Ethical and Legal Considerations in Marital and Family Therapy
| Contact us | ||
| Phone: | (601) 580-1640 | |
| (601) 544-8935 | ||
| Email: | dan@yourfamilyclinic.com | |
Ethical Implications Regarding Minors and the Therapeutic Human relationship: The Appropriate Age of Consent
by Michelle Boucher
Minnesota Country University
Ethical Implications Regarding Minors and the Therapeutic Relationship: The Appropriate Historic period of Consent
by Michelle Boucher
Minnesota State University
Ethical Implications Regarding Minors and the Therapeutic Relationship: The Appropriate Age of Consent
by Michelle Boucher
Minnesota State University
Abstruse
The post-obit paper examines the ethical implications in reference to a minor's informed consent within the context of the therapeutic human relationship. The onset of the newspaper provides a brief clarification of informed consent and the available ethical guidelines delineated past the American Psychological Association. Upon establishing the definition and ethical obligations of informed consent, the current legal obligations are addressed. Finally, a persistent debate among psychologists is also presented. Questions such as: "are minors competent"; "tin children recognize rights"; and "can children participate in treatment planning" facilitate the search for a predetermined protocol to discern a minor'due south power to provide informed consent. Endmost remarks focus on the implications of assent versus consent.
A review of the literature through PsychLit provided the research and theoretical articles used in this newspaper to draw the upstanding and legal problems associated with informed consent and children. This paper provides no clear implications regarding this issue but instead provides the available theoretical views posed by those in the field of ideals, legality, and therapeutic intervention.
Ethical Implications Regarding Minors
and the Therapeutic Relationship:
The Advisable Age of Consent
An individual must provide informed consent for psychological treatment if whatever of the following conditions exist: 1) if handling may have positive or negative furnishings; 2) if one treatment is not superior to another; 3) if treatment may be hazardous; or 4) if total cooperation is required for success of therapy (Jensen, Josephson, & Frey, 1989). Therefore, prior to the onset of any therapeutic intervention, it is imperative that the client provides informed consent. This consent protects the client and the therapist legally and besides provides a framework for the development of the therapeutic relationship. Informed consent is comprised of three factors: voluntariness, noesis, and intelligence/competence (DeKraai & Sales, 1991; Grisso & Vierling, 1978; Levine, Anderson, Ferretti, & Steinberg, 1993). In other words, the client must willingly (without coercion) participate in treatment. Not but must the client concur to treatment, merely the client must be knowledgeable of the parameters of the treatment that would include both possible benefits and hazards. Finally, the client must be capable of understanding all data presented to her and based upon this information make a logical decision regarding consent.
The concept of informed consent may initially appear simplistic and to the point, but it is not so when applied to the minor. According to Levine et al.(1993), fifty-fifty legal and upstanding codes do not provide an like shooting fish in a barrel to follow protocol when dealing with bug of a modest's informed consent as there always exists "competing principles that can never be settled by unambiguous reference to some overriding principle." There often will be a discrepancy betwixt the ideals of psychology and the law of the land. For example, the Ethical Principles of Psychologists and Code of Conduct from the American Psychological Association (1992) list several ethical principles toward each psychologists should strive: respect for the customer's rights and autonomy, and the exhibition of beneficence toward that customer. Each of these principles should be ascribed to despite the client's various cultural, private, and role differences (this would include historic period). It is hither where the paths of ethics and legality diverge. A small is legally prevented from obtaining complete autonomy thereby creating a dilemma for the clinician. The kid may exist required by parents, who provide the informed consent, to nourish therapy sessions. Typically, a minor's consent to handling is acknowledged just dissent largely goes unrecognized by the clinician as a small'southward consent is frequently viewed but as a "right to know" (Grisso & Vierling, 1978). Pearce (1994) would suggest consent is non possible unless the private is too able to reject every bit well. If this refusal is denied, the clinician is unable to respect the child'south autonomy. Apropos the result of beneficence, the clinician is responsible for maintaining the client'southward welfare as the goal of therapy. This responsibleness may become diluted when dealing with children as clients as society's and families' interest may also exist important (Levine et al., 1993). A alienation of either of these principles may seriously hinder the therapeutic relationship.
Presently, state statutes vary according to treatment purpose regarding the legal age of consent (Grisso & Vierling, 1978). More often than not speaking, the standard historic period of consent is 18 years. In improver, the individual must exist both democratic and competent (Broome & Stieglitz, 1992). The age of 16 years is also predominant in some states equally 16 is the age of consent recommended by National Plant on Mental Health (every bit cited in Melton, 1981). The Commonwealth of Virginia is the only country which allows minors to consent to psychotherapeutic treatment in the absence of parental consent (Keith-Spiegel & Koocher, 1985).
The ages of consent stated above refer to a minor's ability to provide consent without accompanying parental consent, but oft a parent may insist upon treatment for an unwilling minor. Regarding such a dilemma, the Supreme Courtroom ruled in the instance of Kremens 5. Bartley (1977, as cited in Hendrix, 1991) that informed forced consent was prohibited beyond the age of 14. This new law established the right of individuals 14 years and older to voluntarily commit to or withdraw from institutional treatment.
There exist certain exceptions to the rule of parental consent. Conditions which may endanger public health (i.e. sexually transmitted disease) supplant parental permission and only the consent of the small is required for treatment. A second exception would be if the minor would likely not seek handling if confidentiality was non maintained (i.east. pregnancy, nativity control, drug treatment). Furthermore, if damage is likely to ensue in the absence of handling, either to the small or another party, parental consent is not required (i.e. suicidal/homicidal threats). A final exception is if the pocket-sized has been "emancipated," a small who is contained from her or his parents (Keith-Spiegel & Koocher, 1985; Melton, 1981).
Although future trends in children'south legal rights are focusing on the expansion of rights to cover the following: adequate diet, good for you environment, continuous loving care, sympathetic community, intelligent and emotional stimulation (Rodham as cited in Glenn, 1980), and right to life, home, educational activity, and liberty (Forer as cited in Glenn, 1980), many of these rights are often denied children, and the concept of a child's right to provide consent is, for the most part, ignored. The courts have largely placed responsibility upon the mental wellness professionals to mediate between the best interest of the child and the intentions of the parents (Keith-Spiegel & Koocher, 1985). Of form, the concept of parental consent assumes the parent or guardian has the best interest of the child in mind. Unfortunately, the parent may not be competent to evaluate the best interest of the child. In such a case, the court can be petitioned to appoint a guardian advert litem that would stand every bit an advocate for the child. Typically, this action is non necessary (DeKraai & Sales, 1991).
Although minors are commonly not granted the right of informed consent, several studies accept demonstrated that minors may indeed be capable of providing it (Hall & Lin, 1995). It is here where the scope of legality ends and ethical implications evaluate a child's capabilities for consent. Why even bother evaluating a child'southward capability for consent? The importance of allowing whatever capable minor to provide consent is supported by many in the field of psychology. This support stems from the concept that a lack of consent or control in the therapeutic process debilitates the relationship and inhibits the individual growth of the child (Glenn, 1980; Levine et al., 1993). The law does non acknowledge the importance of the child's development of self-determination.
Lee (as cited in Varhely & Cowles, 1991) concluded at that place is a significant difference between a parents evaluation of their kid's decision making capabilities and that child's self-evaluation of her conclusion making capabilities. The child rated ability higher that did the parents. The question then is, "Can a minor actually possess decision making capabilities?" In other words, "At what historic period is a kid competent to provide consent?" Competence is divers as when an "individual is able to understand sufficiently to make an autonomous decision" (Levine et al., 1993, p.110). In an endeavor to provide a conclusive reply to the question of competence, many in the field have approached the single question through the evaluation of a child's capabilities within the three areas of consent: knowing, intelligence, and voluntariness. This angle of determining competency eradicates the determinant of historic period as a proxy for competence and incorporates a more than fluid and comprehensive approach.
"Knowing consent" constitutes ane's agreement of the semantic content. This understanding is tested past requesting that the client paraphrase in her or his own words the information the clinician has provided (Grisso & Vierling, 1978). Typically, children in grades 5-12 "have a vague knowledge at best almost what psychologists do" (Keith-Spiegel & Koocher, 1985, p. 104). Keith-Spiegel and Koocher (1985) advise children prepared for therapy are less probable to cease handling prematurely and are judged by the clinician to be less disturbed.
Not just must the child be capable of verbally understanding the data presented by the clinician, the child must also be able to make intelligent decisions based upon this information. "Intelligent consent" is not merely acquiescing; it is an agile process equanimous of many steps. Based upon the function intelligence plays in an individuals chapters to provide informed consent, Glenn (1980) proposes the utilize of mental historic period rather than chronological age to determine competency. This suggestion may be just as narrow in its focus equally the legal standpoint (that a given age unequivocally provides a standard for competence or incompetence). For an private to competently provided "intelligent consent," the following must be present: 1) capability to attend to task; 2) adequacy to delay response in guild to process information; 3) possess cognitively complex processing ability; 4) capability to weigh treatment benefits and risks; 5) capability to reason both inductively and deductively (Grisso, 1978; Hall & Lin, 1995).
Belter and Grisso (1984) conducted a written report designed to examine whether informing minors of their rights (knowledge) would have an effect on their ability to recognize when their rights were violated and their ability to take the appropriate activeness to protect themselves (intelligence). The results indicate the children below the age of x should be assumed unable to protect their ain rights. Children over the age of 15 proved to be competent in self-protecting their rights. Lastly, children between the ages of x and 15 are developing the capability to self-protect but should not exist assumed competent in this expanse.
Adelman, Lusk, Alvarez, and Acosta (1985) conducted a study which also examined a minor'south capacity to provide "intelligent consent." This study evaluated minor'southward (ages 10-19) capability to make treatment decisions. Adelman et al. (1985) conclude "both our enquiry and clinical findings betoken that many minors not only have a willingness and bones competence to join in making treatment decisions, but they are interested in improving skills related to such participation as well" (p. 433).
The final component of competence is voluntariness. The concept of "voluntary consent" encompasses the caste to which an individual is autonomously provides consent. Autonomy is "personal self-governance: personal rule of the cocky past adequate understanding, while remaining free from controlling inferences by others and from personal limitations that prevent choice" (Faden & Beauchamp as cited in Levine et al., 1993, p. 83). Issues which ofttimes impede a child's strive toward autonomy are parental and professional person influences, want for approval, compliance, conformity, and the child's direct fight against conformity. Pre- and early adolescents tend to conform more to external influences than other age groups. It is important to notation that many adults likewise succumb to the aforementioned external influences.
Pearce (1994) incorporates the previous concepts and adult suggestions for evaluating the competence of a minor to consent. Offset, the child must possess a articulate concept of self in relation to others. The kid must likewise provide a articulate understanding of his or her disorder and treatment implications. Third, both risks and benefits must be understood. Finally, these risks and benefits must be understood in relation to the influence of time.
Grisso & Vierling (1978) base their suggestions upon chronological age and Piaget's cerebral developmental stages. Typically, no child under the age of 11 is competent to provide informed consent. Once a child has reached 15 years of age, it is probable he or she is competent to provide consent. These age stipulations would indicate that between the ages of xi and fifteen occurs a transitional catamenia during which a child may or may non embrace the necessary elements required to provide informed consent. Melton (1981) agrees with the age of fifteen being the typical age at which minors are competent to provide consent.
According to Varhely and Cowles (1991), regardless of legal and ethical obligations, a child should always be provided with the almost opportunity possible to exercise their decisional rights. That is, in any opportunity regardless of how modest, the child should be provided with command over his or her own path. This opportunity will increase not only the therapeutic alliance only likewise the child's capacity for cocky-decision (Levine et al., 1993).
This opportunity is often provided through informed assent. DeKraai and Sales (1991, p. 855) define assent as "affirmative agreement by a youth to participate even though the youth lacks the legal capacity to consent, and is generally required when youths are determined incapable of providing assent." Margolin (1982) suggests a child over the age of 7 provide assent. Despite the virtuous intentions of assent, none of the literature reviewed provided suggestions for placating a child who refuses to provide assent. In such a case, the clinician may be deemed untrustworthy past the customer as she or he will be required to continue in therapy despite dissent. This dilemma in itself raises ethical questions.
When the fourth dimension comes for a clinician to make the final decision regarding the power of a minor to provide informed consent, Hall and Lin (1995) advise approaching this decision from a metaethical approach. Each child should be evaluated per case therefore the clinician relies upon an intuitive level of moral reasoning. Although this proposal may sound philosophically upright, clinicians are still bound past distinct legal obligations both to the kid and the child's parents. These legal obligations must take precedence over the personal impressions of the clinician.
References
Adelman, H.Due south., Lusk, R., Alvarez, V., & Acosta, Northward.Grand. (1985). Competence of minors to understand, evaluate, and communicate nearly their psychoeducational issues. Professional person Psychology: Research and Practice,16(3), 426-434.
American Psychological Association. (1992). Ethical principles of psychologists and lawmaking of conduct. American Psychologist, 47, 1597-1611.
Belter, R.Due west., & Grisso, T. (1984). Children'due south recognition of rights violations in counseling. Professional person Psychology: Enquiry and Practice, 15(six), 899-910.
Broome, M.E., & Stieglitz, Grand.A. (1992). The consent procedure and children. Research in Nursing and Health, fifteen, 147-152.
DeKraai, Yard.B., & Sales, B.D. (1991). Liability in child therapy and research. Journal of Consulting and Clinical Psychology,59(6), 853-860.
Glenn, C.M. (1980). Ethical issues in the practice of child psychotherapy. Professional Psychology, 11(iv), 613-619.
Grisso, T., & Vierling, 50. (1978). Minors' consent to treatment: A developmental perspective. Professional Psychology, 9, 412-426.
Hall, A.Due south., & Lin, Chiliad.-J. (1995). Theory and do of children'south rights: Implications for mental wellness counselors. Journal of Mental Wellness Counseling, 17(1), 63-80.
Hendrix, D.H. (1991). Ethics and intrafamily confidentiality in counseling with children. Journal of Mental Health Counseling, 13(3), 323-333.
Jensen, P.S., Josephson, A.M., & Frey, J.,III. (1989). Informed consent as a framework for treatment: Upstanding and therapeutic considerations. American Journal of Psychotherapy, 63(3), 378-387.
Keith-Spiegel, P., & Koocher, G.P. (1985). Ethics in Psychology: Professional Standards and Cases. Hillsdale, NJ: Lawrence Erlbaum Associates.
Levine, K., Anderson, E., Ferretti, L., & Steinberg, Thousand. (1993). Legal and ethical issues affecting clinical child psychology. In T.H. Ollendick, & R.J. Prinz (Eds.), Advances in Clinical Child Psychology: Volume xv (pp. 81-117). New York: Plenum Press.
Margolin, G. (1982). Ethical and legal considerations in marital and family unit therapy. American Psychologist, 37(7), 788-801.
Melton, Thousand.B. (1981). Children's participation in treatment planning: Psychological and legal issues. Professional person Psychology, 12(2), 246-252.
Pearce, J. (1994). Consent to handling during childhood: The assessment of competence and abstention of conflict. British Journal of Psychiatry, 165, 713-716.
Varhely, S.C., & Cowles, J. (1991). Counselor self-awareness and client confidentiality: A relationship revisited. Elementary School and Guidance Counseling, 25, 269-276.
The tiptop photograph was past Taylor Deas-Melesh on Unsplash. We are grateful.
If you would like, please check out our affiliate programs. Nosotros receive payment on qualified purchases from the links below.
Get-go End Commencement Finish
| Home | Disclaimer | Copyright © 2004-2021, Your Family Clinic LLC, All Rights Reserved | ||
| Habitation | ADHD | Autism | Bipolar Disorders | Oppositional Defiant | Disclaimer | Copyright © 2004-2021, Your Family unit Clinic LLC, All Rights Reserved | ||
Source: https://www.yourfamilyclinic.com/pro/ageconsent.html
Post a Comment for "Ethical and Legal Considerations in Marital and Family Therapy"