Happy Friday, ethics enthusiasts!
Today marks the inaugural Friday Challenge. Are you at the edge of your seat with anticipation? Do you like to be challenged? Play games? Ponder life’s mysteries? Well ok then, join in the fun!
Here’s how it works: I post an ethical challenge, some unbearable uncomfortable professional ethical dilemma. You read it and squirm. After an appropriate squirming, your brain then starts to churn. “What would I do?” you ask yourself… and then you answer. In writing. In the email form listed below. Then I read it and publish a few. Sound like fun? Are you ready? Set? Begin.
The following challenge was actually first posted exactly 5 years ago to the day! Originally published on 9/27/14 as the inaugural challenge of the first incarnation of this blog. Because of the date sympatico, we are publishing this as our first this year. We will post current responses and those sent in 5 years ago, in honor of the past and in celebration of the present. Here goes.
John is a client you have worked with for the better part of a year. He came in with several goals, related to the depressive symptoms he couldn’t shake on his own. Prior to coming into your office, John had successfully ceased his methamphetamine abuse and had developed a solid foundation in recovery. As he works with you, he continues to build on this foundation, getting active in the 12-step community, avoiding negative relationships and anyone who actively uses drugs. He surrounds himself with supportive, healthy people, and creates a balanced life filled with healthy activities.
Yet despite this success, John had consistently struggled with crippling depression even after he had managed to quit the methamphetamine. Thus, he found himself in your office, asking for help in coping with the symptoms. You worked for months, understanding his symptoms, applying all the treatment techniques at your disposal, developing coping skills and tools for John, evaluating them, throwing out the failing tools, and sticking with the helpful ones. The two of you had a good professional run, and met the goals you set together to the best of your ability. One of the things you both learned is that John was incredibly fearful of living alone. He worried that after becoming stabilized, he would unravel if living alone. You both decide that a supportive living program would be ideal as a stepping stone for John. He is excited and grateful for the opportunity.
And you are feeling lucky, because there is a wonderful supportive living facility in John’s community, which will allow him to continue to access the sober network he has worked to develop. You call them up, and discover there is a bed available. What good luck! The referral paperwork is faxed to you and you start filling it out…and then hit a snag. The paperwork clearly states that the program requires no substance use diagnosis, as it is aimed at serving clients with mental health issues, not those dually diagnosed with a mental and substance use disorder. The program is perfect for John, and you suspect he will do well and use it for all it has to offer him, just as he did with your program. You also worry about his well being, and his ability to keep the depressive symptoms managed, if he does not access this level of support. You also think about the fact that John no longer meets criteria for an active substance use disorder because of the length of time in recovery. At this point, he would be classified as “methamphetamine use, in full sustained remission.”
So you wonder… should you send in the referral paperwork, omitting the substance use (in remission) diagnosis, or should you tell John the referral can’t be made?
Clinical Ethics 