To Code or Not to Code: Some Ethical Conflicts in Diagnosing Children

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A significant percentage of child clients present with mild or subthreshold symptoms that make classification using the available diagnostic coding systems difficult. Furthermore, these systems are based on discrete categories and do not consider overlapping behavior patterns, developmental psychopathology, or the dimensional nature of mental and emotional disorders. Yet, clinicians are faced with making diagnostic decisions if all clients are to have access to services realistically. In this article, the authors address a clinician’s ethical obligations in diagnosing children within the current diagnostic classification system with specific attention to beneficence and nonmaleficence, maintaining integrity, and working toward justice. Then, they delineate the responsibilities of each stakeholder and make recommendations for clinicians. The authors conclude with a clinical vignette to illustrate the ethical decision-making process, guided by a decision-tree with the aim of aiding diagnostic decisions and easing documentation of difficult ones.

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