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The Drug and Alcohol Forum

AN ETHICAL DECISION-MAKING MODEL FOR PRACTITIONERS

by A. Kathryn Coleman, LSW, CAC
Program Manager, Adult Chemical Dependency Unit
St. Francis Medical Center, Pittsburgh, PA

Abstract

Drug and alcohol professionals are increasingly faced with ethical dilemmas in their daily professional practice. Making choices to deal with these challenges can be difficult, especially choices that uphold the public trust placed on the counselor by society. It is essential for counselors to clarify their personal value system, to identify the ethical principles from which they operate and to develop an ethical decision-making model to assist in their decision-making process. In this way, counselors can avoid obstacles that deter ethical behavior and develop a decision-making routine that insures service in the best interest of the client based on solid ethical ground.

After completing this article, participants will:

  • Recognize ethical issues that impact clinical practice.
  • Be able to define the concept of ethical sensitivity.
  • Be able to describe the elements of a code of ethics.
  • Recognize obstacles to ethical decision making.
  • Recognize the key steps in making ethical decisions.

Headline story: Client claims counselor abused her. Counselor continues to treat patient.

Overheard at a lunch table conversation: "Mr. C. told me he was grateful for me ‘giving him back his son.’ But when I received the gold watch in the mail, I couldn't believe it. My supervisor said I should return it, but I don't want to hurt his feelings. And besides, it's a beauty. I'll have to figure out what I'm going to do quickly; my supervisor is waiting for my response."

Morning coffee chatter between counselors:

A: "I thought all this time JT was clean. She told the group she was doing well. At the meeting last night I saw her pick up her 24 hour key chain. You should have seen her face when she saw me. I can't wait until group tonight. I haven't quite figured out what I'll do."

B: "You know you can't say anything. Not if you learned it at a meeting."

A: "I'll have to decide how to handle this. But it sure should be an interesting group."

Staff lounge conversation:

A: "I really need to get the house fixed up and ready to sell. The place needs to be painted badly, but I'm short on time and money."

B: "Why don't you ask BR. Remember him? He's that fellow who was in my group. He finished treatment last year and has put together a contracting business. He needs the work. I'm sure he'll give you a great rate. Just tell him you work with me. I'll get you his number."

Counselor to supervisor in supervision session: "Sheila told me today that her boyfriend is so abusive. Turns out he has been for some time. It makes me so furious that she stays with a guy like that. She wants me to tell her what to do and I'm thinking I'll tell her to leave the guy – she'd be better off without him. She's just wasting her life and deserves more. Then we can plan how she will confront him about it."

Voice mail message received from a colleague: "Hi Sam. I just heard that HT came in for detox. He's being seen by one of the therapists in my practice group. I was wondering if you'd give me a call and fill me in, unofficially of course."

In the counseling business, these situations are all too familiar. The dilemmas they create are occurring all around us on a daily basis. Sometimes they are handled well, and unfortunately, sometimes not. A nationwide survey indicates that ethical complaints across the country are rampant. Ethical misconduct ranges from accepting gifts from clients, to misrepresenting credentials, breaching confidentiality, and dating or engaging in sexual relationships with ongoing clients (Miller, 1995). The National Association of Social Workers adjudicates approximately 100 complaints per year, 32% of which are substantiated (National Association of Social Workers, 1993). Again, the range of behaviors reflects those already described: dual relationships, boundary violations, conflict of interest, exploitation for personal gain. These behaviors are not new and are troublesome to many counseling relationships in medicine, psychology, addictions, social work and education. Addictions counselors are standing in line with other professionals facing the complex issues involved in establishing and maintaining professional and ethical standards in their counseling practice. It may be of some comfort to know we are in good company, but that serves little ease when it comes to grappling with the difficult ethical issues faced by the counseling professional.

The Roots Of Ethical Behavior

So what are these ethical issues all about? What do we do about them? What's all the hoopla that's being raised these days? Well, truth to tell, the " hoopla:" is as old as time itself. Plato identified elements of ethical behavior as basic virtues of civilization. Among those virtues he identified courage, temperance, justice and wisdom (Soulis, 1989). Hippocrates, known well for the oath that is his legacy, left his mark on behavioral expectations for our health care providers. Confucius is said to have conceived of his Golden Rule which has been a guide for many through the ages (Stein, 1990). And Jesus Christ left a lifetime of standards for behavior which have long since been formulated as a "Christian ethic." Throughout the ages, mentors from many cultures have spoken truths that have served as guidelines for behavior which stand firm today. Beyond guiding personal behavior, ethics has become a more salient issue as the values represented are applied to working client-counselor relationships. Ethical behavior has evolved into an expectation and the question has become "How can we meet the challenges placed upon us?" Given our charge as professionals to act above reproach, let us examine a model of how we can better think and act ethically and then consider what might stop us from doing so. Let us begin with a basic definition. Just what is ethics? LeClaire Bissell offers a definition that states ethics "comprise the principles of morality, including both the science of the good and the nature of the right, and that they constitute the rules of conduct in respect to a particular class of human actions" (Bissel, 1987, p.1). Ethics establishes standards or benchmarks that prescribe "what humans ought to do in terms of rights, obligations, benefits to society, fairness or specific virtues" (Stein,1990, p.23). It is the embodiment of specific beliefs, values and virtues in our relationships with self and others. It has broad implications and cuts across wide parameters that include personal behavior, professional behavior (vis a vis colleagues and consumers), business practice and social policy.

Many of us function without any conscious awareness of our ethics. We have been raised in our family of origin with some type of behavioral guidelines. Deep inside lay the origins of a value system which may operate largely on an unconscious, habitual level. Until challenged, we might not have been pressed to put value into action, to put our moral code to the test. In the developmental process of maturation, we define and redefine what we believe. Within that process are the external influences that family, law, religion and society have placed on us; each play a key role in our ethical development. We develop a set of standards, guided by an internal voice known as conscience and modulated by the external "Big Brother" who is watching – the Church, the workplace, the family, the community, the legal system. Society, not unlike the individuals who constitute it, has undergone a similar process, arriving, too, at guidelines in all its many faces: medicine, law, education, business, counseling and religion to name a few. Perplexing questions continue to surface that boggle the mind of the morally upright person. The complexity of contemporary society offers issues that range from the computer age of information sharing to toxic waste and environmental pollution, cloning and organ transplant, assisted suicide, and managed care and corporate health options. It is difficult to keep up with the pace. Just as we think we know how to act, things change around us.

Why Should A Counselor Be Ethical?

But what of the basic issues of the counseling professional? Why and how is it that we should concern ourselves with ethics? Ronald Stein (1990) cites several reasons. The first stems from the nature of the profession itself. Along with the rights and privileges of this role come special obligations. Counselors are "vested with a special trust to rank service above self interest ... to promote the client's goals, including protecting the client's rights, maximizing the client's benefits, and minimizing potential harm" (Stein, 1990, p.21).

The second reason is related to the nature of the client/counselor relationship. This is unequal and dominated by a position of power. The counselor role is to help the client discover options and make deliberate, informed choices around these options. The counselor must be aware that client's must learn to direct their own lives. Because of the inequity of power, clients are vulnerable to counselor influence on their choices. We must be vigilant not to impose our choice on a client who may be likely to accept it as their own.

Third, because counselors are engaged in goal directed activity, we must maintain constant awareness of the morality of our own behavior. Clarity regarding our own value system is essential and must serve as a source of direction for our actions. At the same time, we must be committed to promoting values in the actions of those served. We must help the client to clarify their own values, and to make decisions based on them. As counselors, we must avoid putting our own values on the client; clients may operate from a very different value system as they make their personal choices and this needs to be respected by the counselor regardless of how different it may be from our own (Tennyson & Strom, l988).

Finally, counselors are engaged in different forms of moral education. We are involved in helping clients understand their moral rights and exercise those rights by demonstrating responsible behavior (Leader, 1976; London, l964; Tennyson & Strom, 1986). We are teaching clients to understand the implications of their attitudes, beliefs and behaviors and the consequences of their choices, all of which have moral overtones. As teachers we are charged "with an obligation to exemplify the highest ethical standards in our own professional and personal lives" (Stein, 1990, p.22).

In short, by virtue of our role and the special place it has in the public trust, it is imperative that we safeguard the client – counselor relationship by absolute sanctity of that trust and a standard of best practice that must support that trust.

A MODEL FOR ETHICAL DECISION MAKING:

AN ESSENTIAL TOOL

Step One: Increasing Ethical Sensitivity

Given our responsibility, let us turn to the question of ethics in process. The initial step in the process of ethical thinking is to become sensitive to the ethical nature of a situation, i.e. to heighten and improve our conscious awareness that ethical issues are inherent in counseling situations. This is the development of what Biggs & Blocker (1987) call "ethical sensitivity," the empathic ability of counselors to see a situation through the eyes of their client (Rest, 1984). We view the circumstances from the perspective of the client which allows us to do as the Native American proverb suggests – to walk in the moccasins of the other. This makes every client uniquely individual and challenges the counselor to consider framing ethically relevant questions suitable to each situation. It requires that we become not only professionally astute in the skills of content and process in our counseling, but now adds an overlay of moral awareness to deepen our understanding of the client's circumstances and the complex nature of the help we are to provide. So, for example, looking back at our initial situations, the counselor questions the acceptance of a gift and what meaning it has to the client. Would acceptance suggest inappropriate behavior, or would it, perhaps, be more detrimental to refuse the client whose motive is to give back something for what was received? Is it appropriate to contract a former client to do work? Isn't it helpful to support him in his new business? Or is it taking unfair advantage of the client and entering into an inappropriate dual relationship? Clarity becomes possible when the situations are viewed from all facets of the situation.

Step Two: Identifying And Prioritizing Guiding Principles

Recognizing that an ethical dilemma exists puts us up against the need to consider choices, for few situations have only one "right" answer. How one perceives the circumstances, identifies principles, and defines obligations within which individuals can frame their choices is the next phase (Stein, 1990). And so it becomes essential to consider several questions. These are posed by Levy in his paradigm for making ethical judgements (Levy, 1993). First we are charged to consider what principles of ethics are applicable. These are identified rules of conduct that guide our behavior. Some are global, others more specific. Consider, for example, the Golden Rule, charging us to treat others as we would be treated. Other global concepts include such ideas as ethical relativism, in which what is right is that which is defined by a particular society as "right." So what is acceptable in Margaret Mead's Samoa would be different from that which is acceptable in the USA. The cultural context guides the choice. Or perhaps one follows the principle of the sanctity of life (Stein, 1990). In this case the priority is absolute value on all life, no matter what the circumstance. Issues including abortion, euthanasia, and assisted suicide play themselves out uniquely using this guideline. Contrasting this would be autonomy, in which self determination is paramount. This recognizes that people are responsible for their own behavior and have the right to make individual choices (Kitchener, 1984). Beneficence (Kitchener,1984) obligates counselors to act on what is best for the client, while Hippocrates promoted its cousin, nonmaleficence, in which we do no harm (Stein, 1990). Others subscribe to a more utilitarian perspective. Act utilitarianism focuses on the outcome; the act is good if it produces good consequences and bad if it produces bad consequences. Rule utilitarianism does not judge the act bad or good, but sees the "rule" as good if adopting it produces better consequences for the majority than would be produced if an alternative rule were adopted (Edwards, 1967). Other examples of guiding principles include justice, which mandates fair play and equality; consistency, which suggests using precedents in new situations; and fidelity, which espouses keeping one's promises.

Each profession today is guided by codes of ethics wherein ethical values and principles have been standardized in adopted rules for expected and acceptable behavior. Codes of Ethics often cover several areas including:

A. Conduct As A Specified Professional

1. Integrity and propriety, which governs high standards of personal conduct that include but are not be limited to avoiding unlawful conduct, sexual misconduct and fraud related conduct.

2. Competence and professional development, which may include maintaining proficiency in the practice skills of our function and refusal to practice outside the boundaries of such.

3. Scholarship and research, which guides the behavior of those professionals engaged in research.

4. Non-discriminatory behavior, which safeguards appropriate treatment regardless of race, creed, gender and the like.

B. Ethical Responsibility To Clients

1. Primary client interest, which prioritizes responsibility to act in the client's best interest.

2. Rights of clients, which maximizes dignity and self determination and promotes informed choice.

3. Confidentiality and privacy, which protects all information obtained in the course of professional service.

4. Fair fees, which safeguard reasonable charges commensurate with services performed and ability to pay.

5. Dual relationships , which involves refusal to participate in the development or maintenance of exploitative relationships with present or past clients and avoidance of any situation that may lead to conflict of interest.

6. Appropriate clinical process, which outlines participation in appropriate therapeutic process and closure for clients.

7. Duty to warn, which protects the safety and welfare of clients especially in situations involving imminent danger to self or others.

8. Record keeping, which mandates the maintenance of appropriate and accurate records.

C. Ethical Responsibility To Colleagues

1. Treatment of colleagues with respect, fairness and courtesy.

2. Treatment of clients of colleagues with professional consideration.

D. Responsibility To Employer

1. Adherence to protocols and expectations of the employing agency to which one is committed.

2. Avoidance of situations that may lead to conflict of interest.

E. Responsibility To The Profession

1. Enhancement of the values, ethics, knowledge and mission of the profession.

2. Adherence to the high standards of competence, education and training.

3. Commitment to upholding legal standards of the profession.

4. Refusal to claim directly or by implication qualifications or affiliations not possessed by the professional.

F. Responsibility To Society

1. Promotion of the general welfare of the society which we serve.

2. Fair and accurate reporting to the public in all matters.

It is essential to know and choose the principles that one believes to be important. Rarely are circumstances so simple that only one is involved. In such cases we find principles in competition to guide our choices. Levy (1993) suggests that the question then asked is: "How might priorities be justifiably ordered and ranked?" In sifting through this Levy suggests that we ask: "What are the risks and possible consequences to be considered?" The "if ... then" process is useful. If I act on principle A, then my choice would be B, and the consequences/risks would be C. Sorting our options helps to clarify what outcomes may look like and which of these fall into the realm of being realistically possible and acceptable and physically, emotionally and spiritually satisfying. This is the familiar Plan A, Plan B, Plan C idea used in many problem solving models with the added dimension of clarifying the significant values that are hinged to the choice. This values dimension enhances our choice satisfaction. Many options fall into the range of possible but leave much to be desired for the soul and do not allow us to feel morally at peace. In ethical decisions, the body, mind and spirit must be satisfied before an option falls on the top of the list and becomes the number one action plan.

Levy (1993) interjects another question at this point and suggests we ask: "Are there considerations or values that supersede ethical principles?" For example, are there laws in place that must be considered and obeyed? Are there regulatory or agency protocols that support/prohibit a particular course of action? Are there financial constraints that act as obstacles? Are some plans unrealistic from a practical point of operation? Answers to these questions can alter the course of a decision.

In applying this step to our initial case scenarios, the counselor who is dealing with the client with an abusive boyfriend may know what s/he would do in this situation but must refrain from imposing a personal course of action and weigh issues like autonomy, client safety, self determination and the client's best interest before proceeding. And the counselor who saw a client at a 12 Step meeting must be clear about what both AA and the employing agency mandate regarding confidentiality, anonymity and privacy in deciding how to handle the situation appropriately.

Step Three: Developing An Ethical Plan Of Action

Given that we have identified our ethical principles, we then move to develop a specific strategy or action plan (Rest, 1984; Biggs & Blocker, 1987). This involves identifying the behavioral outcomes we hope to achieve and putting a plan in place to achieve these. It may also involve including provisions and precautions necessary to address the consequences of the action (Levy, 1993). It is at this stage we gather as much additional data and information needed to implement a successful behavioral course. The logistics are identified, difficulties sorted out and focus is maintained to stay on the desired course. Distractions are resisted, impediments overcome, and the course is set for straight ahead. Looking at one of our case examples, the counselor who is considering accepting the gift examines, for example, such aspects as the cultural context of gift giving from which the client is operating, the agency rules around accepting gifts, the value of the gift, the personal nature of the gift and the like. These considerations factor in to whether to accept or refuse the gift and how to explain the decision to the client.

Step Four: Implementing Ethical Action

We then move directly into the final step, taking the action designated (Rest, 1984). Herein lies the crux of our role – the implementation of a well thought out choice that identified positive outcomes based on a solid ethical rationale. This choice, for which we are well prepared to accept the consequences, is where the proverbial "rubber hits the road." While sounding relatively easy at this point, this is often the most difficult part because ethical actions are not always the easiest or the most popular actions. Money, status, client relationships, friendships, jobs and even love have been lost in the process. But ethics without action is reduced to a mere mental exercise. It is when one's ethics and underlying values are put to the test that a counselor truly provides evidence of oneself as an ethical professional.

Referring to the initial cases, the counselor who receives the phone call requesting information must be clear on agency and federal and state guidelines around confidentiality of information and necessary consents required to release such information. The counselor may need to remind the colleague of these guidelines and may also suggest the impropriety of asking a professional colleague to consider a violation of these guidelines. Perhaps the colleague will be angry or insulted. But client information is safeguarded and standards are upheld.

Step Five: Evaluating The Outcome

Most stop their decision making models at the action step. It is important to add one more step to the paradigm – to evaluate the action to see if it gained the desired outcome. Asking key questions to determine what unexpected factors developed provides data that become a source of learning to build for future decision making and action.

Using the confidentiality example above, the colleague requesting information without consents may provide further information to indicate that the client has appeared on agency premises in what appears to be a psychotic state and is threatening to assault a staff person. The client is unable to provide clear information about his/her condition and about next of kin. Clarifying the extreme nature of the circumstances changes the situation and allows the counselor receiving the request to act beyond the norms of confidentiality. It indicates a situation in which the release of limited pertinent information helps the inquiring colleague to respond more effectively to the immediate crisis and insures both appropriate crisis intervention and client and staff safety.

When put into place, the steps described can become part of the professional's routine in decision making. They can become so habitual that they operate automatically. We go through the series of relevant questions as a "check list" for ethical conduct to assure us that we are performing in an ethical manner.

Obstacles To Ethical Behavior

A final consideration is to identify factors that serve as obstacles to ethical behavior. Ramsey (1986) states several factors that may be involved: ignorance of standards, financial incentives, perfectionism, fear of criticism, high affiliative needs, personal/professional immaturity, and counselor substance abuse. Each of these factors will be expanded with application.

Lack of Knowledge of Standards

As professionals we are charged to know the rules of conduct governing our behavior and to update ourselves on new additions to the standards. This is no easy task given the complexity of our world today and the fast changing legal and moral ramifications that impact our decisions. But it is essential that we remain up to date through involvement in professional organizations, constant education on new developments in our profession, and maintenance of our certification/licensure and commitment to the standards promoted therein. Referencing our scenario regarding confidentiality, for example, the counselor needs to know the exceptions to confidentiality regulations to be able to respond appropriately.

Financial Incentives

A second issue identified relates to the financial gains possible when we "look the other way." As was mentioned previously, ethical choices are not always easy or popular and are not without cost. So it is that we may succumb to the temptation to "do something just this once." We tell ourselves we are grossly underpaid and work hard and deserve some rewards for the efforts of our labor. The gain could not only be in money but in product or favors as well: the cut rate, the special gift, the link to the right person who will pull some special strings. We can rationalize our way out of the situation and easily stray. Personal gain can be a tantalizing incentive if we are not well grounded and do not stay focused on our moral guidelines. A case in point is our counselor who is tempted to get the contracting job done at a discount rate. The counselor must think twice before entering into a dual relationship that may create a conflict of interest with a former client.

Perfectionism: The Need To Be Right

A third factor to consider is the fear of making a good decision. We want to do a good job and are motivated by trying to do the best we can. We can get paralyzed in trying to find the "right" solution. Recognize that there is not always one "right" choice. This allows us to become comfortable in sorting out our options and making an action oriented decision. A well thought through decision can be reevaluated and, at the very least, can serve as a starting point from which further action can be initiated. By way of example, the counselor who is invested in the "right" plan for his/her abused client will need to move beyond self interest to consideration of what the client herself may want to do and what the client can realistically accomplish at the time of treatment.

Fear Of Criticism

Another obstacle that may roadblock our behavior is fear of being chastised by others. Very few of us are immune to the sting of criticism. We need to remind ourselves that we will never please everyone, so it is a good rule of thumb to please ourselves.

Witherow's poem "The Man In The Glass" reminds us:

"You may fool the whole world down the pathway of life

And get pats on the back as you pass.

But your final reward will be heartache and tears

If you've cheated the man in the glass.

He's the fellow to please, never mind all the rest,

For he's with you clear up to the end.

You've passed your most dangerous, difficult test

If the man in the glass is your friend."

(Swisher, 1994, p.38)

Consider the example of the counselor who does not want his/her colleague to become angry if confidential information is refused over the phone. The counselor needs to seriously consider the implications of that choice on the client and on professional integrity.

Fear Of Scrutiny By Others

Another deterrent suggested by Ramsey is the fear that taking a strong moral stand may lead others to examine our own moral behavior closely. We would do well to remind ourselves in this instance of what the Bible offers us:

"Let the man among you who has no sin be the first to cast a stone" (Mark 8:7).

We are, none of us, without our flaws and imperfections. And it is probably true that when we take a moral stand, someone in the crowd is going to question who appointed us the values police. Accept this, do the right thing and move on. It is good to know that we are expected to be able to pass a morals test. But it is also good to balance this with the realistic understanding that what we seek is progress in our behavior, not perfection. By example, the counselor who is going to set the abused client "straight" may have experienced his/her own problems with relationships that the supervisor may discover as they work this through with the client. Doing it "right" may be the counselor's way of avoiding this discovery.

High Affiliative Needs

Many of us suffer from another key problem – the high need for affection or acceptance. This is known as our affiliative need – to be liked and seen as a really nice person. In this vulnerable space we can become more susceptible to compromise and to bend the rules just to be accepted and liked. It takes developing a tough hide to act morally – to withstand it when others may attempt to manipulate us into compromise by threat of withdrawing their favor if we do not bend to their wishes. We must remind ourselves that the friend/colleague worth maintaining is one who will respect our tough decisions in the face of disagreement and who will support us in the position we must take. As an example, the counselor who wants to accept a gift from a client because he does not want to hurt the client needs to consider all the facets involved before accepting or rejecting the gift. Likewise, the counselor who is willing to give out confidential information without proper consents in order to avoid the ire of a colleague is dangerously driven by these affiliative needs and risks serious repercussions.

Personal/Professional Immaturity

Some of us, unfortunately, lack the maturity we need to make good choices. We act on impulse rather than conviction. Poor impulse control is another issue of concern raised by Ramsey. Behavior is in action before the brain is engaged to evaluate the parameters of the circumstances. This is where the routine of following a structured decision making model can be helpful. It helps us to avoid the "act first – think later" trap that can result in disastrous consequences not only for ourselves but for the clients we serve. The counselor, for example, who is attracted to a client to the point of harmful sexual involvement needs to think long and hard about the personal and professional ramifications of such a choice.

Counselor Substance Abuse

The last deterrent cited by Ramsey is of special significance to the substance abuse counselor. This is acting under the influence of drugs and alcohol. Drug or alcohol use on the job is totally unacceptable. It impairs the judgement of the professional and our capacity to fulfill professional responsibilities. In the case of the recovering counselor, continued use in spite of receiving therapy compromises their position as a role model (Bissell, 1994). Even more difficult may be problems presented by the person who does not have a previous history of chemical dependency but who develops a dependency while working in the addictions field. There may be no advance notice that trouble was on the way (West, 1988, p.37). It is essential for us to have some idea of how these circumstances will be handled. If the staff member is in denial, are co-workers who notice the problem responsible to intervene? Does the staff who recognizes the problem seek help independently or through the supervisor? And what repercussions ensue? Will the job be lost? Is treatment mandated? Can the employee return to work post-treatment? There are many implications that must be considered that make chemical use or return to use a complicated issue requiring clinical expertise as well as professional compassion. It is clear that there must be appropriate guidelines about personal use of alcohol and other drugs and clear consequences if rules are violated.

The use of alcohol and other drugs is just one of the many areas where, in one's personal life, one is under inspection even when not "on duty." One must know the guidelines in this and other areas as defined by the code of ethics and the employer/agency for whom the professional is working and follow them with rigor. The impaired counselor has much to lose and will be easily compromised as a result of the impairment, often at the cost of loss of integrity, reputation, job and even license. It is one of those occupational hazards that carries with it far reaching implications.

Lack Of Personal Values Clarification

To Ramsey's list of obstacles, three other issues can be added to consider. One is the lack of personal values clarification. It is the obligation of the professional to spend time in introspection to examine and to clarify personal values and examine ways they impact professional conduct. Our view of what is right defines as well as limits our work. We must expand our views to encompass multicultural frames of reference, non discriminatory practices and an inclusive, not exclusive, approach to people and behaviors. This is only possible through the stretch involved in ongoing personal scrutiny as we mature and develop through professional and personal experience and growth. It is commensurate with taking a personal "values/morals" inventory, not unlike the moral inventory we recommend for our clients in recovery. Ethical behavior is tonic not static. It must flow from experience and be modulated through experience so that who we are is constantly evolving. We are actualizing individuals whose commitment to personal and professional growth remains an ongoing life long process.

Limitations Of Codes Of Ethics

A second addition is the limitation of the code of ethics, those standards to which we subscribe and which we prescribe for ourselves in practice. Stein (1990) sites several concerns. Codes are often more generic than specific and, as such, are not always sufficient as reference guides. Sections of codes may conflict with other codes, laws and judicial systems. So discerning our duty under the code vs under the law can be a difficult chore. Further, codes may often be reactive not proactive. It is only "after a sufficient body of ethical conduct develops that run counter to that contained within regulations, the professional organization establishes a task force or some other vehicle to draft amendments to the regulation" (Stein, 1990, p.71). Furthermore, some codes remain silent on some topics and, as in the above analogy, make no clear guidelines in areas where the field is developing new experience. Consider assisted suicide, genetic bioengineering, computer information sharing and the like. And Stein recognizes another fact in suggesting that "even when codes do give answers to questions surrounding a given solution, the codes do not explain how to choose one action over another" (Stein, 1990, p.71). It is left up to us as practicing professionals to fill in the gaps and to build foundations for our work that apply specifically to the drug and alcohol field and to counseling practice as we approach the new millennium. We must be proactive in our work and not wait for others to make the difficult decisions that will guide not only our practice today, but in the future.

Lack Of A Decision Making Model

The final concern is the lack of a decision making model. If we do not have a methodology for resolving ethical conflicts it is unlikely we will find success facing these conflicts and achieving reasonable outcomes. Impulsive or reactive behaviors can deter appropriate ethical action. Examining the codes can be part of the guide in ethical conduct, but a more global context, i.e. the decision making model, can be an invaluable tool in walking us through a responsible proactive way to come to a morally acceptable, clinically appropriate action that suits both client and counselor interests.

And so we come full circle – back to the model introduced as a tool to assist us in meeting the challenges of thinking and acting as ethical professionals. Wouldn't Plato et. al. be pleased! The historical figures all had something of merit to offer us in managing the complexities of the new age. We now have the responsibility to advance clinical practice in support of meeting the challenges of the public trust placed in our hands today and for the next generation. May we live it with dignity and honor it well.

REFERENCES

Biggs,D., & Blocker, D. (1987). Foundations of Ethical Counseling, New York: Springer Publishing Company.

Bissel, L., & Royce, J. (1987). Ethics for Addiction Professionals. Center City, MN: Hazeldon.

Bissel, L., & Royce, J. (1994). Ethics for Addiction Professionals. (Second edition), Center City, MN: Hazeldon.

Edwards, P. (ed.). (1967). The Encyclopedia of Philosophy. (Vol. 1-8) New York: MacMillan.

Kitchener, K. (1984). Institution, critical evaluation and ethical principles: Foundation of ethical decisions in counseling psychology. The Counseling Psychologist, 12 (3), 43.

Leader, W. (1976). Moral dilemmas encountered in psychotherapy. In A.G. Benet (Ed.), Creative Psychotherapy. LaJolla, CA: California University Associates.

Levy, C., (1993). Social Work Ethics on the Line. New York, Haworth.

London, K. (1964). The Modes and Morals of Psychotherapy. New York: Rinehart & Winston.

Miller, G. (1995). Ethics Workbook for the Addiction Professional. Workshop sponsored by the Pennsylvania Chemical Abuse Certification Board (PCACB), Pittsburgh, PA.

National Association of Alcoholism and Drug Abuse Counselors. (1987). Code of Ethics. Arlington, VA.

National Association of Social Workers. (1993). Facts about Infractions, Random Survey, 1982-1992. Washington, DC.

National Association of Social Workers. (1997). Summary of Management Principles, Code of Ethics. Washington, DC.

Pennsylvania Chemical Abuse Certification Board. (1996). Rules of Conduct. Harrisburg, PA.

Ramsey, K. (1986, May). Ethics. Paper presented at the Pennsylvania Department of Health, Office of Drug and Alcohol Program’s Annual Drug and Alcohol Abuse Conference, Poconos, PA.

Rest, J. (1984). Research on moral development: Implications for training psychologists. The Counseling Psychologist, 12 (19), 18-27.

Soulis, M. (1989). Ethics: a different approach to teens. Adolescent Counselor, Feb/Mar, 38-40; 56-58.

Stein, R. (1990). Ethical Issues in Counseling. Buffalo, NY: Prometheus Books.

Swisher, C. (1994). The one minute ethics check. Professional Counseling, Oct, 38-39.

Tenneyson, W., & Strom, S. (1986). Beyond professional standards: Developing responsibleness. Journal of Counseling and Development, 14, 298.

West, J. (1988). Ethics and the impaired counselor. The Counselor, 6 (2), 37.

COMPLETE TEST FOR 1 PCACB–APPROVED CREDIT HOUR

(Record answers for COLEMAN Test on Answer Sheet)

1. To heighten and improve our conscious awareness that ethical issues are inherent in counseling situations is to develop what is called:

a. moral enlightenment
b. ethical sensitivity
c. ethical relevance
d. values clarification

2. Identified rules of conduct, both specific and global, that serve to guide expected and/or appropriate behavior are referred to as:

a. ethical priorities
b. personal values
c. ethical principles
d. behavioral codes

3. In the role of a counseling practitioner, the counselor has serious responsibilities s/he is charged to uphold to the:

a. counseling profession
b. the employer/agency
c. the client
d. all of the above

4. The specific strategy that weighs the set of circumstances against competing ethical principles and prioritizes the principles that will guide decision making is called:

a. an ethical action plan
b. a behavioral map
c. values centered course
d. designated decision

5. An identified deterrent to ethical decision making includes the following:

a. lack of knowledge of standards
b. fear of criticism and scrutiny
c. high affiliative needs
d. all of the above