Common Sense or careful deliberation Resolving Ethical Issues Jeannette Baca, Ed.D.,LPC In 1984, Kitchener argued that relying on personal value judgment's was not adequate because not all value judgments are equally valid. She then proposed a model based on Beauchamp & Childress’ ethical principles. Two systems of decision-making: 1) Intuitive; fast, automatic, effortless, implicit and emotional, and 2) Slower, conscious, systematic and organized (Bazerman & Tenbrunsal, 2011). Counselors are obligated by the ACA code of ethics to use a carefully considered ethical decision-making process (ACA Purpose). Common Sense or careful deliberation

Your Presenter Jeannette Baca, Ed.D., LPC Jvbaca@nmhu.edu Counseling, Consulting and Training, Owner Albuquerque, NM Adjunct Faculty New Mexico Highlands University Rio Rancho, NM Retired Educator (30 years) Licensed Mental Health & School Counselor New Mexico Webinar contents: Participants will be asked to consider a recent ethical issue which will be examined using an ethical decision-making process as indicated in the 2014 Code. Code revisions will be indicated with a star.

What is your ethical dilemma? A dilemma has competing alternatives, all of which have both positive and negative aspects. A counselor experiences conflict in determining an appropriate standard of conduct. Standard of care refers to what a reasonably competent counselor would do in a similar situation. Standard of care is articulated in ethical codes, laws, training and professional development, literature, policy… “An ethical dilemma is a circumstance that is confusing for the counselor because (a) there are competing or conflicting ethical standards, (b) there is conflict between what is ethical and moral (c) the situation is such that complexities make application of ethical standards unclear, and (d) some other circumstance prevents a clear application of standards.” (Cottone & Tarvydas, 2007, p. 2)

ACA Codes of Ethics [Purpose] 2005 Ethical Code “When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a carefully considered ethical decision- making process.” “Through a chosen ethical decision- making process and evaluation of the context of the situation, counselors are empowered to make decisions that help expand the capacity of people to grow and develop.” (p.3) 2014 Ethical Code “When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a carefully considered ethical decision- making process.” “Counselors acknowledge that resolving ethical issues is a process; ethical reasoning includes consideration of professional values, professional ethical principles, and ethical standards.” (p.3) The 2005 ethical code stated that counselors are expected to use an ethical decision-making process, yet the results of a survey of ethical dilemmas faced by college counselors found that most of the counselors (93%) reported relying on common sense to resolve ethical dilemmas (Hayman & Covert, 1986). The 2014 code provides more specific directives about the process and what ethical reasoning involves. Before engaging in an ethical decision making process, the context is set by considering profession values of counseling and looking at ethical principles which provide the foundation for the ethical standards and ultimately ethical judgment.

Resolving Ethical Dilemmas Professional Values Ethical Principles Ethical Code

Core Professional Values of Counseling 1. enhancing human development throughout the life span; 2. honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts; 3. promoting social justice; 4. safeguarding the integrity of the counselor-client relationship; and 5. practicing in a competent and ethical manner. (p.3) Counselors should ask themselves whether their core values fit with values of the profession.

The fundamental principles of professional ethical behavior include: Ethical Principles The fundamental principles of professional ethical behavior include: Autonomy Beneficence Nonmaleficence Veracity Fidelity Justice Autonomy; free will, freedom to choose Beneficence; do good, not just while working with clients, but in general Nonmaleficence; do no harm Fidelity; to be faithful and keep promises Justice; fairness Veracity; to be honest

Section I: Resolving Ethical Issues (2014) I.1.b. Ethical Decision Making “When counselors are faced with an ethical dilemma, they use and document, as appropriate, an ethical decision- making model that may include, but not limited to , consultation; consideration of relevant ethical standards, principles, and laws; generation of potential courses of action; deliberation of risks and benefits; and selection of an objective decision based on the circumstances and welfare of all involved.” (p.19) Using the process provided in this standard, each action will be examined. Be mindful of your ethical issue as we go through each step.

Ethical Decision-Making Process Counselor Laws Ethical Principles Course of Action Risks and benefits Consult Ethical Codes Client Welfare A.1.a. Primary responsibility of counselors is to respect the dignity and promote the welfare of clients” p.4 Section I.1.b. provides counselors with specific steps involved in ethical decision-making; client welfare being the ultimate goal. A review of ethical decision-making models can be found at Cottone & Claus, (2000)

Ongoing Consultation! I.2.c. Consultation: When uncertain about whether a particular situation or course of action may be in violation of the ACA Code of Ethics, counselors consult with other counselors who are knowledgeable about ethics and the ACA Code of Ethics, with colleagues, or appropriate authorities, such as the ACA Ethics and Professional Standards Department. Trusted Colleague Counselor Attorney ACA Someone who has solved issue Practice Board Consultation should be ongoing, not just a step in the process. It is important to consult with someone who will be honest and candid. Many time friends and co-workers will support you, even though they disagree. An objective, neutral individual like ACA’s ethics department is a good resource. Professional Literature Expert in the field

Define the Problem Acknowledge your emotions and “gut feeling”; happy, sad, afraid/surprised, angry/disgusted.  Identify the core issues; clinical, legal, ethical. Determine if a personal or professional value conflict exists. “Intellectualize” the problem, define objectively; what are the facts? Talk to someone! What is their immediate reaction (knee-jerk) Consult Define the problem both emotionally and cognitively; this means separating emotions and fact. Considering whether the dilemma is clinical, legal or ethical; this will determine your course of action. A personal value conflict means the dilemma is driven by a counselor’s personal values, morals and beliefs (will discuss this in next slide) and professional value conflicts involve training or competency. Use your counselor observation skills to assess non-verbal behaviors of others; talking about the dilemma will help to be objective.

Counselor “Self-Check” World View attitudes & beliefs Ethical Traps Common sense “Gut” reaction “Instinct” Biases & value Influences Emotional Reaction Overconfidence Counselors’ personal values influence their beliefs about counseling and the counseling process. It is important to be aware of your world view, ethical traps, biases (including unintentional) and emotional reaction. Awareness alone is not sufficient, counselors should consider alternative points of view and search for evidence that contradicts your beliefs (will discuss this again). It is okay to be uncertain.

Personal Values 2005 ACA Code of Ethics 2014 ACA Code of Ethics A.4.b. Personal Values Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants. (p.5) 2014 ACA Code of Ethics A.4.b. Personal Values Counselors are aware of –and avoid imposing---their own values, attitudes beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature. (p.5)

Value Conflicts (Kocet & Herlihy, 2014) Ethical Bracketing (EB) Intentional separating of personal values from profession values; setting aside counselor’s personal values in order to provide appropriate counseling to all clients. 1. Immersion; self reflection & awareness 2. Consultation; codes, professional literature 3. Education; training 4. Supervision & ongoing consultation 5. Personal Counseling (if necessary); identify barriers & personal biases Ethical Bracketing is a strategy that seeks to ensure that a client is not harmed, whether intentionally or unintentionally, by a counselor’s imposition of a certain value set. Help counselor maintain fidelity

Counselor Values-Based Conflict Model (CVCM) (Kocet & Herlihy, 2014) The CVCM is a working model designed to assist counselors when faced with a value-based conflict between themselves and a client, supervisee, or student. Counselors are asked to first determine if the conflict is a personal conflict or professional values conflict (p. 184). Step 1 Determine Nature of Value-Based Conflict; personal or professional Step 2 Explore Core Issues and Potential Barriers to Providing Appropriate Standard of Care Step 3 Seek Assistance /Remediation for Providing Appropriate Standard of Care Step 4 Determine and Evaluate Possible Courses of Action Step 5 Ensure That Proposed Actions Promote Client Welfare

Consider all Relevant Ethical Codes, Laws and Institutional Policy Know and identify applicable ethical standards Access relevant state and federal laws; e.g. licensing laws, abuse, privilege, HIPPA, HITECH Familiarize yourself with institutional policies

Apply Ethical Principles Beneficence Autonomy Nonmaleficense Fidelity Veracity Ethical principles serve as the foundation for the code of ethics; the 2014 code is more consistent with the principles.

Termination or referral of clients must be carefully considered… Generate Potential Courses of Action *consider risks and benefits of each action *possible and unintended consequences *create an argument for (pro) and counter-argument (con) Course of Action Risks Benefits Consequences ACTION A ACTION B ACTION C Termination or referral of clients must be carefully considered…

Termination and Referral A.11.a. Competence Within Termination and Referral If counselors lack the competence to be of professional assistance to clients they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship. (p.6) A.11.b. Values Within Termination and Referral Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the clients goals or are discriminatory in nature. (p.6)

Evaluate Course of Action Stadler’s Decision-Making Assessment (1986) Justice Publicity Universality Justice: assess your own sense of fairness by determining if you would treat others in this situation the same way. Publicity: ask yourself if you would want your behavior reported in the press; can you defend your behavior? Universality: could you recommend the same course of action to another counselor in the same situation?

Select An Objective Decision Define the Problem [Ongoing] Consultation Counselor “Self-Check” Consider Relevant Ethical Codes, Laws, & Institutional Policy Apply Ethical Principles Generate Potential Courses of Action Evaluate Course of Action Select Objective Course of Action Although not every ethical dilemma requires a comprehensive decision-making process that is deliberate, explicit and logical, a step-by-step process that is defensible is a counselors best defense. Relying on our intuition or common sense is a flawed process full of questionable advice.

“It is always the right time to do the right thing.” Dr. Martin Luther King

Resources American Counseling Association. (2005). ACA code of ethics. Alexandria, VA: Author. American Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author. Cottone, R.R., & Claus, R.E. (2000). Ethical decision-making models: A review of the literature. Journal of Counseling and Development, 78, 275. Hayman, M.P. & Covert, J.A. (1986). Ethical dilemmas in College Counseling Centers. Journal of Counseling and Development, 64, 318. Kocet, M.K. & Herlihy, B.J. (2014). Addressing value-based conflicts within the counseling relationship: A decision-making model. Journal of Counseling & Development, 92, 180- 186. Stadler, H.A. (1986). Making hard choices: Clarifying controversial ethical issues. Counseling & Human Development, 19, 1-10.