Madison, age 13, seeks family planning services. She lives with both parents and her younger brother, and is enrolled in high school. She tells the nurse she has a 19-year-old boyfriend with whom she has been sexually active for about three months. She does not want her parents to find out that she is seeking birth control, as they do not know she is sexually active. The nurse discovers that Madison is pregnant. Madison indicates that she would like to have an abortion. Madison is referred to you for counseling. She asks you to please keep her information confidential.

Apply the nine steps of the ethical decision-making model as her counselor - 1. Identify and define the problem 2. Involve the client in the decision-making process; 3. review relevant codes of ethics and the professional literature 4. Consider the principles and virtues, 5. Tune in to your feelings, 6. Consult with colleagues or experts, 7. Consider the context, 8. Identify desired outcomes and consider possible actions to achieve the outcomes, 9. Choose and act on your choice.

• Can Madison's counselor keep her disclosure about the sexual relationship with her boyfriend in confidence, or must she notify Madison's parents and/or children services?
• Can Madison's counselor keep her disclosure about the abortion in confidence, or must she notify Madison's parents and children services?
• If the counselor breaches confidentiality, what are the risks to her relationship with Madison?

Please refer to the relevant New York State laws and ACA ethical guidelines. Address informed consent and confidentiality in the response.