PS508 Unit 3 Suicide Risk Ethics Paper Example

A Deckhand, a Rifle and a Signed Release: A PS508 Unit 3 Paper on Ethical Duties When a Young Client Shows Suicide Risk

[Student Name]

Purdue University Global

PS508: Ethics for Addictions Professionals

Unit 3 Suicide Risk Ethics Paper

[Instructor Name]

[Date]

The writer, the program, the client and every detail of the case are composite and illustrative; the sources cited are real.

The Case

Eli is 19 and works as a deckhand on a salmon seiner during the summer and in a seafood plant during the winter. Eli started outpatient care with us in January, sent by the court after a second drunk-driving charge. At intake Eli signed our standard consent forms, which list the exceptions to privacy in our program: danger to the client or someone else, a child or vulnerable adult who may be abused, and a court order. Eli also signed a release allowing us to speak with an older sister, Dana, about attendance.

In the sixth session, Eli talked about a breakup and about being laid off from the plant for the season. Near the end, Eli said, "Sometimes I think everyone would be better off," and then, when asked, that the hunting rifle in the bedroom is always loaded. Eli denied having a plan and said, "I wouldn't actually do it." The session had ten minutes left.

Risk Factors in Context

Burns and Patton (2000) organize the evidence on youth suicide by domains of risk: individual, family, community, school and peer. Their review found that several traditional approaches, including school-based suicide education programs and telephone hotlines, had little evidence of effect, while interventions aimed at important risk factors, such as depression and substance use, and restricting access to lethal means had stronger support. Eli's situation carries risk in several domains at once: heavy drinking, a recent loss, a job ending, a loaded firearm within reach and an island community where the next mental health appointment may be a week away.

None of this predicts that Eli will attempt suicide. It does mean the counselor cannot treat the remark as ordinary venting.

What the Ethics Codes Require

The NAADAC code treats confidentiality as a core duty and allows disclosure without consent only in limited circumstances, including when disclosure is needed to protect a client from serious and foreseeable harm (NAADAC, 2021). It also expects clients to hear, before treatment begins, where privacy ends, which our intake forms covered. The ethical tension in Eli's case is not whether the counselor may act, but how much to disclose and to whom, given that Eli is an adult who has not asked for help and has denied a plan.

The principle of respect for autonomy argues for working with Eli rather than around Eli. The principle of doing no harm argues for acting before the session ends. A good decision has to honor both.

The First Step: Assessment and Planning With Eli

I used the remaining ten minutes, and extended the session by twenty minutes with the director's approval, to assess risk more fully and to build a safety plan with Eli. Stanley and Brown (2012) present a short written plan that clinician and client build together, moving in order from the client's own early signals of a crisis, to things the client can do alone to ride it out, to places and company that pull attention off the crisis, to particular people the client trusts to call, to clinics and crisis numbers, and finally to making the home safer, above all by putting distance between the client and the most lethal method available.

Eli named warning signs (drinking alone after a fight with a coworker), coping steps (walking to the harbor, calling a friend on another boat) and two people to ask for help: Dana and a former skipper. We added our program's after-hours number and the national 988 crisis line.

The hardest step was the rifle. Eli did not want to give it up, explaining that hunting season mattered and that the rifle was a gift from a grandfather. We agreed that Eli would unload it, give the bolt and ammunition to Dana that evening and get them back in the fall after a review with me.

Asking Eli to store the rifle with family for a season respected what the rifle meant and still put distance between a bad night and a loaded gun.

The Second Step: Disclosure to Dana

Dana was the person who would hold the bolt and ammunition, so she needed to know why. Eli's release covered attendance only, not clinical information. I asked Eli whether we could call Dana together from my office. Eli agreed and signed an expanded release limited to the safety plan. The call took five minutes. Dana agreed to come that evening.

Had Eli refused, the decision would have been harder. The code would have allowed limited disclosure to protect Eli from serious and foreseeable harm, and I would have consulted the director before calling. Because Eli agreed, the disclosure was consensual and limited to what Dana needed.

Documentation and Follow-Up

I documented the remark, the assessment questions and answers, the safety plan, the means-restriction agreement, Eli's consent to the call and the director's consultation. We scheduled a session for two days later instead of the following week, and I called Eli the next morning to confirm Dana had picked up the bolt and ammunition. At the next session we added treatment for depressed mood to Eli's plan and referred Eli to the island's mental health clinic for evaluation.

Changes to My Own Practice

Eli's remark came in the closing minutes, which is when many clients finally say the hard thing. I now leave the last fifteen minutes of each session free from paperwork so there is room to respond. I also realized our intake release form makes it too easy to sign for attendance only. We are revising it to include a separate, optional line allowing contact with a named support person in an emergency. A client who chooses that option at intake, when calm, makes the decision ahead of time instead of in the middle of a crisis, which respects autonomy better than asking for consent with ten minutes left in a hard session.

Conclusion

Eli's case shows that the ethical duty in suicide risk is less a single decision to break confidentiality than a series of choices about how to protect a client while respecting the client's control over their own life. Burns and Patton's review supports focusing on risk factors and lethal means rather than on generic warnings. Stanley and Brown's safety plan offered a collaborative way to act, and the NAADAC code's provisions on confidentiality and harm defined the limits of what could be shared, with whom and on what grounds.

References

Burns, J. M., & Patton, G. C. (2000). Preventive interventions for youth suicide: A risk factor-based approach. Australian and New Zealand Journal of Psychiatry, 34(3), 388-407. https://doi.org/10.1080/j.1440-1614.2000.00738.x

NAADAC. (2021). NAADAC code of ethics. NAADAC, the Association for Addiction Professionals. https://www.naadac.org/code-of-ethics

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001