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Number one priority for Dr. Orenstein is to always focus on what is best for the patient. Nothing else is more important.
First, Dr. Orenstein needs to identify the ethical issues that are of concern in this case. One of the main questions is: should Amala's parents be notified of what she is planning to do?

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In terms of the relevant Ethical Principles that are involved in this case, we have to focus on Maintaining Confidentiality (4.01) and of course talk about the limits of confidentiality (4.02), since this is the premier example of both.

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3.  Applicable Federal, State and Civil Laws

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3.  Applicable Federal, State and Civil Laws

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From the first glance, it appears that there are no specific federal or other laws that applicable in this case, other than the insurance disclosure requirements - which are in fact at the heart of the case, since the patient is afraid that due to those, her parents will learn of this issue.

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In this case, the interested stakeholders are Amala (the patient), insurance company and of course Amala's parents. The doctor has to analyze how this is perceived from the standpoint of each of these interested parties.

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5.  Analysis of the alternatives and selecting a course of action.

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5.  Analysis of the alternatives and selecting a course of action.

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Dr. Orenstein has to follow the precise ethical standards analyzed in Step 2, and has to decide on the course of action that best benefits Amala, while still adhering to the ethics and not violating any laws or regulations.

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After the chosen course of action is put in place, Dr. Orenstein has to continue monitoring Amala's progress, and at all times ensure the safety and complete confidentiality of the records obtained during the sessions, since they may have a very material impact on Amala's well-being.