Ethical Decision-Making Exercise France Goulard APSY 603

Ethical Decision-Making Exercise Step 1: Identification of the Individuals or Groups Potentially Affected by the Decision: The primary individuals I see being affected by any decision I make are the boy and the grandmother. However, other family members (if any), the aboriginal community, the residential school, the psychiatrist, and my credibility could also be affected by my decisions. Step 2: Identification of Ethically Relevant Issues and Practices, Including the Interests, Rights and Any Relevant Characteristics of the Individuals and Groups Involved and of the System or Circumstances in Which the Ethical Problems Arose: Principle 1: Respect for Dignity of Persons I.1: Demonstrate appropriate respect for the knowledge, insight, experience and areas of expertise of others. Whatever the decision, I need to respect the native culture and insights, respect for the family (grandmother and parents) and the Psychiatrist. I.16: Seek as full and active participation as possible from others in decisions that affects them respecting and integrating as much as possible their opinions and wishes I will need to make sure that I maintain proper collaboration with all parties involved in the entire process, and that I respect the opinions, thoughts, and insights others have to offer. I.18: Respect the expressed wishes of persons to involve other in their decision making regarding informed consent. This would include respect for written and clearly expressed unwritten advance directives. This is something that will be important, especially if the grandmother is the sole caregiver of the boy and that she has a hard time functioning due to her present state of health. I.45: Share confidential information with others only with the informed consent of those involved, or in a manner that the persons cannot be identified By having others involved in the case, I will have to be cautious about maintaining confidentiality. Appropriate measures will need to be taken in order to properly explain the nature of the consent forms to the grandmother and ensure that although a third party will be involved, her grandson confidentiality will not be at risk. Principle 2: Responsible Caring II.1-II.5: General Caring

3 Whatever I choose to do as a psychologist, I will need to accept the consequences of my actions (good or bad) and try my best to serve my client in the best way in can. I will need to be flexible if there are any changes in the course of action. I will stay true to the ethical decisionmaking process and the oath I took to serve human kind as best as I can while practicing as a psychologist. II.6-II.12: Competence and Self Knowledge I will need to be true to myself and the competence I have as a psychologist to know when I need help in order to ensure the needs of the clients are met. I will have to be careful by not overstepping my boundaries and attempt to provide services that I am not competent to provide. Principle II.8 is probably the one that reflects this vignette the best. It is important that I respect this principle and like I said, be honest of the services that I am able to offer. If including other professionals improves the quality of the services of the child, then it would be my duty to do so. It would also be my duty to assure that the other professionals involved, like the psychiatrist, will have the best interests of the child in mind. Overall, I will need to assure that my own experiences, beliefs, values, biases, and others, will benefit this client and not harm him. Again, I will need to critically analyze my own biases and other views, and not let it affect my services in a negative way or in a way that is disrespectful to the boy and grandmother. II.13: Assess the individual, families, groups and communities involved in their activities adequately enough to ensure that they will be able to discern what will benefit and not harm the persons involved. I will have to make sure that I gather all important and necessary information but be able to better understand what the boy is going through and better evaluate and counsel him as a psychologist. I will need to maintain the respect and confidentially of the client while I gather the information. II.14: Be sufficiently sensitive to and knowledgeable about individuals, groups, community and cultural differences and vulnerabilities to discern what will benefit and not harm persons involved in their activities. It is my duty to find out as much as possible about my client as an individual, his surroundings, and culture. I would need to visit the boys community and get as much information of his culture through a local aboriginal center, from his grandmother and/or other family members. Furthermore, in order to keep the clients confidentiality, I would de some research in regards to hearing voices and how it can relate to his culture. Asking people around his community (especially if it is small) might lead to the reasons why I would be interested in their culture in the first place. This would create a breach in confidentiality. II.20: Make themselves aware of the knowledge and skills of other disciplines and advise the use of such knowledge and skills, where relevant to the benefit of others.

4 Here, I would research other professionals that could further help my client that may have dealt with similar cases or have a good knowledge of the aboriginal culture. II.33: Maintain appropriate contact, support and responsibility for caring until a colleague or other professional begins service, if referring a client to a colleague or other professional. I would maintain my services regardless of the length of time it took for the child to seek a psychiatrist. Even once the child would begin service with another, I would still maintain my support and help and make sure that his services and being help to the highest standards. Principle 3: Integrity in Relationships III-8: Acknowledge the limitations of their own and their colleagues knowledge, methods, findings and views, acknowledging alternative hypotheses and explanations. Even though, it would be easier to acknowledge my own limitations, it would also be my duty to assure that others involved in the case are competent for proper care of the client. III.10: Evaluate how their personal experiences, attitudes, values, social context, individual differences, stresses, and specific training influence their activities and thinking, integrating this awareness into all attempts to be objective and unbiased in their research, service and other activities In order to effectively work with this client and his grandmother, I would need to put my views and biases aside in order to properly assess the situation. What is known to be as socially unaccepted in my culture could be seen as very valuable in theirs. With that being said, I will have no choice but to learn about their views and their culture and respect their beliefs and choices. I will not be able to relate to the boy with my own personal experiences in life and this could potentially harm or disadvantage the client and his needs. III.34: Manage dual or multiple relationships that are unavoidable due to cultural norms or other circumstances in such a manner that bias, lack of objectivity, and risk of exploitation are minimized. Given the fact that the grandmother is also experiencing some dilemmas of her own, it might be beneficial to me and to them to give my services to both. It would definitely help me get a deeper knowledge of where they are coming from and what they have been through as a family. Principle 4: Responsibility to Society IV.6: Participate in the process of critical self-evaluation of the disciplines place in society, and in the development and implementation of structures and procedures that help the discipline to contribute to beneficial societal functioning and changes.

5 By becoming more knowledgeable with the aboriginal culture, I could become more involved in their community and give my services to others in need of counselling. IV.26: Exercise particular care when reporting the results of any work regarding vulnerable groups, ensuring that results are not likely to be misinterpreted or misused in the development of social policy, attitudes, and practices. I would need to be extra careful when reporting the childs results to the grandmother. I would not want to scare her in any way and make her not want her grandson to receive the services he really needs. Also, the boy needs to understand himself what he is going through and what are the types of strategies he will need to follow in order to get better.

Step 3: Consideration of How Personal Biases, Stresses, or Self-interest Might Influence the Development of, or Choice Between, Courses of Action: My personal biases could influence the course of action in this scenario if I dont take the time to understand the aboriginal culture and beliefs. In my culture, hearing voices would automatically mean there is a problem, more specifically schizophrenia, brain tumour, drug hallucination, etc. Whereas, in the aboriginal culture, it might mean something totally different, and could even represent a spiritual link to the dead. For this reason, I will need to familiarize myself with the situation to figure out if these voices being heard by the boy are seen as a negative experience causing stress and anxiety or as a positive experience causing calmness and soothing effects. Furthermore, I will need to gain insight of the situation to better familiarize myself with the nature and meaning of this voice prior to making judgement. My self-interest would primarily be the childs wellbeing. Being a mom of four children I always strive to do what is best for my child regardless of cultural expectations so I will have to be mindful of the boy and his familys strong ties to their aboriginal culture and customs. Step 4: Develop Alternative Courses of Action: Option 1: Given the fact that I am not familiar with the aboriginal culture and that the boy is hearing voices, I would probably try to refer him to another psychologist in the area that has more experience within that culture. With that being said, I would also refer him to his general practitioner or local doctor and relay the information to them so they can help him get the help he needs. I would follow up with the psychologist to whom I referred in order to make sure he received proper treatment and service. Once diagnosed, I would then like to become part of the treatment team. That way I would know what I could and could not do and I wouldnt feel that I would be unable to help him or his grandmother.

6 Option 2: Although I am not familiar with the aboriginal culture, I would still commit to helping him and try my best to give him the help he deserves. Hearing voices, especially as a child, could mean high levels of anxiousness. Although with the chance of it being a severe disorder, I would definitely refer him to a psychiatrist, but giving the wait, I would keep up with my services and collaborate with the psychiatrist. Due to the potential of the boy not being able to travel or feel uncomfortable leaving his surrounding I will have to think outside the box to organize a consultation with the psychiatrist. Some examples that come to mind are consults via teleconference, and/or request that the psychiatrist visit the boy instead of making the boy travel. Furthermore, still in collaboration with the psychiatrist, I would administer a battery of behavioural psychological assessments in order to start analysing and understanding the boys behaviour. Schizophrenia usually has negative signs (behavioural changes) before someone start to hear voices. Therefore, a discussion with the boys parents and/or family members in their home would be my first task and would allow me to assess the environment in which they live, further understand the relationship between all family members and find out if the family has encountered any tragedy in the past. I would also want medical background information to see if there is a history of mental illness in the family. A meeting with his with his teachers and other school members will allow me to assess if his behaviour has gotten worse or stayed unchanged over the past couple of months. Essentially, I will need to familiarize myself with the progression of his condition; has he become withdrawn recently or has he always been that way. Lastly a trip to the local aboriginal center will allow me to find out more about their cultural background and belief system. Step 5: Analysis of Likely Short-term, Ongoing and Long-term Risks and Benefits of Each Course of Action on the Individual(s)/groups(s) Involved or Likely to Be Affected (e.g., Client, Clients Family or Employees, Employing Institution, Students, Research Participants, Colleagues, the Discipline, Society, Self) Alternative 1 Possible Positive Consequences
Short Term: The boy might get better and faster services as the other psychologists would already have background information on their culture.

Possible Negative Consequences

Short Term: The boy might not get better service and I would run the risk of his condition getting worse by making him wait longer and add greater stress to his grandmother. I may hinder my reputation by having members of the community lose confidence in my ability to do my job. Possibly feel lack of control and may not be chosen to be involved in the treatment of this case. Ongoing: The boy might not be able to afford all the services he will need and I might not be able to join the treatment team and might feel like my lack of involvement made the situation worse. The grandmother might be upset with the diagnosis, and worsen her condition. (you are choosing someone who understands the culture so this is not likely) The school might not be able to support his needs.

Ongoing: Once the diagnosis is given, the boy will get the interventions and services lined up in order to accommodate his needs and I would become part of his treatment team. The grandmother might start eating and sleeping a little bit better knowing that her grandson will get the help he needs. Accommodations at school would be implemented

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Long-term: The boy, potential parents and his grandmother will be able to live a happier life and be in better control of their emotions. I would keep treating the boy and learn more about their culture and become more ready if a similar case was to arise. The boy will do better at school with the proper accommodations. Long-term: The boy, potential parents and his grandmother might not agree with the diagnosis and refuse the treatment plan or not be able to afford long term care if that is what is needed. I would feel like I should have been there for him from the beginning and make sure that I learn more about the culture in case a similar case would arise. The boy drops out of school.

Alternative 2 Possible Positive Consequences

Short Term: The boy will get services right away. The grandmother will be relieved that someone is helping her grandson. I will take on the challenge and learn as much as I can about the situation and assure proper assessments are being lined up.

Possible Negative Consequences

Short Term: The boy will get services right away, but due to the fact that I have no knowledge of his cultural background and the fact that he is hearing voices, I might just not be the best person to help him or it may take more time to assess as I will need to gain insight on their culture and even consult with peers or a psychiatrist to ensure proper steps are being followed. I might miss an important fact based on my personal biases. Ongoing: It will be an ongoing learning experience for me as a psychologist to better understand where the boy and his grandmother are coming from and continuously find ways to suit their needs. This might result in a longer time before the boy gets the right interventions.

Ongoing: The boy will get proper diagnosis and help from the professionals involved. The grandmother will feel better about the situation and feel that her grandson is getting proper help. I will build strong relationships with my colleagues. I will also develop contacts in the world of Psychiatry as I will have collaborated with one. Long-term: The boy gets proper treatment and he and his grandmother live happier lives. I would learn a lot by staying the boys counsellor and improve my work ethics with other cultures. The boy will have a better learning experience at school with the right accommodations.

Long-term: Given the fact that I am not a psychiatrist, if the boy does indeed have a severe mental illness that is beyond my knowledge and that the psychiatrist can only come a couple of times a year, I would be responsible for his treatment. This could become a very difficult task for which I am not trained. Re-write this sentence and just write your point.

Step 6: Choice of Course of Action after Conscientious Application of Existing Principles, Values and Standards After looking at both course of actions and conscientiously applying the existing principles, values and standards, my thoughts would be to go with number 2. I feel that it would be my duty to help the child as he came to me for help and it is my job to help people. Furthermore, even though I do not know much about their culture, there are other people in the community that could help me gain a better understanding. I would be honest with the grandmother from the start, and would let her know that, although he will need the services of a psychiatrist, I would do my best as a

8 psychologist to address his needs and work in collaboration with him/her to better counsel the boy and to help him improve his overall quality of life. Since there is not enough information presented in his condition, it would be unethical for me to assume that I would not be able to help him. It is my duty as a psychologist to help other people. The consequences and actions for this alternative support the values of all principles; mostly those included in Principle II (responsible caring) and Principle III (Integrity in Relationships) Step 7: Action with a Commitment to Assume Responsibility for the Consequences of the Action Once I have started my course of action, it would be my duty to fully commit to the child and accept responsibility for both the negative and positive consequences of my actions. Although I would be flexible in my practice, I would constantly review the status of treatment to ensure maximization of positive results and minimize negative ones. Step 8: Evaluation of the Results of a Course of Action I realize that wherever I start, the next step will depend on the information I receive from the school and potential parents and grandmother, and the reactions I get from the boy during those evaluations. A follow-up with the boy will be very important in order to ensure that the right strategies and/or medication are effective. Step 9: Assumption of Responsibility for the Consequences of Action, Including Correction of Negative Consequences, If Any, or Re-engaging in the Decision-making Process if Ethical Issue Is Not Resolved This case, like any other is a sensitive one and can go negative very fast regardless of how careful one can be. There could be a multitude of issues or problems along the way. My job is to uncover all of them and be prepared to face each and every one by consulting the decision making process. It is my responsibility to not give up on my client and to give the best help I can possibly give. The ethical decision-making process will be my key in assuring proper counselling and use it well every time something changes (good or bad). It is important that I get familiar with it, as it will serve me with great importance during my entire career as a psychologist. Step 10: Appropriate Action, as Warranted and Feasible, to Prevent Future Occurrences of the Dilemma (e.g., Communication and Problem Solving with Colleagues, Changes in Procedures and Practices) In the future, I need to be more sensitive to the diverse cultures in my surroundings. With that being said, I will start to learn some general knowledge of those cultures and be better prepared for my future in counselling involving children from diverse cultures. I need to formulate an action plan, especially for those who seek the attention of a psychiatrist, to form a partnership with other organizations that will want to come to our town and/or is willing to do assessments through videoconferencing when travelling is not an option. It will also be important to form good relationship with some of the aboriginal people in my surroundings to better understand their

9 culture, beliefs and way of thinking. Working in collaboration with other professionals will also be important as they often carry a wealth of information that is a different for everyone.