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HOW

WHY

WHEn

Ethical Dilemmas

&

the Decision-Making Process

Rebecca Smith

Overview:

  • Introduction to the Code of Ethics
  • Kohlberg’s Stages of Moral Development
  • The Ethical Principles
  • Potential Ethical Dilemmas in Counselling
  • Cultural Considerations
  • The Steps to Ethical Decision-Making
  • The Case of Sally
  • Ethical Mindfulness

What ARe Ethics?

WHAT

Ethics

vs.

morals

vs.

Figure 1. Illustration of Ethics vs. Morals. Adapted from "Ethics vs. Morals – Definition, Difference & Examples" by D. Mcleod, n.d., Grammarist. Retrieved from https://grammarist.com/usage/ethics-morals/

Kolberg's

?

Figure 2. Illlustration of the stages of moral development. Adapted by "Kolberg's Stages of Moral Development" by S. Mcleod, 2023, SimplePsychology. Retrieved from https://simplypsychology.org/kohlberg.html

Ethical principles

"Being proactive in promoting the best interests of clients" (CCPA, 2020, p. 2)

beneficence

Ex. taking a client on pro bono or sliding scale

"honouring commitments to clients and maintaining integrity in counselling relationships" (CCPA, 2020, p. 2)

fidelity

Ex. using the agreed upon interventions

"refraining from actions that risk harm and not willingfully harming clients" (CCPA. 2020, p. 2)

nonmaleficence

Ex. scope of practice and expertise, maintaining boundaries

"respecting the rights of clients to agnecy and self-determination" (CCPA, 2020, p. 2)

Autonomy

Ex. client included in decision-making process

"respecting the dignity of all persons and honouring their right to just treatment" (CCPA, 2020, p. 2)

Justice

Ex. equal access to services

"upholding responsbility to act in the best interests of society" (CCPA, 2020, p. 2)

Societal interest

Ex. protecting society and advocacy

What is an ethical dilemma?

?

Figure 3. Text definition of an ethical dilemma. Adapted from "What is an Ethical Dilemma?" by Religh, n.d., deepstash. Retrieved from https://deepstash.com/idea/97676/what-is-an-ethical-dilemma

Common ethical dilemmas include:

?

  • Client confidentiality
  • Dual relationships
  • Sexual relationships
  • Incompetence
  • Misrepresentation of qualifications
  • Third party information
  • Self-disclosure
  • Child protection
  • Boundaries
  • Privacy

Cultural Considerations:

Example:

?

“You are a counsellor working at an educational institution. A Vietnamese student, Tu Li, is assigned to you because of academic difficulties. You note that the student is a reluctant speaker and is slow in his conversational style. In attempting to establish a positive relationship with Tu Li, you lean toward him, look him straight in the eyes and ask him directly to tell you about the difficulties he is having in his academic work. When the student looks away and does not respond, you suggest that he has a language problem and that a class in English as a second language might help him to communicate more effectively. In the course of your counselling sessions, Tu Li says that he is feeling mounting pressure from his father to major in the sciences in order to pursue a career in medicine. Tu Li feels he is not suited for medicine and is keen to study interior design. Besides, he is getting “B” and “C” grades in his biology course, which he fears will bring embarrassment and shame to his family. You notice that the student is becoming increasingly despondent because of his perceived academic failures. You encourage Tu Li to follow his passion and pursue the career path of his choice" (Sheppard, n.d., para. 3).

Cultural Encapsulation:

!

  • Attending skills
  • Differences in communication patterns
  • Cultural norms (e.g., filial piety, family obedience, and collecivist decision-making)
  • Parenting styles
  • Traditions

  • Ethnocentrism
  • Cultural assumptions and stereotypes
  • Insensitibe to cultural variations

(Sheppard, n.d.)

Virtue-based vs. principle-based

  • Character
  • Rules
  • Codes
  • Standards

The Case of Sally:

?

Figure 4. Illustration of a sad young girl sitting with her counsellor. Adapted from "Female Psychologist", n.d., iStock. Retrieved from https://media.istockphoto.com/id/1053122702/vector/therapist-psychologist-consulting-depressed-woman.jpg?s=612x612&w=0&k=20&c=DaQHfVyDW4BvGTpI2KnWx3cxTQun8lh2SucsiPUkXl0=

"Client Sally, who is deemed to be a ‘mature minor’ attends her first visit with me, a new therapist. Sally disclosed that there is considerable domestic violence within her family and that her father usually carries out violent behavior to her 14-year-old brother and has caused him to be physically bruised. Sally shared that her father plans to move out recently; she also did not want to bring any outside agencies as she wanted to avoid extra violence from her father. In the meantime, the limits of confidentiality were not discussed with Sally during the first visit due to the crisis situation in this first session" (Ethical Dilemma in Sally’s Case, 2022).

0

Step One: What are the key ethical issues in this situation?

1

  • Limits to confidentiality
  • Should the potential child abuse be reported without first informing Sally of the limits to confidentiality?

Step two: What ethical articles from the CCPA Code of Ethics are relevant to this situation?

2

  • CCPA Code of Ethics (2020) states that the counsellors primary responsibility is promoting client welfare and protecting confidentiality, except when there is potential danger to self, others or a child is in need of protection.

Step three: Which of the six ethical principles are of major importance in this situation?

3

  • Beneficence
  • Nonmaleficence
  • Societal Interest

Step four: how can the relevant ethical articles be applied in this circumstance?

4

  • Autonomy
  • Ontario’s Child, Youth and Family Act
  • Ruptured therapeutic alliance

Step five: What do my feelings and intuitions tell me to do in this situation? (Consider Virtue-Based Ethical Decision-Making)

5

  • I should report the child abuse to protect the welfare of the client and family

Step six: What plan of action will be most helpful in this situation?

6

  • Report the child abuse
  • Consult with colleagues and/or supervisor
  • Repair rupture
  • Review limits to confidentiality and informed consent to prevent future ethical dilemmas

Ethical Mindfulness:

  • Being sensitized to emotions in everyday practice
  • Acknowledging and understanding the ways in which emotions are significant in practice
  • Being able to articulate the emotions at play during ethically important moments
  • Being reflexive and acknowledging both the generative aspects and the limitations of emotions
  • Being courageous.

Ethics

(Guillemin & Gillam, 2015)

References:

!

Canadian Counselling and Psychotherapy Association. (2015). CCPA standards of

practice (5th ed.). Canadian Counselling and Psychotherapy Association. http://www.ccpa-accp.ca/wp-content/uploads/2015/07/StandardsOfPractice_n_June2015.pdf

Canadian Counselling and Psychotherapy Association. (2020). Code of ethics.

Canadian Counselling and Psychotherapy Association. https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA-2020-Code-of-Ethics-E=Book-EN.pdf

Ethical Dilemma In Sally’s Case. (2022). Edubirdie.

https://edubirdie.com/examples/ethical-dilemma-in-sallys-case/

‌Guillemin, M., & Gillam, L. (2015). Emotions, Narratives, and Ethical Mindfulness.

Academic Medicine, 90(6), 726–731. https://doi.org/10.1097/acm.0000000000000709

‌Knapp, S. J., Gottlieb, M. C., & Handelsman, M. M. (2015). Introduction: Problems,

pitfalls, and potentials. Ethical Dilemmas in Psychotherapy: Positive Approaches to Decision Making., 3–12. https://doi.org/10.1037/14670-001

‌Lerner, J. S., Li, Y., Valdesolo, P., & Kassam, K. S. (2015). Emotion and Decision Making. Annual Review of Psychology,

66(1), 799–823. https://doi.org/10.1146/annurev-psych-010213-115043

‌Ontario Association of Children’s Aid Societies (2017). Duty to report. Child, Youth

and Family Services Act, ON: Ontario Association of Children’s Aid Societies. http://www.oacas.org/childrens-aid-child-protection/duty-to-report/

Resnik, D. B. (2012). Ethical Virtues in Scientific Research. Accountability in Research, 19(6), 329–343.

https://doi.org/10.1080/08989621.2012.728908

‌Sheppard, G. (n.d.). Notebook on Ethics, Legal Issues and Standards in Counselling.

Canadian Counselling and Psychotherapy Association.

https://www.ccpa-accp.ca/wp-content/uploads/2015/05/NOE.Valuing-Diversity-and-Acting-Ethically.pdf

‌Mcleod, S. (2023). Kohlberg’s Theory of Moral Development. SimplyPsychology.

https://simplypsychology.org/kohlberg.html

‌Varkey, B. (2021). Principles of Clinical Ethics and Their Application to Practice.

Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

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