Counseling practice is both an art and a science, which requires practitioners to make both value-laden and rational decisions. The ethical decision-making process considers both facts and values. Within ethical deliberation, the practitioner blends such elements as personal moral sensitivities and philosophies of practice with clinical behavioral objectivity and the quest for efficient care of clients. Rehabilitation counselors must be able to demonstrate high levels of competency in the ethical aspects of their practices. Ethical practice requires rehabilitation counselors to understand ethical principles, professional standards, ethics governance, and to understand and apply an ethical decision-making model when faced with an ethical dilemma. Counselors also must be aware of the potential impact of any contextual factors that may influence both counselor, client and stakeholder worldviews and the impact of contextual factors on the ethical decision-making process. This chapter uses a case scenario to assist rehabilitation counselors in developing the knowledge, skills, and awareness needed to address ethical dilemmas in rehabilitation counseling practice.