Ethical Case Study: Applying The Forester-Miller And Davis M

Ethical Case Study: Applying the Forester-Miller and Davis Decision Model

Ethical case study analysis involves examining complex dilemmas faced by counselors, ensuring that decisions align with professional ethical standards and documentation. This paper employs the Ethical Decision Making Model by Forester-Miller and Davis (1996), endorsed by organizations like the American Counseling Association (ACA) and the American School Counselor Association (ASCA), to analyze a detailed case involving a minor's mental health and substance use concerns. The goal is to systematically explore the ethical, legal, and professional issues through each step of the model—identifying the dilemma, reviewing relevant ethics codes, analyzing the case with literature and consultation, generating and evaluating courses of action, and implementing the chosen resolution—while justifying decisions based on evidence and literature. This structured approach aims to clarify how professional standards guide complex counseling situations involving confidentiality, diagnosis, informed consent, and situational ethics. The case revolves around Tommy, a 17-year-old with behavioral, academic, and substance-related issues, and the ethical challenges encountered by counselor Ben in balancing client autonomy, parental rights, confidentiality, and legal responsibilities within the counseling process.

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The case presents multiple ethical concerns, including confidentiality, adolescent autonomy, informed consent, diagnostic accuracy, and the impact of documentation on a young client’s future. The primary dilemma centers on whether to uphold Tommy's confidentiality and autonomy or to consider the parents' concerns and legal responsibilities, especially given his recent 18th birthday. Based solely on the facts, Tommy's behavioral issues, substance use, and academic decline are clear, but his insistence that he is not using drugs and his belief that his substance use is "normal" complicate the clinical picture. Moreover, the diagnosis of substance use disorder (SUD) was documented, which has profound implications for Tommy's future, especially in terms of stigma and eligibility for college sports scholarships. The prominent ethical issues involve confidentiality versus parental rights, especially since Tommy just turned 18, and the proper process for diagnosis disclosure and documentation.

The applicable code of ethics for this case comes primarily from the ACA (2014), which emphasizes confidentiality (Section B.1), informed consent (Section A.2), and the importance of cultural competence and autonomy (Section C). The ACA Code states that clients should be fully informed of limitations to confidentiality, especially regarding minors and legal adults, and that counselors should respect clients' autonomy when appropriate, balancing it with parental rights. Additionally, since Tommy just turned 18 during the course of counseling, legal issues around consent and confidentiality are relevant, requiring careful ethical navigation. The counselor must also consider the implications of diagnosis disclosure, balancing the duty to provide accurate clinical information with potential harm from stigma or mislabeling.

The nature and dimensions of the dilemma involve conflicting principles—respect for autonomy versus beneficence and non-maleficence, the legal rights of minors versus adults, and the potential harm of disclosure or nondisclosure. The literature suggests that adolescent confidentiality is complex; Miller and their colleagues emphasize the importance of promoting adolescent autonomy while recognizing the need for parental involvement in certain circumstances (Miller et al., 2014). Other research highlights the impact of diagnostic labels on young clients, especially concerning stigma and future opportunities (Klingler et al., 2018). Consultation with colleagues and review of existing literature provide strategies for ethically managing the case.

Considering potential courses of action, the counselor might: 1) Maintain confidentiality if legally permissible and discuss with Tommy, emphasizing his right to privacy; 2) Inform the parents of Tommy's diagnosis and progress, balancing transparency with the adolescent’s rights; 3) Seek to obtain appropriate consent for diagnosis disclosure to the parents, especially since Tommy recently turned 18; 4) Reconsider the diagnosis based on new information or further assessment, possibly adjusting or clarifying what was documented; and 5) Develop a safety or intervention plan if substance use or behavioral issues threaten safety. Each option must be carefully analyzed regarding its potential consequences, legal constraints, and ethical alignment.

In evaluating these courses, justice, publicity, and universality tests are essential. Justice involves fairness in decision-making and respecting both Tommy’s and his parents’ rights. The publicity test asks whether the decision could be openly justified, while the universality test considers whether similar cases would be handled similarly if applied universally. Given the client’s age and recent legal and developmental changes, transparency, respect for autonomy, and adherence to legal standards support a course that respects Tommy’s evolving rights (e.g., informed assent and confidentiality) while considering parental concerns.

Implementing the chosen course involves clear communication with Tommy about confidentiality limitations and the implications of diagnosis documentation, seeking his assent for disclosure, and documenting decisions thoroughly. In practice, this could involve having a conversation about his rights, explaining the diagnosis’s impact, and explaining how information will be shared with his parents if appropriate. Follow-up might include reassessment of his substance use and mental health status, review of documentation accuracy, and considering whether a different diagnosis or additional assessments could be appropriate. Documentation should always reflect the clinical reasoning and adherence to ethical standards, maintaining records that protect the client’s rights and meet legal requirements.

In conclusion, applying the Forester-Miller and Davis ethical decision-making model provides a clear, systematic pathway through the complex ethical landscape of this case. Respecting Tommy’s autonomy and confidentiality while honoring legal and ethical responsibilities requires careful, thoughtful decision-making, ongoing consultation, and clear communication. The case highlights the importance of balancing clinical accuracy, confidentiality, and legal considerations within adolescent counseling, emphasizing that ethical decision-making is a dynamic and context-sensitive process. Ultimately, the counselor's goal is to promote the client’s well-being while adhering to professional standards and fostering trust and integrity in the counseling relationship.

References

• American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/ethics
• Miller, F., et al. (2014). Ethical decision-making in counseling adolescents. Journal of Counseling & Development, 92(3), 285-292.
• Klingler, C. M., et al. (2018). Impact of diagnostic labeling on adolescent mental health. Journal of Youth and Adolescence, 47(2), 340-355.
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• American School Counselor Association. (2016). Ethical standards for school counselors. Alexandria, VA: ASCA.
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