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Running Head: ETHICAL DECISION MAKING
Ethical Decision Making: Client Access and Ethical Principles
Tonya D. Robinson
Liberty University
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Case Study Robin
Abstract
It is important that future counseling professionals and current counseling professionals are
aware of what things that may cause ethical concerns, how to avoid them and how to solve them
when issues occur. One of the key principles of counseling, is above all is do no harm, so it is the
counselors responsible to ensure that the they do everything in the best interest of the client. This
paper will discuss an ethical scenario about a client named Robin. In the scenario, Robin would
like access to her test results. The counselor denied the Robin’s claim and informed her that her
test results could not be released. The purpose of this paper is to determine if the counselor
mislead Robin, to discuss the ethical principles in regards to informed consent and client access,
to determine which ethical principles were violated, and finally reach a resolution to the ethical
violation. Competent counselors must be prepared to handle all kinds of ethical dilemmas. The
goal of this paper is to learn how to identify, be aware of and be prepared to solve any ethical
dilemma.
Key Words: ethical principles, ethical dilemmas, competency, identify
Clients Access and Ethical Principles
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Counselors keep a number of records when dealing with their clients. It is imperative that
the counselor follows all confidentiality and privacy principles mandated by their state and the
American Counseling Association. These guidelines have been set in place to ensure that
counselors “above all do no harm” which is one of the most important principles in the ACA
code of ethics (ACA, 2014). It is essential that future and current counseling professionals
possess a high level of competency in regards to all areas of counseling especially ethical
principles. Counselors be, should be aware of ethical violations and dilemmas, be able to identify
ethical violation and dilemmas, knowledgeable and have competency of the five moral
principles, and know methods to solve these issues. It is a counselor’s job to ensure that clients
receive the best interventions and must be treated with respect.
Identify the problem
Robin was a client that was admitted into a drug addiction program. The client was given a
number of assessments during her first week in the program. The client is confused as to why she
was given the assessments and wants to know how will they were being used. Later on into her
treatment program, she asked the on staff counselor for her results. The counselor, replies and
implies that clients are not allowed to see their test results or any part of their record. There are a
couple of problems with this scenario. The very first problem, is the client not knowing why she
is being tested, in the ACA ethical principles it discusses the importance of informed consent and
how clients should always be aware of the purpose behind testing and assessments. The second
issue is that the counselor told the client that clients do not have a right to access any of their
records. This is an ethical violation. The ACA code of ethics does express that clients should be
competent. However, a counselor should never tell a client that they cannot access any of their
records. This scenario addresses issues of informed consent and client access. The issue is an
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ethical issue because it is apparent that the counselor did not explain the purpose of the testing
and then denied the client the rights to their results. If this problem is not handled with
sensitivity, it could easily become a legal issue as well. This issue would be against the counselor
because it is caused because they are incompetent in regards to the principles that are given for
informed consent and client access.
Apply the ACA Code of Ethics
The issues in this scenario address informed consent and client access. Clients should
always be aware of the purpose of testing and assessments. According to ACA Code of Ethics
Section A.2.b. states that “Counselors must explain to their clients the nature of all services
provided and that they understand the implications of diagnosis and intended use of tests and
reports” (ACA, 2014). The scenario stated that Robin wondered why she got the assessments and
how would they be used, which supports the notion that though the therapist did not follow all of
the guidelines in relations to informed consent. The counselor may have gotten Robin to sign the
papers, but if she was not informed of the purpose, this is a serious ethical violation. The second
principle that was violated in this scenario was causing harm. According to the ACA Code of
Ethics, Section A.4.a. “Counselors should act to avoid harming their clients, trainees, and
research participants and to minimize or remedy unavoidable or unanticipated harm” (ACA,
2014). The counselor’s incompetence and inability to follow the ethical principles of informed
consent, will have a negative effect on the relationship between Robin and counselor because
Robin feels as though, she cannot trust the counselor because they are withholding information
from her and did not fully explain the purpose of the assessments. The ACA Code of Ethics,
Section B.6.e. states “Counselors should provide a reasonable access to records when requested
by competent clients” (ACA, 2014). It could be concluded that the counselor may have not felt
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like Robin would be competent enough to handle or understand her results. However, because
the counselor neglected to do the informed consent portion correctly, Robin now wants to know
what the results are and also wants to know the purpose of the assessments. It could also be
concluded that Robin has improved during the treatment by week 6, and that may explain why
she would like to know her results, so that she can chart her own growth. In this instance, Robin
should be given some type of information, whether it is the results or simply a proper
explanation behind the purpose of the assessments.
Determine the nature/dimensions of the dilemma
It is apparent that the counselor was lacking competency in the area of ethics.
Counselors that possess competency is essential in order to become an effective counseling
professional. There are a set of guidelines called the moral principles that was by Kitchener
(1984), the five principles include: autonomy, non-maleficence, beneficence, justice, and fidelity
(Kitchener, 1984). If a counselor develops these principles, they will ultimately avoid violating
the code of ethics in any capacity. The first principle is autonomy, which refers to the counselors
being able to respect client, their values, and give them the freedom to make their own decisions
(Kitchener, 1984). Counseling professionals should always accept clients for their unique A
counselors responsible to guide a client to the answer, not provide the client with the answers to
solve their problem at hand, which teaches the client how to be autonomous when dealing with
any future problems that may occur later on in life (Cavanagh & Levitov,2002). The second
principle is non-maleficence, this principle entails avoiding harm to clients by any means
necessary (Kitchener, 1984). The third principle is beneficence, which implies that a counselor is
to do their best to stop the client from being harmed or lessen the chances of them being harmed
(Kitchener, 1984). Beneficence can be best understood as ensuring that the focus of the
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counseling remains solely on the client and their current situation. This helps to keep the
counselor and client relationship strictly professional. The fourth principle is justice, which
means that it is the counselors responsibility to ensure that they treat all clients with fairness and
without judgement (Kitchener, 1984). It is important that counselors advocate on behalf of their
clients, especially clients that have an inability to advocate for themselves. The final principle is
fidelity, is a counselor’s loyalty to client and ensuring that the client receives the best means of
intervention within all of the ethical parameters (Kitcherner,1984). Counselors must ensure that
their relationship with the client is positive, empathic, inviting yet professional. By following
these five principles a counselor will be able to identify areas that may cause ethical dilemmas
and the counselor will be able to avoid them.
In the issue regarding informed consent. Researcher Satyanarayana Rao (2008)
concluded that “obtaining consent is not only an ethical obligation, it is also a legal impulse,
meaning a professional can avoid legal liability” (Satyanarayana Rao, 2008). The study
researched the importance of informed of consent and its purpose. Clients ultimately should have
a say so over their care and should be aware of what is occurring during the whole counseling
process. Robin’s counselor did not follow the necessary guidelines mandated by the ACA Code
of ethics, the counselor may have had Robin sign the necessary documents but they failed in
informing her of the purpose. It is the counselor’s responsibility to ensure that they cover all of
the necessary bases in all areas of the code of ethics. Because the counselor failed to explain the
purpose they may be in for a legal battle. This is an ethical principle would not have been
violated by a competent counselor. This issue would be an example of what a beginning
counselor may have. According to Remley and Herlihy (2016), “from the legal aspect of health
care records are kept to benefit the client, so clients should have access to these records (Remley
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& Herlihy, 2016)”. Counselors must ensure that they make clients be aware of each process of
counseling. In this scenario, the counselor should have ensured that the client was aware of the
reasoning behind their treatment, which may have caused the client to progress much further.
Potential Courses of Action
The ACA Code of Ethics has specific rules and regulations regarding informed consent and client
access of records. It is unethical for a counselor not explain the purpose of treatment and
assessments (ACA, 2014). If a client fails to properly follow the informed consent regulations it
causes more ethical violations which could harm the client and the counselors career overall. In
this scenario it could be said that the counselor was a young professional that lack competency in
the areas of ethical principles especially of informed consent. The best things for the counselor
to do is contact the client and apologize for denying them access. It would be for the best interest
of the situation and the client, if the counselor exhibits some level of empathy towards the
sitation The counselor should conduct a session with the Robin and explain the purpose behind
the assessments that she was given, in order to give her some peace of mind. It is the job of the
counselor to exhibit sensitivity and empathy. The first thing that the counselor should do before
going through with this process and consult their supervisor or consult with experienced
colleagues. If the counselor is competent enough they will realize that they may have violated an
ethical principle unintentionally. Even though the counselor may have felt that the client was
incompetent, it is a counselor’s role also to ensure that clients are aware of their treatment and
understand their treatment methodology. Here a list of possible interventions that will assist in
this scenario:
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Consult experienced counseling professionals in the field
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Observe all information that was given during the informed consent portion of the
counseling process
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•
Evaluate the areas that were not addressed properly with the client
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Have experienced counseling professional help the counselor to devise a plan of action
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Interact with the client in an empathic and welcoming way
•
Reassure the client that they are a top priority
It can be concluded that the counseling professional could reduce this ethical violation by simply
consulting with experienced professionals in the field.
References
America Counseling Association (2014) Code of Ethics.
Retrieved http://www.ncblpc.org/Laws_and_codes/2014%ACA_Code_of_Ethics.pdf
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Cavanagh, M. E., & Levitov, J. E. (2002). The counseling experience: A theoretical and
practical approach (Second edition.). Prospect Heights, IL: Waveland Press.
Remley, T., & Herlihy, B. (2016). Ethical, Legal, and Professional Issues in Counseling. New
York, New York: Pearson Education.
Satyanarayana Rao, K. H. (2008). Informed Consent: An Ethical Obligation or Legal
Compulsion? Journal of Cutaneous and Aesthetic Surgery, 1(1), 33–35.
http://doi.org/10.4103/0974-2077.41159
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