It seems to me that the juxtaposition of medical and behavioral services in a single clinic produces an abundance of ethical conundrums. Not only do the ethical principles of one profession get piled on top of the other, they can some times work at cross-purposes.
Perhaps an appropriate metaphor would be a physician prescribing 2 medications that have a dangerous interaction, or, a counselor who works with a husband toward reconciliation while simultaneously working with the wife toward separation.
In recent weeks I've had 2 very similar clinical experiences. In both situations a resident physician and I were scheduled to see a 16-year-old female and her parents. Both times the parents didn't show and instead called the clinic during the appointment time. Both parents denied their daughter permission to keep the appointment out of concern for defiant behavior (running away and staying out all night).
This is complicated by the fact that in Colorado, the legal age of consent for mental health services is 15 years old, but is 18 years old for medical services. Both the patients had a similar reaction, breaking down crying ("This is SOOO like my parents-always trying to make my life more difficult").
What do you see as being the ethical principles at play in this scenario?
Putting yourself in the places of the counselor and the physician, what would you do in these situations?
