Ethical Decision-Making Models, and Why You Document the Decision
By Felix Murad, M.Ed., LPC-S, Licensed Professional Counselor-Supervisor (Texas & Washington)
Ethical dilemmas are not rare, exotic events you’ll face twice in a career. They’re routine: the dual-relationship gray zone, confidentiality colliding with safety, a mandated-reporting judgment call, a gift, a boundary, a question of your own competence, a social-media tangle. They arrive on ordinary Tuesdays, and they rarely come labeled.
There are two ways to meet them. The amateur way is to go with your gut, or to do whatever feels kindest in the moment. The professional way is to run a recognized ethical decision-making model and document your reasoning. Here’s the part new clinicians often don’t realize: your professional bodies don’t merely suggest this. They expect it. Let’s look at what they require, the models you can actually use, and why the documentation is not an optional flourish. It’s the whole point.
What the codes actually require
Start with the mandate, because it reframes everything.
The ACA Code of Ethics (2014), in its section on resolving ethical issues, is explicit that ethics is a process, not a reflex: when a dilemma is hard to resolve, counselors are expected to engage in a carefully considered decision-making process and consult as needed. And while it endorses no single model as always best, it expects counselors to use a credible model that can bear public scrutiny of its application (American Counseling Association [ACA], 2014, Section I).
The NBCC Code of Ethics (2023) is more directive still: it’s an enforceable set of standards, and it states that when facing complex dilemmas, the counselor shall engage in an ethical decision-making process and consult (National Board for Certified Counselors [NBCC], 2023).
Sit with the phrase “bear public scrutiny,” because it does a lot of work. A process that can withstand scrutiny is, by definition, one that can be examined, which means it has to exist in a form someone other than you can review. We’ll come back to that. For now: both bodies frame ethics as a deliberate, consultative, examinable process. Not a vibe. Not a hunch.
The foundation underneath the models: principle ethics
Most counseling decision models rest on the same five moral principles, articulated for the field by Kitchener (1984): autonomy (respecting self-determination), nonmaleficence (avoiding harm), beneficence (promoting welfare), justice (fairness), and fidelity (loyalty, honoring commitments). When a dilemma surfaces, the first move in most models is to hold it up against these principles, and often the conflict reveals itself precisely as two principles pulling against each other (a client’s autonomy versus your duty of nonmaleficence, say). The models exist for when checking the principles alone doesn’t resolve it.
The models, and how each has its own steps
There is no shortage of credible models, and they differ less in skeleton than in emphasis. Three worth knowing:
Forester-Miller and Davis (the ACA-endorsed model). Published by ACA and the one most counselors are taught (Forester-Miller & Davis, 2016; orig. 1996), it lays out seven sequential steps:
- Identify the problem.
- Apply the ACA Code of Ethics.
- Determine the nature and dimensions of the dilemma.
- Generate potential courses of action.
- Consider the potential consequences of all options and choose a course of action.
- Evaluate the selected course of action.
- Implement the course of action.
At step 6 it borrows Stadler’s three tests: justice (would you treat others the same?), publicity (would you be comfortable if your choice were reported in the press?), and universality (would you recommend this action to another counselor in the same situation?). It’s practical, principle-grounded, and a sensible default.
Welfel’s model. Welfel’s approach (2016) is distinctive for two things the others underweight. It begins earlier, with cultivating ethical sensitivity, on the logic that you cannot resolve a dilemma you never noticed was one. And it foregrounds consultation and, explicitly, documenting the reasoning as steps in their own right rather than afterthoughts. If you only learn one model’s emphasis, learn this one’s.
Tarvydas’s integrative model. Cottone and Tarvydas (2016) emphasize what most models gloss: context and culture, the clinician’s own reflective stance and biases, and the implementation phase, actually carrying out the decision and managing its fallout, which is where good reasoning often dies in practice.
Different as they look, they share a backbone: identify the problem → consult the code and the principles → consult colleagues or your supervisor → generate options → weigh consequences and apply the tests → choose and implement → evaluate, and document throughout. Pick one, learn it well, and use it consistently. The point isn’t the brand; it’s that you have a credible, repeatable process.
Why use a model at all
The utility is not bureaucratic. A model does for ethical reasoning what structured assessment does for risk: it counters your worst tendencies.
Left to instinct, clinicians reason emotionally, anchor on the first option, and drift toward whatever is easiest or feels nicest, none of which reliably tracks what’s right. A model slows the reactivity, forces you to consult the code rather than your memory of it, requires you to generate more than one option, and builds in consultation and a consequence check before you act. The result is a better decision, not merely a defensible one. And for those of us who provide clinical supervision for LPC Associates: a supervisee who can run a model is a supervisee learning to think like a clinician instead of guessing like a layperson.
Why you document it, clinically and ethically
This is the part you flagged, and it’s the part most clinicians shortchange. Using a model is half the obligation. Notating your reasoning is the other half, and it matters on two separate axes.
Ethically. Recall the code’s standard: a process that can bear public scrutiny. Scrutiny requires something to scrutinize. An ethical decision that lives only in your head can’t be examined by an ethics board, a supervisor, or a court, which means, functionally, it cannot meet the standard the code sets. Documentation is how you convert private deliberation into a process that actually satisfies the expectation. Put bluntly: an undocumented ethical decision doesn’t demonstrate ethical reasoning. It just asserts it.
Clinically and legally. The standard of care, in a board complaint or a malpractice action, is almost never “did you achieve a good outcome?” It’s “did you deliberate reasonably?” A reasoned, principled, consulted decision can be entirely defensible even when hindsight or a bad result suggests another path. But you can only defend what you can document. The chart is the evidence that you identified the dilemma, weighed the principles, sought consultation, considered alternatives, and acted for articulable reasons. In risk work I tell supervisees that good documentation is the visible trace of having actually thought; the same is true here. If it wasn’t documented, for evidentiary purposes it wasn’t done.
There’s a third, quieter benefit: writing it down makes the decision better. Forester-Miller and Davis themselves note that committing the dilemma to paper produces clarity that turning it over in your mind does not. The act of documenting is itself part of the reasoning.
What to actually document
Keep it factual and contemporaneous. A defensible note captures: the dilemma and the relevant facts; the codes, laws, and principles you consulted; who you consulted (supervisor, colleague, legal, and when); the options you considered; the decision and your rationale; and the plan, including follow-up and how you’ll evaluate the outcome. You’re not writing an essay. You’re leaving evidence that a competent professional reasoned through a hard call.
Frequently asked questions
Which model should I use? Any credible one. ACA endorses Forester-Miller and Davis but explicitly declines to mandate a single model (ACA, 2014, Section I). Choose one, learn it, and apply it consistently so your reasoning is repeatable.
Do I really have to write it down? Yes. The standard is a process that can bear public scrutiny, and scrutiny requires a record. An undocumented decision is also an indefensible one if it’s ever questioned, and documenting it tends to improve the decision itself.
What if I reason carefully and still make the ‘wrong’ call? The standard isn’t perfection; it’s a reasonable, principled, consulted process. A documented decision made in good faith through a credible model is defensible even if someone would have chosen differently. That protection is exactly what the documentation buys you.
Isn’t needing to consult a sign I’m not competent? The opposite. Consultation is a step in essentially every model and an expectation of both the ACA and NBCC codes. Skipping it to look self-sufficient is the actual lapse.
Before your next gray-area call, sit with these
- The last genuinely hard ethical call you made: could you reconstruct your reasoning from your notes, or only from memory? Which one would survive a board’s review?
- When a dilemma feels obvious, is that clarity coming from a principled analysis, or from what’s easiest and most comfortable for you?
- If your decision were reported on the front page, or recommended to a colleague in your seat, would it hold? If you’re not sure, you haven’t finished the model yet.
Run the model, and capture the rationale
Knowing the steps and actually documenting them under pressure are two different skills. I built an Ethical Decision-Making and Documentation Worksheet, a one-page tool that walks you through a credible model and captures the rationale in a form that can bear scrutiny, so the reasoning and the record happen in the same motion.
Download the Ethical Decision Worksheet →
And remember: consultation is a step in every one of these models, not a confession of weakness. When a dilemma is genuinely hard, working it through with a supervisor is the process, which is a large part of what supervision is for. See what makes a good supervisor for the kind who’ll reason it through with you instead of just signing off.
Felix Murad, M.Ed., LPC-S, LMHC, CMHC, NCC, Licensed Professional Counselor-Supervisor. Licensed in Texas, Washington, New Hampshire, and Florida (telehealth). This article is professional education for clinicians and is not legal advice; documentation and standard-of-care questions specific to your situation should be reviewed with your supervisor, your liability carrier, or an attorney.
References
American Counseling Association. (2014). ACA code of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf
Cottone, R. R., & Tarvydas, V. M. (2016). Counseling ethics and decision making (4th ed.). Pearson.
Forester-Miller, H., & Davis, T. E. (2016). A practitioner’s guide to ethical decision making. American Counseling Association. (Original work published 1996)
Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. The Counseling Psychologist, 12(3), 43–55.
National Board for Certified Counselors. (2023). NBCC code of ethics. https://www.nbcc.org/ethics
Welfel, E. R. (2016). Ethics in counseling and psychotherapy: Standards, research, and emerging issues (6th ed.). Cengage Learning.