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Answer the following questions about the case examples below from the chapter. Then, read the rest of the chapter and return to this feature. Reread the case examples and revisit your answers, this time employing what you have learned. How, if at all, did your responses change? Even when you are aware of ethical and legal guidelines, determining the best course of action in specific situations can be difficult, especially when ethical and legal standards conflict!
Dahlia
Dahlia is a 24-year-old woman who calls a suicide-prevention hotline feeling extremely depressed. She was recently laid off at work and is now struggling to pay her bills. “I think about dying most of the time and have tried to kill myself several times before—most recently about six months ago by swallowing the entire bottle of antidepressants my doctor prescribed me,” she reluctantly admits. Dahlia also reports that she has little family support because her mother died when she was 9 years old, and the rest of her family stopped speaking to her when she came out to them as a lesbian several years ago. “Life just seems too pointless and painful,” she laments, “and when it comes to getting my family to talk to me again, I’d rather be dead than violate who I am.” When asked if she has the means to kill herself, Dahlia responds elusively and declines to answer directly.
1. Do you think Dahlia is likely to hurt herself? Why or why not?
2. Should Dahlia be involuntarily hospitalized to prevent her from self-harm? What rationale are you relying on to make this determination?
3. If Dahlia is involuntarily hospitalized to prevent her from attempting suicide, what positive and negative consequences might result?
Dr. S
Dr. S, a local psychologist has a new patient, Norman, a 35-year-old man seeking therapy for “scary thoughts” he is having about his 22-year-old neighbor, Tammy. Norman reports fantasies in which he violently murders Tammy. Norman has a history of impulse-control issues and did once spend a night in jail following a fist fight in a bar. When asked directly by Dr. S if he plans to follow through on his violent fantasies, Norman looks away and mutters, “Not if I can help it.” Dr. S wonders if he needs to break confidentiality to protect Tammy from possible harm.
1. How would you feel if you were in Dr. S’s position?
2. What ethical and legal principles are at play in this scenario?
3. Should Dr. S warn Tammy? Why or why not?
Niki
Niki, a 35-year-old woman, was recently arrested for physically assaulting a neighbor. Mr. B, the attorney assigned to defend Niki in court, finds her difficult to communicate with when they discuss her case. When Mr. B asks Niki if she wants to plead innocent or guilty, Niki stares at the ceiling and keeps repeating: “It’s a conspiracy! The water supply is laced with truth serum!” Unsure about whether Niki comprehends what he is telling her or the circumstances she faces, Mr. B considers requesting a court-appointed psychologist to assess her competency to stand trial.
1. Should Mr. B raise the issue of competency to stand trial with the court?
2. Why might Mr. B be unsure whether to raise the issue of Niki’s competency?
3. What would you do if you were Mr. B?
Marta
Marta, a 21-year-old woman studying at the local university, has begun seeing and hearing things that alarm her psychotherapist, Dr. Y. During sessions, she keeps saying the university president monitors her via the thermostats in campus classrooms. Marta’s appearance has deteriorated in recent weeks. She has lost weight, looks gaunt, and appears to be getting little sleep. Marta’s lack of grooming also concerns Dr. Y. Her hair is unkempt and tangled, and she hasn’t been bathing regularly. Dr. Y begins to wonder if Marta is currently able to properly care for herself.
1. Should Dr. Y pursue emergency civil commitment of Marta?
2. If Dr. Y does pursue civil commitment, what ethical and legal issues should he consider?
3. Let’s imagine Dr. Y does have Marta civilly committed. Her condition improves after a brief stint on antipsychotic drugs. However, after she is released from the hospital, she refuses to see Dr. Y (or any other therapist, for that matter) because she feels Dr. Y broke her trust by having her hospitalized. How would you feel if you were Dr. Y? Would you regret your decision or feel you did the right thing?
Dr T. (Testifying in Court)
Dr. T receives a subpoena from the courts to release information about his client, Juanita, a government employee on trial for sharing sensitive government data with an underground organization previously engaged in terrorist activity. The courts want Dr. T to share both a written summary of his work with Juanita and to testify about Juanita’s mental status in open court. Juanita has not signed a release form giving Dr. T permission to communicate with the court, and her attorney recently contacted Dr. T to tell him that Juanita does not want him to disclose personal information she shared in therapy. Dr. T knows that Juanita never discussed any illegal activities in sessions with him, although she did confide her distrust and anger at the government office that employed her due to what she perceived as gender discrimination that prevented her promotion.
1. What ethical principles are important in this case?
2. How should Dr. T handle this situation?
3. What would you do if you were in Dr. T’s position?
For those of you who wish to grapple with additional dilemmas, a rich assortment is available at http://www.ethicalpsychology.com/p/vignette-warehouse.html.
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