http://www.cfha.net/forum_thread.php?t=82Recent posts in Randall Reitz: Monday Morning Ethics Quarterbackinghttp://www.cfha.net/forum_thread.php?t=82#post176pOne last note I remember being 16 and thinking my parents wanted to make my life difficult.nbsp I probably could have used some help back then during my rebelious years then again would i have really listened.nbsp My parents would have probably laughed at the idea of family counseling back then because in mexican culture you only go to a psychologist if your crazy.nbsp So its important to explore the reasons why the parents are refusing help.nbspphttp://www.cfha.net/forum_thread.php?t=82#post175pI have to agree with Dr. Fifield without knowing more its tough to say what I would do.nbsp Are these teens at risk if they are not provided the helpnbsp If their parents are putting their lives at risk I would try to use all the resources possible but that is what we are all obliged to do in that case.nbsp So is it that these girls perceive their parents as trying to make their lives difficult when theyre really notnbsp There has to be some sort of middle ground and its probably what Dr. Fifield suggested.nbspphttp://www.cfha.net/forum_thread.php?t=82#post172pQuarterbacking on Monday is so much easiernbsp Without having more facts what immediately runs through my mind is that the parents are fearful in some way of change regarding the daughters need to grow up.nbsp Getting the entire family present is obviously key yet proving to be difficult.nbsp Having a discussion with the parents focusing on how change in any form is difficult and furthermore how to facilitate parenting around normal behaviors of a sixteen year old female would also be helpful.nbsp As well that same emchangeem conversation could be had w the two daughters that are claiming mom and dad are making life SOOO difficult.nbspphttp://www.cfha.net/forum_thread.php?t=82#post171pIt seems to me that the juxtaposition of medical and behavioral services in a single clinic produces an abundance of ethical conundrums.nbsp Not only do the ethical principles of one profession get piled on top of the other they can some times work at cross-purposes.nbspppnbspppPerhaps 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.ppnbspppIn recent weeks Ive had 2 very similar clinical experiences.nbsp In both situations a resident physician and I were scheduled to see a 16-year-old female and her parents.nbsp Both times the parents didnt show and instead called the clinic during the appointment time.nbsp Both parents denied their daughter permission to keep the appointment out of concern for defiant behavior running away and staying out all night.ppnbspppThis 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.nbsp Both the patients had a similar reaction breaking down crying This is SOOO like my parents-always trying to make my life more difficult.ppnbspppemWhat do you see as being the ethical principles at play in this scenarioemppememppemPutting yourself in the places of the counselor and the physician what would you do in these situationsemp