Identify how to best engage clients and co-professionals in discussions about these distinctions.

Risks and Limitations to the course include:

• Ethical and legal obligations may vary significantly between different regions and cultures. This training focuses on general principles and is not intended to be a substitute for consultation with your professional code of ethics, local laws, supervisors, or legal counsel.

Ethics Codes:

Below are links to Ethics Codes for some of the major behavioral health professions. Please ensure you always refer to your own ethical code.

• AAMFT
  • https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx 
• ACA: 
  • https://www.counseling.org/resources/aca-code-of-ethics.pdf
• APA: 
  • https://www.apa.org/ethics/code 
• NBCC:
  •  https://nbcc.org/assets/ethics/nbcccodeofethics.pdf
• NAADAC: 
  • https://www.naadac.org/code-of-ethics
• NASW: 
  • https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
• Ohio Laws and Administrative Rules
  • https://codes.ohio.gov/ohio-administrative-code/rule-4758-8-03

A preliminary poll conducted during the webinar revealed that 95% of participants reported being primarily guided by their moral or ethical duties, with only 5% guided by what is morally good. This initial finding sets the stage for a deeper exploration of why prioritizing duties is often essential, and how a nuanced understanding of these concepts can refine professional conduct.

Introduction: Key Concept

Distinguishing Goods & Duties

To effectively navigate ethical dilemmas, a clear understanding of "moral good" and "moral duty" is essential. While both relate to appropriate behavior, their implications for professional conduct differ significantly.

Key Concepts

• Moral Good: A moral good refers to an action, behavior, or personal quality that contributes positively to the well-being, flourishing, or dignity of individuals and society. These are commendable and desirable actions but are not necessarily required. For example, a mental health professional's desire to be helpful to others, often a driving force for entering the profession, aligns with the moral good of beneficence. Attending a professional development session, while beneficial for enhancing competence, is a moral good, not a strict moral obligation, unless it directly addresses a specific competency deficit that would otherwise lead to harm. There are generally no punitive consequences for not pursuing every moral good.
• Moral Duty: In contrast, moral duties are behavioral rules or requirements that are aligned with values or ethical principles. They are mandated and required, implying that failure to adhere to them can lead to negative repercussions, such as punishment or corrective actions by professional associations, licensing bodies, agencies, or even legal entities in cases of malpractice or criminal charges.

Ethics and Morals

While "ethics" and "morals" are often used interchangeably, it is useful to note their traditional distinctions. "Ethics" typically refers to professional guidelines, principles, and standards that govern one's conduct within a specific professional role (e.g., as a psychologist, counselor, or social worker). "Morals," on the other hand, are often associated with everyday behavior, guiding actions in non-professional contexts (e.g., as a parent, friend, or neighbor). However, for the purpose of this discussion, Dr. Barsky uses "ethics" and "morals" interchangeably to refer to guidelines for both appropriate and inappropriate behavior, regardless of professional context.

Related Concepts 

The distinction between moral good and moral duty can be further understood by examining related concepts.

• Aspirational Ethics (Moral Good): These are guidelines or rules within professional codes of ethics that inspire practitioners to go beyond the bare minimum. They represent values and principles that professionals aspire to, such as respecting dignity and worth, promoting human well-being, and advocating for social justice. These are "reaching for the stars" rather than just meeting baseline expectations. An example of a "supererogatory act" or "good deed" that goes beyond the call of duty is someone risking their life to protect another from harm during a shooting incident. While preventing harm is good, sacrificing one's own life is aspirational and not morally required.
• Mandatory Ethics (Moral Duty): These define the minimum acceptable standard of ethical or appropriate behavior. They employ language indicating what "must" or "shall" be done, or what is "prohibited." Failure to adhere to mandatory ethics can lead to accountability from professional bodies, licensing boards, agencies, and potentially legal action. Examples include prohibitions against exploiting clients sexually or financially.

(Chiappinotto et al., 2024)

Language

The language used in professional documents (codes of ethics, agency policies, contracts, laws) often indicates whether an action is a duty or a good.

• Mandatory (Duty): Words such as "shall," "will," or "must" denote a duty. Non-compliance typically carries consequences.
• Morally Good: Language like "should" suggests a desirable action but not a strict requirement. Sometimes "will" can also be used in an aspirational sense.

Distinguishing - Examples

To make these concepts concrete, consider the following examples.

Moral Good.

• Promote mental health: Advocating for policies that advance mental health or providing clients with suggestions for activities that promote their well-being.
• Treat clients with respect: Using preferred names and pronouns, employing strengths-based language, and ensuring basic needs are met.
• Demonstrate care: Showing empathy and compassion for clients struggling with personal challenges.
• Engage in self-care: Prioritizing one's own mental, physical, and social well-being to ensure effective service delivery.
• Continuously learn and enhance skills: Attending professional development sessions to improve practice.

Moral Duty.

• Act within areas of competence: Not attempting interventions (e.g., prescribing medication) for which one is not trained or licensed.
• Obtain informed consent: Clearly explaining services, choices, and their pros and cons, and ensuring clients make voluntary, informed decisions.
• Avoid dual relationships: Specifically, avoiding relationships that pose a significant conflict of interest, risk of harm, or exploitation of clients.
• Do no harm: Not intentionally or negligently causing harm to clients. While some therapeutic interventions may involve discomfort, the overall aim is beneficence.
• Do not have sexual relationships with current clients: This is a clear violation of professional duty across all licensed professions.

Bernard Gert's Common Morality

Bernard Gert, a prominent ethicist, developed a framework called "Common Morality," which outlines duties applicable to everyone, not just professionals. This framework is useful for distinguishing moral goods from moral duties and emphasizes baseline behaviors. His rules are often phrased as "do not," similar to the Ten Commandments, setting minimum standards (Gert, 2025).

Do Not Cause Harm

• Do not kill.
• Do not cause pain.
• Do not disable.
• Do not cheat.
• Do not deprive people of freedom (e.g., respecting client self-determination and informed consent).
• Do not deprive people of pleasure.

Do Not Violate Trust

• Do not deceive (e.g., obligations of honesty and integrity).
• Keep your promises (e.g., adhering to scheduled appointments or providing promised documentation).
• Do not cheat (e.g., not overbilling insurance).
• Obey the law (e.g., following licensing laws and continuing education requirements).
• Do your duty (e.g., fulfilling obligations to employers, maintaining records, providing supervision).

These duties underscore the special responsibility professionals have towards vulnerable clients, given the power imbalance and clients' potential struggles with mental health issues, poverty, or trauma.

What if...

When faced with a situation where a choice must be made between doing what is morally good and doing what is morally required, the ethical response is to choose what is morally required (a moral duty) over a moral good.

Example

A client urgently needs help due to a serious, imminent suicide risk, but the professional also needs time for self-care.

• Moral Good: Self-care. While important, it is not an absolute requirement at this specific moment.
• Moral Duty: Safeguarding individuals from serious, imminent, and foreseeable harm.
  In this scenario, the moral duty to protect the client from harm takes precedence. If no other professional can intervene, the responsibility falls to the current practitioner. This does not negate the importance of self-care but highlights the critical need to prioritize duties when lives are at stake.

Constructive "Moral" Discussions

Ethical decision-making is rarely a solitary process. Engaging clients, co-professionals, and others in constructive conversations about moral issues is crucial. This involves more than just making a unilateral decision; it requires active listening, empathy, and a willingness to explore diverse perspectives.

Engaging Clients, Co-professionals, or Others in Conversations About Moral Issues

When a conflict arises, rather than immediately deciding on the moral duty, it is beneficial to engage in a conversation. This involves the following.

• Understanding their concerns: Asking about their perspective, the facts leading to the concern, and perceived conflicting obligations.
• Allowing space to discuss moral choices: Creating an environment where individuals can express their views without judgment.
• Listening actively and encouraging reflection: Reflecting back what is heard, clarifying, and ensuring accurate understanding.
• Validating what others are saying: Showing understanding and appreciation for their viewpoint, even if there is disagreement. This aligns with Carl Rogers' principles of demonstrating respect, empathy, and genuineness.
• Using "we" language: Encouraging joint problem-solving and consensus-building rather than debate. This fosters a collaborative approach to ethical dilemmas.

Examples of Challenging Discussions

Discussions around complex moral issues can be particularly challenging. Examples include the following.

• End-of-life decisions: Whether to remove life support, or discussions around medical aid in dying in states where it is permitted.
• Abortion care: Navigating state laws restricting abortion and helping clients make decisions about appropriate, ethical, and legal care.
• Gender-affirming care: Addressing restrictions on care for youth and balancing professional beliefs with legal limitations.
• Suicide risk/Homicide risk: Intervening in situations where there is a risk of harm to self or others.
• Adult guardianship: Determining when state intervention is necessary to protect frail older adults or dependent individuals with disabilities.

Discussion Example - End-of-Life Decision Making

The way questions are framed can significantly impact the depth and openness of moral discussions.

Closed questions (limiting):

• "Should artificial respiration be removed?" (Yes/No)
• "Is it ethical to do something that hastens death?" (Confining)
• "Is there a duty to prolong life?" (Focuses on legal/moral duty, but limits broader discussion)

Open questions (facilitating discussion):

• "What is a good life?" (Encourages diverse perspectives on quality of life)
• "What do you believe about an individual's right to choose the timing and manner of their death?" (Opens up discussion on autonomy and personal beliefs)

Using simple, nonjudgmental language is crucial. Avoid jargon like "deontology" or "teleology." Instead, ask questions like "What are we required to do?" or "What are the consequences if we don't act in a particular way?" The language should be appropriate for the audience, promoting open and meaningful discussion (de Groot et al., 2017).

Moral Discussions

Effective moral discussions also involve:

• Option generation: Brainstorming a wide range of possibilities before evaluating them. For instance, in a case of potential elder abuse, options might include calling adult protective services, conducting a more in-depth assessment, facilitating family meetings, or seeking consultation without revealing identifying information.
• Inviting many perspectives ("hat switching"): Considering the situation from various viewpoints—e.g., the client's, family's, legal professional's, agency administrator's, or law enforcement's. This broadens understanding, even if it doesn't lead to agreement. For example, when law enforcement requests client information, clarify what information is being sought, the authorizing law, and the timeframes for response, and determine if legal advice is needed before complying.
• Clarifying and checking out what others mean: Not making assumptions. If a family member says, "I don't have time to take care of my father," explore the underlying reasons rather than assuming a lack of care. Neglect may not be intentional but could stem from work obligations, childcare responsibilities, or a complex family history. It is also important to help individuals distinguish between moral goods and moral duties. For example, while parents have a moral and legal duty to care for minor children, adult children do not have the same legal duty to care for their elderly parents, though it is a moral good. Exploiting parents, however, would be a violation of a moral and legal duty.

Application to Situations

Applying the distinction between moral goods and moral duties to specific practice situations helps clarify ethical obligations and guide decision-making.

Situation 1: Client Treatment

Scenario: A psychotherapist believes residential treatment would be beneficial for a client with an addiction, but the client prefers outpatient services.

Conflict: Respecting client autonomy versus promoting what the therapist believes is good for the client.

Analysis:

• Promoting good for the client (e.g., ensuring effective treatment): This is a moral good, but not a moral duty in itself. The therapist's professional judgment might suggest residential treatment is more effective, or even medically necessary for safe detoxification.
• Not coercing a client/Respecting client autonomy: This is a moral duty, as outlined in ethical codes and Gert's common morality (do not deprive of freedom). Imposing the therapist's will on the client, even with good intentions, violates this duty.

Prioritization: In general, prioritize client autonomy over promoting what you believe is good for the client, unless there are clear exceptions.

Exceptions:

• Lack of mental capacity. If the client lacks the mental capacity to make informed decisions, a surrogate decision-maker or legal intervention (e.g., Florida's Marchman Act for involuntary commitment for substance abuse) may be necessary.
• Legal mandates. If a client is mandated to specific services as part of a criminal sentence or probation.

Even when clients make choices that may lead to harm, the professional's role is to provide education, options, and support, and to be available if the client needs help, rather than overriding their self-determination.

Situation 2: Client Referral

Scenario: A colleague refers a client for cognitive therapy, but you decline due to a busy caseload.

Conflict: Moral good of helping clients/being generous with time versus moral good of self-care.

Analysis:

• Moral good of helping clients, being generous with time, and prioritizing client needs: These are commendable actions.
• Moral good of self-care: Limiting new clients to prevent burnout is also a moral good.

Distinction from Duty: There is no moral duty to accept every referral. However, there is a moral duty not to abandon clients in need. While this specific individual is not yet your client, the broader principle of not abandoning people in need still applies.

Options to Avoid Abandonment:

• Provide alternative referral sources.
• Explore organizations that accept Medicaid or offer pro bono services.
• Discuss waitlist options with the client/colleague.
• Suggest self-help support groups.
• Consider terminating with existing clients to create capacity for new, high-need cases.
• Explore the responsible use of AI programs for support, especially for clients on waiting lists (e.g., anxiety apps).
• Adjust current client frequency (e.g., bi-weekly sessions instead of weekly) to accommodate more clients.

The goal is to be creative and collaborative in finding solutions that promote good without breaching a duty.

Situation 3: Client Documentation

Scenario: You are providing therapy to a teenager whose parents have consented to treatment. The teen discloses being sexually active but asks you not to document this, as parents have access to records.

Conflict: Keeping promises to the client (confidentiality) vs. keeping promises to parents/following agency policy.

Analysis:

• Duties:

• Keep promises to the client and parents.
• Follow agency policy regarding documentation and information sharing.

• Moral Good (for the teen): Not documenting this information could foster greater trust, encourage the teen to be more open, and prevent them from closing down or terminating services. This also allows for continued counseling on safer sex practices.

Prioritization: Ideally, an agreement should be established in advance with both the parents and the teen regarding what information will be shared. Ethical codes often encourage such agreements when working with minors. If an agreement exists (especially in writing), adhering to it is a duty. Agency policies also constitute duties.

Considerations:

• Benefits of not documenting: Increased trust, continued engagement in therapy, opportunity to provide guidance on safer sex.
• Harms avoided: Teen's emotional distress, termination of therapy, parental overreaction if they discover the information from the therapist.
• Risks of not documenting: Parental anger if they eventually find out, potential termination of services by parents.

The aim is to balance duties (to client, parents, agency) with promoting the moral good (teen's trust and continued well-being). This might involve encouraging the teen to eventually disclose to their parents, facilitating that conversation, or finding ways to provide support without breaching confidentiality, while still adhering to established agreements and policies.

Questions and Answers

If a client chooses not to engage in a recommended higher level of care deemed clinically necessary after significant assessment, is it ethical to discharge them from your care?

In general, yes. Adults with mental capacity have the right to self-determination. If a client declines recommended services, they can discharge themselves, even "against medical advice." It is prudent to document this decision, and if possible, have the client sign an acknowledgment. Exceptions arise only in cases of mental incompetence or serious, imminent risk (e.g., suicide). In such cases, consultation with legal counsel or an ethics committee is advisable.

Is there a difference in how this should be handled if the client is seeing you face-to-face versus outpatient telehealth?

Mostly, the considerations are the same: informed consent, options, understanding consequences, and respecting confidentiality. However, assessing suicidal ideation can be harder remotely. If the client is at a distance, it's crucial to know local crisis intervention services and potential backup options (e.g., mental health services for a check-in), while being mindful not to invade privacy or provoke a negative reaction. Documentation of outreach efforts is important.

If a client is 18 years old and drinking alcohol, are you mandated to tell the parent?

This depends on state laws. The ideal approach is to have an agreement with the client (and parents, if applicable) beforehand about what information will be shared. Often, for youth, maintaining a safe space for open communication is prioritized over automatic disclosure, as reporting might lead to the youth closing down. Consult state laws and agency policies, and strive for pre-established agreements.

Is it ethical to refer a client to AI while on a waiting list? Personally and professionally, I don't believe we should have waiting lists. That is our obligation to try to connect them with a therapist that does, that does have openings immediately.

While ideally, waiting lists shouldn't exist, if they do, offering AI as one among various options can be ethical, depending on the nature and severity of the need. For example, apps for anxiety or problem-solving might be helpful. It should not be the only option. Providing a range of options (self-help groups, other therapists, AI) and discussing their pros and cons, along with potential follow-up, demonstrates a commitment to client well-being even when direct services are limited. The professional's duty is not to serve every client, but to act in their best interest, which may involve advocacy for immediate connection with other therapists.

Conclusions

The webinar concludes with several key takeaways that summarize the core principles discussed:

• Goods are good - not required: Moral goods are helpful and admirable, offering a sense of personal satisfaction, but they are not mandatory. There are no punitive consequences for not fulfilling every moral good.
• Duties are duties - mandatory or expected: Moral duties are obligations that are expected and mandated. Violating a duty can lead to accountability and consequences.
• Be aspirational - "reach for the stars": While duties set the baseline, professionals should strive to go beyond the minimum. Aspirational ethics encourage continuous improvement and proactive measures that often serve as excellent risk management strategies, ensuring clients receive comprehensive care even beyond strict requirements.
• Act prudently - duties are baselines: Prudent practice involves not just meeting the bare minimum but acting in a smart, well-trained, and wise manner. When unsure, consult with colleagues and supervisors, and meticulously document decisions, including options considered, their pros and cons, and the rationale for the chosen course of action. Ideally, this is done with client consent, though sometimes it may conflict with client preferences.
• We can, and often should, do more than the baseline: The ultimate message is to respect and fulfill one's duties as the foundational ethical standard, but to also embrace an aspirational approach, consistently seeking opportunities to provide care that exceeds basic requirements. This proactive stance contributes to better client outcomes and a more robust ethical practice.

By understanding and applying these distinctions, mental health professionals can navigate complex ethical landscapes with greater clarity, ensuring both compliance with mandatory duties and a commitment to aspirational, client-centered care.

References

American Counseling Association [ACA]. (2014). Code of ethics. https://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=55ab73d0_1

American Psychological Association [APA]. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code 

Barsky, A. E. (2017). Conflict resolution for the helping professions. Oxford University Press.

Barsky, A. E. (2023). Essential ethics for social work practice. Oxford University Press.

Barsky, A. E., & Barsky, J. D. (2024). Practice standards for addressing social justice in social work research. International Journal of Social Work Values and Ethics, 21(1), item 10. https://doi.org/10.55521/10-021-110; https://jswve.org/volume-21/issue-1/item-10

Chiappinotto, S., Igoumenidis, M., Galazzi, A., Kokic, A., & Palese, A. (2024). Between mandatory and aspirational ethics in nursing codes: A case study of the Italian nursing code of conduct. BMC Nursing, 23(1), 1-17. https://doi.org/10.1186/s12912-024-01697-3 

de Groot, J., & van Hoek, M. E. C. (2017). Contemplative listening in moral issues: Moral counseling redefined in principles and method. The Journal of Pastoral Care & Counseling, 71(2), 106–113. https://doi.org/10.1177/1542305017708155

Gardiner, D., McGee, A., Simpson, C., Ahn, C., Goldberg, A., Kinsella, A., Nagral, S., & Weiss, M. J. (2023). Baseline ethical principles and a framework for evaluation of policies: Recommendations from an international consensus forum. Transplantation Direct, 9(5), e1471. https://doi.org/10.1097/TXD.0000000000001471 

Grannan, D. (2022). What’s the difference between morality and ethics? Encyclopedia Brittanica. https://www.britannica.com/story/whats-the-difference-between-morality-and-ethics 

Gert, B. (2005). Morality: Its nature and justifications. Oxford University Press.

Knapp, S. J., Gottlieb, M. C., & Handelsman, M. M. (2024). Avoiding failures when applying principle-based ethics to difficult ethical situations in psychotherapy. Practice Innovations, 9(3), 205–214. https://doi.org/10.1037/pri0000239

Muñoz D. (2021). Three paradoxes of supererogation. Noûs, 55, 699–716. https://doi.org/10.1111/nous.12326

National Association of Social Workers [NASW]. (2021). Code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English 

Stanford Encyclopedia of Moral Philosophy. (2024). Moral responsibility. https://plato.stanford.edu/entries/moral-responsibility

Weisenmuller, C. M., & Luzier, J. L. (2023). Technology is a core competency in professional psychology. Training and Education in Professional Psychology, 17(3), 241–247. https://doi.org/10.1037/tep0000423 

Additional Current References

Note: The following resources have been included for members to view additional resources associated with this topic area. These resources were not used by the presenter when creating this course.

Coblentz, J. (2025). How (not) to theologize psychological distress: Lessons from thinking across conditions. Journal of Moral Theology, 14(1), 89–108. https://doi-org.ezproxy.uu.edu/10.55476/001c.127970

McLoughlin, S., Thoma, S., & Kristjánsson, K. (2025). Was Aristotle right about moral decision-making? Building a new empirical model of practical wisdom. PLoS ONE, 20(1), 1–48. https://doi-org.ezproxy.uu.edu/10.1371/journal.pone.0317842

Stagner, B. H., Livingstone, J., Gottlieb, M., DeMatteo, D., Chard, A., Perillo, J. T., Boness, C. L., Wise, R. A., & Fairfax-Columbo, J. (2025). Red Flag Laws: Psychologist duties and professional responsibilities. Professional Psychology: Research & Practice, 56(1), 4–18. https://doi-org.ezproxy.uu.edu/10.1037/pro0000600

Terris, C., & Tumilty, E. (2025). High hopes: Legal and ethical Issues with post-trial access to psychedelic drugs. Journal of Health Care Law & Policy, 28(1), 1–23. 

van Baarle, E., & van Baarle, S. (2025). Advancing ethics support in military organizations by designing and evaluating a value‐based reflection tool. Bioethics, 39(1), 5–17. https://doi-org.ezproxy.uu.edu/10.1111/bioe.13255