Purpose: The purpose of this discussion question is to apply your understanding of ethics to real cases and critically evaluate your own thoughts about ethical dilemmas in counseling.

Post: Select one of the two Ethical Cases below and respond to the questions.

CASE 1: She's Done This Before

Jenna is a 23-year-old White female who was recently admitted to the hospital emergency room for alcohol withdrawal symptoms. When she was brought to the emergency room, Jenna was very agitated and repeatedly screamed obscenities at staff members. At one point, the hospital security department was summoned to restrain her to her bed. A treatment team consisting of a case worker, a psychiatrist, and a nurse has been assigned to be responsible for her care.

Once Jenna is relatively stable and no longer a threat to herself or others, she is invited to participate in group counseling, which is offered once a day by Keith, a counseling intern (not assigned to Jenna's treatment team) who works throughout the hospital. When Jenna declines to participate in the group, Keith follows up with her, realizing that she is about to be discharged. Jenna describes her situation in detail when she talks with Keith. She describes her current feelings of depression and her struggles with addiction. Keith perceives her mood to be depressed, as evidenced by tearful affect. She seems to be ambivalent about leaving the hospital, as she says that her family members do not support her, she recently lost her job, and she is homeless. Keith determines that he needs to assess for suicide. Jenna states that if she is discharged from the hospital she plans to run into the middle of a busy interstate highway and kill herself. Further questioning from Keith reveals that Jenna has a history of multiple suicide attempts of varying potential lethality and that she has a detailed plan. She can think of no scenario or turn of events that would keep her from following through with this plan. Keith knows that Jenna has met with the staff psychiatrist to discuss her discharge, so he asks if she revealed her plan to the psychiatrist. Jenna replies that the psychiatrist never asked her about suicide, and she did not want to tell him.

Because the hospital staff members work as a treatment team, Keith immediately reports the client's suicidality to the staff members. He documents in Jenna's chart her distress and suicidal intent and asks to attend the treatment team meeting. When the treatment team meets, they are ambivalent in their reactions to Keith's report. They tell Keith that Jenna has expressed suicidal intentions in the past as a way to stay in the hospital because she has nowhere else to go; in addition, they are concerned about the safety of other patients given her initial outbursts. One of the team members comments, "She's done this before." The psychiatrist states that, without direct knowledge of Jenna's suicidal ideation and given the consensus of the team, he intends to discharge her with a list of available homeless shelters in the area. The team moves on to discuss other cases. As Keith leaves at the end of the meeting, he remains concerned about the client's safety if she is released and is unsure how to proceed.

2. If you were the counselor intern, what would your next step be? What is your role in this scenario? Do you think the intern should advocate for this client?
4. Based on this week's reading, what ethical issues (both for the specific case and from a systemic perspective) can you identify in this case?