Introduction
Psychologists in present times often encounter moral dilemmas during their practice. Conflict arises when deciding on the best course of action that fulfills all the ethical requirements. The American Counseling Association (ACA) and American Psychological Association (APA) codes of conduct clearly state these ethical guidelines. Furthermore, a model constructed by Forester-Miller sufficiently provides directions on how to devise the best assessment of a patient. This essay focuses on diagnosing a patient struggling with alcoholism who accuses the clinician of wrong evaluation.
Utilize the model for ethical decision-making presented in the Forester-Miller and Davis article to analyze the case and describe your ethical decision-making process.
A model for ethical decision-making is a framework that contains instructions on maneuvering ethically challenging decisions (Johnson, 2020). A model is a reference when assessing alternative resolutions for a moral quandary (Johnson, 2020). Forester-Miller’s decision-making model guides clinicians on the appropriate approach to ethical dilemmas (Practioner’s Guide to Ethical Decision-making, 2023). The model also includes the five principles of ethical reasoning: autonomy, justice, beneficence, nonmaleficence, and fidelity (Practioner’s Guide to Ethical Decision Making, 2023). These values are essential when deciding what course of action to take.
A clear definition of ethical principles is vital. First, the principle of autonomy advocates for freedom of choice, rational decisions, and the power for self-determination (Varkey, 2020). However, children and mentally challenged persons are exemptions as they are considered incompetent. Secondly, the value of beneficence urges practitioners to be beneficial and supportive of their clients’ well-being (Varkey, 2020). Psychologists must prevent harm or hazardous conditions on their patients as outlined by the principle of nonmaleficence (Varkey, 2020). Lastly, the value of justice outlines the importance of equal treatment for all equal patients and proper treatment of the minority, such as persons with disabilities (Varkey, 2020). These principles, as mentioned earlier, find application in evaluating ethical cases.
Application of the Foster-Miller Model
The following discusses the Forester-Miller model’s seven ethical decision-making steps.
The process begins with identifying the problem by gathering all the relevant information (Jacob et al., 2020). The primary problem is that Kassi has a habit of drinking to relieve work stress, which has poorly impacted her work productivity and maternal duties at home. Kassi only seeks treatment to fulfill work requirements. Based on her assessment, Kassi is not an alcoholic, and she has the autonomy to not seek counseling in this regard and dispute the assessment that deems her an alcoholic.
The next step is applying the ACA code of conduct or any other code that may apply (Jacob et al., 2020). The ACA code dictates that the clinician thoroughly understand the case before using the assessment results to make decisions (ACA Code of Ethics 2014). Thus despite Kassi’s claim to have no alcoholism problem, the effect of her habits cannot be neglected. A professional counselor should make a completely unbiased assessment and recommendations. However, the ACA discourages diagnoses that could harm the client, which in Kassi’s case is losing her job (ACA Code of Ethics 2014). Despite these considerations, a clinician should also weigh the purposes of counseling, such as promoting human development.
The third step is determining the nature and dimensions of the dilemma (Jacob et al., 2020). Research has shown that 30% to 50 % of individuals with alcohol use disorder are in denial (Schuckit et al., 2020). Despite the complaints at work and her daughter’s, Kassi fails to see that her drinking is problematic. Kassi claims to be in control of her alcohol consumption and should receive treatment according to the principle of justice. Nonetheless, the harm to her work productivity and capacity to look after her daughter must be addressed, failure to do so would breach the value of nonmaleficence by association.
The fourth action involves consideration for every possible course of action (Jacob et al., 2020). For instance, Kassi’s constant intake of alcohol requires rehabilitation. However, she is the sole provider of her daughter; thus, staying at work would be more beneficial. Counseling to learn self-control while still going to work is also actionable (Witkiewitz et al., 2019). These possibilities require further exploration and evaluation.
The fifth step demands consideration of the consequences of all the possible actions available (Jacob et al., 2020). Personal considerations to examine include the reflection of the decision on one’s professional competence. The final decision should also factor in Kassi’s daughter’s and Kassi’s well-being. Continuing counseling to learn self-control is the best option.
The subsequent step evaluates the chosen course of action (Jacob et al., 2020). The decision to seek further counseling on substance abuse is just, as it empowers Kassi to continue caring for her daughter and improve her performance at work. Concerning public interest, this choice is the best for all parties involved.
The final step is implementing the decision (Jacob et al., 2020). In this case, I will provide a clear recommendation to present at work. I will then assist Kassi in acquiring new counsel. I will also follow up on the progress at home and work.
Evaluate the clinician’s justification for the diagnosis given.
The Diagnostic and Statistical Manual of Disorders (DSM-5) assesses mental health use, including alcohol abuse and addiction (DSM-5 2017). This diagnostic criterion lists eleven symptoms observed within 12 months. The diagnosis criteria 303.90 specifies severe alcohol intoxication due to six or more symptoms (DSM-5 2017). Justification of the verdict requires more insight into this assessment.
The symptoms enumerated by the clinician’s diagnosis evaluation are as follows. Criteria 1 states that a large amount of alcohol is taken frequently over prolonged periods, a symptom observed in Kassi’s case (DSM-5 2017). Criteria 3 foundation is on time spent acquiring, using, or recovering from alcoholism (DSM-5 2017). This symptom is not evident in Kassi’s case. Criteria 5 focuses on the negligence of significant obligations due to recurrent drinking, manifested by Kassi’s low productivity at work and lack of involvement in her daughter’s after-school activities (DSM-5 2017). Criteria 6 concerns persistent alcohol abuse despite the adverse effects on one’s social and interpersonal life (DSM-5 2017). This behavior is evident in Kassi’s case, although she is in denial. The tenth criterion (a) deals with gaining tolerance that encourages increased amounts taken (DSM-5 2017). Kassi reports taking three or more drinks after work which meets the tenth criterion. Finally, criterion 11(a) deals with associated withdrawal symptoms, which in Kassi’s case, include nausea, anxiety, and sleeping problems (DSM-5 2017). Results from this analysis will determine the validity of the clinician’s decision.
This evaluation justifies five criteria and disqualifies criteria 3. Based on the DSM-5 guidelines that 4-5 symptoms are moderate alcohol abuse, this evaluation concludes that Kassi does not suffer from severe alcohol use disorder. The clinician’s assessment needs amending.
Explain whether using the diagnosis, in this case, was ethical or unethical, according to the ACA and APA codes of ethics.
The ACA code of conduct defines professional values psychologists should possess. Some of these values include promoting human development during their lifetime and honoring the diversity of cultures when making ethical decisions (ACA Code of Ethics 2014). The clinician’s diagnosis using APA and ACA codes was unethical as it failed the DSM-5 criteria. The clinician needed a clearer understanding of Kassi’s case, which led to an inaccurate assessment.
Conclusion
Violating the code of conduct is a common phenomenon, whether intentional or not. Psychologists must therefore observe the established guideline in every action taken. The ACA and the APA codes have zero tolerance for personal perspectives when making ethical decisions. Furthermore, breach of conduct leads to client dissatisfaction like Kassi.
References
ACA Code of Ethics – American Counseling Association. (n.d.). Retrieved April 3, 2023, from https://www.counseling.org/resources/aca-code-of-ethics.pdf
Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). (2017). The SAGE Encyclopedia of Abnormal and Clinical Psychology. https://doi.org/10.4135/9781483365817.n433
Jacob, C., Wildermuth, D. L., & Thomas, A. (2020). A practical ethics worktext for professional counselors. https://doi.org/10.1891/9780826165343
Johnson, M. K. (n.d.). Deciding on ethical decision-making models. DigitalCommons@USU. Retrieved April 3, 2023, from https://digitalcommons.usu.edu/etd/7818/
Practioner’s Guide to Ethical decision making. (n.d.). Retrieved April 3, 2023, from https://www.counseling.org/docs/default-source/ethics/practioner-39-s-guide-to-ethical-decision-making.pdf?sfvrsn=f9e5482c_10
Schuckit, M. A., Clarke, D. F., Smith, T. L., & Mendoza, L. A. (2020). Characteristics associated with denial of problem drinking among two generations of individuals with Alcohol Use Disorders. Drug and Alcohol Dependence, p. 217, 108274. https://doi.org/10.1016/j.drugalcdep.2020.108274
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science Advances, 5(9). https://doi.org/10.1126/sciadv.aax4043
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