Ethical Dilemmas in Counselling: Case Studies and Decision Making

This report discusses ethical dilemmas in counselling through case studies and decision making. It evaluates the benefits and risks of different courses of action and promotes client welfare while maintaining confidentiality and respecting autonomy.

Running head: ETHICS
Ethics
Name of the student:
Name of the University:
Author’s note

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Assessment task 1:
Response for Case study 1:
The ethical dilemma in the case is that of conflict between autonomy and client safety.
The counsellor has the responsibility to take all reasonable steps to ensure that client does not
suffer any kind of harm during counselling session (Australian Counselling Association Code of
Ethics, 2012, Section 3.2 a). In this situation as Helen’s problem need long term therapy, taking
the decision to refer her to other therapy is part of responsibility towards client safety. However,
counsellors also have the responsibility to colleagues and others regarding respecting the
privacy, needs and autonomy of the client. Hence, if Helen’s wish is not kept, then this may
violate the ethical practice of respecting client’s autonomy. Counsellors are responsible to
respect client and encourage client’s ability to make decisions on their own in different context
(Australian Counselling Association-Code of Ethics and practice, 2012, section 3.3). Therefore,
going against Helen’s wish would lead to breach in code of conduct for counsellors.
Response for Case study 2:
The ethical dilemma in the case is related to confidentiality and client respect. During
exceptional circumstances, clients have the responsibility to ensure that any disclosure of
confidential information is conveyed only to appropriate people. Hence, it needs to be decided
whether Allan’s disclosure about stealing his father’s pain medication and being addicted to it
should be disclosed to his parents or not. The ethical consideration in this situation is to disclose
confidential information only to those persons who can alleviate exceptional circumstance and
achieve balance between acting the best interest of the client (Australian Counselling
Association-Code of Ethics and practice, 2012, section 3.6). It is also a part of their

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responsibility to other colleagues to respect the contract of confidentiality agreed with the client
(Australian Counselling Association-Code of Ethics and practice, 2012, section 3.2). Helen’s
information is disclosed to his parent, it may lead to breach in confidentiality of client and
Helen’s father may not have the capacity to keep the best interest of the client even if Helen’s
confidential information is disclosed to him.
Response to case study 3:
The ethical dilemma in this case is related to the counsellor’s awareness. The counsellor
has tried to question Donald about his wish to harm his wife’s alleged lover. However, by the sen
of session, the counsellor is unclear about Donald’s wishes. This ethical conflict is related to
code of ethics of anti-discriminatory practice which states that counsellors have the responsibility
that any problem with mutual comprehension due to language gap or any other issue should be
addressed at an early stage (Australian Counselling Association-Code of Ethics and practice,
2012, section 3.3c). Hence, in the scenario, if the counsellor has failed to comprehend Donald’s
future plan, it is necessary that he decides alternative course of action. The ethical dilemma is
also related to client safety as counsellors have the responsibility to protect client from emotion,
physical or psychological harm (Australian Counselling Association-Code of Ethics and practice,
2012, section 3.2).
Assessment task 2
1. Dilemma associated with the case study:
I find case study 3 related to Janet as the most challenging to work with because I would
struggle with the final decision due to conflict between ethical code of client autonomy and
beneficence. This is because Janet has been diagnosed with leukaemia and she wants to

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refuse her treatment based on religious ground. Though based on client’s autonomy right, she
has the right to make her own decision regarding treatment. However, as medical advice
suggest that Janet’s prognosis will be good if she proceeds with blood transfusion treatment.
Hence, allowing Janet to take her own decision would violate the ethical principle of
beneficence and cause harm to client. Therefore, I would struggle to decide whether final
treatment should be decided based on religious values or based on medical advice. The
concern of Janet’s husband and the well-being of her husband will also be important for me.
As I am not religious myself, it would very difficult for me to decide whether Janet should be
given the freedom to take decision based on religious values or not. I will have to consider
various options as well as ethical code of conduct to decide the best option for Janet. The
essay provides further details regarding the ethical dilemma and possible options that can be
taken.
2. Rational for the ethical dilemma to be challenging:
The ethical dilemma related to taking decision based on religious ground or medical ground
is challenging for me because it conflicts with my personal values as well as ethical code of
conduct too. For example, personally I am not very religious and I would never take such life
changing decision based on my religious values. Hence, understanding Janet’s decision to avoid
treatment based on religious ground might be difficult for me. However, I cannot oppose her
decision because based on ethical code of conduct in counselling, I have the responsibility to
respect the autonomy of the client. My professional code of conduct requires me to respect the
uniqueness of each individual and be sensitive to the cultural context of the client (Australian
Counselling Association-Code of Ethics and practice, 2012, section 3.2). Evidence suggest that
every patient have their own specific relationship with one or more religion and practitioners

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should assist patient to make their own informed choices (Torry, 2017). This action demonstrates
respect for the autonomy of the patient. However, the situation in the case scenario is challenging
for me because I cannot allow Janet to take her own decision as this would cause risk to her life.
Another rationale behind considering the ethical dilemma to be challenging is that it might
create professional issues for me because allowing Janet to refuse her treatment may lead to her
death. The issue is significant and complex because not continuing with the treatment has impact
on her likelihood of living. She is at risk of death. As per my professional code of conduct, I
have the responsibility to protect client from any harm. The ethical principle of beneficence also
suggests that there is an obligation not to do harm to clients and balance benefits against risk
(Gupta & Menon, 2015). However, going forward with the principle of beneficence would
violate client’s autonomy rights. Hence, the situation is challenging because client’s autonomy
would come in conflict with my beneficence. I cannot force Janet to receive treatment without
her will. Another challenge for me is that Janet’s husband is also against Janet’s decision. I
cannot deny her husband’s request too because according to professional values, active
participation of family is also necessary to resolve any issue (Sori & Hecker, 2015). However,
the duty is that involvement should be done with client consent and this might not be an easy
task based on the case study scenario.
3. Options for responding to the dilemma:
To respond appropriately to the dilemma, I would sit with Janet to explain how her decision
would affect her life. I will make her aware about the risk associated with the decision. The first
risk is risk to life and the second risk is that her children as well as her family’s well-being would
be affected by the decision. This action is within my scope of ethical practice as counsellors have

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a duty of care and responsibility not to mislead clients (Australian Counselling Association-Code
of Ethics and practice, 2012, section 3.1). Hence, as Janet might not understand the graveness of
the situation, giving her proper guidance may help her to understand that her decision would
negative affect not only her but also the life of her family. I would also use the family values
principle to explain her importance of her existence for her children and husband’s well-being.
This approach might help her to change her decision. Janet’s husband will also be involved so
that Janet understands the emotional turmoil and suffering for her husband based on her decision.
Family’s personal values and beliefs would be integrated to as this is morally correct (Kiyimba
& O’Reilly, 2016). I would also research religious decisions related to death and find out
religious positions and options in relation to Janet’s scenario. This would help to take culturally
sensitive approach to respond to the dilemma too. This would not cause any risk to patient
autonomy and patient dignity too.
Research or consultation:
To respond appropriately to the dilemma, I would consult my supervisor regarding what
should be the best strategy to be taken when patient autonomy and beneficence principle. I would
also research Janet’s religious values and principles to understand whether Janet can change her
decision based on religious ground or not.
Assessment Task 3
Introduction:
Counsellors may encounter several ethical dilemmas while engaging in counselling
services with diverse clients. Different client related factors or contextual factors may present
several dilemmas which could increase risk of professional consequences for them. To ensure

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that counselling service is provided in a proper manner, it is necessary that proper evaluation of
the situation, benefits and risks of the problem and decision making takes place. This report used
a case study to demonstrate how ethical decision making can take place in counselling.
Defining the ethical dilemma:
The case scenario is related to the disclosure by a 13 year old female that she faced
difficulty in coping as her parents have divorced recently. During the counselling session, she
has also revealed that she is sexually active with boy friend and she is also planning to become
pregnant to come up with family dilemma. The counsellor’s dilemma is related to whether this
disclose should be told to her parent or not. The ethical dilemma in this situation is related to
client safety as counsellors have the responsibility to ensure safety of client (Australian
Counselling Association-Code of Ethics and practice, 2012, section 3.2).The ethical dilemma has
been defined in this way because the client’s disclosure regarding being sexually active without
using birth control pills suggest that she is at risk of physical and psychological health
consequence. In addition, she has expressed her desire to have a baby with her boyfriend, this
may conflict with the legal age of consent before entering into intercourse. In Tasmania, the legal
age of consent for sexual engagement is 17 years (Australian Institute of Family Studies, 2017).
As the client is only 13 years old, she is at risk of breaching the legal act too. Hence, considering
client safety and ensuring confidentiality of client information is a dilemma in this case.
Participants affected by the dilemma:
The client and her boy friend are directly affect by the dilemma because both of them are
involved in sexual act and both have used unsafe and illegal method to enter into sexual contact.
Indirectly, client’s parent and the counsellor is also affected by the dilemma. Client’s decision to

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go become pregnant would indirectly influence her parents as being a mother at young age
would lead to legal consequences and psychological sufferings for client. This would lead to
humiliation and extra stress for her parent (Furstenberg, 2016). In case of the counsellor, the
dilemma is to balance the ethical code of client safety and maintaining confidentiality of client’s
information. Due to the responsibility to the client, disclosing client’s information to others
would be difficult.
Potential course action:
There are two potential course of action to resolve the ethical dilemma. The first course
of action is to inform client’s parent regarding the intention of their daughter to have baby to
cope with family conflict. The benefit of this action is that it would make client’s parent aware
about the risky decision making of their child. However, there are many risk associated with the
action as this would lead to breach of ethical code of confidentiality and client autonomy.
According to ethical code of conduct for counsellors, respecting client’s decision and maintain
confidentiality is necessary (Australian Counselling Association-Code of Ethics and practice,
2012, Section 3.2). However, another responsibility of maintaining safety of client and keeping
client’s information confidential would be violated in going forward with this decision. Hence,
chance of ethical conflict is high for counsellor because counsellors are required to maintain
certain boundaries throughout the counselling session. Bond (2015) states that conflict between
autonomy and client beneficence create decisional conflict for counsellors.
The second course of action would be to inquire whether the client is willing to disclose
her wish to her parents or not. If the answer is yes, then there would no further ethical challenges
in going with the decision. However, if the client denies telling this to her parents, then in such

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case it would be necessary to achieve balance between serving best interest of the client and
counsellor’s responsibility according to the code of conduct (Australian Counselling
Association-Code of Ethics and practice, 2012, section 3.6). This can be done by further
discussing the consequence of the decision with the client and motivating client to involve her
parents in counseling session. The benefit of this decision is that it would maintain client’s
welfare rights and autonomy rights and ensure that parental’s right to their child’s information is
also maintained (Cowie & Pecherek, 2017). This would facilitate resolving the coping issues for
client. However, the risk associated with course of action is that the client may resist joining her
parents in her decision. This would lead to contribute to professional boundaries related issues
and compromise autonomy rights of clients.
Evaluation of benefits and risk:
A. Contextual
1. Personal development:
a) My person view point of the situation is that client’s decision is not morally as well as
ethically correct. This is because I view the decision to become pregnant as a very
responsible task. Based on my family values too, I feel respecting parents and
multicultural consideration is important before taking such decision. However,
proceeding with unsafe sex without consulting partner and parent would cause both
physical and mental harm to client. The client’s decision to keep her parents unaware
about the decision is in conflict with my family values. I value respecting and involving
parents in important decisions of life. The client is immature and her decision reflects her
immaturity. My ethical sensitivity also suggests not inquiring about partner’s consent in
the decision as a wrong act. Family values act as protective factor for adolescents and

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plays a role in strengthening characters and avoiding anti-social behaviour (Haghdoost et
al., 2014).
b) My personal preference is to ensure that client’s parent become aware about the decision
and both of them are engaged in counselling session so that client could be counselled
regarding the risk and challenges related to her decision. I feel parent involvement as
important because family stress and low adolescent self-regulation is linked to increased
engagement in risk sexual behaviours (Haghdoost et al., 2014). Hence, family
engagement can control and regulate risk behaviour of adolescents. The main perspective
that is operative in relation to this decision is that my focus is to maintain safety of client
by all means. In my professional practice, I regard prioritizing client safety as a good and
ethical practice in counselling. In the field of counselling, acting ethically safeguard
clients from any kind of harm (Tarvydas, 2016). My developmental level has also
influenced my decision because I am mature enough to understand the future
consequence of client’s action. Hence, my focus is on resolution of immediate as well as
future issues for client. I have behavioural decision making style as I believe in ensuring
that there is minimum conflict and everyone works together. This is why I want both the
client and her parents to get involved so that I can use my persuasive communication
skills to convince them regarding the right course of action. My focus is to negotiate and
eliminate differences in opinion (Phillips et al., 2016).
c) My blind spots include having a empathetic feeling for the client. I believed that the
client is not to be blamed for entering into such situation. She has opted to engage in
sexual activity and plan a baby because she did not get the right environment at her home
for her holistic development. As she has been exposed to stress because of their parent’s

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conflict, I empathise with her and I will use my empathy to make sure that the client
understands the ill-effect of being pregnant at an early stage.
2. Relational-Multicultural
a. The success of my decision making is also dependent on level of trust I have with client.
Effective client-counsellor relation is one in which there is high level of trust, good bonding
and mutual understanding between counsellor and client. This helps to achieve positive client
outcome (Merriman & Joseph, 2018). However, since this is my first interaction with client, I
feel this could be a disadvantage because the client may not have trust in my decision. It
would take time to negotiate and convince client regarding changing her decision.
b. Differences in cultural factors may also come into play. This is because individual cultural
values affect behavior and decision making of a client. Hence, my cultural values may not
match with that of client and coming to the same page would be difficult.
c. Differences in religious values may also create dilemma for me because from religious
view point, the client may not regard engaging in sexual relationship as a wrongful act.
However, my religious values strongly forbid such acts. Hence, despite religious differences,
the challenge is to maintain cultural and religious sensitivities, yet convince the client
regarding the morality of decision based on existing laws and evidences.
3. Organizational ethics:
a. My organization core values is client safety, maintaining boundaries, protecting
confidentially and promoting well-being of client. This core values influence to prevent risk

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and any form of harm for clients. However, the actual core values differ because many states
values interact and conflict with each other during service delivery in practical setting.
b. The issue for client is grave because in UK, public view teenage pregnancy as a grave and
sinful act. The client is most likely to be stigmatized if she becomes pregnant. Client might
be subject to objection and protest from the community. Hence, to protect social well-being
of client too, convincing her to change her decision is important.
B. Professional
a. The standard of care for minor clients engaging in risk behaviour is still sub-standard in
Australia. Although some new agencies are coming up for the cause of such teenagers,
however this does not guarantees full support for the client in the case study.
b. The issue of adolescent engagement in risky behaviour can be resolved by adopting the
best practices of family engagement and strengthening family functioning, making
communities supportive for children and youth and promote development of good
relationship with carers (Kerpelman et al., 2016). This can alleviate risky behaviour in client.
c. Research scholar like Simons et al. (2016) states that risk sexual behaviour among
adolescent is associated directly with pareneting practices and parental control. Hence,
parental support is vital to promote self-esteem and reduce sexual exploration among youths.
As the issue in the case study is related to minor’s engagement in sexual activity, the
counselling tradition says that best interest of the client should be preserved (Grubbs, Muro
& Clements, 2016). Therefore, decision making should be based on action that causes
minimum harm to the client.

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C. Ethical/legal:
1. The ethical principle of confidentiality, client safety and autonomy is applicable to this
case as the decision making would have direct impact on well-being and client’s right to
decision making. The ethical value of protecting client’s confidentiality will also be
challenged.
2. The professional codes 3.7 (management and confidentiality), 3.4 (confidentiality) and 3.2
(client safety) is applicable in this scenario (Australian Counselling Association Code of
Ethics, 2012).
3. The legal statute of the Age of Consent Act in Australia is applicable to this scenario
because the client is a minor and she is not legally eligible to enter into sexual intercourse as
per the age of consent Act in Australia. The legal age is 16-17 years and client is only `3
years old (Australian Institute of Family Studies 2017).
Consultation:
I would like to consult my supervisor if the client does not agree to share the information
with her parent. This is important for me to understand whether avoiding parental rights to
child’s information would cause any professional risk for me or not. I would also like to
consult regarding the approach needed in scenarios where client safety and confidentiality
right is in conflict with each other.
Feasible option:
Based on the goal of serving the best interest of client, I feel that the second option of
convincing client to engage in counselling session and disclosing her wish is feasible. This is

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because it would help to prevent the client from violating the age of consent laws and it will
help me to comply with ethical code of practice during counselling too. This option is the
most feasible option because through my counselling and negotiating skills, I would be able
to improve relation between client and her parent and make them understand that family
engagement and spending quality time with family is important for client to cope with stress
instead of planning to be pregnant. As I have used insights from different ethical codes of
practice and theories, I am sure the decision is effective (Tveit & Sunde, 2016). Getting
parental support would also help her to understand risk associated with unsafe sexual activity
and adapt other means to cope with stress in life.
Implementation and evaluation of the decision:
To implement the decision, I would first take client’s consent and inform her regarding
her parent’s inclusion in the counselling session. Next I would disclose about client’s sexual
exploration to her parents and I would use legal statutes and counselling skills to help client
adapt positive course of action to minimize harm and legal implications in the future. The
decision is relevant with the moral justice principle too as client’s right is preserved and
appropriate guidance is provided to motivate client to change their behaviour.
Conclusion:
The report summarized decision making process in relation to ethical dilemma in a
scenario. By following the seven steps of ethical decision making process (Sperry, 2007), the
report revealed that evaluating different option and measuring consequence from different
context is vital to take the right decision.

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References:
Australian Counselling Association-Code of Ethics and practice (2012). Code of Ethics and
Practice. Retrieved from: https://www.theaca.net.au/documents/ACA%20Code%20of
%20Ethics%20and%20Practice%20Ver%2013.pdf
Australian Institute of Family Studies (2017). Age of consent laws. Retrieved from:
https://aifs.gov.au/cfca/publications/age-consent-laws
Bond, T. (2015). Standards and ethics for counselling in action. Sage.
Cowie, H., & Pecherek, A. (2017). Counselling: approaches and issues in education. Routledge.
Crandall, A., Magnusson, B. M., Novilla, M. L. B., Novilla, L. K. B., & Dyer, W. J. (2017).
Family financial stress and adolescent sexual risk-taking: The role of self-
regulation. Journal of youth and adolescence, 46(1), 45-62.
Furstenberg, F. (2016). Reconsidering Teenage Pregnancy and Parenthood. Societies, 6(4), 33.
Grubbs, L., Muro, J. H., & Clements, K. (2016). School counselors and nurses: Collaborative
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to Learn—South Asian Perspective. In Mental Health in South Asia: Ethics, Resources,
Programs and Legislation (pp. 63-77). Springer, Dordrecht.

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Haghdoost, A., Abazari, F., Abbaszadeh, A., & Dortaj Rabori, E. (2014). Family and the risky
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