Ethical Dilemmas

Ethical Issues in Counseling the Developmentally Disabled Population
The focus of this paper will discuss ethical issues faced when professionally counseling the (Developmental Disability) population ages 18 and older. It will touch basis on informed consent with the knowledge that these individuals understand the care being provided. Also I will provide examples of court cases and legal aspects of the practice when dealing with such population, as well as recommendations on particular treatment. Challenges of working with this population from an ethical standpoint respecting their rights within state guidelines will be discussed as well.
To give a brief description of the Developmental disabilities are a group of conditions due to impairment

in physical, learning, language, or behavior areas. The conditions begin during the development period, may impact day-to-day functioning, and usually last throughout a person’s life time” (CDC, 2015). Each state may have slightly varied definitions of DD. From state to state it is defined by IQ testing and proof of an individual’s condition existing before the age of 18.
According to Developmental Disabilities Law & Legal (2001-2016), “In the U.S., developmental disability refers to the life-long disabilities attributable to mental or physical impairments of an individual ranging from ages 5 years of age or older. Developmental disabilities are birth defects which are likely to continue indefinitely and can cause lifelong problems with how a body part or system works”.
Developmental Disabilities “impose limitations on the major activities of life such as self care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency. Developmental disabilities can be nervous system disabilities, sensory-related disabilities, metabolic disorders, and degenerative disorders. Persons with developmental disabilities use individually planned and coordinated services and supports of their choosing, especially, housing, employment, education, civil and human rights protection, health care, to live in and to participate in the activities of the community” (Developmental Disabilities Law & Legal, 2001-2016).
Counseling those with this disability can be risky if you are not careful with the practice. During the ages of 18 and older individuals with disabilities have to sometimes care for themselves. With that comes a practice of professional counseling. As a professional counselor it is important to discuss informed consent with the individual. “Informed consent, psychologists inform clients/patients as early feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers” (Corey, Corey, Corey, Callanan, 2015, p.152). Having a disability does not automatically exclude an individual from being able to give informed consent, nor does it mean they are capable of giving consent.
Practicing as a counselor it is important that one discuss informed consent with the client explaining what has to or will be done during counseling sessions. In some cases the level of understanding can be very limited with the individual. This may seem very difficult for the counselor when helping the individual. “There are several challenges faced by treatment providers in acquiring informed consent from persons with MR/DD. Possible deficits in comprehension, memory and verbal expression, problem-solving difficulties, concreteness, and problems processing complex sequences of information challenge the requirements of knowledge and capacity. Tendencies toward acquiescence, and limited experience with decision making challenge the requirement of voluntariness” (Felgoise, Nezu, Nezu, Reinecke, 2005, p.180).
When providing counseling to individuals with DD, the professional should consider the legal requirements that include mental capacity and all other certain information that must be considered.

Capacity can be defined by the level of mental ability/functioning that one has to understand/process significant information during treatment. Specific information to consider when developing a treatment plan includes benefits, risks, alternatives and any other significant information included in the treatment plan that can be seen as valuable to the client. It is important for the counselor to discuss aspects of care provided with the patient. Such information provided should be specific and tailored in a way to fit the needs of the client along with documentation throughout the process. Making sure the client posses some type mental capacity whether it is mild or moderate, consent will need to be addressed accordingly. Thorough assessment and documentation for a plan of treatment is critical. At any time during the assessment process the individual has the right to refuse or accept treatment at any time they feel necessary.
“Although capacity is not static and it could change over time requiring distinct abilities depending in the nature or complexity of the treatment decision. Specific capabilities may be lost or gained at different times during the life of the patient. Capacity could also vary from occurring on a day to day basis. For example, a client in an altered state of consciousness

may not be coherent to give consent but later on during recovery is able to” (Health Care for Adults with Intellectual and Developmental Disabilities, 2016, p.6).
Assessing mental capacity can change at any time for individuals due to certain or specific supports provided.

It is important for the counselor to help the client adapt a level or better means of communication that best fits the individual. Creating appropriate systems of communication and support tailored to fit the client will produce a better understanding for the individual’s mental capacity. Developing specific systems for client can lead to them making their own decisions to give informed consent or refuse treatment plans put in place for them. For a counselor to be effective they should try different technique approaches. Such methods/techniques may involve ones that the client may be more familiar with or have experienced before. Such technique approaches may include using symbols, gestures or electronic devices, or people that know that share a considerable amount of history with the individual. Often times such relationships/bonds occur between family members or individuals that provide paid care. The involvement with others can help the process tremendously, because valuable information can be obtained to help/accommodate the process, clients understanding and means of communication.
However, if the individual is incapable of giving consent or there is doubt regarding capability, it is necessary to follow legal procedures and ethical guidelines for assessing ones capacity. If the individual is incapable, the counselor should delegate/improvise authority for decision

making based on his/her best interests depending on the circumstances. Whenever possible even if consent is obtained from a person that can advocate or make important decisions, approval should be obtained from the client and documented at all times.
Other legal aspects that should be addressed when counseling or working with the developmental disability population, includes having knowledge about the mental health court system. When dealing with these individuals’ necessary measures should be taken when faced with issues involving their client in the court system. The counselor should be aware and have knowledge of the neurobiological basis of mental disorders, in which they are outside the willful control of individuals. According to a report by the Council of State Governments Justice Center (2006), “people with mental illness cannot simply decide to change the functioning of their brain. As with physical illnesses, it is believed that mental disorders are caused by the interplay of biological, psychological, and social factors”. Mental health counselors offer their clients a model that involves taking accountability for their actions that can ultimately led to the involvement of the court along with opportunities to engage in treatment of underlying mental health disorders.