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Informed Consent and Clinical Competency in Risk Management

Esther Hernandez, Ph.D., a specialist in the psychology of addictions, conducts group therapy sessions for patients treated at a local methadone Medicaid clinic. She has been meeting with a group of 12 women on a weekly basis for 2 months and has been pleased that, for the most part, members attend the meetings regularly. Although the women take methadone as a substitute for their heroin habits, many also take other illicit drugs. At the initial session, Dr. Hernandez and group members agreed on a rule that members should not come to a session if they are high or intoxicated. The rule has been enforced several times during the past 2 months.

At the beginning of the most recent session, Angela, one of the group members, walks in late and is obviously intoxicated. Dr. Hernandez reminds Angela about the rule, noting that Angela must leave but will be welcome back at the next meeting if she is sober. Angela starts crying and begs to stay. Dr. Hernandez expresses sympathy and then restates the rule. Angela stands up and states that a drug dealer to whom she owes money has found out where she lives and she is afraid for her life. Then as she rushes out of the building, she tells the group "You will all be sorry when I'm dead."

The other group members are obviously shaken by Angela's behavior. Some in the group feel Dr. Hernandez should end the group meeting and try to find Angela to make sure she is okay. Others think Dr. Hernandez should call the police. Still others in the group believe that Angela was trying to manipulate Dr. Hernandez into permitting her to break the rule. They note that in the past she has tried to get around other group rules.

Ethical Dilemma

Dr. Hernandez is shaken and does not know how best to handle this situation.

Discussion Questions

1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?
2. Who are stakeholders and how will they be affected by how Dr. Hernandez resolves the dilemma?

I think what makes this an ethical dilemma is her competence; however I am confused on the APA Ethical Principles help frame the nature of the dilemma. As well I understand that the group members are the stake holders what I am not understanding is how they will be affected.

Solution Preview

So, here is what we are looking at: The ethical dilemma here is really a few of things. To begin, clinical competency and needing supervision, safety of the client who presents intoxicated and her leaving that way, and also informed consent: Now, Dr. Hernandez would need to redirect the situation by doing two things. First, asking that since she has been using and is clearly intoxicated, she be called a Taxi if she was driving because driving under the influence and allowing a client to drive under the influence is another issue. Dr. Hernandez can have her staff all ...

Solution Summary

This solution discusses informed consent and clinical competency in risk management.

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