Mental health clinicians are not the only professionals that are being urged to rely on ethical decision making models or procedures for resolving ethical dilemmas. A review of the examples of decision making models provided below shows that ethical decision making in the field of mental health is quite comparable to approaches that are used in the business community.

The professions of counseling, marriage and family therapy, and social work may more readily rely on their professional codes of ethics to set standards, but it is clear that the business models for ethical decision making provide guidance for situations when there are competing rights or core values that must be addressed and that, as Forrester-Miller and Davis have concluded, it is the systematic process to get to a solution that is important, and that good people acting ethically in attempting to resolve the same issue may come up with different solutions.

Following are some ethical decision making models from leaders in the business community.


Business Model I: Rushworth M. Kidder - Nine Checkpoints for Ethical Decision-Making

Founder of the Institute for Global Ethics, former columnist and author on the subject of international ethics, Rushworth M. Kidder, in his book, How Good People Make Tough Choices (1995), lays out a framework for resolving ethical dilemmas for both the lay person and the corporate executive.

He states that: “Developing real skill at jazz or baseball – or ethics – requires that intelligence fuse with intuition, that the processes be internalized, and that decisions be made quickly, authoritatively, and naturally. For musician, athlete, and moral thinker, making good decisions usually requires a patient investment in process – and plenty of practice.” (pg 182) Kidders’ Nine Checkpoints, which are summarized below, are offered as a: “guide to the underlying structure of ethical decision-making.” (pg 183)

Kidder’s Nine Checkpoints for Ethical Decision-Making

1. Recognize that there is a moral issue.
2. Determine the actor. Whose moral issue is it?
3. Gather the relevant facts.
4. Test for right-versus-wrong issues. If the choice is between a right vs. wrong issue, it is a legal issue and not a moral one.
5. Test for right-versus-right paradigm. This helps bring the focus on the fact that it is a real dilemma that pits two deeply held core values against each other.
6. Apply the resolution principles. Utilitarian or ends-based; Kantian or rule-based; or Golden Rule or care-based. What is the line of reasoning that seems most relevant to the dilemma?
7. Investigate the “trilemma” options. Is there a third way out of the dilemma – a compromise? This question can be asked at any time.
8. Make the decision.
9. Revisit and reflect on the decision. This should be done when the case is essentially closed as a way to learn from the process and gain experience. (pgs. 183 – 186)

Kidder, R. M. (1995). How good people make tough choices. New York, New York: Simon & Schuster.

Business Model II: Doug Wallace and Jon Pekel - Checklist for Resolving Ethical Dilemmas

Twin Cities-based business and organizational consultants Doug Wallace and Jon Pekel provide a ten-step approach to resolving ethical dilemmas. Prior to starting the process, they suggest that a value assessment be done to determine the values held by the stakeholders.

They also suggest that the decision maker consider the serious nature of the possible consequences. The final step of the process offered by Wallace and Pekel includes a checklist to evaluate the efficacy of the process. Wallace and Pekel suggest that the decision maker be familiar with this checklist prior to starting the decision making process.

Regardless of the ethical decision making approach used by a mental health clinician to resolve an ethical dilemma, the Wallace and Pekel checklist provides a good self-assessment of the integrity and thoroughness of the process that has been used and therefore may be appropriate as a supplement or evaluation tool to any of the other models.

THE TEN STEPS AT-A-GLANCE (Includes hints for using each step)

Before You Get Started: Do a Preliminary Ethical Assessment.

Use the following 2 tests to determine to what degree there is a significant ethical dimension to this situation.

1) Value-conflicts. How different are the kinds of values held by different stakeholders?
2) Consequences. How significant are the possible consequences of this situation?

1. IDENTIFY THE KEY FACTS
“Role play” key stakeholders to see what they see as facts.
Watch out for assuming causative relationships among coincidental facts.

2. IDENTIFY & ANALYZE THE MAJOR STAKEHOLDERS
Make sure to identify both direct and indirect stakeholders.
Genuinely “walk in their shoes” to see what they value and want as a desired outcome.

3. IDENTIFY THE UNDERLYING DRIVING FORCES
Think like a M.D. – look for what’s beneath the presenting symptoms.
Use these driving forces to develop your Step 8 preventive component.

4. IDENTIFY/PRIORITIZE OPERATING VALUES & ETHICAL PRINCIPLES
Think of this step as determining the up-front “design parameters” for an effective solution.
Don’t rush this step – building consensus here will pay off later.

5. DECIDE WHO SHOULD BE INVOLVED IN MAKING THE DECISION
All stakeholders have a right to have their best interests considered.
If you can’t actually involve all stakeholders, have someone “role play” their point of view.

6. DETERMINE & EVALUATE ALL VIABLE ALTERNATIVES
Critical: all possible alternatives must pass the 3-part review-gate criteria.
Imagine possible consequences of each alternative cascading down on each stakeholder.

7. TEST PREFERRED ALTERNATIVE WITH A WORST-CASE SCENARIO
This step helps prevent a “rush to judgment” towards a wrong solution.
Emphasize this step when all stakeholder interests are not being adequately considered.

8. ADD A PREVENTIVE COMPONENT
“Problem-solving heroes” want to get on to the next problem and won’t take time for this step.
Only immediate-solution decisions usually come back to bite you.

9. DECIDE AND BUILD A SHORT & LONG-TERM ACTION-PLAN
The devil is usually in the details – take the time needed to be detailed and comprehensive.
Make sure that the means used in your action-steps correlate with your desired ends.

10. USE DECISION-MAKING CHECKLIST
Become thoroughly familiar with this end-point checklist before you get started in Step 1. Don’t allow group-think here -- make sure everyone involved fills this out individually.

The decision making checklist includes the following six tests.

Relevant Information Test. Have I/we obtained as much information as possible to make an informed decision and action plan for this situation?

Involvement Test. Have I/we involved all who have a right to have input and/or to be involved in making this decision and action plan?

Consequential Test. Have I/we anticipated and attempted to accommodate for the consequences in making this decision and action plan?

Fairness Test. If I/we were assigned to take the place of any one of the stakeholders in this situation, would I/we perceive this decision and action plan to be essentially fair, given all of the circumstances?

Enduring Values Test. Does this decision and action plan uphold my/our priority enduring values that are relevant to this situation?

Light-of-Day Test. How would I/we feel and be regarded by others (working associates, family, etc.) if the details of this decision and action plan were disclosed for all to know?

The user is asked to rate each item on a Likert-like scale from 1 to 5, with "1" = not at all and "5" = totally yes. The scores for each of the six tests are added up to arrive at the Total Ethical Analysis Confidence Score. Scores in the lowest range, starting at around 7, mean that there is not a great deal of confidence that the decision is ethical, while towards the upper range of 35, the user is very confident that the decision is ethical.

These six tests have been drawn from other sources concerned with ethical decision making, and do not represent original thinking. However, the utility of this scale lies in integrating the various ways of examining ethical dilemmas into a single continuous scale.

For further information on this scale, and for a copy of the checklist, you may wish to view the original source material, shown below.

Wallace, D. and Pekel, J. (2006). The Ten Step Method of Decisionmaking. Consultants of the Twin Cities-based Fulcrum Group; 651-714-9033; e-mail at jonpekel@atti.com. Retrieved 12.26/07 from http://www.authenticityconsulting.com/misc/long.pdf. )

Decision-Making Checklist from: Wallace, D. and Pekel, J., Fulcrum Consulting Group, St. Paul, MN, in McNamara, C., Complete Guide to Ethics Management: An Ethics Toolkit for Managers, Retrieved 12/26/07 at: http://www.managementhelp.org/ethics/ethxgde.htm.

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