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Ethical Dilemma Case Study Presentation

CPCE5553 Ethics & Professional Issues in Counseling
by

Jessica Dahmer

on 16 May 2013

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Transcript of Ethical Dilemma Case Study Presentation

Case Study
Dilemma:
AIDS and Confidentiality Possible
Courses
of Action Option 1 Jake is removed
from contact
sports Encourage Jake
to tell his parents himself,
if he is willing to be
tested for HIV/AIDS If results are +,
formulate plan for
disclosing to parents if Jake
has not already
done so himself Immediately inform Jake’s
parents about his possible
exposure to HIV/AIDS after informing Jake of intent to
disclose Coordinate with
parents
for Jake to be
tested Stage 1, Component 1: Enhance sensitivity and awareness Jake- Fear and uncertainty causing anxiety
Do I have AIDS?
Did give it to 2 other people?
If I have AIDS, what do I do?
Should I tell my parents?
Will I still be able to play sports and hang out with my friends?

Mrs. Wright- Empathy, Urgency, Empowerment Stage 1, Component 2: Major stakeholders, ethical claim Jake- confidentiality, access to health services
Jake’s parents- FERPA grants access to records, responsible for child’s health
2 other partners- possibly protected by duty to warn, access to health services
Coaches- duty to protect other players, not included in exceptions to confidentiality
Mrs. Wright- primary obligation is therapeutic relationship, confidentiality, empowering Jake, duty to warn Stage 1, Component 3: Fact-finding process Discuss with Jake: How long ago was the sexual encounter in question? Did you have protected sex? Are your 2 other partners students in this school? If so, what are their names? Why don’t you want to tell your parents you’re gay? When do you plan to get tested for HIV?

Who will the health department notify if Jake is HIV+?

Disclosure- research ASCA ethical codes and state laws Stage 2, Component 2: Missouri Revised Statutes Jake is not required by law to get tested.
Jake can get tested confidentially or anonymously.
Confidential, HIV+ results will be reported to Missouri Health Department
MO Health Dept. will report to parents and District Superintendent or Chief Administrative Officer of a non-public school
Superintendent or Chief Administrator may report to School Counselor (Mrs. Wright)
Mrs. Wright may disclose to parents without being held liable for violating confidentiality Stage 2, Component 5: Consult with professionals Robert Lopez, High School Counselor:



Kathie Mahan, Oak Park High School, Professional School Counselor, Gay/Straight Alliance Coordinator:













Michael Pritchett, SE Missouri Circuit Judge: Kristina Brown, Jessica Dahmer,
Annie Pritchett, & Veronica Wilcox University of Missouri-Kansas City Stage 3, Component 1: Reflect on competing values, blindspots or prejudices Biases/Prejudices Preserve sanctity of marriage Relationships should be between man and woman Views on premarital sex Fear of HIV infection Ignorance about LGBTQIA community

Nonmoral Values Promote social harmony in student relationships Stage 3, Component 2: Consider contextual influences on values Team Removing player could hurt team’s season
Infected student could harm teammates as well as opponents

School and District HIV student could affect school or district’s reputation Stage 3, Component 3: Select preferred course of action Option 2 •Counselor will not inform student’s parents if he agrees to get tested •Counselor encourages student to inform parents about concerns of infection

This option has no conflicting non-moral values or blindspots Stage 3
Selecting an Action by Weighing Competing Nonmoral Values, Personal Blind Spots, or Prejudices Stage 2
Formulating an Ethical Decision Stage 1
Interpreting the Situation Through Awareness and Fact Finding Stage 2, Component 1: Review the problem or dilemma In reviewing the ethical dilemma present in the case study, it is clear that the primary issue is that: Jake is ambivalent toward being tested for HIV/AIDS and does not feel obligated to remove himself from contact sports. Stage 2, Component 2: Determine what ethical codes, laws, ethical principals, institutional policies and procedures apply Codes:
A.1.a-d (Responsibilities to Students)
A.2.c and A.2.g (Confidentiality)
A.7.a (Danger to Self or Others)
B.2.c (Responsibilities to Parents & Student Confidentiality)
E.1.a (Professional Competence)
E.2.a-d (Diversity) How do these principles apply to Mrs. Wright’s actions? Ethical Principles
Beneficence- Urging Jake to be tested/insisting on removal from contact sports
Nonmaleficence- Refraining from immediately informing Jake’s parents to avoid potential harm of relationships involved
Autonomy- Urging Jake to talk to his parents himself and want to be tested for his own safety
Justice- adhering to laws and codes to ensure that Jake is not discriminated against based on his sexual orientation
Fidelity- discussing the plan with Jake and being transparent about intentions to involve his parents Option 2 If results are -,
follow up with sex
education and planning
for prevention of STDs Positive Negative Tell
Parents Jake Tells Parents Consequences Parent awareness
Parents can help coordinate healthcare/testing 5+7= (cc) image by anemoneprojectors on Flickr Possible therapeutic relationship damage
Possible damage to parent/student relationship Maintains trustful relationships with Jake
Promotes autonomy for Jake
Jake takes responsibility
Jake has chance to tell parents himself May damage counselor/parent relationship
Less support system if parents don't coordinate healthcare Stage 2, Component 6: Best Ethical Course of Action While neither course of action is unethical, the second course of action lends itself to more ethical principles than the first plan.  If Ms. Wright refrains from immediately informing Jake’s parents, she is upholding the principle of fidelity while promoting autonomy and beneficence.  The end result of both courses of action is the involvement of Jake’s parents.  The second course of action allows Ms. Wright to give Jake an opportunity to take an active role in getting his parents involved. You are a high school counselor working primarily with juniors and seniors. A student you recognize from previous work together asks to see you. You remember him as a good student active in various sports and academic and social clubs. During your meeting, he announces to you that he is gay and has recently become sexually active. He is now concerned because an older male with whom he has had sexual contact has been identified as having AIDS. This older male no longer resides in the area and your student heard about the supposed diagnosis through the rumor mill. He has been unable to contact this person with whom he had sexual contact and cannot verify or deny the rumor. He says he has been sexually active only infrequently since the encounter, and then only with two people. Since hearing the rumor, he has had no further sexual contacts, but he has not told his partners that he may have been exposed to AIDS. He verbalizes to you his ambivalence about being tested for HIV and also the fact that he may have to tell his parents he is gay. He has continued to be active in contact sports as well as other activities and is again unsure of what to do or how to do it. After talking to you, he says he feels somewhat relieved, though no less ambivalent, and says he knows you will keep this information confidential. Ethical Dilemma Tarvydas
Integrative
Decision-Making Model
of Ethical Behavior Stage 4
Planning and Executing the Selected Course of Action Ensure
Jake gets
tested for HIV Maintain therapeutic relationship and continue to support Jake in any way he or Mrs. Wright see fit Obtain
Test
Results If Negative:
Provide information regarding prevention & sex education. If Positive:
Work collaboratively with Jake to disclose condition to parents (if they have not yet been informed)
Help Jake seek appropriate medical treatment
Mrs. Wright has duty to warn if a) the 2 potentially infected partners are students at the school and b) other parties have not yet issued warning.
Take all necessary measures to ensure safety of entire student body by considering implications of Jake's student involvement (participation in sports, etc.) Sequence of
Specific
Actions Component I: Encourage Jake to discuss concerns related to HIV with his parents. Stage 4, Component 2: Anticipate and work out contextual barriers that would impede upon successful execution Jake may refuse to get tested
inform the parents
educate Jake about available resources, severity of effects on others, and ramifications of not being tested

Jake may get tested anonymously
encourage him to take necessary steps in ensuring others' safety
without results the counselor cannot prove that there is eminent danger or any validity to the rumor

Jake may refuse to disclose to his parents after positive result
be transparent with Jake about rationale behind informing parents
conduct a meeting involving the counselor, parents, and student to create a plan of action Stage 4, Component 3: Carry out,
document, and evaluate Carry out specified plan of action
Document all consultations
Evaluate decision-making model and success of its application thereafter Help Jake make a plan to get tested and tell his parents
Immediately remove Jake from contact sports "If there was a clear case of imminent danger, there would be no doubt about warning others or the student’s family, however, in this case there is still a great deal of question and doubt about the validity of any of this information."

"Without a clear diagnosis and without the older sexual partner to consult with, much of this is supposition and to divulge the student’s sexuality at this point could cause great harm. In high school there is really very little confidentiality as parents are the holders of record and could force the conversation, if they knew enough to bring it up." “There would be tremendous privacy issues if a test was required, not to mention liability issues should the test results not remain confidential.” The End
Any Questions? Jake is removed
from contact
sports. Remove Jake from contact sports
Full transcript