Question: Irina, a 13-year-old girl of Arabic cultural heritage living in Boston, Massachusetts, was brought by her parents to a hospital emergency room after an assault by a stranger. Based on her injuries, the hospital staff suspected that the attacker had also sexually assaulted the girl, but she and her parents refused medical evaluations for rape. The family received a referral to see Janet Matthews, a clinical psychologist specializing in adolescent trauma. During their initial meeting with Dr. Matthews, the parents asked the psychologist not to discuss any sexual aspects of the assault with their daughter but to treat the psychological trauma from the assault in general.

They told the psychologist that admitting a rape had taken place would cast a stigma on their daughter and make her ineligible to be married to men in their closely knit ethnic community. When asked in private, the girl also requested that sexual issues not be discussed for the same reason.

Ethical Dilemma: Dr. Matthews does not know if she should agree to the parents' and child's request.

Discussion Questions: 1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?

2. Who are the stakeholders and how will they be affected by how Dr. Matthews resolves this dilemma?

3. How might Irina's age and parents' involvement in the referral affect how Dr. Matthews can resolve this dilemma? How might state law on treatment of minors and HIPAA rules on access of guardians to a minor's health care records influence Dr. Matthew's decision? (See sections on "A Word About HIPAA" in the Preface of this book, on parental rights under Standards 3.10b, Informed Consent, in Chapter 6, and the Hot Topic at the end of Chapter 7 "Confidentiality and Involvement of Parents in Mental Health Services for Children and Adolescents.")

4. What attitudes, knowledge, and skills are required to develop a culturally competent treatment plan for Irina (see the Hot Topic for Chapter 5 "Multicultural Ethical Competence")?

5. Is Irina likely to benefit from the treatment if the possibility of sexual aspects to the trauma is not explored?

6. How are APA Ethical Standards 2.01a, b, and c; 2.04; 3.04; 3.06; 4.01; 4.02; and 10.10a relevant to this case? Which other standards might apply?

7. What are Dr. Matthews's ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principles and enforceable standards, legal standards, and Dr. Matthews's obligations to stakeholders? Can you identify the ethical theory (presented in Chapter 3) guiding your decision?

8. What steps should Dr. Matthews take to ethically implement her decision and monitor its effect?