Ethics for Psychologists _______________________________________________________________________
passwords or encryption, backing up stored informa- tion before moving hardware, and maintaining patient privacy.) Also discuss the use of insurance, collection of copayments, the insurance company’s request for records and information, and the right to decline to use insurance for services. Many of the difficulties psychologists have with reference to ethical complaints involve clients not fully understanding the nature of the services, including the policies and procedures of the office, the risks and benefits, and the alternatives avail- able. A simple signature on a form can document what is expected and thought to be understood but is not sufficient for establishing informed consent. Informed consent is not a single process that takes place at the outset of treatment; it is involved in every step of the treatment process and often must be revisited as treatment progresses through different stages. Consider how informed consent may or may not have been attained in the following scenarios: • Mr. X is contacted by his employer for an evaluation by Dr. J prior to returning to work after an injury. He signs paperwork at Dr. J’s office and completes an initial intake form. He did not bring his reading glasses to the appointment, and the office clerk has to show him where to put his signature on the form and read ques- tions to him so he can understand what is required. When Mr. X sees Dr. J, there is no mention from the clerk that his reading glasses are not available or the fact that he was unable to sign forms without assistance. Dr. J simply asks Mr. X if he had any questions prior to the evaluation. Mr. X says, “No.” The evaluation is then completed, and the report is provided to Mr. X’s employer. Mr. X is upset that information was not kept confidential and that he was not allowed to return to work. He did not understand the purpose of the evaluation or the fact that it was going to be used by his employer in determining whether he could return to work. Dr. J had a form signed by Mr. X that spelled out all of this information. The fact that Mr. X viewed the form as a formality and was not able to read it was not known to Dr. J. • Dr. S decides that in vivo desensitization is the best form of treatment for Ms. Z’s fear of spiders. Ms. Z consents to therapy. When Dr. S actually brings a spi- der into the office, however, Ms. Z runs from the room sobbing, indicating that she “had no idea” that actual spiders were to be used in her treatment. • Miss C is 5 years of age and is afraid of anyone wear- ing a mask or costume. Her parents bring her into treatment for her fearfulness. Dr. D explains to Miss C directly the purpose of treatment and how treatment would progress. Dr. D outlines to Miss C and her parents that the patient will start by drawing masks and
throwing them out and that at any part of drawing she can stop or just close her eyes. She would progress to using dolls and putting dolls in masks. Again, she could stop or close her eyes. She would then put dolls in costumes. Eventually, she would be expected to go on a field trip to see people dressed in animal costumes and is expected to do that without being scared or afraid. In addition to her parents understanding what is involved in treatment, Miss C is explained the treatment in detail. It is possible to abdicate or waive the informed consent process. In these cases, the client must demonstrate an understand- ing of the right to have information about treatment and be involved in decisions about the treatment process. The client then may specifically indicate that he or she wants the psy- chologist to make those decisions on the client’s behalf. This is often referred to as an “opt-out” procedure and involves research with minimal risk, in which full disclosure will be detrimental; emergency process and potentially life-saving techniques are being studied; or a substitute for the consent process is not readily available and failure to provide treatment would result in harm. There are also cases in which the person is not competent to make decisions due to being a minor or having been found by the court to be incompetent. In these cases, assent or dissent to treatment will not authorize or constitute a valid refusal, and a substitute for informed consent would be required. This is contrasted with someone who may be psychotic, intoxicated, severely intellectually disabled, or unconscious and is unable to make rational decisions and understand the information that is being presented by the psychologist. When reviewing the following case examples, analyze how issues of incompetence might apply: • Mr. I is an autistic adult being evaluated for a sheltered workshop program at the request of his parents. He has been recognized as incompetent by the court, and his parents are his legal guardians. • Ms. P has taken a Minnesota Multiphasic Personality Inventory and wants to review the results. Her psycholo- gist determines that such information may worsen her depression and increase her already present suicidal ideation and withholds the information based on thera- peutic privilege. • Ms. T is unconscious following a suspected overdose when brought to an emergency department for evalua- tion by a psychologist. In each of these situations, the decision about treatment will be made by someone other than the patient. Family members or friends, the treating psychologist, a governmental authority, or hospital authority will provide third-party consent.
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