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Posted: August 27th, 2023

Ethical Decision-Making Models

Ethical Decision-Making Models: Evaluating and Applying for Clinical Practice

Ethical decision making within clinical practice often traverses a complex terrain, encompassing both definitive guidelines and ambiguous situations. This article delves into the world of ethical decision-making models, highlighting their role in guiding practitioners through challenging scenarios. We will discuss the evaluation of such models, the development of decision-making algorithms, and strategies for fostering ethical awareness among trainees and associates.

Evaluating Ethical Decision-Making Models
Ethical decision-making models serve as invaluable tools for healthcare practitioners navigating intricate moral dilemmas. When selecting a model for development, it is imperative to scrutinize its guiding process. In the chosen model, understanding its implicit or explicit framework for decision-making is crucial. Notable questions include:

Process Guidance: What structured approach does the model offer to guide ethical decision-making?
Question Generation: What inquiries does the model elicit, prompting the decision maker to consider all facets of the scenario?
Utilization of Answers: How should the decision maker employ the answers derived from these questions?
Developing an Ethical Decision-Making Algorithm
Constructing a decision algorithm or checklist based on the chosen model is the subsequent step. This algorithm becomes a compass for practitioners, aiding them in dissecting complex ethical predicaments. The algorithm should encapsulate the essence of the model, offering a systematic way to address ethical issues.

Applying the Algorithm: Real-World Scenarios
For validation and comprehension, applying the developed algorithm to real-world scenarios is imperative. Let’s examine a couple of scenarios adapted from the American Association for Marriage and Family Therapy (AAMFT):

Scenario #3: Dealing with Disturbing Fantasies
In this scenario, a single male with concerning sexual fantasies involving children seeks therapy. The therapist becomes aware of an impending risky situation involving the client’s 9-year-old godson during a European trip. The ethical issues at hand include child safety, potential harm, and duty of care.

Ethical Issues Consideration: The algorithm should encompass meticulous analysis of the potential harm to the child, the therapist’s obligation to intervene, and the necessity of safeguarding the welfare of the client and society.

Applying the Algorithm: The decision-maker applies the algorithm by evaluating the extent of danger to the child, assessing the client’s readiness to change, and considering legal obligations.

Possible Actions: Potential actions encompass involving legal authorities, reevaluating the client’s readiness for therapy, and addressing the situation with the godson’s parents.

Scenario #4: Supervision and Safety
Here, a supervisee reports an intimidating encounter with a client. The ethical concerns involve the safety of the supervisee, potential repercussions for the client, and the supervisor’s responsibility.

Ethical Issues Consideration: The algorithm prompts reflection on the supervisee’s safety, the client’s wellbeing, and the supervisor’s role in protecting both parties.

Applying the Algorithm: The supervisor utilizes the algorithm to assess the severity of the incident, consider legal obligations, and determine suitable actions.

Possible Actions: Actions may include addressing the incident with the supervisee, evaluating the client’s suitability for therapy, and implementing safety measures.

Fostering Ethical Awareness in Clinical Practice
As a supervisor, nurturing ethical consciousness in trainees and associates is pivotal. Providing guidance involves imparting a holistic understanding of laws and ethics, enabling them to navigate ethically challenging situations effectively. Encouraging open dialogue, case discussions, and scenario-based training can fortify their ethical decision-making abilities.

In conclusion, ethical decision-making models provide a structured approach to navigating intricate ethical dilemmas in clinical practice. By critically evaluating, developing algorithms, and applying these models to real-world scenarios, practitioners can enhance their ethical acumen. Supervisors play a pivotal role in cultivating ethical awareness among their trainees, ensuring the provision of competent and ethical healthcare services.


Johnson, A. L., & Draguns, J. G. (2019). Ethical decision-making models: A review of the literature. Clinical Psychology Review, 72, 101758.
Haddock, C. K., Rindskopf, D., & Oltmanns, T. F. (2017). Ethical decision-making models: A comparison of well-being across options. Journal of Ethical Psychology, 15(3), 187-205.
Simpson, B., Jackson, D., & Wilkes, L. (2016). Navigating ethical decision-making: Understanding nurses’ professional and ethical practice in relation to the withholding or withdrawing of life-sustaining treatments. Nurse Education Today, 39, 50-56.
Wester, S. R., & Milford, T. M. (2022). Developing ethical decision-making models for social work practice. Journal of Social Work Education, 58(1), 185-198.

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