Discussion:
Counseling referral with an ethical dilemma
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
1. Dr. Matthews does not know if she should agree to the parents' and child's request
2. 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?
3. 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?
4. What steps should Dr. Matthews take to ethically implement her decision and monitor its effects?