HSP Medical Ethics & Patient Rights 3 — Questions and Answers
Question 1: A 15-year-old seeks treatment for substance abuse without parental knowledge, which is permitted under state law. The parent later contacts the psychologist demanding information. What should the psychologist do?
- Disclose all information because the parent has legal authority over a minor
- Decline to disclose, respecting the minor's legally protected confidentiality in this context (Correct answer)
- Discharge the minor to avoid the conflict
- Ask the court to resolve the dispute before continuing treatment
Correct answer: Decline to disclose, respecting the minor's legally protected confidentiality in this context
Many states grant minors the right to consent to substance abuse treatment without parental involvement, and this statutory privilege overrides general parental access rights.
Question 2: Which doctrine requires that patients receive sufficient information about risks, benefits, and alternatives before consenting to a procedure?
- Therapeutic privilege
- Informed consent (Correct answer)
- Parens patriae
- Substituted judgment
Correct answer: Informed consent
Informed consent requires disclosure of material information so a competent patient can make a voluntary, knowledgeable decision about proposed treatment.
Question 3: A psychologist's client reveals they are HIV-positive and is sexually active with a partner who does not know the diagnosis. The client refuses to disclose. What is the psychologist's BEST course of action under the APA Ethics Code?
- Immediately notify the partner without informing the client
- Terminate therapy immediately to avoid liability
- Use clinical judgment, consult, and consider applicable law before deciding whether to disclose (Correct answer)
- Ignore the issue as it is outside the scope of psychological treatment
Correct answer: Use clinical judgment, consult, and consider applicable law before deciding whether to disclose
APA Ethics Code 4.05 permits (but does not require) disclosure to protect third parties; the psychologist must weigh duty to protect, applicable state law, and clinical factors.
Question 4: Which of the following best describes 'therapeutic privilege' as an exception to informed consent?
- The therapist's right to withhold information the patient might find emotionally distressing
- The legal right of a therapist to treat a patient without consent in a life-threatening emergency
- A clinician withholding information when disclosure would likely cause direct harm that outweighs the benefit of disclosure (Correct answer)
- The patient's privilege to refuse any part of a therapeutic intervention
Correct answer: A clinician withholding information when disclosure would likely cause direct harm that outweighs the benefit of disclosure
Therapeutic privilege is a narrow doctrine permitting non-disclosure when revealing certain information would foreseeably and substantially harm the patient, though it is applied very restrictively.
Question 5: A patient demands to review their psychotherapy notes. Under HIPAA, how are these notes treated differently from the general medical record?
- Psychotherapy notes are fully accessible under HIPAA's patient access right
- Psychotherapy notes are carved out from HIPAA's patient access right and may be withheld (Correct answer)
- Psychotherapy notes must be shared only with the patient's insurer
- HIPAA does not regulate psychotherapy notes in any way
Correct answer: Psychotherapy notes are carved out from HIPAA's patient access right and may be withheld
HIPAA specifically exempts 'psychotherapy notes' (process notes kept separate from the medical record) from the patient's general right of access to their records.
Question 6: An ethics committee is reviewing a psychologist's dual relationship with a former client. Which factor would MOST reduce the ethical concern?
- The psychologist initiated the new relationship
- Significant time has passed and the new relationship is in a clearly different context (Correct answer)
- The psychologist was the client's primary treater for many years
- The client and psychologist share the same professional network
Correct answer: Significant time has passed and the new relationship is in a clearly different context
The passage of substantial time and a clearly different, non-exploitative context are among the factors APA identifies as mitigating the risk of post-termination relationships.
Question 7: Which of the following represents the ethical concept of 'justice' in the context of healthcare psychology?
- Ensuring all interventions produce measurable improvement
- Providing fair, equitable access to services and distributing benefits and burdens fairly (Correct answer)
- Maintaining honesty in all professional communications
- Prioritizing the welfare of the individual patient above all else
Correct answer: Providing fair, equitable access to services and distributing benefits and burdens fairly
Justice in bioethics refers to the fair distribution of health resources and the equitable treatment of patients regardless of background or status.
HSP Medical Ethics & Patient Rights 3
A 15-year-old seeks treatment for substance abuse without parental knowledge, which is permitted under state law.
The parent later contacts the psychologist demanding information.
What should the psychologist do?