EDMM

EDMM (Ethical Decision Making Model)
** Ethical Decision Making Model **
 * The first step in the EDMM is to identify the problem. Jason has told his counselor that he plans to stop his medications due to the unpleasant side effects and poor quality of life. He has a history of depression and anxiety, and he reports lacking a significant support system or relationship in his life. He also wants to discontinue counseling and maybe travel instead. Jason presents as having little to no hope for his current situation or future. His issues seem to present possible ethical, legal, and clinical implications. His dilemma is very complex and we believe consultation with fellow counselors as well as an attorney could be beneficial. **


 * The next step in the EDMM is to apply the ACA codes of ethics. Several codes of ethics could be applied to this case. A very important code to apply to this case is A.2.a: Counselors strive to take measures that enable clients: to obtain high quality end-of-life care for their physical, emotional, social, and spiritual needs; to exercise the highest degree of self-determination possible; to be given every opportunity possible to engage in informed decision making regarding their end-of-life care; and to receive complete and adequate assessment regarding their ability to make competent, rational decisions on their own behalf from a mental health professional who is experienced in end-of-life care practice. Another code that could be applied is A.2.a. This code states: Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Counselors have an obligation to review in writing and verbally with clients the rights and responsibilities of both the counselor and the client. Informed consent is an ongoing part of the counseling process, and counselors appropriately document discussions of informed consent throughout the counseling relationship. Jason has the right to end the counseling relationship at any point. He can choose not to come back for additional sessions, and ethically, we would respect his decision. As counselors, it is our job to enhance Jason’s autonomy. He has the right to make his own decisions, and deserves to know as much information as possible so he can make rational end-of-life decisions. For instance, he dislikes the side effects from his HIV medications, but he also admits to having past depression and anxiety. With adequate information, will he choose to discontinue these medications as well? In order to preserve and enhance his autonomy, we, as counselors, must ensure that he has adequate information regarding the effects of all his options and decisions. The ACA codes of ethics A.4.b. states that counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants. We must not let our own biases about death influence Jason or his decisions. We would also make sure he is competent to make such decisions, and that the decisions are rational. The code of ethics C.2.a. considers the boundaries of competence for counselors; counselors practice only within the boundaries of their competence based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population. As Jason’s counselors, we would assess our own competency as counselors in dealing with end-of-life clients, and if we felt that we lacked the proper experience, we would be ethically obligated to refer Jason to a more qualified counselor. **


 * The third step in the EDMM deals with the nature of the dilemma. During this step, I would consider the moral principles. These principles include: autonomy, nonmaleficence, beneficence, justice, and fidelity. We believe autonomy would be a priority for Jason’s case. Part of autonomy is having the freedom to choose, and as counselors, we would encourage autonomy for all of our clients. For Jason, we would assist him in understanding the possible outcomes of his end-of-life decisions. We want our client to be able to make his own decision and be content with it. For Jason, beneficence is also a moral principle that is extremely important. Beneficence is the counselor’s responsibility to contribute to the welfare of the client. As his counselors, we would be committed to do good and prevent harm. This is a tricky moral principle in Jason’s case. He wants to discontinue his AIDS medication and that would bring harm to him, as well as death. We could discuss this with him and assess his understanding of the consequences of ceasing his medications. However, that decision is still ultimately his. Another moral principle that could apply in this case is fidelity. We would strive to build rapport with Jason so he could trust us and our counseling relationship. At this point in his case, this relationship should already be put in place. He states his lack of a significant relationship and support system in his life, so his counseling relationship could be very important to nurture. **


 * The fourth step in the EDMM is to generate courses of action. At this step, consulting with several counseling peers to gather ideas and brainstorm possible actions could prove very beneficial. Our first option is to do nothing, although that does not seem like a good idea. We think the most important thing to consider is trying to get Jason to come back for additional sessions. In order for us to attempt any course of action, he must return for another session. He mentions that counseling has benefited him so reminding him of this may be a good way to get him to return for additional session. We could also explain to him the dangers and side effects of discontinuing his medications and suggest that he get a second opinion from a physician. We could ask that he sign a contract and promise not to stop medications until he has 2 medical opinions and weighs all those consequences. Encouraging him to get some financial advice would also be an option, so talking with a financial professional may benefit Jason. We could also encourage him to find meaning and purpose in his life perhaps by making some friends, exploring the option of reconnecting with his family, or even joining a club to build some significant relationships. **


 * During the fifth step, we would go through the potential consequences for each option that we generated in step four. If we do nothing, we are showing Jason that we do not care as well as breaking some of our ethical obligations to him as our client. If we remind Jason that he has benefited from talking about his decisions in counseling, he may agree to more sessions. If he signs the contract stating that he will not stop his medication until he gets a second medical opinion, it could ensure that he is well-educated on the consequences and side effects from discontinuing the medications. We could discuss with Jason the possible results of finding meaning and relationships in his life. We would validate his feelings of isolation and hopelessness and try to instill some hope. **

** Once a desirable course of action has been decided, we must evaluate it. Convincing Jason to come back for more counseling is important. Evaluating his own decisions and being content with them will give Jason additional peace as he prepares for the end of his life. The option with the most positive outcomes seems to be suggesting he sign a contract that states he will not stop his medicines until he gathers another medical opinion. Educating him on the effects of ceasing his medications will allow him to make a well informed decision. Also, his doctors could give some feedback on his anxiety medications and if they think he needs to continue those even if he stops the HIV medication. This decision does not seem to present additional issues; it allows him to have more time and information to make his decisions. If he sticks with his original decision to stop taking his medications, we can continue counseling and instill hope for him to gain some purpose for the remainder of his life. Encouraging him to take control of his isolation and share his life with more meaningful relationships could be positive. We would apply three simple tests to this course of action. The first test, justice, would help us determine if the course of action is fair. We believe it is fair to allow Jason to think about his choices and the consequences so he can decide how the remainder of his life is going to be. We would recommend striving to enhance autonomy for any client. The second test is publicity. We would be comfortable with anyone knowing that we chose this course of action. The third and final test is universality. We would recommend this course of action to other counselors and share our experience. Jason is a sensitive case that is very unique, but if another counselor were in a similar situation, this course of action would be an option. **
 * The final step in this model is to actually implement the course of action. When Jason tells us he may not be returning to the next session, we would bring up the positive effect counseling has had in his life thus far. After he agrees to come to the next session, we would introduce the contract and encourage him to get a second medical opinion before the next session. At the next session, we would discuss the second opinion and talk about his final decision. We would adhere to all ethical and legal guidelines and do our best to help Jason with his end-of-life decisions. **