1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?
This is an ethical dilemma because Dr. Yeung has an ethical obligation to maintain the confidentiality of her client but he has also made a veiled threat of violence on her answering machine. This puts her in the position of determining what threat level this message poses and if or should she override her professional duty to maintain confidentiality in order to prevent violence from happening. The APA ethical standards which frame the nature of the dilemma are Confidentiality and Privacy.2. Who are the stakeholders and how will they be affected by how Dr. Yeung resolves this dilemma?
The stakeholders in this case include the parents and girlfriend of Aiden, Aiden himself, the other participants in Dr. Yeung's research study, any third party persons providing funding for the research study, the university which has approved and vouched for Dr. Yeung's research study as well as Dr. Yeung herself and any graduate students or research assistants who might be employed on the study as well. There are many parties that may be negatively affected by the dissolution of a research study that has already been approved for funding and taken several (possibly hundreds) of man hours to prepare and execute. In this case the confidentiality breach may render the current study unfeasible to continue based on ethical as well as local judicial law. If Aiden's confidentiality is broken, he may be sent back to prison, which would likely have a striking effect not only on his life course outcomes, but possibly the psychology states of his immediate family and friends. Aiden's girlfriend could potentially be under threat of life or death, or the situation could be negligible.
3. Does this situation meet the standards set by the Tarasoff decision’s “duty to protect” statute (see Chapter 7)? How might whether or not Dr. Yeung’s state includes researchers under such a statute influence Dr. Yeung’s ethical decision making? How might the fact that Dr. Yeung is a research psychologist without training or licensure in clinical practice influence the ethical decision?
The case of Tarasoff v. Regents of the University of California (1976) has set a legal and ethical standard for how therapeutic practitioners should handle confidential information and what duty they have to warn others if a client appears or vocalizes a potential threat or act of violence either to themselves or others. The Tarasoff case concerned Tatiana Tarasoff who was murdered by Porsenijt Poddar, a therapy patient of Dr. Lawrence Moore of the University of California. During a therapy session, Podar disclosed that he intended to murder Tarasoff because she had not accepted his romantic advances. Although Poddar was considered to be a threat following this disclosure, he was only held briefly and soon after released, in which he carried out his plan with a knife and pellet gun.
The victim's family sued the University of California, the police and Dr. Lawrence for wrongful death. Their argument was that Dr. Lawrence knowing that Poddar was a violent threat who intended to murder his victim shifted the moral responsibility to Dr. Lawrence, who then had a duty to war Tatiana. The court's decision sets a precedent both for the state law in California as well as the mental health profession nationwide. The decision stated that if a therapist or practitioner assesses a client as a dangerous threat to another person, he or she is duty bound as well as legally bound to inform the target victim.
In my view, the situation that Dr. Yeung faces does reflect similar circumstances, but Dr. Yeung does not have a duty to warn per se based on the words left on the messaging machine. Aidan has used the metaphor in his emotion-laden message. In my view, Dr. Yeung is compelled to protect both Aidan (from himself) as well as any other potential victims. But at this point, Aidan has not made a credible threat of violence. If Aidan had called and left a recorded message (or communicated via some other means) but explicitly states his intent to murder his girlfriend, then Dr. Yeung would be bound legally to inform the girlfriend of these threats. The fact that Dr. Yeung is a research psychologist without licensor frees some threat of licenser revoking or suspension for breaching confidentiality in unwarranted circumstances. Because she does not have a license to worry about, this may free her behavior to act with greater zeal and err on the side of precaution. Any misstep could spell a black mark on her professional record, however, and the utmost care and sensitivity must be taken.
4. In addressing this dilemma, should Dr. Yeung consider how her decision may affect the completion of her research (e.g., the confidentiality concerns of other participants)?
Dr. Yeung may be concerned about the confidentiality concerns of other participants and possibly even this fiasco destroying the viability of her research project. However, she is professionally obligated to maintain the utmost professionalism in this case. She would be ethically compromised if she sets her own self-interests regarding her research project over and above the duty to protect or possibly warn other innocent people from the threat of violence.
5. How are APA Ethical Standards 2.01f, 3.04, 3.06, 4.01, 4.02, 4.05, and 8.01 relevant to this
Integrity, Respect for People's Rights and Dignity, Confidentiality. The APA Ethics code emphasizes competence with respect to forensic situations involving mental health practitioners (2.01f). This principle mandates that practitioners should become reasonably familiar with local the judicial code regarding their roles and responsibilities. Dr. Yeung therefore has an obligation to familiarize herself with local law in order to understand the legal ramifications of her actions.
3.04 requires that Psychologists take legitimate and reasonable steps in order to avoid causing harm to their patients, and where harm may be expected or reasonably foreseeable, that the practitioner should seek to minimize the effect of harm's receipt on their clients. This means that Dr. Yeung should not act with haste over the message left on her answering machine; to do so may cause unnecessary harm. 3.06 is the conflict of interest rule which emphasizes the need to maintain objectivity and for psychologists to refrain from assuming roles or relationships with clients where their objectivity may be unduly impaired.. Dr. Yeung should refrain from assuming she knows and understands the personal behavioral quirks of Aiden. She should remain objective when receiving a message that sounds like a threat. Standard 4.01 requires that psychologists take every measure possible to protect the confidentiality of any documentation or assessments in any medium. This means that Dr. Yeung must maintain the utmost privacy and confidentiality with all correspondence with Aiden. 4.02 requires informed consent be given to a client or patient under any and all circumstances where a psychologist plans or decides upon an intervention. If it becomes necessary or essential that the Dr. Yeung must break the confidentiality of their client, she is ethically bound only to share information that is relevant and necessary towards resolving the client's difficulties. Information is shared only with third parties who need to know, as well. 8.01 regards the institutional approval of research surrounding this case. 8.01 requires that all research practices by Dr. Yeung are reviewed by an Institutional Review Board (IRB). The IRB also ensures compliance that research is only conducted and follows the approved protocol. In this case, Yeung would not be approved to include any of this information in her research. Other principles that may apply include a mandate to have competence as well as care for the well being of other people. Psychologists are required and expected to be in the helping profession in order to work for the good of others. Hence, the do no harm principle takes penultimate importance.6. What are Dr. Yeung’s ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principles and enforceable standards, legal standards, and obligations to stakeholders? Can you identify the ethical theory (discussed in Chapter 3) guiding your decision?
I believe the best ethical theory to employ in this case is the Do No Harm principle. It is difficult to know what criteria constitute a threat serious enough to override the confidentiality clause. Recent case law provides some assistance in this case. Does the threat pose an imminent and clear situation of great danger to the victim? “
7. What steps should Dr. Yeung take to implement her decision and monitor its effect?
In my view, it is unclear to what extent Aidan is intoxicated and if his language indicates an imminent and real threat. He does sound dangerous, however. In this case, I believe the appropriate response may be to have him voluntarily hospitalized if appropriate. The psychologist should immediately contact an attorney and other authorities in order to clarify how to handle this situation without revealing identifying information first.
References
American Psychological Association. (2010). Ethical Principles of Psychologists and Code of
Conduct. Retrieved from: http://www.apa.org/about/division/div56.aspx
Fisher, C. B. (2013). Decoding the ethics code: A practical guide for psychologists. Thousand
Oaks, CA: Sage.
