Ethical Decision Making AssignmentAshley Evans Northwestern University Abstract This paper discusses ethical dilemmas and the ethical decision making process

Ethical Decision Making AssignmentAshley Evans
Northwestern University
This paper discusses ethical dilemmas and the ethical decision making process. The scenario presented addresses the topic of duty to warn and protect, confidentiality and its limits, and the amount of information that ought to be disclosed. The scenario presented below is presented and analyzed using the Ethical Decision Making Model created by Wheeler and Bertram. To add substantial clarity to the claimed ethical dilemma, I will include a brief look at the ACA Code of Ethics, applicable state laws and statutes, and examine the scholarly literature that appropriately applies. It is with the sincerest hope that the reader walks away with a clear understanding of the dilemma presented, the correct course of action, and its justified reason.

Ethical Decision Making AssignmentEthical dilemmas occur quite frequently within the realm of mental health counseling. An ethical dilemma is a situation in which a counselor must make a decision that might involve conflicts in ethic codes or other areas within the professional relationship or situation (Kerulis, 2018). Counselors are often faced with complex situations with their clients and must ensure that they make the most ethically effective decision for the wellbeing of both the client and the public. Counselors are obligated to utilize an ethical decision making model, the ACA Code of Ethics, and applicable state laws. With these tools, along with scholarly research available for gaining further competence, counselors are equipped to develop a safe course of action. The scenario below addresses duty to warn and protect and the parameters of confidentiality.
Presented Case
The client is a forty-seven-year-old man named Mr. Keepitquiet. He has scheduled an appointment with the intention of seeking help for his depression. During the initial phone conversation, along with the first face to face dialogue, he has repeatedly asked for assurance that the information he will disclose remains confidential. As the session progressed, he revealed that the source of his depression was the passing of his mother, which occurred a year ago. His mother had suffered from a combination of Alzheimer’s disease and a severe respiratory problem.
He has been the care provider for both of his parents, and his mother had required total care in her last two years. Mr. Keepitquiet also disclosed that, out of compassion for her suffering, he gave her an excess dose of sleeping and pain medication. Although he feels guilty, he believes that he made the right decision for her. His father’s health has rapidly declined since the passing of his mother and now requires total care. During a conversation that Mr. Keepitquiet had with his father, his father has mentioned that his wife peacefully passed away and hoped that his passing is similar. Mr. Keepitquiet needs help working through his issues but is concerned about confidentiality.

Legal and Ethical Decision Making Model
In 2015, Anne Marie Wheeler and Burt Bertram developed a legal and ethical decision making model. They believed that many of the harmful behaviors conducted by counselors derive from a failure of knowing, understanding, and abiding by various state and federal laws. Wheeler and Bertram stated that “counselors who are mindful and respectful of ethics and the law can develop practices that are creative, thoughtful, passionate, and always in the best interests of the client” (Wheeler & Bertram, 2015, p.2). Throughout the course of this paper, Wheeler and Bertram’s Legal and Ethical Decision Making Model will be utilized to study the case and develop a course of action.

The Problem, Issue, Dilemma
According to Wheeler and Bertram’s model, the first step is to identify the problem, subissues, and the ethical dilemma. Mr. Keepitquiet’s clinical problem is that he’s experiencing depression that originates from his mother’s passing. The first subissue is that, although he believes he did the right thing by administering an excess dose of sleeping and pain medication, he does feel guilty. The second subissue is that his father’s health is rapidly declining and now requires total care. Because Mr. Keepitquiet gave an excess amount of medication to his mother that may or may not have caused her death, and his father has mentioned that he would like a departure like that of his late wife, the ethical dilemma presented is whether the counselor should break confidentiality and report this to his father and proper law enforcement channels.
Relevant Variables.

The second step is to identify the relevant variables that are present. His father now requires total care because of his health. It is not a fact that the excess dose of medication given to the mother caused her death because the Medical personnel didn’t question or investigate her death. Mr. Keepitquiet never disclosed whether his mother asked him for that excess amount.

The Law and Ethic Codes
The third step is to review and consult the law, ethic codes, and institutional policy. Three ethical codes apply to this case: B.1.c. Respect for Confidentiality – counselors must protect confidentiality of new and prospective clients, and can only disclose information with appropriate consent, or with sound ethical or legal justification (ACA, 2014). Without ethical or legal reasoning, the counselor would have to maintain confidentiality. B.1.d Explanation of Limits – at the initiation, and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify situations in which confidentiality must be breached (ACA, 2014). The counselor should inform the client that, although generally bound to respect confidentiality, there are exceptions that the counselor must seek out and identify.
B.2.a Serious and Foreseeable Harm and Legal Requirements – maintaining confidentiality does not apply when the disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed (ACA, 2014). Because Mr. Keepitquiet’s mother may have died from the excess amount of pain and sleeping medication given to her, and his father now requires the same total care resulting from his rapidly declining health, the counselor has an ethical obligation to inform the proper channels and the father. Looking at the case from a legal perspective, there are specific statutes that prohibit this type of behavior. In the state of Georgia, his actions are considered involuntary manslaughter.
According to Georgia code 16-5-3, a person commits the offense of involuntary manslaughter when he or she causes the death of another without any intention of doing so (GA, 2017). In the state of Wyoming, his actions are considered criminal negligence. According to Wyoming statute 6-2-107, a person is guilty of criminally negligent homicide if he or she causes the death of another by conduct amounting to criminal negligence (WY, 2017). Because his actions violated the law, and there is a possibility that he may do it again, the counselor must report his behavior and notify the father with the appropriate amount of disclosure.
Personal Influences
The fourth step would be to examine any personal influences. As a counselor in training with a background in law enforcement, my immediate thought was that the counselor should report the client, but my immediate thought was not justified. Contrary to the mindset of law enforcement, there are no good guys or bad guys here. Instead of jumping to conclusions and being closed-minded, the counselor should still facilitate a safe environment for the client to share his truth. The main priority is the overall wellbeing of the client and the protection of the public.
Consulting Outside Perspective
The fifth step is obtaining outside perspective. During my process of analysis, I spoke to two of my cohort members, and they also agreed that the counselor is both ethically and legally justified in breaking confidentiality. The shared concern was how much information needs to be disclosed to the father? After considering the possible ramifications for both the client and father, the consensus is only to share the information that appropriately applies. The father does not need to know that his son gave his wife an excess amount of medication; only that his life might be threatened if the son continues his care.
Options and Consequences
The sixth step is to enumerate the actions and consequences. Given the presented problems, dilemma, and recognized variables, there are several potential actions and consequences to review. Before comparing actions and consequences, it’s best for the counselor to look at what professional values are at stake and which take precedence. In this case, we are looking at fidelity (maintain the client’s trust), beneficence (promoting good for the individual and society), nonmaleficence (avoiding actions that create harm), and veracity (honestly dealing with the client).
Regardless of the selected course of action, the counselor should maintain veracity by being empathetically truthful with the client. The professional values that take precedence in this matter are beneficence and nonmaleficence. The goal is for the client to conduct himself safely and healthily, and for the father to get the safe and proper care that’s required. There are three potential courses of action that the counselor can choose.
The counselor can break confidentiality with the client, report him to proper law enforcement authorities, and warn the father. The counselor can also elect to maintain confidentiality with the client and encourage him to tell his father the truth about the medication to his mother. While maintaining that confidentiality, the counselor can also encourage Mr. Keepitquiet to send his father to an assisted living facility where he can receive the best care. With that, there are consequences to match.
If the counselor reports the client, the client could face jail time, a steep fine, or both. The client might not be able to see his father, and if fined, might lose the monetary resources needed to continue the care of his father. If the counselor does not report the client, the client could repeat his actions. As stated earlier in this case synopsis, he believes he made the right decision. The counselor could also be subjected to disciplinary action. If the client is encouraged to tell his father the truth, that could fracture or completely sever the relationship between the two.

Studying peer-reviewed articles related to the case is essential in developing the correct course of action. Numerous past court cases similarly resemble this one. One is the 1976 case of Tarasoff v. Regents of the University of California. The case involved a graduate student at the University of California – Berkley who disclosed in counseling his intention of killing a young woman because she no longer wanted to date him. The psychologist notified the campus police and reported his concerns to his supervisor. The supervisor determined that no further action needed to be taken because the student didn’t meet the civil commitment criteria (Wheeler & Bertram, 2015).
Campus police detained the individual but released him because he seemed rational. Neither party notified the city police or the woman. Consequently, the student murdered the young woman. The parents sued, and the Supreme Court ruled that a therapist who knows or should have known that a patient poses a “serious danger of violence to others” and does not exercise reasonable care to protect the intended victim or notify the police can be held liable (Wheeler & Bertram, 2015).

Because of the case, along with a few others, clinicians have spent time focusing on the duty to warn and protect. Cabrera and Zachariades discuss risk assessment versus assessment of dangerousness. They believe that the concepts are not the same. The former contains more of a legal construct, whereas the latter more empirically based. However, duty to warn and protect requires counselors to make a professional judgment regardless of if the danger is clear and present (Cabrera & Zachariades, 2012).

While many counselors believed that there was ambiguity that came with the ruling, the state of Michigan provided specific steps that should be taken: hospitalizing or attempting to hospitalize the patient, warning the third party, or notifying law enforcement (cite here). Dr. Anton Tolman also discusses, in his work Clinical Training and the Duty to Protect, a proposed training model that arms future clinicians with the tools needed to evaluate risk and take appropriate action. The California court case has been reshaped by several cases that have followed it over the years. One to include is the case of Jablonski v. United States. Jablonski, a psychiatric patient with a history of rape and homicidal ideation against girlfriend and mother, murdered his girlfriend after being discharged. In the ruling, the court modified the Tarasoff case by expanding the definition of foreseeability (Beck et al., 2001).

Decide and Document
To resolve the dilemma, the counselor should break confidentiality and inform law enforcement and the father. Once all notifications have been made, the counselor should ensure that the father is safe. Afterward, the counselor needs to properly document the interactions and all the decisions that were made.
2017 Georgia Code :: Title 16 – Crimes and Offenses :: Chapter 5 – Crimes Against the Person :: Article 1 – Homicide :: § 16-5-3. Involuntary manslaughter. (n.d.). Retrieved from Wyoming Statutes :: TITLE 6 – CRIMES AND OFFENSES :: CHAPTER 2 – OFFENSES AGAINST THE PERSON :: ARTICLE 1 – HOMICIDE :: SECTION 6-2-107 – Criminally negligent homicide. (n.d.). Retrieved from Counseling Association (2014). ACA Code of Ethics. Alexandria, VA
Tolman, A. O. (2001). Clinical training and the duty to protect. Behavioral Sciences & The Law, 19(3), 387-404. doi:10.1002/bsl.448
Walcott, D. M., Cerundolo, P., & Beck, J. C. (2001). Current analysis of the Tarasoff duty: An evolution towards the limitation of the duty to protect. Behavioral Sciences & The Law, 19(3), 325-343. doi:10.1002/bsl.444
Wheeler, A. M., & Bertram, B. (2015). The counselor and the law: A guide to legal and ethical practice. Alexandria, VA: American Counseling Association.

Zachariades, F., & Cabrera, C. (2012). The duty to warn revisited: Contemporary issues within the North American context. Journal Of Ethics In Mental Health, 71-5.