Ethical Dilemma In Sally’s Case

This paper will be exploring the provided scenario Sally’s case based on the Principle-Based Decision-Making Models introduced by Canadian Counselling and Psychotherapy Association (CCPA) Code of Ethics (2007) consists of six steps which will be go through in details in this case study.

The case description

Client Sally, who deemed to be ‘mature minor’ during her first visit with me, a new therapist. Sally disclosed that the considerable domestic violence within her family that her father usually carries out violent behavior to her 14-year-old brother and caused him physically bruised. Sally shared that her father plans to move out recently; she also did not want to bring any outside agencies as she wanted to avoid extra violence from her father. In the meantime, the limits of confidentiality were not discussed with Sally during the first visit (Yorkville University, 2020).

Step one: identify the key ethical issues in this situation

According to Martin, Shephard & Lehr (2015), confidentiality should be always kept during counselling relationship except:1) when disclosure is required to prevent clear and imminent danger to the client or others; 2) when legal requirements demand that confidential material be revealed; 3)when a child is in need of protection. According to Sally’s case, a potential child abuse was reported, however Sally was not willing to involve any third-party agencies to help in this situation. Due to the crisis situation in the first session, the therapist did not have chance to talk to Sally about the limits of confidentiality. However, according to CCPA’s Code of Ethics, Sally’s 14-year-old brother is in considerable dangers which meet one of the exceptions of confidentiality listed in the Codes. Thus, key ethical issue in this situation is “whether I should report the potential child abuse from Sally’s father without inform Sally the limits of confidentiality in our counselling relationship”.

Step two: research ethical articles from CCPA Code of Ethics are relevant to this situation?

CCPA Code of Ethics (2017) stated that counsellors primary responsibility including promote welfare of the client, while keep every information of client confidential, except when there shows potential danger to others or a child is in need of protection (p.7). As the limits of confidentiality was not discussed with Sally, counsellor should discuss with Sally about the limits of confidentiality before any action being made.

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Step three: ethical principles are of major important in this situation

According to CCPA (2007), counsellor’s primary responsibility incorporates six ethical principles: beneficence, fidelity, autonomy, nonmaleficence, justice and societal interest. In Sally’s case, beneficence, nonmaleficence and social interest can be applied. Beneficence means promoting client’s best interest in counselling relationships; by applying beneficence to Sally’s case, reporting the existing child abuse in her household in order to prevent future violence happen again as the violence is also her initial issue that brought her to counselling. Nonmaleficence can be explained as the obligation not to harm others; the action of reporting suspect child abuse is a form of protecting Sally from potential domestic violence from her father. Social interest embodies us as counsellors should be respecting the needs of all persons in the society;

Step four: risks and benefits of acting on the identified most important principles

Reporting this issue may violating client’s autonomy, which is violating Sally’s own will that she does not want to have any outside agencies involved that may escalate the violence. However according to Ontario’s Child, Youth and Family Act (2017), every person has the ‘duty to report’ to protect the most valuable members of our community. In the province of Ontario, it is counsellor’s duty to call Children’s Aid when acknowledged a child is in need of help which is also an action applying to societal interest required by CCPA as each counselor also has responsibility to the society. CCPA (2017) also outlined it is counselor’s duty to warn the person in danger to avoid foreseeable dangers (p.7). On the other hand, reporting the domestic violence may cause Sally lost her trust in our therapeutic relationship as we did not discuss the limits of confidentiality during the first session.

Step five: what do my feelings and intuitions tell me to do in this situation?

I have conflict in between reporting this issue and keep it a secret. Based on the Virtue-based ethical decision-making introduced by CCPA (2017), I asked myself how can my values best show caring for the client in this situation? How will my decision affect Sally in this ethical dilemma? What decision would be best defined who I am as a person? By reporting this issue, I can show my great empathy towards Sally and her brother as Sally may also be potential victim of domestic violence in this household. However, reporting this may destroy our trust built in the first session and Sally may wanted to end this counselling relationship as I did not keep her privacy confidential. Moreover, my intuition as a person in the society tell me I should report this issue as everyone as the duty to report when acknowledge a child is in need of help. If I did not report and keep it a secret, Sally and her brother may continue being victims of domestic violence.

Step six: what is the most helpful plan of action in this situation

Based on the previous steps within the decision-making model established in Sally’s situation, I decided to report the key ethical issue founded in step one. In addition to it, based on CCPA’s Standards of Practice (2015), I decided to also consult with another knowledgeable professional before making any action as I am a new therapist. In next session with Sally, I will tell her that I have to break confidentiality as her brother is in need of help and it is also my duty to report any child in abuse not only as a counsellor but also a member of the society. From Sally’s best interest, reporting this issue will avoid Sally to become a future victim in the household and also help her brother from the existing violence. I will inform Sally that I have already consult with another experienced professional without telling her personal information, to help me made this best ethical and moral decision. I would also apologize to Sally that we did not go over the limits of confidentiality in the previous session as she was in crisis. During next session, I will explain with Sally about the informed consent as well as the limits of confidentiality to avoid similar ethical dilemma happen again. Sally has the right to participate in the following counselling plans or to refuse any recommended services as its client’s rights outlined in CCPA’s Code of Ethics (2015).

References

1. Canadian Counselling and Psychotherapy Association. (2007). Code of ethics. Ottawa, ON: Canadian Counselling and Psychotherapy Association. Retrieved from http://www.ccpa-accp.ca/wp-content/uploads/2014/10/CodeofEthics_en.pdf
2. Canadian Counselling and Psychotherapy Association. (2015). Standards of practice (5th ed.). Ottawa, ON: Canadian Counselling and Psychotherapy Association. Retrieved from http://www.ccpa-accp.ca/wp-content/uploads/2015/07/StandardsOfPractice_en_June2015.pdf
3. Ontario Association of Children’s Aid Societies (2017). Child, Youth and Family Services Act, ON: Ontario Association of Children’s Aid Societies. Duty to report. Retrieved from http://www.oacas.org/childrens-aid-child-protection/duty-to-report/
4. Martin, L., Shepard, B., & Lehr, R. (Eds.). (2015). Canadian counselling and psychotherapy experience: Ethics-based issues and cases. Ottawa, ON: Canadian Counselling and Psychotherapy Association.
5. Yorkville University. (n.d.) Counselling scenario 1. Retrieved from courses.yorkvilleu.ca