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Counseling referral with an ethical dilemma

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Irina, a 13-year-old girl of Arabic cultural heritage living in Boston, Massachusetts, was brought by her parents to a hospital emergency room after an assault by a stranger. Based on her injuries, the hospital staff suspected that the attacker had also sexually assaulted the girl, but she and her parents refused medical evaluations for rape. The family received a referral to see Janet Matthews, a clinical psychologist specializing in adolescent trauma. During their initial meeting with Dr. Matthews, the parents asked the psychologist not to discuss any sexual aspects of the assault with their daughter but to treat the psychological trauma from the assault in general. They told the psychologist that admitting a rape had taken place would cast a stigma on their daughter and make her ineligible to be married to men in their closely knit ethnic community. When asked in private, the girl also requested that sexual issues not be discussed for the same reason.

Ethical Dilemma
Dr. Matthews does not know if she should agree to the parents' and child's request
How might Irina's age and parents' involvement in the referral affect how Dr. Matthews can resolve the dilemma? How might the state law on treatment of minors and HIPAA rule on access of guardians to a minor's health care record influence Dr. Matthews' decision?
What are Dr. Matthews' ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code's aspirational principle and enforceable standard, as well as legal standards and Dr. Matthews' obligations to stakeholders?
What steps should Dr. Matthews take to ethically implement her decision and monitor its effects?

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Dr. Matthews does not know if she should agree to the parents' and child's request. How might Irina's age and parents' involvement in the referral affect how Dr. Matthews can resolve the dilemma? How might the state law on treatment of minors and HIPAA rule on access of guardians to a minor's health care record influence Dr. Matthews' decision?

Since in this is case, clearly, the trauma is related to being subjected to harassment and sexual violation, then there is no reason why the parents of the minor client should not be made fully aware of the consequences of not addressing and investigating the nature of the assault that their daughter was subjected to.
If still the parents and the minor client decline such investigation, medically and psychologically, then at least parents should be clearly made aware of the consequences of not addressing such an important background to the reasons why their daughter was referred to psychological treatment.
What are Dr. Matthews' ethical alternatives for resolving this dilemma?
Which alternative best ...

Solution Summary

This solution involves a counseling referral with an ethical dilemma - cultural context and minor patient with suspected sexual assault. It also discusses reasons for ensuring that the psychologist must do all that she can to work in the best interest of the minor client.

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Ethical Dilemma Scenario

Suppose you are a school counselor, and a student comes to see you with concerns about how much his parents are fighting with each other. After talking with the student, you plan to meet again in a week. The next day, the student's mother calls you, wanting to know what you talked about in your counseling session with her child. It is obvious that the student told her the nature of the topics he discussed with you.

Address the following in this discussion:

Would you disclose what the student told you to his parent? Why or why not?
If the student's self-referral is a step toward autonomy in solving his problems, could you handicap his efforts by talking to the parents and breaking confidentiality? Or could you help the family by revealing the impact of the parents' arguing on their child?
If you comply with this request, how would it affect you, the student, and the parents?
Would you answer these questions differently if the mother had asked you to speak with her child, then later asked you about the content of that counseling session?

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