1. Ethical Decision Making
Level 4 Counselling

2. AIMS
Will be able to identify own values and beliefs towards a specific ethical dilemma in respect of suicide
Should be able to apply a list of risk factors to the dilemma
Could apply new knowledge to other areas of ethical practice

3. What are ethical decisions?
In a group of 3 decide what you mean by making ethical decisions?
(5 minutes)
What did you decide?

4. THE BACP say …….
Ethical decision making is the practical process through which clinicians or counsellors base their actions, behaviour and choices on informed, sound judgement. It draws on values, principles and standards of behaviour that inform professional practice
Dr Nicola Davies, BACP GpiA 033

5. Ethical decision making involves
gathering facts
determining whether a problem or dilemma truly exists
whether or not there is an ethical, legal, moral, professional or clinical issue involved

6. In your Supervision groups:
I will be giving you an ethical scenario
1. Decide what your personal values and beliefs say you should do
2. Discuss this with your peers, has this prompted you to consider other factors?
You have 40 minutes to decide what the consensus is of the group

7. Scenario 1
Clare has recently received some medical test results. Her diagnosis is bad news. She has a disease that will eventually destroy her quality of life and kill her. How should her counsellor respond, particularly when she talks about ending her life? What are the most important issues to consider

8. Scenario 2
Jane is eight months pregnant and has been told that she has pre-eclampsia by her GP and should be admitted to hospital urgently for a Caesarean birth and treatment in order to protect her and the foetus from serious disability or death. Jane believes that serious illness and death are natural events that should not be interfered with. She refuses an emergency admission and instead asks to see the practice counsellor for personal support and insists on minimum medical intervention during the birth should she reach that point

9. Scenario 3
David is a student teacher who has chosen to see a counsellor privately rather than see the university counsellor or the one attached to his doctor’s practice. He has made this decision because he wants to protect the confidentiality of the counselling. However, his counsellor insists that he inform his GP or she will do so when he discloses that he is feeling suicidal. David refuses to do so because he does not want his emotional state to be recorded on his medical notes. He is concerned that this might lead to him failing a compulsory medical which he needs to pass in order to practise as a teacher.

10. Scenario 4
Brian is over-burdened by financial problems and social isolation following the ending of a longstanding relationship. He is becoming increasingly depressed and is talking about suicide as a way out of his problems and to escape the emotional pain he is experiencing.

11. What did you decide:

12. Factors to take into consideration are::
• gender, males generally present with greater risk across different ages
• age, males aged and over 75
• relationships, single, widowed, divorced/separated
• social isolation
• mental health diagnosis, including:
– depression
– schizophrenia
– alcohol/drug misuse
– homelessness
– paranoia
– mood disorders
– psychosis
– affective disorders
– lack of affective control
– anxiety/ panic disorders
– PTSD
• occupational factors e.g. unemployed/retired
• personality disorders, e.g. sociopathy, aggression
• history of child sexual abuse/child physical abuse/ adult sexual assault
• specific plan formulated
• prior suicide attempts/family history of suicide or suicide attempts
• physical illness and ie biochemical hormonal other medical factors changes.

13. Take some time
Will the factors advised alter your approach to your client?
(10 minutes)

14. How can you assess risk? CORE forms Becks Depression Index
Padesky Depression Index
Scaling

15. Protective factors Some capacity for emotional expression
Willingness to talk about thoughts and feelings
Informal support networks (friends/family etc)
Formal support networks
Involvement in interests and activities
Established successful coping strategies
Other key individuals the client is willing to talk to
Options for out of hours support
Physical activity, such as exercise
Important and identified key attachment figures
A collaboratively agreed crisis plan
Attending counselling
Quality of therapeutic engagement and the therapeutic alliance

16. Now ……………….
What sort of things might you ask/need to find out?

17. REVIEW
Did you identify own values and beliefs towards a specific ethical dilemma in respect of suicide?
Were you be able to apply a list of risk factors to the dilemma
Could you apply this new knowledge to other areas of ethical practice?