What are the ethical problems? What ethical principles and codes appear to have been breached?
The fundamental ethical problem in the case revolves around choice, namely who deserves help: the individual or society. Society here is represented in the form of family, Jenny’s sexual partner, and the community. The primary threat to society is that while the professional psychologist will work with Jenny, highlighting the significance of treatment and protection, people will not know her status and may possibly get infected with HIV as well.
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The price for the psychologist’s inaction would be quite high, as many people may get infected and suffer from HIV, which can become AIDS. On the other hand, if psychologists were allowed to talk about patients’ diagnoses with other people and make this information public, infected people would be much less likely to seek the help of professionals (Morrissey & Reddy, 2006). If patients do not tell specialists about their diagnoses, the result would effectively be the same as in the described case, with society being unaware that a person has HIV.
Clearly the psychologist in this case is facing a difficult choice: on the one hand, to harm society but to respect the rights and personal choice of the infected person, or on the other hand to break the trust of the patient and protect other people from possible infection. In fact, situations like these are the very reason that certain rules, such as the code of ethics, were developed (Francis, 2009). The code of ethics allows people with problems to feel comfortable sharing them with specialists (Code of ethics, 2007). According to the code of ethics standard A.5.1, psychologists should follow the principles of confidentiality.
When the life or well-being of the majority is endangered, then it can be ethical to sacrifice the freedom, rights, and personal life of an individual for the sake of the group. The fundamental dilemma in this case is that the psychologist is breaking this norm to protect the individual over society. According to The APC Code of Ethics 2009/2010, psychologists should avoid multiple relationships that harm clients or other parties (Ethical guidelines, 2010).
Although the health status of a patient should be confidential, according to The APC Code of Ethics 2009/2010, standard A.5, the professional should disclose the information if and only if public disclosure would prevent harm or immediate risk to other people. Another ethical breach in this case comes from the fact that the specialist was untrained to work with adolescents, as she specialized in working with adults. According to Ethical Guidelines B.1.1, “Psychologists bring and maintain appropriate skills and learning to their areas of professional practice” (Ethical guidelines, 2010).
Thus, in the described case, the specialist violated this rule by working outside of her area of competence (National practice standards for the mental health workforce, 2013). Guided by the principle that “some therapy is better than no therapy”, the psychologist may actually harm an adolescent patient if she is not properly trained to work with teenagers. Standard B.1.2 reinforces this guideline, stating that professionals should work “within the limits of their education, training, supervised experience and appropriate professional experience” (Ethical guidelines, 2010).
What might be the motives (justifications) for the psychologist’s ethical breach in this instance?
One possible motivation for the psychologist’s ethical breach is that she did not want to ruin her relationship and trust with the patient. The clinical psychologist felt sure that with therapy, Jenny would realize the importance of treatment and of disclosing her status to her sexual partner. Thus, the psychologist took her time and kept waiting for the girl to talk to relatives and choose treatment.
Another possible justification for the actions of psychologist is the fact that the specialist was aware that Jenny had only one sexual partner. This situation is a classic moral dilemma (MacKay & O’Neill, 2010). On the one hand, Jenny’s sexual partner should be aware of her diagnosis. Moreover, the psychologist could be mistaken about Jenny’s number of sexual partners, meaning that the risk of infection applies to more than one person.
Thus, the psychologist’s disclosure of the information is justified and corresponds to the code of ethics. However, in this case, the relationship between the patient and specialist is based on trust, and Jenny is not lying, so the psychologist’s choice can also be justified from a moral point of view. Nevertheless, the psychologist cannot wait forever because the specialist cannot trust the sexual partner of Jenny. Even if he is her only partner, it is not right to assume and trust her partner based on Jenny’s words. Waiting only worsens the ethical trap that the psychologist faces; the more the therapist waits, the more people can get infected. The professional is not supposed to work with adolescents as it is not her sphere of competence.
The psychologist’s violation of the code of ethics might consequently lead to a secondary ethical decision, and the specialist would face an ethical trap (Steinman, Richardson, & McEnroe, 1998). If the professional does not report Jenny’s status and if Jenny does not use protection during sexual intercourse, she can potentially infect other people, and the psychologist will be responsible for Jenny’s partners’ infection with HIV.
Is the psychologist’s behaviour justifiable in this instance?
On the one hand, the psychologist’s behaviour is justifiable because there is no immediate risk; the patient had no intention to infect other people. Thus, to provide security and protection for Jenny, the psychologist should communicate the rules Jenny should follow and focus the conversation toward highlighting the importance of disclosing her status to her partner. If the specialist were to make the information public, she could possibly destroy the life of a girl, and Jenny may become depressed or even commit suicide.
What is the point of such an action when the primary role of a psychologist is to provide help and support? However, on the other hand, if the psychologist does not disclose Jenny’s HIV status, she violates standard A.5.2, which is focused on the disclosure of confidential information in the case of risk to others.
Ultimately, the actions of the psychologist in this case are not justifiable according to the code of ethics. According to standard A.5.3, the patient had to be informed regarding the limits of confidentiality (Ethical guidelines, 2010). According to standard A.5.4, only the information concerning the HIV infection should be disclosed and only to people whose life depends on it. Principle B.1.2 was violated as well, as the work of the specialist was not limited to her area of competence. Standard B.3 states that the professional should forecast the consequences of her conduct. If there was no benefit for Jenny, the psychologist was supposed to terminate the service according to standard B.11.1.
In this case, the psychologist was working in a rural location, and the work in this type of area has some peculiarities. According to the Ethical Guidelines standard 5.1, specialists who work in remote or rural settings should take the time to build relationships in the community based on trust (Ethical guidelines, 2010). In accordance with these guidelines, the specialist decided to build trust by giving Jenny time and not disclosing her health information.
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According to standard 5.4, there are not very many mental health specialists who can help people in rural areas, so the specialist should be guided by the ethical principle not to harm. The limits of professional competence should not be forgotten despite the fact that not every person is provided with a chance to undergo therapy.
How would another psychologist facing a similar situation act ethically?
First and foremost, to make an ethical decision, another psychologist should be guided by a certain model of behaviour (Miner, 2006). The ethical decision-making model is commonly based on finding the answers to two questions:
- What am I supposed to do?
- What am I going to do?
The psychologist should analyse all risks and benefits before making a decision (Koocher & Keith-Spiegel, 2008). Moreover, the specialist should follow the ethical decision-making model, which includes the following steps:
- Identify the ethical standard involved;
- Determine potential ethical traps;
- Frame a preliminary response;
- Consider the consequences;
- Prepare ethical resolution;
- Get feedback; and
- Take action (Steinman, Richardson, & McEnroe, 1998).
Taking into consideration this model, the professional can make better decisions.
Another psychologist facing a similar situation could act ethically by following all of the standards described in the code of ethics. First and foremost, according to standard B.1.2, the professional in this case had no right to provide the adolescent with therapy as the psychologist was limited with the competence. This is the first violation that consequently led to a new ethical dilemma and brought the psychologist into an ethical trap.
If another psychologist was aware of Jenny’s HIV status, that professional could act ethically by disclosing the information according to standard A.5.2 (c) as there is the immediate risk to the partners of the girl as well as to the girl’s personal health. The professional should not only report this information but also insist on the patient undergoing special treatment. Also, according to the code of ethics, parents are legally responsible for their children, and thus another psychologist should inform Jenny’s parents of any health-related problems.
Code of ethics. (2007). Victoria, AU: Australian Psychological Society.
Ethical guidelines (9th ed.). (2010). Melbourne, AU: Australian Psychological Society.
Francis, R. (2009). Ethics for psychologists. Chichester, UK: British Psychological Society/Blackwell.
Koocher, G., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions: Standards and cases. Oxford, UK: Oxford University Press.
MacKay, E., & O’Neill, P. (2010). What creates the dilemma in ethical dilemmas? Examples from psychological practice. Walfwille, CA: Lawrence Erlbaum Associates.
Miner, M. (2006). A proposed comprehensive model for ethical decision-making. Victoria, AU: Thomson.
Morrissey, A., & Reddy, P. (2006). Ethics and professional practice for psychologists. Victoria, AU: Thomson Learning Australia.
National practice standards for the mental health workforce. (2013). Victoria, AU: Victorian Government.
Steinman, S., Richardson, N., & McEnroe, T. (1998). The ethical decision-making manual for helping professionals. Pacific Grove, CA: Brooks/Cole.