Assignment
Read case study and answer the following questions.
Dr. Saxena provides professional services primarily to families and adolescents. She understands the difficulties in balancing ethical practices when working with minors, including confidentiality, mandatory reporting, and informed consent. Dr. Saxena has developed a fully explanatory informed-consent agreement for parents to sign and for minors to review. She makes the discussion of informed consent part of her intake interview and explains to families the conditions of informed consent.
Dr. Saxena provides for assent, including the request for privacy for the minor. Her view is that confidentiality through informed consent, and throughout the therapeutic process, is vital to the success of therapy. As a result, she explains to families that confidentiality within family therapy sessions is of utmost importance. She is also careful to identify the limits of confidentiality.
Dr. Saxena is counselling a family for several presenting reasons. The parents have been receiving negative reports from their 9-year-old son's teacher about misbehaviours and fighting at school. The parents are also quite concerned about their 15-year-old daughter because of her grades, moodiness, and her isolation from friends and activities at school. After several weeks of family therapy, the parents privately report to Dr. Saxena that their daughter seems to be getting more despondent and uncommunicative. However, she talks easily with Dr. Saxena and seems to like her. They hope that she will see her separately while continuing to see the family.
Dr. Saxena agrees to see the daughter, thinking that she might be more disclosing and interactive without her parents there. A few weeks have passed; as thought, the daughter has begun to be more disclosing of her feelings and problems. Suddenly, Dr. Saxena receives a call from the father saying that the parents have heard rumours that their daughter is involved in sexual activity within a group of her peers at school. They want Dr. Saxena to weave questions into her sessions that would lead her to discuss this subject. When she rejects this idea, they begin to pressure her for this information and begin making veiled comments during family therapy. They do not want to discuss this matter in front of their son, however, so they suggest that he not come to all of the family sessions.
Dr. Saxena begins to feel the therapy is unraveling. The son begins to feel marginalized and wants to start seeing Dr. Saxena individually as his sister has. He also comments that his parents are not as worried about him as they are about his sister. The parents further pressure Dr. Saxena to reveal the content of her sessions with the daughter. When she reminds them of the informed consent agreement, they retort that they had agreed to that before they knew about the rumours regarding their daughter's behaviour. They claim that she cannot hold them to that now. The daughter had thought that she could trust Dr. Saxena, but now, knowing how formidable and intimidating her parents can be, begins to have doubts about Dr. Saxena and becomes suspicious of the entire therapy process.
Required
I. List all of the individuals and/or groups present within this vignette. Indicate any relevant characteristics, rights, and interests of these individuals and/or groups.
II. What are the ethically relevant issues present in this vignette?
III. Suggest alternative courses of action that would address the ethically relevant issues you have identified in this vignette.
IV. What are the risks associated with each of the alternative courses of action you have suggested?
V. What are the benefits associated with each of the alternative courses of action you have suggested?