ETHICAL VIGNETTE PAPER 2
Ethical Vignette Paper
The ethical decision-making process is a key factor in making sounds decisions when
counseling a client, it involves several steps from identifying the issues, acknowledging what
type of issue it is, applying state and ethic codes, conducting consultation, and implementing a
plan. Counselors need to understand the importance of utilizing an ethical decision-making
model when dealing with ethical and legal concerns due to the complexity of issues that arise
when counseling clients. In the video “Whose records,” we see an interaction between counselor
and client, where the client is asking for records and the counselor does not feel this is a
acceptable request. This video raises ethical and legal concerns when the counselor denies the
client access to her records, I will utilize the ethical decision-making model to address the ethical
and legal issues of this situation along with coming to a resolution and address the issues.
Identify the Problem(Elaborate)
The problems that arise in this example are when the client requested access to her
records that the counselor had been keeping and records from previous counselors. The
counselor does not offer any explanation and states, “I really don’t think what I’ve written will
be very helpful to you.” There is an ethical issue of declining to give a client’s records, along
with a legal issue in failing to produce client’s records without explanation.
Apply the ACA Code of Ethics
The American Counseling Association (ACA) code of ethics is a guideline that all
professional counselors must follow, it helps professionals conduct themselves in accordance
with a set of ethical principle. Code B.6.e states that a counselor should comply with the request
of a client who is in the right mindset unless releasing records would cause harm to the client.
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(American Counseling Association [ACA],2014). This code can be applied to the situation when
the counselor states “I really don’t think what I’ve written will be very helpful to you.” The
counselor understands that procurement of the records might contain harmful information. Code
B.6.e allows the counselor to provide records to clients containing limited information (ACA,
2014). Going over the client’s records with them can help facilitate an understanding, allow the
client to ask questions, and receive clarification about records to limit harm as talked about in
ACA code B.6.f (ACA, 2014). Applying the ACA code of ethics helps us to navigate the
example shown and better understand our obligations as counselors.
Applicable state Codes/Laws and Federal Mental Health Laws
California state has specific laws to address when and when not to release records to
clients and how to provide them. “Code § 123110” states any minor or adult has the right to
request and receive records taken by the counselor, a fee must be paid when requesting records,
and a request can be denied showing of records if client’s records will in danger of any type at
the desecration of counselor (California Health & Safety Code, 2020) California law, however, is
often left up to the desecration of counselor to deem what can be harmful. California law
describes the legal issues that are violated when the counselor denies the request of client for her
records without explanation. Another legal aspect the example brings up is the violation of
Health Insurance Portability Accountability Act (HIPAA) privacy rule. Under HIPAA privacy
rule the client has the right to request any type of protected health information (PHI) with a
written request. “45 CFR § 164.524” goes into detail to outline that you can only deny a client’s
request when it could lead to endangerment of a person’s life physically or psychologically
(Health Insurance Portability Accountability Act [HIPPA] privacy rule, 2024). This is like “42
US Code § 9501” with the only difference being the refusal must be in writing (Bill of Rights,
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2024). We can see a common theme between all laws allowing one access to their records with
the caveat of harm.
Determine the Nature and Dimensions of the Dilemma
In the example of the counselor denying the client their records, we can see two moral
principles in action, both non-maleficence and beneficence.
There are many consequences to think about when acting on non-maleficence especially
between withholding information and providing information. Withholding information to prevent
harm can also cause harm to the client with thoughts of the unknown (Lim et al., 2023).
Professionals have an obligation to abide by ACA morals. The bible makes note that the Lord
has a plan for us and made that plan in our best interest to give us a hopeful future and prevent
harm upon us. (New International Version Bible, 1978/2011, Jeramiah 29:11). As a counselor we
must utilize this training and prevent harm to clients. Showing records can also cause
disagreements between counselors and client which can diminish the counselor client
relationships and raise concerns about how services are provided to the client (Zanaboni et al.,
2022). As a counselor, like the Lord, we have power over others and must ensure that we use our
power to prevent harm to clients during periods of vulnerability, as the Lord dose we must chose
to love and have compassion (Daniel., 2020).
Beneficence is another issue raised by the counselor who is denying records for clients.
An example of beneficence is when Christ dies on the cross for our sins (New International
Version Bible, 1978/2011, Romans 5:8). He chose to provide for the best interest of society as a
counselor must choose what is in the best interest of the client. The counselor can act in the
client’s best interests by denying her the right to see her records. A professional’s ideas can be
imposed on the client when thinking of what is in the best interests of the client. This is
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subjective and can be manipulated by the counselor’s own morals and values (Lim et al., 2023).
Denying records for the client’s best interest can harm the counseling relationship as the client
might mistrust the counselor for failing to provide records (Zanaboni et al., 2022).
Abiding by ACA morals is not the only aspect to consider when trying to come to a
decision about an ethical dilemma. I can also consult with NAADAC (The Association for
Addiction Professionals) and the CALPCC (California Association for Licensed Professional
Clinical Counselor). Both have their own code of ethics which can help address issues and aid in
ethical decision making. I can also consult with my peer a LPCC in the state of California and
his clinical supervisor. When speaking with the LPCC he often referred to the weight of each
situation and to follow California code because “that is what governs us a counselor.”
Generate Potential Course of Action
When applying ethical decision-making model to the interaction between the counselor
and client regarding the request for records there are many different interpretations. Utilizing the
California code, ACA codes of ethics and federal mental health laws I concluded three separate
ways to address these issues.
One of the ways that I would address the example is to inform the client that I do not
think that providing their records will be beneficial to them. I would explain how notes are taken
and their purpose for insurance, billing, diagnosis, and consultations with other
specialties/providers. I would inform them of the process of termination and offer to provide a
warm hand off to the next counselor, including sending all current records and documentation to
that provider. With the client’s permission I would complete a release of information to forward
documentation.
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A second way I can manage this example is to inform the client that I do not think that
the records would be beneficial, however I would respect the client’s request for records. I would
provide records as asked for by the client and offer to review them with the client. Reviewing
information and process with the client is important when remaining open and ethical with your
client and part of ethical decision making (Froehlich et al., 2023). I would make sure that the
client fully comprehends her records and make sure to allow the client to ask any questions to
help understand. This would follow through with California state law, ethics, and morals.
A third and final way I could address these issues if for me is to discuss what the client
hopes to get out of the receiving her records. I would provide counseling around the idea of
frequently changing counselors and how that impacts the client to receive effective services. I
would not provide the client records in this meeting as it would focus on finding the deeper
reason for switching counselors. I would then consult with peers, consulting with peers is one of
the most widely implemented steps that counselors often chose to lean on when making utilizing
an ethical decision model (Burkholder et al., 2020). I would then follow up in the next session
with a decision.
Conclusion
It is vital to utilize the ethical decision-making model when running into ethical or legal
issues. Applying the ethical decision-making model ensures that the counselor provides best
practice and ensures the client’s best interest is being accounted for. Throughout this paper I
have applied the ethical decision-making model to the video involving the client and counselor. I
have discussed the importance of each step and applied the situation to each and came to three
different conclusions on how to deal with this situation. This paper embodies the importance of
using an ethical decision-making model in the field of counseling.
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References
American Counseling Association. (2014). ACA code of ethics.
https://www.counseling.org/resources/aca-code-of-ethics.pdf.
Bill of Rights (2024), 42, U.S.C. § 95
https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-
section9501&num=0&edition=prelim01
Burkholder, J., Burkholder, D., & Gavin, M. (2020). The role of decision‐making models and
reflection in navigating ethical dilemmas. Counseling and Values, 65(1), 108–121.
https://doi.org/10.1002/cvj.12125
California Health & Safety Code (20222) § 123110
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?
lawCode=HSC§ionNum=123111.
Daniel, D. (2020). Counseling Principles and Christian Beliefs: An Integrated Approach.
Kendall Hunt.
Froehlich, R. J., Hicks, S. B., Hill, J. C., Tichy, N., & Riedy-Rush, C. (2023). Using the Revised
CRCC Code of Professional Ethics for Rehabilitation Counselors as a Tool in Resolving
Ethical Issues. Rehabilitation Counseling Bulletin, 66(4), 301-309.
https://doi.org/10.1177/00343552221148200
HIPAA Privacy Rule. (2024). 45 CFR 164.524.
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html
Lim, I., Korfmacher, J., Steier, A., Zeanah, C., & Zeanah, P. D. (2023). The ethics of infant and
early childhood mental health practice. Infant Mental Health Journal, 44(5), 651–662.
https://doi.org/10.1002/imhj.22055
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New International Version (2011). Bible Gateway,
https://www.biblegateway.com/versions/New-International-Version-NIV-Bible/
#booklist. (Original work published 1978)
Zanaboni, P., Kristiansen, E., Lintvedt, O., Wynn, R., Johansen, M. A., Sørensen, T., &
Fagerlund, A. J. (2022). Impact on patient-provider relationship and documentation
practices when mental health patients access their electronic health records online: A
qualitative study among health professionals in an outpatient setting. BMC Psychiatry,
22. https://doi.org/10.1186/s12888-022-04123-7
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