In this assignment, you will discuss the issues pertaining to informed consent in conducting evaluations and apply ethical decision making to a scenario in which there is a professional ethical conflict.
Review vignette 3 from the following article:
After you have read the vignette, answer the following questions in a 2- to 3-page paper:
Inmate X has a long history of violent behavior, which has resulted in his current imprisonment. While incarcerated, he has been a model prisoner. Inmate X has now been scheduled for a parole board hearing. Upon reviewing Inmate X’s central file, the warden believes that the inmate is still a dangerous individual who should not be granted parole despite his record of no institutional infractions. Accordingly, the warden requests that Dr. R evaluate Inmate X using psychological tests. The warden would like information about the inmate’s personality relating to his continued threat to public safety, and he would like this evaluation to be performed without the inmate being informed of its purpose because he believes Inmate X might otherwise refuse to participate in the evaluation.
The identification of dangerousness by mental health professionals has remained a much-debated issue. There are, however, a sizable number of clinicians who assert that through proper training, education, and experience, they can identify those features relevant to an individual’s threat of harm. One means of accomplishing such an evaluation would be through a thorough clinical interview, review and consideration of collateral sources of information, and the administration of select psychological measures.
In this scenario, the warden’s concern revolves around the issue of release of an individual whom he considers dangerous into the community. The warden, in his quest to obtain all relevant information to the issue of dangerousness for presentation to the parole board, solicits the assistance of the psychologist. The warden’s request for such an evaluation is qualitatively no different from commonly accepted requests made by judges to forensic psychologists and psychiatrists for probation and sentencing purposes. Moreover, psychologists and psychiatrists routinely evaluate hospitalized insanity acquittees as to their readiness for release into the community on the basis of their mental condition and the threat of harm to others. Therefore, it is not unreasonable or unrealistic for the warden to anticipate this as a job responsibility for the correctional mental health worker.
The problematic element in this scenario refers to the warden’s request for a covert evaluation where the inmate is deprived of his right to informed consent. The application of psychologists’ skills in such an important issue as the identification of dangerousness in an incarcerated individual demands respect and adherence to this fundamental ethical principle; however, an exception to this principle exists. Standards developed for mental health professionals in corrections have defined emergency conditions where one does not need to obtain informed consent prior to evaluation (AACP, 1980; American Medical Association, 1979; American Psychiatric Association, 1989; Dubler, 1986). These standards define the emergency as limited to life-threatening circumstances where there is a risk of escape or the creation of internal disorder or riot (American Psychiatric Association, 1989). We believe that to allow this scenario to fall under this exception would be grossly inappropriate.
The issue of informed consent also illustrates a basic difference between the correctional administrator and the mental health worker. For the latter, professional ethics and standards strongly dictate obtaining informed consent, maintaining confidentiality, and discussing the limitations of confidentiality with the client (APA, 1989, 1992; Committee on Ethical Guidelines for Forensic Psychologists, 1991). Correctional administrators, on the other hand, may not understand the need for this because they are not expected by their colleagues or the inmates to adhere to the above principles.
It is possible that correctional psychologists in certain situations could view themselves as having to function in a role similar to that of correctional administrators and thus justifiably deviate from their professional standards. For example, in this scenario, an argument could be made that by informing the inmate of the nature and purpose of the psychological assessment, one, in essence, sabotages the evaluation. Along these lines, it could be stated that the greater good of protecting public safety outweighs the compromise of informed consent. Ultimately, these arguments would fail because they would not be accepted by the mental health community. Idiosyncratic interpretations by individual clinicians as to what constitutes an exception to confidentiality and informed consent essentially undermine the validity of the written standards and ethics. The credibility of a profession requires that those who identify themselves as belonging to the professional group must respect and adhere to its shared concept of ethical behavior. Confidentiality and informed consent are by definition the cornerstones of psychological practice and our professional identity and therefore must be vigorously protected.
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