From the American Society for Adolescent Psychiatry in New York City
Medical ethical debates can be exciting and entertaining, even when the stakes are high. Arguments over industry involvement in medical research comes to mind.
But on March 14th, attendees at the American Society for Adolescent Psychiatry in New York tackled a thornier ethical dilemma when they discussed the balance between protecting the rights of adolescent patients who are accused of a sexual assault with the rights of their alleged victims.
Meg Kaplan, Ph.D., director of the Sexual Behavior Clinic at the New York State Psychiatric Institute, introduced the issue when she noted that she tries not to conduct full clinical evaluations of adolescents accused of sexual assault until after they have been through the court system. Why? For treatment purposes, she wants to find out about the full extent of any past abuse they have perpetrated. However, if those past actions come up during the criminal process, it could result in a greater sentence for that patient. The issue, Dr. Kaplan explained, is that the teen offender could end up with a hefty jail sentence, rather than receiving needed treatment. Treatment isn’t just good for the teen offender, she said, but for society as a whole since treatment offers the potential to reduce recidivism.
Dr. Kaplan’s comments sparked a series of questions from psychiatrists in the audience about the ethics of confidentiality versus the need for justice for other potential victims. Should the clinician actively discourage the adolescent offender from sharing information on other victims, limiting the effectiveness of treatment? Or should the physician encourage full disclosure at the risk that the patient will be fully punished, but not fully treated.
Physicians wrestle with patient confidentiality issues all the time, but the issue is especially sensitive when it involves sexual assault and adolescents.
—Mary Ellen Schneider