Issues and Ethics in Abnormal Psychology

Informed consent is a legal document which serves as an agreement for treatment, non-treatment, or for an invasive procedure that requires physicians to disclose the benefits, risks, and alternatives to the treatment, non-treatment, or procedure (1). In order for informed consent to be considered valid, the client must be competent and the consent should be given voluntarily. For individuals who are legally incapable of giving informed consent, psychologists need make sure to provide an appropriate explanation, seek the individual's approval, consider his or her preferences and best interests, and obtain permission from a legally authorized person, if such substitute consent is permitted or required by law.
If one were to create an informed consent document, one would need to include a number of things. This document needs to start out by explaining the purpose of the intended treatment or therapy, expected duration, and any procedures that they follow to make it know to the client exactly what will be happening throughout their time with the psychologist. An Informed consent document also would need to include the right to decline or withdrawal from treatment along with the possible consequences not participating in therapy or treatment, and reasonably foreseeable factors that may be expected to influence his or her willingness to participate such as potential risks, discomfort, or adverse effects. Any prospective research benefits, limits of confidentiality, incentives for participation, would also be very important elements to an informed consent document because they also provide the opportunity for participants to ask questions.

To increase the chances of providing effective assistance to culturally different clients, the therapist have to have cultural competence. Cultural competence is achieved by identifying and understanding the needs and help-seeking behaviors of individuals and families (4). The therapist has to be aware of the client’s cultural values, the stress prejudices, and stereotypes that the client has been exposed to, and the hardships they have faced. The therapist can provide more effective therapy by helping the clients on a number of things: recognize the impact of both their own culture and the dominant culture on their self-views and actions identify and expressed “bottled-up” anger and pain, achieve a comfortable bi-cultural balance, and most importantly raise their self-esteem and provide them with a sense of self-worth that has often been damaged by narrow-minded members of society. (3)
Additional steps that can be taken in providing effective assistance to culturally different clients would be to familiarize them with the city they are in so that they don’t feel the ever present “culture shock” that often occurs when living in an area that they are unacquainted with. The therapist could also help the client feel more comfortable with the city by giving them basic information about the city, along with a city map and English-Spanish translation dictionary to help them communicate with others.

Patient confidentiality is a person’s right to have their personal information kept private. Any medical data gathered from a patient should not be disclosed to anybody else without the patient’s permission. Confidentiality is a crucial part of the doctor-patient relationship. It is very important that a patient trust their doctor. There are many instances on a daily basis where patients’ medical data must be disclosed. Some examples of this are for payment reasons for insurance companies, for health-related services or benefits, for research purposes, for fundraising activities, for treatment alternatives, or when the law requires it. These are all pretty clear, unavoidable reasons for patient disclosure and are generally uncontroversial. There are, however, other times when situations arise where it is not as clear how to handle the issue of confidentiality. One example of this is if disclosing would be in the greater public interest, such as if details of a serious crime (or intended crime) were revealed, like in the Tarasoff case. I believe that the principles from this case apply to AIDS related cases for the most part. Both Tanya Tarasoff and Jenifer Lawson (the affected victim in the case Reisner v. Regents of the University of California) were not warned about the potential of being hurt a boyfriend or acquiring HIV, respectively, from the psychiatrist or doctor. However, the main difference was that Tanya was an “identifiable 3rd party” that could be affected and Daniel Reisner (contracted HIV from Jenifer Lawson) was unidentifiable. These still need to be viewed in the same way because, whether the 3rd party is known or not, there still needs to be some sort of warning from a doctor or psychiatrist of the potential dangers or health problems that can occur from or as a result from their care.
Another case that can apply to AIDS-related cases would be disclosing something in the greater public interest, like if someone intends to or already has abused a child. This needs to be disclosed to other family members and or Social Services so that the child is out of the abusive environment.

The cases of Jeffery Dahmer and Andrea Yates are similar in the sense that they involve murders. In Dahmer’s, and Yates’ case initially, guilty verdicts were decided. Jeffery Dahmer was found guilty of murdering 15 young men in 1992 and Yates was found guilty of drowning her 5 children in 2002. However, in 2006, Yates was found not guilty by reason of insanity and sent to a mental health facility because a Texas appeals court decided that a prosecution witness provided misinformation in his testimony. After murdering 15 young men, Dahmer dismembered his victims’ bodies and stored their parts to be eaten. Although he was found guilty, I feel that one could argue that a “sane” person would not think or act like that.

The trials of John Hinckley and Lorena Bobbitt involved them harming another individual, no deaths occurred and both were found not guilty by reason of insanity. John Hinckley attempted to assassinate President Ronald Reagan to prove his love for actress Jodie Foster in 1981 and Lorena Bobbitt cut off her husband’s penis while he slept. The difference between the two cases was that while John Hinckley was found guilty by reason of insanity, Lorena Bobbitt was found not guilty by reason of temporary insanity from a brief psychotic episode where it was seized by an “irresistible impulse.” In the case of Hinckley, the verdict he received as proven the test of time due to the fact that he still remains in St. Elizabeth’s Hospital in Washington D.C. after he committed the act 32 years age. Lorena Bobbitt, on the other hand, was committed into a state mental hospital for further assessment and treatment and was released few months after her verdict. It is very difficult to understand what she was thinking at the time she cut off her husband’s penis, but the fact that he raped her could have made her mind think that cutting off his penis was the best thing to do.

The law regarding insanity defense in Indiana is that the mental disease or defect must be a severely abnormal mental condition that grossly and demonstrably impairs the defendant’s perception. The insanity test that Indiana courts use is a test designed by the American Law institute that holds people to be insane at the time they committed a crime if; because of a mental disorder, they did not know right from wrong or could not resist an uncontrollable impulse to act. The trials that are conducted for these cases are not bifurcated, meaning that a verdict is decided in one trial, not two. The verdict that defendants can receive if he or she is insane is “not guilty by insanity. The treatment decided by the court is discretionary, which means the court proposes an appropriate time frame for treatment and mental health institution the tried individual needs to go and the court also has the authority to release the individual from treatment.