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Ethical Decision THIS IS A PAPER THAT WAS WRITTEN
IN ORDER TO COMPLETE COURSEWORK
Orientation to Counseling Professional Identity (Liberty University)
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Running head: ETHICAL DECISION-MAKING 1
Ethical Decision-Making Paper-Scenario 1
Michael B. Blue
Liberty University
COUC 501-D21
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Abstract
Counseling is meant to help patients address issues and explore options while providing a
safe space to talk about for the client to talk about their personal problems. All of this hinges on
the counseling relationship that the counselor has with his client. If this relationship is
compromised, then the wellbeing of the patient may also be compromised. This is the reason that
the American Counseling Association (2014) published a unified code of ethics. The counselor
needs a guide to help him navigate situations that will cause the counseling relationship to be
jeopardized if not handled properly. When these situations arise, the Counselor needs to be able
to choose a method of ethical decision-making.
While the ACA does not advocate for one ethical decision-making process they do
require counselors to approach any problem that may arise logically and ethically because,
“Through a chosen ethical decision-making process and evaluation of the context of the
situation, counselors work collaboratively with clients to make decisions that promote clients’
growth and development (ACA, 2014).” By making choices ethically and openly the counselor
will be able to promote the client’s growth and maintain the purity of the client-patient
relationship.
The purpose of this work is to examine a hypothetical scenario where a counselor is
placed in a situation where it is necessary to make tough, ethics-based decisions. The model that
will be used to work through this scenario is the seven-step Ethical Decision-Making Model
presented by Holly Forester-Miller and Thomas Davis, (1996). This work will examine the
counselor’s actions and look to find a potential course of action to reinforce or reestablish the
counselor and patient relationship.
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Ethical Decision-Making Paper – Scenario 1
“Jane is a hardworking, licensed professional counselor who has a very successful private
practice. Jane has not had a vacation in over a year. She is feeling the stress and burnout and
knows she needs to do something quickly for her mental health. Thus, she decides to go on
vacation for a week. She quickly makes the arrangements and then emails all of her clients with
whom she has appointments during the week of vacation, informing them of the need to cancel.
She fails to let her other clients know she will be gone; since none of her clients are in crisis, she
decides to not worry about getting someone to cover her clients while she is gone.”
Identify the Problem
Before identifying the problem with Jane’s actions, it should be noted that she did a few
things correctly. Jane had worked for one year straight without taking time off, which most
likely to the success of her private practice. Jane realizes that she is feeling the strain of her
work, and afraid of burnout, does not want to become impaired. To avoid counselor impairment
Jane carves out some time on her calendar to go on a vacation. The second thing that she did
correctly was to send an email to each of her clients that she had appointments with during that
time.
However, the problem in this scenario is that Jane did not contact any of the clients that
she did not have appointments with or leave them with any coverage. She left an entire group of
her clients vulnerable to harm due to her oversight. While there were no clients in crisis, that
does not mean that they will not experience a crisis while she is on vacation. They should have
been informed of her absence and temporarily placed under the care of another counselor (ACA,
2014). If something would have happened to any of her clients, even the ones that she informed,
that could be traced back to lack of care would be her responsibility. When she entered into
these counseling relationships, she took on the responsibility of making sure that her clients
were
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completely covered. By abandoning her clients, Jane has opened herself up to a malpractice
lawsuit and left her clients exposed to potential harm.
Applying the ACA Code of Ethics
The American Counseling Association Code of Ethics (2014), states clearly
in section A.12 that the counselor cannot abandon the client.
“Counselors do not abandon or neglect clients in counseling. Counselors assist in making
appropriate arrangements for the continuation of treatment, when necessary, during
interruptions such as vacations, illness, and following termination.”
The purpose of making the appropriate arrangements for clients is that there will be no gap in
coverage even in the case of client termination. When the client’s wellbeing cannot be assured it
breaches the trust that exists in the counselor-client relationship.
In addition to the American Counseling Association, the Ohio State Counselor, Social
Worker, and Marriage and Family Therapist Board (2011) has made a provision in their revised
code dealing with abandonment and termination. They have set forth that no client will be
abandoned or gapped in their access to a counselor (CSWMFT Revised Code, 2011).
Determine the nature and dimensions of the dilemma
Jane’s actions violate at least two of the American Counseling Association’s Code of
Ethics (2014), moral principles. The first principle that it violates is nonmaleficence, which is
the value that perpetuates the idea of “Above all do no harm (ACA, 2014).” Whether or not she
intentionally meant to harm her clients, Jane engaged in actions that risked harming her clients
(Forester-Miller & Davis, 1996).
The second moral principle that Jane violated was beneficence. The essence of this value
is for the counselor to promote the wellbeing of the client and working for the good of the
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individual (ACA, 2014). Jane was not promoting her client’s wellbeing or working for the good
of the individual. She left her clients without an option for help while she was unavailable.
This dilemma is one that could have been avoided with the intake of each client. When
each contract is written it should be worded in a way that allows for a reevaluation of coverage
and a contingency plan for times of separation (Barnett & Jeffrey, 2015) Joy Natwick (2017),
says “to avoid abandoning or neglecting clients, counselors and organizations should take the
necessary steps to arrange for continuation of treatment that is appropriate to a client’s needs in
the absence of the original provider.”
When a licensed counselor who runs her own private practice, such as Jane, there is no
direct supervisor to talk to. As a peer, if I saw this happening, I would go to another practitioner
who had their own private practice and talk to them about how to handle the situation. Then if
the situation needed to go higher than being dealt with at the peer level I would have to go to the
Ohio State Counselor, Social Worker, and Marriage and Family Therapist Board.
Generate potential courses of action
Before making a decision like leaving clients unattended Jane should have reviewed the
code of ethics. Part of ethical decision-making is ensuring that you are meeting all of your ethical
obligations under the American Counseling Association.
Jane should also do a full audit of her contracts with managed care providers. Some
specify how many sessions are obligated to the counselor as well as availability. Some of her
contracts may state that she must be available seven days a week. If jane were to find any
contracts that required strenuous coverage, she would be able to plan accordingly.
One possible to counteract any contracts that require constant availability to a counselor
would be to partner with another counselor that is equally qualified and could cover for in times
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of absence. Also, having an answering service that provided emergency phone numbers and the
closest emergency department would be acceptable.
Another action that could have been done was to email all of her clients an updated
informed consent that informed each client that she was not going to be available for a certain
period of time. This would have to be incorporated into each client’s care plan in order to make
sure that there were no special cases that she was not missing.
Consider the potential consequences of all options and determine a course of action
If jane would have emailed all of her clients, instead of just the ones that had
appointments during that time the consequences may have been minimal. If something were to
have happened to one of her clients while she was gone, she would be able to state that she had
informed all of her clients that she would not be available. However, this action would not
completely absolve her of wrongdoing because she did not provide them with proper coverage
while she was absent.
If Jane had been more proactive and issued a revised informed consent, I do not believe
that there would have been any consequences because it meets the standard of working with the
client for the client’s own good. It provides the client with the autonomy to be a part of the
decision making.
Furthermore, If Jane wants to be above reproach, she would have found another
counselor that could assist a client that faced an emergent crisis. The most fortified action would
have been to issue a revised informed consent that informed all over clients that she would not
be available to take appointments or emergency calls and provided them with the contact for a
counselor to reach in case of an emergency.
Evaluate the Selected Course of Action
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Having selected to issue a revised informed consent with updated emergency contact
information and the credentials of the counselor that would be filling in the future, I feel that it
does not present any new ethical problems. This new plan has ensured that Jane is meeting the
ethical principle of Nonmaleficence by taking action to avoid harm. Also, Jane is rectifying her
breach of beneficence. This course of action ensures that she is working for the good of her
community and the individual
When applying the test of Justice, I would say that this course of action rectifies the
injustice that is produced by only contacting a select group of clients and not the others. In the
test of publicity, it shows that Jane was willing to admit that she was wrong and quick to rectify
her deficiency so that her clients will be able to receive the best care. In the test of universality, I
believe that this an action that every counselor could take and that it would be beneficial for
them.
Implement the Course of Action
The first thing that Jane needs to do is send out a statement to her every one of her clients
apologizing for not informing them of her absence and leaving them without proper coverage.
Then she should assure them that there will never be an instance where they are without proper
coverage again. While this may be difficult and embarrassing to do it is a necessary step towards
rebuilding that trust which is so integral to the counseling relationship.
Next would be to send out a revised informed consent with the updated emergency
information and the point of contact in the case of Jane’s absence in the future. This revised
informed consent should be given to all new clients upon intake so that this violation will not
happen to any future clients.
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References
47 Ohio Rev. Code. § 4757-05 (2011), available at http://codes.ohio.gov/orc/4757-05.
2014 Code of Ethics - American Counseling Association. (2014).
https://www.counseling.org/resources/aca-code-of-ethics.pdf.
Barnett, J. E., & Johnson, B. W. (2015). Ethics desk reference for counselors. American
Counseling Association.
Forester-Miller, H., & Davis, T. (1996). A Practitioner's Guide to Ethical Decision Making.
Counseling.org. https://www.counseling.org/docs/ethics/practitioners_guide.pdf?
sfvrsn=2.
Liberty University Online. (2016) Counseling 501 – Ethical decision-making paper scenarios.
Retrieved from http://www.liberty.edu/
