Ethics Case Study: The Vignette

The vignette described a woman who comes in for a session in an agitated state. The psychologist has worked with her for a few weeks and she was not overtly suicidal or homicidal. On this visit, the psychologist decided to refer her to an inpatient due to her becoming unreliable and taking 17mg of Xanax in 30 hours instead of 2.5mg prior to her appointment.The decision making process for this vignette is very important because of the dilemma involved. The ethical decisions-making process I am going to engage in will be the Canadian Code of Ethics for Psychologist and the decision- making process that accompanies it.

My first decision will be to identify the key players in this vignette. The individuals and groups are the female patient

in an agitated state, the psychologist, the physician who prescribed the Xanax and the hospital are the important key players.

My second issue is to identify the ethical issues relevant to this scenario. My first interest will be my patient's interest, rights and characteristic of the the groups I will be dealing with on behalf of my patient. Standard 3.01 on Unfair Discrimination; is for a me as a licensed professional to respect my patient's personal characteristic. In this case she is a female who is agitated and needed help, I have to know the limit of my competence and only treat the patient if am knowledgeable about their medical/mental issue. Standard 3.04 on Avoiding Harm; in aligning with Principle A: Beneficence and Nonmaleficence will be to safeguard the welfare of the patient especially since the patient was in an agitated state. Dealing with the hospital will be the issue of maintaining confidentiality (Standard 4.01). The hospital will not divulge wether the client was in their care or not and the psychologist only have a partial generic release form which does not cover much so the psychologist can disclose much to the hospital, but if client was a danger to self and other (Standard 4.05) then it should be disclosed.

My third decision will be about my personal bias and how it will cloud my judgment in dealing with the patient effectively. I have a bias against people who misuse prescribed medication and my rationale for this is that the patient knows what medication compliance means because it will be discussed prior to been given the medication. Not adhering to medication guidance can worsen the client's situation. To deal with my bias on this situation, I have to empathy with the client. Xanax, a medication that is used to treat anxiety associated with depression and panic disorder, and fearful (anxiety symptom) that the medication was not working and kept taking it. She may not remember what the doctor told her about the side effects of Xanax. At this point, she may be at her wits end.

The forth decision will be an alternative course of action will be for me to base my decision by identifying the most important fact surrounding this client and select a criteria that best fits the situation. The most relevant detail in the vignette was the client's abuse of prescription medication. This issue occurred because the client was prescribed Xanax for anxiety. The client was in the hospital already, if she was not that would have been my first course of action. The alternative will be to monitor her behavior and collaborate with the other physician for effective patient care.

Fifth decision will be to first analyze the risk associated with the patient. The patient has been abusing her Xanax medication and this can produce short-term risk. Abusing Xanax has been known cause drowsiness, headaches, dizziness, and these are immediate the immediate reactions. The risk associated risk in this will be her endangering herself by falling and the public if she drives. The long term risk will be developing seizures, psychotic experiences, aggressive and impulsive behavior, deliriousness and cognitive deficit from prolonged abuse of Xanax. Overdose of Xanax can lead to respiratory depression and coma. The course of action will be to discuss with her doctor on tapering her off Xanax until she gradually wears off. The long and short term benefit of this action will safe guard her safety as well as the public. She will also be able to repair are damaged organs.

The sixth decision making process is to apply the standards of APA to the the scenario presented.

There are a lot of ethical standard that can be apply to this scenario, the most and most important one avoiding harm (Standard 3.04). The psychologist should take a reasonable step to avoid harming the patient especially when it is foreseeable. Before referral, the psychologist has known that the patient was abusing Xanax, she had taken 17 mg in the 30 hours when she should have only taken 2.5 mg, her behavior is very unreliable and she was not overtly suicidal or homicidal but the tendancies were there. Practicing within the boundaries of competent (Standard 2.01), the psychologist was knowledgeable enough to know that the client was in danger of harming herself or others. The psychologist took the necessary precautions to avoid harm by referring her to an inpatient facility. The psychologist cooperated with another professional (Standard 3.09) when it was needed which was in the best interest of the client. The psychologist should be aware of HIPPA rules when cooperating with the other professional. The patients written authorization on release of PHI should be communicated to the other professional. This brings us to the pressing issue for the psychologist right now; the psychologist wants to check on the status of the client, but the facility will neither confirm nor deny her stay there. The psychologist can fax the release form but, with the condition that it should be communicated to the inpatient clinic as confidential on the fax cover. The mistake the psychologist made was not getting a full release from the client, this should have been discussed during informed consent (Standard 3.10). This should also have been done as early as feasible before services and the psychologist had ample time since the client has been coming for several weeks. Even though this patient might be in a heightened emotional state due to her unreliable state before

referral, the discussion should still have taken place. This would have been the time when the psychologist will apply the aspirational Principle B: Fidelity and Responsibility. This shows faithfulness and fiduciary responsibility, competency and compassion. Compassion during informed consent discussion shows concern, caring and willing to spend adequate times to ensure that her questions and concerns were addressed. Due to this patient emotional state, the psychologist have to ensue that she understands the procedure in a language she can understand. Explanation about her right to decline the service or withdraw from the service should be given, cope of confidentiality and risk and benefits of procedure. Due to the psychologist trying to see the patient, the previously signed form cannot be used due to the fact that the client diagnosis may have change. Another informed consent needed to be done to include the new procedure including risk and benefits.

The sixth decision making process will be the course of action the psychologist should follow to accomplish the goal of helping the patient. According to the vignette, the patient was not overtly suicidal or homicidal, but a couple of weeks later she increased her Xanax by ingesting 17 mg in the 30 hours prior to admission instead of just 2.5, this information definitely changes the treatment plan. According to Standard 4.05 on Disclosure, psychologists are permitted to disclose confidential information to protect their client. In this case, the client's and public safety was important and this information needs to be disclose which is not unethical to do so. As described above, Xanax can make you drowsy, suicidal tendencies and the agitated state she was in will make me definitely disclose.

My seventh decision will be to assume responsibility for the consequence that will follow my action. I highly doubt that since she was in danger of hurting her self or the public, referring her was the best thing to do. She will be getting the treatment she clearly needed, the psychologist probably saved her life.

The eight decision was to evaluate the result of the action taken and the action was a good
one because according to aspirational Principle D: Justice; the psychologist was being fair and provided appropriate access to treatment and benefit of scientific knowledge, boundaries of competent (Standard 2.01).

My last decision will be based on the of partial release form since the psychologist could not get any information about the patient. Next time the psychologist should make sure informed consent was done as early as feasible to ensure that history does not repeat itself.