Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

Learning Task #2: Ethical Decision Making for an Area of Practice

Irene Estay
Amanda Medland
July 23, 2013

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

Ethical Decision Making

Situation: You have been asked to counsel an 11-year-old aboriginal youth who is withdrawn in
school and spends a lot of time alone. He is accompanied by his grandmother who says that they
need each other very much because her husband has died recently. The youth describes feeling
alone, remembering times when he has been abandoned, and hearing voices singing and the
voice of an old man speaking to him in the tribal dialect. The grandmother is not eating or
sleeping well and she thinks a lot about traumatic events experienced in residential school. You
are uncomfortable about counseling without first obtaining a psychiatric assessment to evaluate
what may be psychotic symptoms. A psychiatric assessment would require a trip some 100 miles
away to a large urban Centre.
Step 1. Identification of the individuals and groups potentially affected by the decision.
The primary individuals affected by any decision made are the boy (lets call him Aiden) and the
grandmother. I also need to consider individuals in the community that have exposure to the
child and the grandmother, as well as myself as the psychologist.
Step 2. Identification of ethically relevant issues and practices, including the interests,
rights, and any relevant characteristics of the individuals and groups involved and of the
system or circumstances in which the ethical problem arose.
Using the chart The Four Ethical Principles with their Respective Values and Standards I can
identify 9 ethical values that pertain to the predicament at hand.

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

The Four Ethical Principles with their Respective Values and Standards
I. 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.1II.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 & SelfKnowledge (II.6-II.12)

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

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

3. Non-discrimination

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

3. Straightforwardness/
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

5. Minimize Harm

(I.16-I.26)

(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

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

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

(I.9-I.11)

(I.31-I.36)
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 I: Respect for the Dignity of Persons

General Respect I.3 Strive to use language that conveys respect for the dignity of persons
as much as possible in all written and oral communication.
When working with Aiden and his grandmother, I have to ensure that I am able to communicate
with them in a way that is easily understood by them. If they are not fluent in English, I may

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

need to find another way (either through simplified English or using a translator) to communicate
with them to ensure they are able to understand fully.
Non-discrimination I.11 Seek to design research, teaching, practice, and business
activities in such a way that they contribute to the fair distribution of benefits to
individuals and groups, and that they do not unfairly exclude those who are vulnerable or
might be disadvantaged.
I must be sure not to discriminate between Aiden and other clients that I may feel more
comfortable with their presenting concerns. I must also consider both Aiden and his Grandmas
opinions about the matter with an open mind and not weigh one persons opinions higher than
the other without investigation. Both Aiden and his Grandma appear to be battling their own
struggles, so taking both peoples perspectives into consideration would reduce unnecessary bias.
Informed Consent I.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.
As per this standard, I must involve both Aiden and his grandmother as much as possible and
take into consideration their views and wishes with the decisions to be made. I must also
recognize that I am also not completely restrained by their wishes when coming to my decision
about services and what I feel is most beneficial for them (i.e. whether I am best suited).
Informed Consent I.23 - Provide, in obtaining informed consent, as much information as is
reasonable or prudent persons would want to know before making a decision or consenting
to the activity. The psychologist would relay this information in language that the persons
understand (including providing translation into another language, if necessary) and would

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

take whatever reasonable steps are needed to ensure that the information was, in fact,
understood.
It would be paramount that Aiden and his grandmother were given as much information as
possible about services, plans of action and treatment options. I may have to use a translator if
Grandma was not fluent in English and verify that Grandma understands the full extent of my
involvement with the family. As well, Aiden must be given as much information as he is capable
of understanding about my involvement.
Informed Consent I.24 - Ensure, in the process of obtaining informed consent, that at least
responsibilities; confidentiality protections and limitations; likely benefits and risks;
alternatives; the likely consequences of non-action; the option to refuse or withdraw at any
time, without prejudice; over what period of time the consent applies; and, how to rescind
consent if desired.
In gaining consent, it would be imperative that I explain the risks and benefits, shall I decide to
move forward with counselling without alternative psychiatric assessment. It is also important
that I let his Grandma know the likely outcome without action without creating unnecessary fear
in her, pressuring her decision.
Freedom of Consent I.27 - Take all reasonable steps to ensure that consent is not given
under conditions of coercion, undue pressure, or undue reward.
Care must be taken to ensure that Aiden and his Grandma feel as if they were not pressured into
consenting to any choices regarding counselling. They must also not feel as if they will be
scrutinized if they decide to refuse consent, nor will they experience consequences if they do not
give consent.

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

Freedom of Consent I.28 - Respect the right of persons to discontinue participation or

service 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 a desire
orally.
I need to take into consideration both Aiden and his Grandmas understanding of consent and
acknowledge if either one appears to want to discontinue. As legal guardian, Grandma has the
legal right to withdraw, but I also need to consider Aidens interest in the matter and how he feels
about counseling services.
Principle II: Responsible Caring
General Caring II.1 Protect and promote the welfare of clients, research participants,
employees, supervisees, students, trainees, colleagues, and others.
First off, I need to look at the welfare of Aiden who may or may not be suffering from an
undiagnosed mental illness. Secondly I need to take into consideration the welfare of the
grandma who has also experienced events that may put her at risk for a mental health issue as
well. Lastly, I need to take into consideration any other community members that may have
contact with Aiden and whether his potential mental illness would affect them.
General Caring II.8 Take immediate steps to obtain consultation or to refer a client to a
colleague or other appropriate professional, whichever is more likely to result in providing
the client with competent service, if it becomes apparent that a clients problems are
beyond their competence.
This is a main concern with my ethical dilemma. Am I capable of providing the best competent
care to Aiden and his situation, or would he benefit firstly from the help of seeing a psychiatrist

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

who would be best able to determine the route of his concerning symptoms? At a minimum, I
will most likely have to seek consultation from a psychologist who has expertise in situations
such as these.
General Caring II.10 Evaluate how their own experiences, attitudes, culture, beliefs, values,
social 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.
I need to be very careful to look into my own beliefs and attitudes to make sure that I am not
imposing my beliefs onto this family. I would need to educate myself about the stresses created
by living in a residential school, and how this may affect the Grandma and her decisions in her
current state.
Risk/Benefit Analysis II.14 Be sufficiently sensitive to and knowledgeable about individual,
group, community, and cultural differences and vulnerabilities to discern what will benefit
and not harm persons involved in their activities.
I must also acknowledge that Native Americans have many cultural differences and viewpoints
on specific topics, such as the acceptance of mental health issues. Would advocating for Aiden to
be seen by a psychiatrist to address his mental health have any negative connotations to the
family or native community? I would need to look into this and create awareness in myself about
cultural differences that may impact mine and the families decisions.
Principle III: Integrity in Relationships
Accuracy/Honesty III.8 Acknowledge the limitations of their own and their colleagues
knowledge, methods, findings, interventions, and views.

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

I need to be honest with myself and my clients when I am not able to effectively help, and when I
have reached my own personal limitations as a psychologist. I also need to consider if my
interventions as a counsellor are adequate without the information gained by a psychiatrists
assessment of mental health issues that are potentially present. If Aiden has mental health issues,
is counselling alone the best intervention?
Objectivity/Lack of BiasIII.10 Evaluate how their personal experiences, attitudes, values,
social context, individual differences, stresses, and specific training influence their activities
and thinking, integrating this awareness into all attempts to be objective and unbiased in
their research, service, and other activities.
Personal experiences have exposed me to many native families that have let their mental health
concerns get in the way of caring for their children and families. I need to make absolute sure
that I am not harbouring any residual feelings from other families similar to this and imposing
any biases on my course of action. I will have to look deeply into any decisions I make, ensure
that I am being objective, and only work off of familial information pertaining to this particular
situation.
Principle IV: Responsibility to Society
Respect for Society IV.15 Acquire an adequate knowledge of the culture, social structure,
and customs of a community before beginning any major work there.
Again, I will need to become familiar with the background, culture, and customs of the families
heritage. Do they live on a reserve or are they living integrated into a community? If in the
community, do they have a strong sense of their native culture?
Respect for Society IV.16 Convey respect for and abide by prevailing community mores,

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

social customs, and cultural expectations in their scientific and professional activities,
provided that this does not contravene any of the ethical principles of this Code.
I will need to gain more information on cultural expectations and how this will affect Aiden and
his Grandmas decision about services. I will need consult other psychologists and address any
social customs that may act as barriers to services I may want to access or implement.
Step 3. Consideration of how personal biases, stresses or self-interest might influence the
development of or choice between courses of action.
Coming from a Psychological Assessment background, I may be quicker to make a decision to
assess without considering other options and weighing the positives and negatives. I need to
make sure not to jump to personal preferences and take the time to consider the families. I also
need to take a self-assessment of other clients I had recently provided services to. I will need to
compare likelihood of saturation of one particular diagnoses (i.e. Schizophrenia or psychosis),
and insure that this does not impact my opinion whether to counsel or refer.
Step 4. Development of alternative courses of action.
Through review and consideration of the ethical values listed above, alternative courses of action
can be identified. I can think of three options as a result of my analysis, which should be weighed
and compared to decide the best alternative to my current dilemma.
Alternative 1
My first option would be to seek out another Psychologist who would be able to address the
issues that Aiden presents with. I would identify and accept that I would not be most adequately
equipped to work with situations similar to Aidens, therefore refusing to provide services.
Alternative 2

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

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My second option would be to offer to counsel Aiden on the contingency that they make
arrangements to have an appointment with a psychiatrist. I would require results from an
assessment prior to providing services to Aiden in order to provide the most effective supports.
Alternative 3
My third option would be to agree to meet with Aiden and his Grandma and start gathering
information in order to determine whether I believed that further assessment to address his
mental health was needed. I could begin to gather information and create a more in-depth picture
of Aidens struggles and needs. This would include consultation from other Psychologists in
order to gain insight into areas that I am unfamiliar with.
Step 5. Analysis of likely short-term, ongoing, and long-term risks and benefits of each
course of action on the individual(s)/group(s) involved or likely to be affected (e.g., client,
clients family or employees, employing institution, students, research participants,
colleagues, the discipline, society, self).
For each of the possible courses of action there are both positive and negative consequences
which can be seen below;
Alternative 1 Possible Positive Consequences: By refusing to provide services to Aiden and
referring him to another Psychologist he would have the benefit of accessing professionals that
have more experience working with situations similar to his. He would hopefully be able to
access support that was more competent and skilled in the areas of his struggles.
Alternative 1 Possible Negative Consequences
By refusing to work with Aiden and his Grandmother there may be some negative feelings
associated with this. Aiden already feels as if he has been abandoned by many people in his life.

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

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By outright refusing to provide services this may add to his feelings of rejection and in turn have
a negative impact on his mental health. There is also no guarantee that referring to another
psychologist will provide support superior to my own.
Alternative 2 Possible Positive Consequences
By insisting that Aiden see a Psychiatrist and receive a report before counseling shall begin will
either rule out or confirm the diagnosis of a mental health issue. Depending on the results of the
assessment, the treatment path could be determined and created more specific to Aidens needs.
More accurate support could be given once Aidens mental health was determined.
Alternative 2 Possible Negative Consequences
Accessing Psychiatric services before receiving counseling may provide more accurate support
but to do this would impose a large cost on the family. Also, there is no Psychiatrist within close
proximity and there also is potentially a long wait time before Aiden could receive Psychiatric
support and assessment. While waiting for this, Aiden will have little to no support to address his
struggles. Lastly, the decision to have Psychiatric assessments completed would be decided on
very little information, and it is not clear if these assessments would be completely necessary.
Alternative 3 Possible Positive Consequences
By meeting with Aiden and his Grandma, I would be able to get insight into what the major
concerns were regarding Aiden. I could start to build an idea of the strengths and struggles of the
family and create a more accurate picture of concerns. Due to the lack of information, it is
unknown whether a Psychiatric assessment is actually needed, but by meeting with the family I
would be able to discern whether or not further assessment would be of benefit. Meeting with

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

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Aiden and Grandma would also allow me to develop rapport so that if I did decide that a
Psychiatric assessment was needed, the family may feel more comfortable in doing so.
Alternative 3 Possible Negative Consequences
If I decided to meet with Aiden and his Grandma first, and build information before referring to a
Psychiatrist, time could be wasted if Aiden did appear to have a serious mental health concern. A
later submission of referral would delay any more specific treatment, making counseling less
effective. For example, if Aiden was in need of anti-psychotics in order to control his voices, the
likelihood of effective counseling sessions taking place in the meantime would be much lower
than if he were effectively medicated. Also, counseling a child who has depression may look
quite different than counseling a child experiencing psychosis, and waiting for diagnosis would
lengthen time before receiving accurate supports.
Step 6. Choice of course of action after conscientious application of existing principles,
values, and standards.
I believe the third alternative is the best option out of the three. It allows Aiden to access
supports sooner, and gives more information about the severity of his issues before sending him
to an expensive option that will most likely take time and is a distance from their community. It
will allow me to gain more information about what is affecting Aiden and will allow me to build
rapport before sending him to assessment. That said, I may decide after intake and information
gathering that an assessment is needed in order to provide the best supports for Aiden.
Step 7. Action, with a commitment to assume responsibility for the consequences of the
action.

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In order to help Aiden, I will need to schedule an intake meeting as soon as possible. If I am to
determine what sort of services Aiden will need, it is necessary to meet with him in order to start
the process.
Step 8. Evaluation of the results of the course of action.
I will need to continually evaluate my choice of starting counseling with Aiden and to determine
if I feel as if he shows symptoms that warrant assessment by a Psychiatrist. I also will need to
pay attention to any negative consequences, and monitor Aidens mental health when meeting
and examining his symptoms.
Step 9. Assumption of responsibility for consequences of action, including correction of
negative consequences, if any, or re-engaging in the decision-making process if the ethical
issue is not resolved.
It is possible that if Aiden is experiencing severe mental health problems that his mental health
will decline as I set up the intake and evaluation sessions. If this occurs I will have to reevaluate
my decision, but I believe that my choice is the most logical starting point when looking to
support Aiden.
Step 10. Appropriate action, as warranted and feasible, to prevent future occurrences of the
dilemma (e.g., communication and problem solving with colleagues; changes in procedures
and practices.
It is highly likely that clients who are seeking services with underlying mental health concerns
will surface again. I can prepare myself for other situations such as this by continuing to consult
with other professionals and educate myself on a variety of issues, backgrounds cultures and

Running head: LEARNING TASK #3: ETHICAL DECISION MAKING

other aspects that differ from mine. By engaging in professional development, I can hope to
prepare myself for future situations and be able to most effectively help my clients.

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References
Canadian Psychological Association. (2000). Canadian code of ethics for psychologists (3rd ed.).
Ottawa: Author. Also included in the course text: Sinclair, C., & Pettifor, J. (2001).
Companion Manual to the Canadian Code of Ethics for Psychologists (3rd ed.). Ottawa:
Canadian Psychological Association
Sinclair, C., & Pettifor, J. (Eds.). (2001). Companion manual to the Canadian code of ethics for
psychologists (3rd ed.). Ottawa: Canadian Psychological Association. Chapter 5: Use of
the Code in Ethical Decision Making.