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Running Head: ETHICAL DECISION MAKING ASSIGNMENT 1

Ethical Decision Making Assignment

Janelle D. Robinson

University of Calgary

ETHICAL DECISION MAKING ASSIGNMENT 2

I have been asked to counsel a young boy who is caught the attention of his teachers at

school, as he presents as very withdrawn, avoids classmates, and prefers to spend time alone.

During my initial meeting with the youth and his grandmother he describes a sense of isolation

and loneliness, and he states that he hears an elderly man speaking a tribal language to him, as

well as singing voices. The grandmother reveals she has recently lost her husband and feels that

her grandson provides support to her, she also states that she is not eating or sleeping and is

overwhelmed with thoughts of past traumatic events involved in residential school. After this

session I am concerned about understanding the psychotic symptoms of the youth, and perhaps

the grandmother as well. I feel that a psychiatric assessment is necessary to provide the

appropriate counselling support and interventions. This assessment may also be helpful for

supports within the school system, as well as the community. However; completing the

assessment may prove to be a challenge, as I am unable to administer the assessment, and the

clients will be required to travel 100 miles to an urban centre. I am utilizing the ethical decision

making model provided by the Canadian Code of Ethic for Psychologists (2000) to assist me in

overcoming his dilemma.

Step 1: Identification of the Individuals and Groups Potentially Affected by the Decision

The individuals that I consider as being the most affected by the decision are the young

boy and his grandmother. However, my decision may also affect the youth’s teachers,

classmates, as well as the grandmother and youth’s family and community members.

Step 2: Identification of Ethically Relevant Issues and Practices

I have identified 23 ethical values that I believe are central to my dilemma by using a

chart that outlines the code. There are seven included under Respect for the Dignity of Persons,


seven involved with Responsible Caring, three included in Integrity in Relationships, and two

involving Responsibility to Society (Canadian Psychological Association, 2000).

Ethical Principles and Respective Values and Standards

1. Respect for the Dignity of Persons

II. Responsible Caring

III. Integrity in Relationships IV. Responsibility to Society

1.General Respect (I.1-I.4)

1. General Caring (II.1-II.5)

1. Accuracy/Honesty (III.1-III.9) 1.Development of Knowledge (IV.1-IV.3)

2.General Rights (I.5-I.8)

2. Competence & Self-Knowledge (II.6-II.12)

2.Objectivity/Lack of Bias (III.10-III.13)

2. Beneficial Activities (IV.4-IV.14)

3. Non-discrimination (I.9-I.11)

3.Risk/Benefit Analysis (II.13-II.17)

3.Straighforwardness/Openness(III.14-III.22)

3. Respect for Society (IV.15-IV.18)

4. Fair Treatment/Due Process (I.12-I.15)

4.Maximize Benefit (II.18-II.26)

4. Avoidance of Incomplete Disclosure (III.23-III.30)

4. Development of Society (IV.19-IV.29)

5. Informed Consent (I.16-I.26)

5.Minimize Harm (II.27-II.36)

5. Avoidance of Conflict of Interest (III.31-III.35)

5. Extended Responsibility (IV.30-IV.31)

6. Freedom of Consent (I.27-I.30)

6.Offset/Correct Harm (II.37-II.44)

6. Reliance on the Discipline (III.36-III.38)

7. Protection for Vulnerable Persons (I.31-I.36)

7. Care of Animals (II.45-II.48)

7. Extended Responsibility (III.39-III.40)

8. Privacy (I.37-I.42)

8. Extended Responsibility (II.49-II.50)

9. Confidentiality (I.43-I.45)10. Extended Responsibility (I.46-I.47


Principle/Values My ThoughtsPRINICPLE I: RESPECT FOR THE DIGNITY OF PERSONS

Value: General RespectI.3 Strive to use language that conveys respect for the dignity of persons as much as possible in all written or oral communication.

Value: General RightsI.8 Respect the right of research participants, clients, employees, supervisees, students, trainees, and others to safeguard their own dignity.

Value: Informed ConsentI.16 Seek as full and active participation as possible from others in decisions that affect them, respecting and integrating as much as possible their opinions and wishes.

I.17 Recognize that informed consent is the result of a process of reaching an agreement to work collaboratively, rather than of simply having a consent formed signed.

I.19 Obtain informed consent from all independent and partially dependent persons for any psychological services provided to them except in circumstances of urgent need…

If contacting a professional for a psychiatric assessment I must utilize respectful language when describing the youth, as well as the grandmother. I also need to be respectful when communicating with the clients and others involved in the assessment or treatment.

I need to respect the dignity of the youth and his grandmother by providing them with choices and considering their concerns.

I need to discuss the possibility of obtaining a psychiatric assessment with the youth and grandmother and discuss the benefits of the results of the assessment. I also need to discuss the possible transportation to and from the assessment site. I will respect the opinions of the youth and grandmother, keeping in mind that a diagnosis may be necessary to obtain the required supports for the youth within the school system and the community.

I need to remember that it is my job to work collaboratively with the youth, grandmother, as well as the individual providing the assessment. Collaboration would also be extended to those providing supports within the school and community.

I need to obtain informed consent from the grandmother, as well as informed consent from the guardian of the youth (grandmother or other individual).


I.25 Provide new information in a timely manner, whenever such information becomes available and is significant enough that it reasonably can be seen as relevant to the original or ongoing informed consent.

Value: Freedom of ConsentI.30 Respect the right of persons to discontinue participation or services at any time, and be responsive to non-verbal indications of a desire to discontinue if a person has difficulty with verbally communicating such a desire (e.g. young children, verbally disabled persons) or, due to culture, is unlikely to communicate such as desire orally.

Value: Protection for vulnerable persons

From the values statement: “…psychologists recognize that as individual, family, group, or community vulnerabilities increase, or as the power of persons to control their environment or their lives decreases, psychologists have an increasing responsibility to seek ethical advice and to establish safeguards to protect the rights of the persons involved.”

Value: PrivacyI.37 Seek and collect only information that is germane to the purpose(s) for which consent has been obtained

Value: ConfidentialityI.44 Clarify what measures will be taken to protect confidentiality, and what responsibilities family, group, and community members have for the protection of each other’s confidentiality, when engaged in services to or research with individuals, families, groups or communities.

I need to provide the grandmother or other guardian with any information regarding booking the assessment, travel plans, results of the assessment, or changes in plans as necessary.

I need to remain aware of the verbal and non-verbal behavior of the youth and grandmother and respect that they may desire to discontinue my counselling regardless of whether the assessment is completed. I also need to be sensitive to their aboriginal culture and understand that they may not feel comfortable verbally expressing that they wish to discontinue my services. This includes deciphering any non-verbal cues that the clients wish to discontinue counselling.

I need to do everything I can to ensure the youth in particular, as well as the grandmother receive their right to treatment whether an assessment is provided or not.

I need to remain focused on the issues brought forth to me during counselling sessions, and collect only that information being careful not to collect any information from situations or sources outside of that setting.

I need to communicate to the youth and grandmother that all discussions within the counselling setting will remain confidential, and that the results of the assessment (if completed) will remain confidential. I will also communicate to both individuals that in order for them to retain privacy and


I.45 Share confidential information with others only with the informed consent of those involved, or in a manner that the persons involved cannot be identified, expect as required or justified by law, or in circumstances of actual or possible serious physical harm or death.

PRINCIPLE II: RESPONISBLE CARINGValue: General CaringII.1 Protect and promote the welfare of clients, research participants, employees, supervisees, students, trainees, colleagues, and others.

II.2 Avoid doing harm to clients, research participants, employees, supervisees, students, trainees, colleagues, and others.

II.3 Accept the responsibility for the consequences of their actions.

Value: Competence and self-knowledge

II.6 Offer or carry out (without supervision) only those activities for which they have established their competence to carry them out to the benefit of others

II.10 Evaluate how their own experiences, attitudes, culture, beliefs, values, social

confidentiality they must refrain from speaking about sessions to family or community members.

I must remember to only share information with individuals or organizations that the clients have consented that I can share with.

I need to ensure I protect the welfare of the youth and the grandmother, and respect their opinions and wishes in regards to obtaining an assessment.

I need to avoid potentially harming the clients and respect, protect, and promote their welfare. I need to keep an open mind that the trip to the nearest assessment location may be harmful to the grandmother’s health (depending on any chronic or serious conditions), as well as the stress involved in travelling for both the youth and the grandmother. If they express the trip would be highly stressful I need to ask myself if the assessment is worth the involved stress or potential harm of the clients.

I need to be accountable for my actions and work to correct any unanticipated negative consequences in regards to traveling to the assessment location, or the any negative consequences of the assessment procedures on the clients.

I need to ensure that I provide the client’s with services that I am competent of providing and only services that will be beneficial to the clients without any chance of harm.

I need to be aware of and correct any assumptions that I have about the client’s


context, individual differences, specific training, and stresses influence their interactions with others, and integrate this awareness into all efforts to benefit and not harm others.

Value: Risk/benefit AnalysisII.13 Assess the individuals, families, groups, and communities involved in their activities adequately enough to ensure that they will be able to discern what will benefit and not harm the persons involved.

II.14 Be sufficiently sensitive to and knowledgeable about individuals, group, community, and cultural differences and vulnerabilities to discern what will benefit and not harm persons involved in their activities.

Value: Maximize benefitII.18 Provide services that are coordinated over time and with other service providers, in order to avoid duplication or working at cross purposes.

II.21 Strive to provide and/or obtain the best possible service for those needing and seeking psychological service. This may include, but is not limited to: selecting interventions that are relevant to the needs and characteristics of the client and that have reasonable theoretical or empirically-supported efficacy in light of those needs and characteristics; consulting with, or including in service delivery, persons relevant to the culture or belief systems of those served; advocating on behalf of the client; and, recommending professionals other than psychologists when appropriate.

II.22 Monitor and evaluate the effect of their activities, record their findings, and communicate new knowledge to relevant others.

aboriginal culture. I also need to be sensitive to past experiences I’ve had within this culture that may influence the interactions that I may have with the clients, in order to benefit these two individuals and not harm them.

I need to have a full understanding of both the youth and the grandmother to not only provide adequate counselling, but also to understand if a trip to an urban centre is a viable option.

I need to have a full understanding about the beliefs, worldview, and values of the youth and grandmother to provide sufficient counselling activities and to understand if travelling to the assessment location will be beneficial or harmful.

I must be open with the individual who will possibly perform the assessment, as well as any other professionals involved with the clients to work collaboratively to benefit the clients.

I will strive to provide my best services to the clients by consulting with individuals within the aboriginal culture to understand if a trip to an urban centre is fundable, as well as beneficial and not harmful for these clients. I will also select only interventions that will be helpful and not harmful for the clients whether or not an assessment takes place.

I will ensure that I will monitor any interventions, and communicate any new findings about the youth to individuals that need to be contacted (this may include guardians and teachers).


Value: Minimize HarmII.29 Be careful not to engage in activities that could place incidentally involved persons at risk.

II.30 Be acutely aware of the need for discretion in the recording and communication of information, in order that the information not be misinterpreted or misused to the detriment of others. This includes, but is not limited to: not recording information that could lead to misinterpretation and misuse; avoiding conjecture; clearly labelling opinion; and, communicating information in language that can be understood clearly by the recipient of the information

II.31 Give reasonable assistance to secure psychological services or activities, if personally unable to meet requests for needed psychological services or activities.

PRINCIPAL III INTEGRITY IN RELATIONSHIPS

Value: Objectivity/lack of bias

III.11 Take care to communicate as completely and objectively as possible, and to clearly differentiate facts, opinions, theories, hypothesis, and ideas, when communicating knowledge findings and views.

Value: Straightforwardness/openness

III.14 Be clear and straightforward about all information needed to establish informed consent or any other valid written or unwritten agreement.

Reflect on the dilemma to understand if taking the clients to an urban centre is potentially putting them at risk due to the stress of travelling, health issues related to the grandmother, and mental issues of the youth.

I need to make sure to clearly communicate with the individual who may be performing the assessment to ensure that my concerns about the youth as well as the grandmother are clear. I also need to be clear about what behaviors and thought patterns need to be assessed.

I need to find a way to get the assessment completed from a qualified individual, as I am unable to perform the assessment myself.

I need to be objective and honest when speaking to the clients about the possibility of taking a trip to an urban centre. I need to speak about the importance of obtaining the results of the assessment and how it will benefit the clients in regards to counselling services and possibly educational services.

I need to be clear about any additional costs, likely experiences the clients may encounter through the assessments, possible outcomes associated with the results of the assessments, or outcomes if the assessment does not occur. I also will be straightforward about who I will


III.15 Provide suitable information about the results of assessments, evaluations, or research findings to the persons involved, if appropriate and if asked. This information would be communicated in understandable language.

III.16 Fully explain the reasons for their actions to persons who have been affected by their actions, if appropriate and when asked.

Value: Reliance on the discipline

III.38 Seek consultation from colleagues and/or appropriate groups and committees, and give due regard to their advice in arriving at a responsible decision, if faced with a difficult situation.

PRINCIPAL IV: RESPONSILITY TO SOCIETY

Value: Beneficial activitiesIV.10 Uphold the discipline’s responsibility to society by promoting and maintaining the highest standards of the discipline.

IV.12 Contribute to the general welfare of society (e.g. improving accessibility to services, regardless of ability to pay) and/or to the general welfare of their discipline, by offering a portion of their time to work for which they receive little or no financial return.

share the assessment information or results with.

If the assessment is completed I need to provide the clients with any pertinent information or answer any questions asked by the clients. I need to remember to use language that is understandable to the clients when doing so.

I need to provide the clients with a rationale about why I think the assessment is important and necessary. This rationale includes how I believe the results of the assessment will provide important information that I require to deliver appropriate counselling services and interventions. The results may also help to obtain necessary supports within the school system.

I need to seek consultation from other professionals in deciding to take the clients to an urban setting for the assessment and reflect on this consultation before coming to the decision.

It is my responsibility to help these clients to the best of my ability and if an assessment is necessary to provide the best practice I should push for it to happen.

If I need to accompany the clients to the assessment I should do so, in order to improve accessibility to services, regardless of whether I’m paid for this time or not.


Value: Respect for society

IV.15 Acquire an adequate knowledge of the culture, social structure, and customs of a community before beginning major work there.

IV.16 Convey respect and abide by prevailing communities mores, social customs, and cultural expectations in their scientific and professional activities, provided that this does on contradict any of the ethical principles of this code.

I need to have a full understanding of the community the clients live in, especially with regards to their aboriginal culture and beliefs before beginning to work with them.

I need to be respectful of how I approach these clients, as well as any potential family or community members in regards to their cultural beliefs.

Step 3: Consideration of How Personal Bias, Stresses, or Self-interest Might influence the

Development of or Choice Between Course and Action

My primary inclination is to secure an appointment to receive an assessment, as I think

that if I have a complete understanding of the psychiatric symptoms I will be able to provide

more suitable services that will benefit the clients. I am stressed, due to a large case load

including clients from various rural locations, and I am looking forward to allowing another

professional to perform the assessment. I also think that discussing the symptoms, as well as

strategies or possible interventions with the assessment administrator will help with my case

conceptualization. As I am accustomed to travelling long distances in my day to day living I

believe that the trip is something that is reasonable for these two individuals to undertake.

Additionally, I am worried that if I don’t receive the results from this assessment I will be

providing these clients with inappropriate services, and if word gets out that I have not been

helpful to the clients it could potentially damage my reputation.


Step 4: Development of Alternative Courses of Action

In examining my dilemma I have eliminated the following courses of action: a) assume

that traveling to get an assessment is an unattainable option for the these clients and decide not to

mention it choosing instead to provide counselling without assessment results; or b) make the

assessment appointment for the clients without discussion and rely on them to follow through

with any travel arrangements or additional costs that may be associated with it.

Alternative One

As a counsellor I understand the ethical importance of obtaining an assessment to have a

full understanding of the psychotic symptoms the client(s) are experiencing and to provide both

clients with extensive support and appropriate interventions. In this alternative I discuss the

importance of the assessment with both the youth and grandmother and disclose how the results

will assist and benefit them in the counselling processes. I will consider any apprehensions the

clients may have about travelling a long distance to an urban setting including extra costs,

transportation, and stressors associated with the trip. I will then brainstorm, with the clients,

means to travel to the urban area including possibly using their own vehicle, getting a ride from

friends or family, taking a grey hound bus or other public transportation, or if they are members

of an aboriginal band utilizing the bands forms of transportation, such as a van. We will also

discuss how to cover additional costs, as well as other travel concerns.

Alternative Two

Again, as a counsellor I understand that obtaining an assessment is of great ethical

importance in order to provide the clients with the greatest amount of counselling assistance. In

this scenario I research modes of transportation the clients may be able to utilize on my own;

including using the band transportation, public transportation such as the grey hound bus, or


rides form community members. Next, I discuss the importance of the assessment and how it

will benefit the clients in the future, then present them with the options that I have researched to

get them to the urban setting. Discuss if any of these options would suit them and examine any

concerns the clients have regarding the trip.

Possible Positive Consequences Possible Negative ConsequencesAlternative 1Maintain an open relationship with the clients by including them in the decision making process.

By discussing any concerns or issues involved in the trip I will gain a better understanding of the client’s lives including health concerns or issues, possible community supports and assistance, and supports from family and friends.

Including the clients in brainstorming means to obtain transportation to the assessment site will create a sense of control over the decision, possibly leading the clients to agree to attend the assessment.

Alternative 2

By researching methods of transportation independently then presenting it to the clients I will appear to have an understanding of the issue and will be perceived by the clients as caring and helpful.

By presenting the options for transportation to the clients they will experience less stress because they will not need to come up with solutions for transportation themselves.

Independently researching methods to obtain the assessment will be a more efficient use of my time, and the clients and I can focus on their emotional issues during our next session instead of brainstorming means of

By including the clients in the decision making process they may be tempted to come to the conclusion that a trip to the urban setting simply is not an option.

Bringing up any issues that may arise due to the trip may upset the clients and in turn they may refuse to follow through on the trip to avoid the possible stressors or issues associated with it.

A discussion around possible transportation may discourage the clients leading them to decide not to follow through with the assessment.

The clients may view me as being controlling and forceful if I present them with the options that are available to them without first discussing their ideas for transportation.

The clients may feel forced into abiding to my solution which may develop a sense of resentment in future counselling interactions.

The clients may be resistant to discussing emotional issues with me after I present my ideas, as they may feel I have not listened to their concerns about the journey.


transportation.

Step 6: Choice of Course of Action after Conscientious Application of Existing Principles,

Values, and Standards.

I believe the actions and consequences of alternative one more evidently espouse the

values included in principle one (Respect for the Dignity of Persons), in particular the value of

informed consent in which I should “seek as full and active participation as possible from others

in decisions that affect them, respecting and integrating as much as possible their opinions and

wishes” (Canadian Psychological Association, 2000). Alternative one also supports principle

two (Responsible Caring) in which I am required to guard and uphold the welfare of clients,

which includes incorporating their thoughts and concerns in the decision making process. My

chosen course of action includes principle three (Integrity in Relationships), as I am willing and

required to explain to the client’s the reasons for my actions to obtain transportation to get to the

assessment. These reasons include: through the results of the assessment I will obtain a better

understanding of the client’s thoughts and behaviors, thus providing appropriate counselling

support. I also take principle four (Responsibility to Society) into account in alterative one as I

plan to develop an understanding of the clients “culture, social structure, and customs of a

community” before I begin working with them (Canadian Psychological Association, 2000). I

also intend to understand how the client’s cultural beliefs, values, and assumptions are associated

with their behaviors and decision making practices (Truscott & Cook, 2013). I believe both

courses of action would be considered ethically appropriate, but I think it is more respectful to

include the clients in the decision making process. If I were to take the second alternative the

clients may perceive me as going above them to make an important decision for them without


their input. This may in turn develop negative feelings towards me, thus potentially damaging

the working alliance.

Step 7: Actions with a Commitment to Assume Responsibility for the Consequences for the

Action

I need to move forward with the first alternative in order to obtain the assessment that is

essential for me to provide effective counselling strategies and interventions. I have specified

two viable alternatives, but I also recognize that the ultimate decision to follow through with the

assessment is dependent on the actions of the clients; however I will provide support and

encourage them to attend the assessment appointment.

Step 8: Evaluation of the Results of the Course of Action

Evaluation of the results will be based on the responsiveness of the clients to the options

that we develop in alternative one. The evaluation will be ongoing and based on the experiences

of the clients as they participate in the journey, the assessment, and future counselling

interactions.

Step 9: Assumption of Responsibility for the Consequences of Action, Including Correction

of Negative Consequences, If Any, or Re-engaging in the Decision-making Process if

Ethical Issue Is Not Resolved.

It is possible through discussing the course of action with the clients that they choose not

to follow through with the visit to the urban centre, thus impeding my full understanding of the

symptoms, diagnosis, or conditions that the clients are experiencing. If this does happen I may

need to develop another strategy to make the assessment available to the clients, which I am

open to if this situation should occur. If the clients should experience any negative consequences


caused by the journey to the urban centre or by the assessment procedures, I need to provide

support and interventions to work through or correct the negative experiences.

Step 10: Appropriate Action, as Warranted and Feasible, to Prevent Occurrences of the

Dilemma (e.g., Communication and Problem Solving with Colleagues, Changes in

Procedures and Practices)

In working through this dilemma future practices for transportation to assessment

location may be put in place. For example, if the aboriginal band agrees to provide a vehicle,

then this practice may be used for other individuals requiring professional services that involve

travel.

References


Canadian Psychological Association (2001). Companion manual to the Canadian code of ethics

for psychologists (3rd ed.). Ottawa, ON: CPA.

Canadian Psychological Association (2000). Canadian code of ethics for psychologists (3rd ed.).

Available in the above Manual and at www.cap.ab.ca and www.cpa.ca

Truscott, D., & Crook, K. H. (2013). Ethics for the practice of psychology in Canada (revised

and expanded edition). Edmonton, AB: The University of Alberta Press.

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