It should be appropriate for practitioners of all experience levels, and the provider should be able to apply it to a wide range of ethical situations, for example, when considering a boundary crossing. Riggin and Lack (2018) note that decision-making models have traditionally failed to take into account the affective components of ethical problem solving. They propose a virtue-driven decision-making model which takes into account the values and morals of the clinician. The congruence of the model with the clinician is then increased, and this fosters a stronger sense of internalized ethical behavior. Their values model incorporates themes of openness, benevolence, justice, and commitment, during six stages when making a decision on a course of action. This type of model, which focuses on values, is popular with the helping professions. ● Stage One: Observation—Recognize and define the situation which requires decision-making. Research codes of conduct and local laws to see if the appropriate action is specified. Explore personal affect including feelings, values, and biases. ● Stage Two: Identification—Identify the culture, value systems, and relevant ethical principles to help clarify how they all influence the potential course of action. ● Stage Three: Consultation—Consult with supervisors, colleagues, and current literature. Brainstorm potential solutions and evaluate each. Develop a list of possible solutions and what the repercussions would be. Involve the client in the decision-making process if appropriate. ● Stage Four: Balance—Consider the balance between personal beliefs and values and the accepted code of ethics. These must be balanced with the values of the client, or the client may be minimized and/or boundary crossings may occur. ● Stage Five: Action—The course of action is prepared and implemented. ● Stage Six: Reflection—Self-reflection, mindfulness, and documentation are completed. Document the details of the dilemma, the procedures followed, the reasoning for choosing a particular solution, and the final effect of the course of action. Determine if something different should have been done. Another popular model is the ETHICS model introduced by Ling and Hauck (2017). It is based on the ethics literature, and it uses the ACA’s suggestions for ethical decision- making models and strategies included in the ACA Code Case Study Regardless of the specific decision-making model the clinician chooses as a best fit for their practice, all models simplify down to the following steps: 3. Consider the potential consequences of all options. 4. Determine a course of action and implement it. 5. Review the outcome. Apply these steps for ethical decision making to the following case study. The case is fictitious but is a situation that would not be uncommon, particularly in more rural areas. Dr. Smith has a private practice in the small town where she lives. Jane has recently moved to the town and has been seeing Dr. Smith for weekly psychotherapy sessions over the past 2 months for symptoms of anxiety with panic episodes. They have a mutually agreed goal of reducing the frequency of panic attacks to one per week. Jane is making good progress in her ability to recognize symptoms and utilize cognitive and behavioral strategies, and the frequency of panic attacks has decreased from multiple times daily to an 1. Identify the problem. 2. Gather information.
of Ethics (2014). This model strives to simplify the ethical decision-making process into six steps, which can be applied to a broad range of ethical dilemmas. ● E—Evaluate the dilemma. This is the most critical aspect of the model. The clinician applies the Ethics Code and any applicable laws to help define the dilemma. Possible courses of action and the ethical codes that support or violate each option are evaluated. There are three possible categories of action: 1. The course of action may not violate any ethical code. In this situation there is no dilemma and no need to apply the decision-making model. 2. The course of action violates an ethical code, and there are no other codes that support the action. This course of action should not be considered. 3. The course of action has codes that simultaneously support the action and some that are violated by the action. This is the most common in clinical practice and is the type of dilemma that a decision-making model is designed to help resolve. ● T—Think ahead. Once the dilemma is defined, think ahead to the possible consequences of each potential action. Consider all who are potentially affected by the action. Clinicians have a duty to do no harm and to work to help the client achieve the best possible outcome, so this step aligns with the general principles of beneficence and nonmaleficence. ● H—Help. It is important to receive help from others in the form of consultation. Receiving help is different than receiving a decision. Receiving help involves discussion of relevant factors to help determine a course of action, keeping the responsibility for the action with the clinician. Help can be sought from different sources: legal clarification from an attorney, risk-management clarification from a liability company; clinical clarification from a supervisor or colleague. The help received is then applied to each potential action. ● I—Information. Information should be sought from all available sources including literature, laws, regulations, and agency policies. The information is then applied to each possible action to highlight pros and cons. ● C—Calculate risk. Assess risk to each potential participant in the action. Decreasing risk to one party may increase risk to another. ● S—Select an action. The clinician determines the most ethical/least unethical course of action. average of three per week. As she has been feeling more in control, she has begun to re-engage in activities that have provided her with support and comfort. One of these activities is church attendance. Dr. Smith was surprised when she saw Jane arrive alone at Dr. Smith’s church one Sunday morning, the only church of that denomination in the town. Jane came up to Dr. Smith and asked to sit next to her during the service. Although somewhat startled, Dr. Smith agreed. At their next therapy session, Jane stated that she has now become a full member of their mutual church and has volunteered to work on the same outreach committee as Dr. Smith but hasn’t attended a meeting yet. How should Dr. Smith proceed? Questions: 1. Is there an ethical dilemma? 2. What about the situation requires decision-making? 3. If a decision is needed, what is the best course of action for resolution?
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