Ethical Dilemma

I am a school counselor working in a remote town in Northern British Columbia. I grew

up in the area, left to attend university, but then returned in this capacity, so I know the area and
the culture of the town well. Recently, a grade 9 student by the name of ody came to my office
and re!uested a session. ody is a very intelligent and mature "irst Nations student that lives on
the nearby reserve with her family. In our first session ody divulged that she has been feeling
very depressed. #s there is a high rate of teenage suicide on the reserve I asked that ody come
for another session so that we might talk about her issues. I wanted to do everything in my
capacity to ensure that ody did not become $ust another statistic.
#s per the policy of my school, students may attend two counseling sessions without
parental consent,and be assured full confidentiality, but if they desire more sessions they will
need to have the informed consent of their parents. %hus, during our second meeting I advised
ody of this policy and re!uested a meeting with both her and her parents so that I could fully
relate the details of the counseling and answer any !uestions they might have. %hen I would
have them sign the paperwork confirming their informed consent.
&hen I evetually met with ody and her parents, she confessed to them that she had
approached me because she been suffering from symptoms of depression. I then e'plained to
them that I would need their consent in order for us to continue our sessions. #lthough I
e'plained the process of counseling and the rights they had as parents in terms of confidentiality
and informed consent, ody(s parents refused to sign anything as they claimed that in their
culture, they addressed issues within their community. %hey did not feel comfortable having
their daughter see a counselor and instead wished to address the issues by approaching their
elders and other community members and partake in a )weat *odge Ceremony, which is a "irst
Nations healing tool.
ody later confessed to me that although she recogni+ed and respected the traditions of
her community, she also believed that one,on,one therapy would most likely be the most
effective tool in dealing with her depression. *ater that day I received a telephone call from her
parents saying that they would be honoured if I would participate in the )weat *odge ceremony
with them and other members of their community.
The Issues
%he first issue pertains to ody(s parents refusing to give informed consent for further
counselling sessions, despite ody(s desire to continue. #s per my school(s guidelines and the
provincial law regarding age of consent, permission from her parents is needed as she is not yet
-. years of age. %he issue is then whether to respect the wishes of her parents and let them
address ody(s problem through their community,based traditional practices, or if I should seek
to e'tend my service by classifying ody as a mature minor.
%he Code of /thics states in principle I.01 to carry out informed consent processes with
those persons who are legally responsible or appointed to give informed consent on behalf of
persons not competent to consent on their own behalf, yet because I work as a )chool
Counsellor and work only with clients under the legal age, the issue of obtaining informed
consent can be confusing. #ccording to 222 )chool Counsellors do not actually need parental
permission before providing counselling, as is e'emplified by the school mandate of providing 3
sessions to students without addressing parental consent. 4et when parents refuse to give
consent for further sessions, some students with sufficient maturity to understand the nature and
conse!uences of treatment, can be classified as a 5mature minor6 7confidentiality8. #lthough this
provides a type of 5way out6, Counsellors need to ensure that the students has the ability to
identify the risks and benefits of therapy 7confidentiality8, and their decision should be genuinely
independent, reflecting a real understanding and appreciate of the decisions and potential
conse!uences 7limits8. #lthough not every child will meet these criteria, it is my $ob to
determine what is the child(s best interest and then protect them 7confidentiality8.
%he other issue is whether I should accept the invitation to participate in the )weat *odge
ceremony. 9y initial instinct is to refuse the invitation based on principle III.00 which states that
we should avoid dual relationships. Indeed, interacting with clients and their families outside of
counselling arrangement might bend the boundaries of our lreationship, thus creating confusion
on what my role with them actually is. %ruscott and Crook emphasi+e that :sychologists should
avoid becoming friends with clients and should refrain from sociali+ing with them, yet this is
more easily done in large urban centers as opposed to smaller rural communitites like the one in
this e'ample.
*iving in smaller communities such as the one in this vigniette does create some ethical
issues, as professional boundary crossings are often unavoidable due to the small population.
But instead of considering a breach in ethics, it should instead be considered a normal and
healthy part of rural, northern living according to 222222. 22 goes on to state that finding
oneself in multiple relationships is not necessarily a sign that one has engaged in unethical
behaviour, but rather that they are engaged in the life of a community. IN fact, in terms of
working as a Counsellor, these boundary crossing actually facilitate development of positive
community relationships, and that involvement in community activities can enhance our
understanding of community needs and its members. %his can then serve to heighten the uni!ue
bond between psychologist and clients.
&orking with "irst Nations populations also raises some ethical !uestions as e'emplified
in the vigniette. "or instance, should :sychologists practice only their own treatment, or should
they be open to their more traditional methods; #nd what opportunities will be missed by not
participating; #ccording to 222 ody(s preference for individual counselling is actually !uite
un!iue as "irst Nations people tend not to use mental health services provided by the mainstream
culture. Instead, they focus on more collective methods of treatment, for to them, effective
healing in "irst Nations culture focuses on interconnectedness rather than autonomy. %hey
believe that connecting with family, community and culture, nature and spirituality are all e!ualy
important, and that when these forces are brought together, it best utili+es the powers that
promote health. /'amples of such practices include a <ision =uest or )weat *odge ceremony.
#lthough we may be familiar with more individualist forms of helaing, according to 2222 it is
the :sychologists $ob not to force our methods and view ont he client, but rather to respect these
naturally occurring support systems and avoid unnecessary disruptions to these groups.
&hen counselling someone from of "irst Nations descent, 22 states that the :sychologist
first needs to accept and understand the family and community conte't. %hey also need to be
familiar with and sensitive to their values and cultures. %herefore, rather maintaining a
professional distance, they should get invovled and participate when invited. %his will allow
the :sychologist to build and maintain a network of contacts in the "irst Nations community
7including elders, spiritual advisors etc.8. %hen, once collaboration has been achieved, and the
:sychologist is comfortable with these practices, the &estern approaches and techni!ues can be
used to assist with and supplement "irst Nations practices.
Step 1 Identification of the individuals and groups potentially affected by the decision.
%hose affected by my decision include primarily include ody and her family. But other
parties also include the :rincipal as he is my employer and so any positive or negative
conse!uences will ultimately rest on his shoulders. I also think that the "irst Nations community
7adults and students8 will also be affected, because my actions will ultimately affect their faith
and trust in me as a professional but also as a contributing community member. 9y actions
might also affect their attitudes regarding counseling.
Step 2 Identification of ethically relevant issues and practices, including the interest, rights,
and any relevant characteristics of the individuals and groups involved and of the system
or circumstances in which the ethical problem arose.
>sing the chart that outlnes the Code 7C:#, 3???8 I can identify twelve ethical values
that I think are key to my current dilemma@ five under Respect for Aignity, three under
Responsible Caring, two under Integrity in Relationships, and two under Responsibilty to
)ociety.
rinciple!"alue
:RINCI:*/ I@ R/):/C% "BR %C/ AIDNI%4 B" :/R)BN)
<alue@ Informed Consent
1.1 Deomonstrate appropriate respect for the knowledge, insight, experience, and areas
of expertise of others.
No matter what decision I make, I need to respect the insight and e'erience of both ody and her
parents. %his pertains to both odyEs personal history, as well as her families knowledge and
e'perience of traditional healing methods.
I.8 Respect the right of reaserch participants, clients, employees, supervisors, students, trainees,
and others to safeguard their own dignity.
#bove all else I need to respect the right of ody who is my client and who is reaching
out for help. %hus to ignore her re!uest at the be!uest of her parents is to rob her of her dignity.
"or although she is technically a minor, she still has the right to services.
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.
IEll need to discuss with ody and have her full participation in deciding which form of services is
right for her. %his includes fully respecting her wishes even if they clash with that of parents. #t
the same time, because ody is a minor, I also need to involve her parents in this process and take
their re!uests into account. #lthough I may have to chose one option over another, I should try
and accomodate both as much as is feasibly possible.
1.21 Establish and use signed consent forms that specify te dimensions of informed consent or
that acknowledge that such dimensions have been explained and are understod, if such forms are
reuired by law or if such forms are desire by the psychologist, the person giving consent, or the
organi!ation for whom the psychologist works.
#s gainined informed consent from parents is mandated by my school for students
seeking help beyond three sessions, I need to obtain this consent from odyEs parents in order to
continue counselling her. 4et because they have refused her service, I have the option of
classifying ody as a 5mature student6 which would also me to gain informed consent from ody
only, without the approval of her parents.
I.46 Encourage others, in a manner consistent with this "ode. #o respect the dignity of persons
and to expect respect for their own dignity.
rinciple!"alue
:RINCI:*/ II@ R/):BN)IB*/ C#RIND
II.2 $void doing harm to clients, research participants, employees, supervisors, students,
trainees, colleagues, and others.
If I respect the wishes of odyEs parents by denying ody counselling, I may be doing her
harm as she may not receive ade!uate care for her symptoms of depression, which have the
possibility of leading to teen suicide.
%his principle can be used two ways in this situation. "irst I can talk to ody and e'press
to her the need to respect the desires of her parents, that being, their wish to involve the
community in her healing process. &hile also understanding that she has the right to have her
own wishes understood and respected. Cer parents also should be encouraged to respect the
desires and needs of their daughter. 4et I also need to communicate that their own culture
traditions are important and should be taken into consideration. %hough the e'tent to which they
need to be taken ito consideration has yet to be determined.
II.10 Evaluate how their own experiences, attitudes, cultures, beliefs, values, social context,
individual differences, specific training, and stresses incfluence their interactions with others,
and integrate this awareness into all efforts to benefit and not harm others.
I first need to talk with ody and find out more how important her cultueral heritage is in
her life, and what role it currently plays. :erahps she considers it a ma$or defining feature of
who she is, in which case i need to respect her traditions and integrate them as much as possible
or even forego our counselling sessions in favor of their more traditional healthing methods. Bn
the other hand, ody may not value such traditions !uite as much as her parents do, and instead
prefers to seek a more &estern type of therapy 7that being one,on,one counselling that stresses
individual health and empowerment8.
II.14 %e 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.
Rather than dismiss the )weat *odge approach to healing as ineffectual and anti!uated, I
need to learn about how it is used and what effect it can have on issues such as depression. I also
need to learn about the community approach to healing, and be sensitive to its role in odyEs
community.
rinciple!"alue
:RINCI:*/ III@ IN%/DRI%4 IN R/*#%IBN)CI:)
111.10 Evaluate how their personal experiances, attitudes, values, social context, individual
difference, stresses, and specefic raining influence their activities and thinking, integrating this
awareness into all attempts to be ob&ective and unbiased in their research, service, and other
activities.
#lthough I grew up in this community and am familiar with "irst Nations traditions and
practices, I admit I have never given them any professional consideration. #s I have been trained
in an urban university, I give full credence to more &estern, individualistic styles of therapy,
believing that these are most effective in treating all problems for all people. "urthermore I
admit that the local reserve in known for causing all sorts of dysfunction, both personal and
social, thus I think I have a bias against their practices. %herefore I know to constantly be aware
of these tendancies try to not let them affect any decisions, especially when it concerns someone
of "irst Nations descent.
III.33 $void dual or multiple relationships 'e.g. (ith clients, research participants, employees,
supervisors, students, or trainees) and other situations that might present a conflict of interest or
that might reduce their ability to be ob&ective and unbiased in their determinations of what might
be in the best interests of others.
#lthough I feel priviledged to be invited to participate in the )weat *odge ceremony, I
am also wary that such involvement could give the impression having a dual relationship with
ody, her family, as well as the larger "irst Nations community. "or not only would I be the
counsellor involved, but I would also be purposefully interacting with them within community
events as a community member. %his could create some confusion in our relationship in terms of
the role I play as well as other issues such as confidentiality. 9y instinct is to turn down the
invitation in order to avoid such complications for odyEs sake.
rinciple!"alue
:RINCI:*/ III@ R/):BN)IBI*I%4 %B )BCI/%4
IV.1 "ontribute to the discipline of psychology and of society*s understanding of itself and
human beings generally, through free enuiry and the acuisition transmission, and expression
of knowledge and ideas, unless such activities conflict with other basic ethical ruirements.
:erhaps my participating in the )weat *odge ceremony could contribute to the discipline
of psychology if I e'amine and take note of the proceedings and results through the eyes of a
:sychologist. If successful, perhaps I could integrate this knowledge into my work with other
"irst Nations students. 4et at the same time, I recogni+e that this conflicts with other ethical
re!uirements, primarly that of avoiding dual relationships.
IV.16 "onvey respect for and abide by prvailing community mores, social customs, and cultural
expectations in their scientific and professional activities, provided that this does not contravene
any of the ethical principles of this "ode.
)imilar to the last principle listed, I need to convey respect for their traditional healthing
methods although to which this can be classified as 5scientific6 or 5professional6 is debateable. I
believe I can respect them from a distance yet I still unconvinced of their actual utility and
effectiveness in treating mental health issues.
Step # $onsideration of how personal biases, stresses, or self%interest might influence the
development of or choice between courses of action.
Because I grew up in this community, I know people from the reservation and thus am
familiar with the dysfunction that can live in the homes of many. 9any "irst Nations people
there are unemployed and living on welfare, alcoholism and physical abuse are rampant, and the
rising rate of suicide is a real concern 7avier, B(Neil, 3??F8. %herefore I know that I harbor a
critical and disapproving attitude towards many aspects of their culture. Gnowing that ody(s
parents are also alcoholics have also biased me against their opinions and recommendations
regarding ody. "urthermore, my education in counselling have biased me towards a certain
style of therapy, one that is opposite that of the more integrative and inclusive style of "irst
Nations communities. "or all of these reasons I am immediately inclined to ignore the wishes of
her parents in favour of continuing my sessions with ody, as I believe that it will be the most
effective approach in dealing with her depression. 4et I know that I must ignore these instincts
and instead weigh all options with full ob$ectivity.
Step & Development of 'lternative $ourses of 'ction
9y analysis seems to rule out one course of action, to stop my sessions with ody at the
re!uest of her parents. %his is because Respecting the Aignity of others means that I need to
primarily be concerned with the needs and well being of my client, ody. %his means that I will
need to classify her as a mature student 7as discussed previously8 so her informed consent will
suffice in lieu of her parents(.
%he choice I then have is whether I should accept the invitation by her parents to
participate in the Cealing Ceremony so that I can learn more about their culture and seek
stronger relationships within that community, or if I should refuse so that I can avoid the issue of
creating dual relationships, and miss what I believe will be an ineffective and purely ritualistic
form of healing anyways.
'lternative 1
9eet with ody and her parents again and e'plain to them the need to continue my
sessions with ody to treat her symptoms of depression. IEll also add that I would like to continue
this approach in combination with their suggestion of participating in a traidition of the )weat
*odge healing ceremony that their community utli+es for such situations. If they still do not
agree with continuing with my form of therapy, I will look into classifying ody as a mature
minor as per her wishes.
In participating in the ceremony, I will emphasi+e that I would like to participate in the
capacity as a counsellor and observer. I will take note of how such ceremnies work, who
participates, how participating in such traditions might benefit ody, her family, and the larger
community. Copefully I can use this opportunity to understand her culture a little better and
forge new relationships with members who might provide some further insight so that I might try
to incorporate some of their traditions when working with other "irst Nations students if they so
desire. #side from providing counselling to ody, respecting culture will be my biggest priority
as it plays a large part in the community where I work, so understanding it and integrating it into
my work will be in my and my studentsE best interest.
'lternative 2
Brgani+e another meeting with ody and her parents and e'plain to them the need for you
to continue my sessions with ody. If they still refuse, I will meet with dy seperatly to e'aplin
to the the details of what it means to be classified as a mature minor. I will also e'plain to ody
and her parents that I need to maintain my role of Counsellor and therefore do not feel
comfortable accepting their invitation to participate in the Cealing Ceremony. Because if i do, I
would be interating with them in a community conte't which might confuse my role in their
family and create boundary issues.
Step ( 'nalysis of )i*ely Short%term, +ngoing and )ong%term ,is*s and -enefits of Each
course of 'ction on the Individual.s/!group.s/ Involved or )ie*ly to be 'ffected .e.g., client,
client0s family or employees, employing institution, students, research participants,
colleagues, the discipline, society, self/.
'lternative 11 ossible ositive $onse2uences
I will create a positive relationship with both ody and her parents by demonstrating my
fle'iblity and cultural sensitivity.
*earn more about cultural traditions in my community so that I might be more
understanding of their methods while also providng better service to "irst Nations students and
their families.
"orging relationships with "irst Nations community members and creating stronger ties.
'lternative 11 ossible 3egative $onse2uences
I will risk creating dual relationships with ody, her parents and other community
relationships, wherein boundaries will be confused and confidientiality could be compromised.
I may not be able to shed my biasE and instead view my participation as a waste of time
while entrenching my negative views of the community.
I may not learn anything noteworthy that could be integrated into my work with students.
'lternative 21 ossible ositive $onse2uences
Aeclining to participate will reinforce my relationship with ody and her family as a
Counsellor,client one only, rather than risk a dual relationship.
By not being present at the Ceremony, I will not be risking further reinforcing my biasE,
as the practice could be purely ceremonial and serve no great benefit to ody in dealing with her
depression.
'lternative 21 ossible 3egative $onse2uences
odyEs parents might resent my infle'ibility and see my refusal to participate as being
apathetic to their family and their culture, thus creating a negative relationship.
By not participating, I could be missing an invaluable opportunity to learn about their
culture, and possibly integrating it into my work.
Step 4 $hoice of $ourse of 'ction after $onscientious 'pplication of E5isting rinciples,
"alues, and Standards
Step 6 'ction with a $ommitment to 'ssume ,esponsibility for the $onse2ueces of the
'ction
#s odyEs problem should not be taken lightly, I should take action to meet her again,
both alone and with her parents. If odyEs parents are firm in their decision to not allow ody to
continue counselling with me, I need to have the paperwork, permission of the principal, and
knowledge to proceed with the process of acknowledging ody as a mature minor. I then need to
ensure that ody is aware of all the issues in relation to this classification so that I can get her free
informed consent.
I also need to inform odyEs parents that I would be delighted to take part in the healing
ceremony. Before the event is to take place I should learn about the actual ceremony and what
my participation will involve. I should also learn about what other individuals will be in
attendance and what role everyone will play.
Step 7 Evaluation of the ,esults of the $ourse of 'ction
I need to evaluate how ody is responding to both types of therapy, and what she feels is
benefitting her most. I also need to evaluate the significance of the traditional therapy, both in
how it has treated odyEs depression, and how it has been significant to individuals and the
community in a cultural conte't. I also need to determine if any unanticipated negative
conse!uences have arisen.
Step 8 'ssumption of ,esponsibility for the $onse2uences of 'ction, Including $orrection
of 3egative $onse2uences, If 'ny, of ,e%engaging in the Decision%ma*ing rocess If Ethical
Issue is not ,esolved
#lthough much research states that engaging in community and cultural norms cna have
a positive impact, my invovlement could have more negative effects than positive. "or instance,
creating fle'ible professional boundaries could place an e'pectatin on me by individuals in the
"irst Nations community to attend all such cultural practices. "urthermore, my attendance might
indicate approval and support for practices that are pureply ritualistic and do nothing to address
the actual issues at hand. %hat being said, I will not know the effectiveness of the practice
without witnessing it firsthand. %hen I will be ina better place to $udge my level of participation
in future events and how they might affect students with real mental health issues.
Step 19 'ppropriate 'ction, as :arranted and ;easible, to revent ;uture +ccurences of
the Dilemma.e.g. $ommunication and roblem Solving with $olleagues, $hanges in
rocedures and ractices/.
"acing this dilemma has made me reali+e how important traditions are to "irst Nations
community, and how they must be respected, whether I think them effective or not. #nd how my
intrerest and involvement in such events will make me better informed and better connected with
the community that I serve. Bne of the outcomes I will strive for is better knowledge of such
traditions so that I might offer a variety of techi!ues to "irst Nations students so that I might
better treat their issues both on an individual level and their valued community,based integrative
level. %herefore I think I need to meet with the principle and perhaps the /lders of the
community so that we can flesh out how this type of service might look.
Mignone, J., & O'Neil, J. (2005). Social capital and youth suicide ris !actors in !irst nations
co""unities. Canadian Journal of Public Health, 96, S5#$%. &etrie'ed !ro"
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