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Take a look at the following ethical dilemmas; choose 4 to answer to the best of your ability in your post. Be sure to make substantial arguments for why you’ve arrived at your decision regarding each ethical quandary.

Case Example 1:

 

A colleague of yours, Dr. Solomon, contacts you for advice regarding a new client she has just seen. The client, Mr. Don Tellanyone, is a 47-year-old man who is seeking services for depression. During the initial phone contact, he asked repeatedly about privacy and wanted assurances that information discussed in session was confidential. The patient repeated this line of questioning during the first face-to-face session.

 

As the session progressed, he revealed that the source of his depression was the death of his mother one year ago. His mother had suffered from a combination of severe respiratory problems and Alzheimer’s. Mr. Tellanyone had been caring for her and his father in his home for 6 years prior to her death.  During the last two years, she required total care. He revealed that she had been suffering greatly and, out of compassion for her, he gave her an excess dose of her sleeping and pain pills. Medical personnel never questioned the death as the woman had been quite sick and “It was only a matter of time.”

 

Mr. Tellanyone goes on to explain that he is now caring for his father in similar circumstances, although there is no dementia. His father has declined rapidly since the death of his wife and now requires total care. Mr. Tellanyone reveals that recently he had a conversation with his father in which the father commented how peaceful his wife’s death was and how he hoped for a similar passing.

 

Mr. Tellanyone is feeling quite guilty about his mother.  Simultaneously, he strongly believes he made the right decision. He would like help to work through the issues. He is also very concerned about confidentiality and wants assurances from Dr. Solomon.

 

Dr. Solomon, feeling uncomfortable with the situation, contacts you for a consultation about the potential ethical issues for this case.

 

What are the potential ethical issues in this case?

 

What would you advise?

 
 
 

Case 2:

A psychologist works in an outpatient substance abuse treatment facility.  His patient reveals, during the course of therapy, that a staff person paid to have sex with another patient, who is a prostitute.  The staff member works in another department in the agency.  And, according to the psychologist’s patient, the patient is not aware that one of her customers works in another part of that facility.  

 

The psychologist does not know the therapist well, but has provided some consultation for the therapist in the past.

 

The psychologist does not dwell on the situation with the patient.  However, after the session, the psychologist feels uneasy about what his patient revealed.

 

—————–

 

Are there any ethical obligations of the psychologist who hears this information?

 

What are potential ethical pitfalls in this scenario?

 

What, if anything, should the psychologist do?

 
 
 

Case 3:

Dr. Faye Miller receives a referral for a 35-year-old female, Betty Drapier, who is both feeling depressed and experiencing marital problems.  During the first few sessions, Mrs. Drapier indicates that her husband, Don, is depressed and in treatment.  Part of her struggle is that she sees her husband as more depressed now than when he started treatment.  By Mrs. Drapier’s report, he appears more stressed because of his job and drinking alcohol more frequently.  She reports that his treating psychologist, Dr. Cooper, is working with her husband and has allegedly advised him to discontinue his medication in favor of an herbal remedy (St. John’s Wort).  Dr. Miller suggests that she meet with both Mr. and Mrs. Drapier to evaluate the marital situation.

 

At that time, Dr. Miller not only wanted to evaluate the marriage, but to evaluate how impaired the husband was, and Mrs. Drapier’s ability to assess her husband and the marriage accurately.

 

During the next session, Mr. and Mrs. Drapier arrive separately, but on time.  Mr. Drapier acknowledges many cognitive, behavioral, and physical symptoms of serious depression.  Mr. Drapier smelled as if he had been drinking.  Mr. Drapier also admits that his alcohol use has increased.  He also divulged that his risk-taking behavior has increased as well, such as speeding. During the session, Mr. Drapier verbalized suicidal ideation in a flip manner (“Sometimes I think it would be better if I just killed myself”).  The marital situation appears deteriorated and Mr. Drapier appears significantly depressed. 

 

As the session winds down, Mr. Drapier spontaneously asks for a second opinion about his treatment with Dr. Cooper.  He indicated that Dr. Cooper recommended that he discontinue a psychotropic medication in favor of an herbal remedy.  Mr. Drapier mentions that Dr. Cooper sells St. John’s Wort to him directly.

 

After reiterating the purpose of the session (which was to assess the marital situation and not to assess his current treatment), Dr. Miller states that she feels uncomfortable with the request, although she is concerned about the psychologist’s reported behavior. She is also concerned about Mr. Drapier’s level of depression, alcohol use, and suicidal statement.

 

Abruptly, Mr. Drapier looks at his watch and leaves the office explaining that he is late for a business meeting.

 

What are Dr. Miller’s potential ethical issues in this situation?

 

What are some actions that you, as the treating psychologist, may have done differently?

 

If you were Dr. Miller, what are your emotional reactions to this situation?

 

What obligations does the psychologist have to Mr. Drapier, Mrs. Drapier, Dr. Cooper, and the public?

 
 

CASE 4:

 

A psychologist receives a phone message from a former patient.  The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

 

The psychologist pulls the former patient’s chart.  The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy.  The psychologist remembers the former patient as a likeable person.

 

How would you feel about receiving this request?

 

What ethical issues are involved?

 

What are your potential options?

 

If you decide to provide information, would you consider communicating with the prior patient’s attorney?  What would you need from the attorney?

 

CASE 5:

 

A psychologist has been working individually with a 17-year-old male for issues related to depression and family dynamics. The psychologist and the young man have been engaged in psychotherapy for the past 2 years. The patient has trust issues with his parents, especially his father.

 

Ten minutes prior the scheduled appointment, the patient’s mother calls the psychologist on the phone. The mother explains that the child has run away and the mother has reported the child missing to the police. The mother further reports that the patient’s cousin has been driving the patient around town. She wants the psychologist to phone the police immediately when the patient arrives in order to arrest the cousin for unlawfully detaining the minor child or kidnapping and recover her minor child.

 

After the phone call, the psychologist checks the waiting room and sees the patient there.  He is talking with a young man, most likely his cousin.

 
 
 

What obligations does the psychologist have to the parent?

 

What obligations does the psychologist have to the patient?

 

What is the psychologist to do?

 
 

CASE 6:

 

A psychologist receives a call from an attorney wishing to seek services for depression, anxiety and substance abuse.  The psychologist screens the potential patient and she believes that she can help him.  When she asks about insurance, he indicates that he will use cash payments.  The psychologist explains the fee structure for the initial appointment as well as ongoing psychotherapy sessions.  The lawyer-patient comments that this seems low.  The psychologist ignores the comment and finishes by setting their initial appointment.

 

The psychologist and the attorney-patient meet for the initial session.  At the end of the session, the psychologist asks for the requisite fee as stated on the phone.  The attorney-patient indicates that he earns about 2.5 times what the psychologist asked.  He indicates that, in order for him to benefit from the treatment, he feels a need to pay what he makes an hour.  He also states that if she does not accept what he is offering, he will lose respect for her as a professional and probably not return for treatment.

 

Not knowing what to do, the psychologist takes the cash and sets up another appointment.  At the end of the day, the psychologist reflects on the interaction between she and her new lawyer-patient.  She does not feel right taking a fee larger than her usual and customary rate.  She is struggling that the situation is not right and feels very uneasy about the arrangement that the lawyer-patient foisted upon her.

 

Uncertain, she calls you for an ethics consultation.

 

What are the ethical issues, if any, involved in this case?

 

What would be your emotional response to this situation?

 

What factors make this situation potentially difficult for you as a psychologist?

 

What factors make this situation potentially easy for you as a psychologist?

 

What do you believe is the best course of action?

 

CASE 7:

 

Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying.  During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats.  Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.

 

After this event, Mrs. Olson became more forthcoming with Dr. Frances.  His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors.  Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.

 

Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility.  Dr. Frances feels an anxiety reaction in her body.  Trying to calm down, Dr. Frances writes out a list of questions.

 

1.      Should I open the letter now (as it is addressed to me)?

2.      Should I tell the patient about the letter before I open it?

3.      What are the benefits of telling the patient about the letter?

4.      What are the drawbacks of telling the patient about the letter?

5.      If the letter contains threatening information toward Mrs. Olson, or me, am I able to turn the letter over to the District Attorney?

6.      Am I required to turn the letter over to the DA if there is threatening information in it?

7.      How much control does the patient have over the letter and its contents?

8.      Is the letter automatically part of the treatment record or does it depend on the contents of the letter?

9.      Do I need a self-care plan as I am stressed out about this situation?

 

Having calmed down and written out these questions, Dr. Frances calls you for an ethics consultation about the letter.

 

What are your responses to her questions about the letter?

 

CASE 8:

 

Dr. Miller is a psychologist who consults with local nursing homes and hospitals when a patient’s capacity to make medical decisions is in question.  Dr. Miller receives an urgent call from an attorney to evaluate Willie Loman at a local trauma unit.  The attorney explains that Mr. Loman is looking for an objective opinion about his ability to make medical decisions.

 

Mr. Loman is a 52-year-old male with a wife and two kids (both in college).  He works as a financially successful salesman.  Over the previous weekend, Mr. Loman was involved in a serious boating accident.  He did not experience any head trauma; however, his physical situation is dire.  The trauma team needs his consent to perform a lifesaving surgery.  If successful, Mr. Loman can live many years.  However, there is a high probability that he will require full-time nursing care. 

 

Mr. Loman has been active man who enjoyed many physical activities.  Furthermore, he believes if he has the surgery and ends up confined to lifetime nursing care, he will exhaust all the funds he has saved for the benefit of his family.  Mr. Loman believes he will be an emotional burden to his family and lose his dignity.  Knowing that he will be physically compromised and a burden on his family, Mr. Loman is asking to die in peace.  He does not want to live in an incapacitated state of existence.

 

Without the surgery, Mr. Loman can be kept alive for about two weeks.  The family filed an emergency petition to obtain guardianship.  The trauma team believes that the patient is not thinking clearly about his demise.  They have already called in their psychiatrist-consultant.

 

Upon examination, Dr. Miller finds Mr. Loman’s mental status is within normal limits.  He demonstrates appropriate memory capabilities and reasoning skills.  He articulates his dilemma well and understands that he will die without surgery.  There is no evidence of hallucinations, delusions, or psychotic processes.

 

In order to clarify his thinking, Dr. Miller calls you to review this case.

 

What are competing ethical principles?

 

How would you feel if you were Dr. Miller?

 

What are the possible consequences of concluding Mr. Loman is competent and capable of making this decision?

 

What are the possible consequences of concluding Mr. Loman is not competent and incapable of making this decision?

 

How do your own professional, personal, and moral values influence how you would participate as a consultant to Dr. Miller?

 

Does Mr. Loman’s age factor into this decision?  In other words, would you make a different decision if Mr. Loman were 72 as compared to 52?

 
 

Case 9:

 

Psychologist Dr. Shermer learns from a colleague that she has been described in very unfavorable terms in a blog posted by an individual who publicly identifies herself as a patient of Dr. Shermer.

 

Dr. Shermer reviews the blog information.  The author is likely not a current patient.

 

The blogger insults Dr. Shermer’s appearance, her style of dress, and her office.  In essence, the blogger combines factual and inaccurate information into a well-formed, yet highly erroneous, description about Dr. Shermer’s role in the community and in the legal system.

 

There are many descriptions of Dr. Shermer that are blatantly false or misleading. Some of the falsehoods on the blog would be serious violations of the Ethics Code.

 

Upon reviewing the charts of several possible candidates as the offensive blogger, Dr. Shermer believes the blogger to be someone she evaluated in the past for a national security position.  The likely blogger can be emotionally labile and frequently feels a victim of “the system.” Dr. Shermer indicated a number of pathological characteristics in the report.  Dr. Shermer does not make the determination for the security clearance, but serves as a consultant for the government agency.

 

Dr. Shermer has a presence on social media and fears how her online reputation may be adversely affected by these ongoing blog posts.  She also fears that if she draws too much attention to the blog, then the blogger will gain greater traction.

 

Dr. Shermer fears the risk that the information could go to a licensing board and result in an investigation.  Although completely unwarranted, an investigation would add unnecessary stress in her life.  There is also a risk that her reputation could be ruined if the former client’s blog posts gain a larger following.

 

The psychologist wonders how she can take proactive action.

 

Dr. Shermer considers hiring an attorney.

 

Dr. Shermer also considers hiring an online reputation management company.

 

Dr. Shermer calls you for a consultation.  What are some recommendations that you would make to Dr. Shermer?

 

How would you feel if you were Dr. Shermer?

 
 
 

CASE 10:

 

Dr. Logan Earthski works with adolescents and their families.  During the course of treating one adolescent male, the parents, Mr. and Mrs. Hawk, expressed frustration with their son Tony’s lack of involvement with sports.  The Hawks detailed how Tony enjoyed team sports in the past, but has not enjoyed participating due to anxiety and constantly comparing himself to others.

 
 

In order to bond and connect with the family, Dr. Earthski explained from his experience with teens, some male teens function better with individual sports.  Dr. Earthski disclosed that he grew up skateboarding and taught lessons for several years.  A few of the children and adolescents he taught fit the description of Tony.  In those cases, the adolescent tried soccer or baseball, but did not really like it because they felt too anxious and overly competitive. 

 

When it came to individual sports, like skateboarding, teens that became involved with individual sports usually showed a decrease in anxiety and an increase in self-confidence.  However, sometimes, when adolescents first show up at the skate park, they may experience a similar level of anxiety and heightened self-awareness that Dr. Earthski helped remediate during his coaching sessions. 

 
 

Dr. Earthski also revealed that he worked with one particular teenager who became very anxious and experienced episodes of panic related to going to the skate park.  That adolescent did not think he was good and was weary of other kids watching and judging him.  Dr. Earthski gave him some coaching on anxiety reduction techniques and worked through those negative, anxiety-provoking emotions.  Further, he did very well at skateboarding once he conquered his symptoms of anxiety and panic.  The teenager’s self-confidence grew as he performed better at the skate park.  Based on Dr. Earthski’s revelations, the parents seemed reassured.

 
 

Prior to the next session, Dr. Earthski received a voicemail message from Mrs. Hawk asking if he could coach Tony on skate boarding.

 
 

After thinking about this request, Dr. Earthski calls you for a consult.  Dr. Earthski puts forward the following concerns:

 
 

1.  Is coaching a teenager-patient on anxiety-related issues in context of a skate boarding lessons definitively a dual relationship?

 

2.  What if the coaching is time-limited, informed consent is given, and this activity is viewed as the exception rather than the rule?  (“Time-limited” means between one and six sessions, depending on his response to treatment.)

 

3.  Can time-limited skateboard coaching be incorporated as part of an in-vivo anxiety reduction technique and billed as therapy services?

 

4.  Would Dr. Earthski’s malpractice insurance likely cover this activity?

 

5.  What would happen if the teen-patient injured himself as part of coaching?

 

6.  Dr. Earthski asks about the use of self-disclosure.  What feedback might you give to Dr. Earthski about what he disclosed about himself?

 

7.  Given everything you know about the case, what is/are the final recommendation(s) about this scenario?