Chapter 10: Conflict of Interest

Involuntary Hospitalization Case Description: A 30-year-old man with schizophrenia threatens self-harm but refuses admission, claiming he’s fine. He’s deemed a danger to himself. Ethical Question: Is involuntary hospitalization ethical?

A. Yes, to protect him.
B. No, it violates autonomy.
C. Yes, if legally approved.
D. No, unless he consents.

Confidentiality Breach for Safety Case Description: A 25-year-old woman in therapy reveals plans to kill her ex-boyfriend. The therapist considers warning him. Ethical Question: Is breaking confidentiality ethical?

A. Yes, to prevent harm.
B. No, it breaches trust.
C. Yes, if legally required.
D. No, unless she consents.

Capacity to Refuse Treatment Case Description: A 40-year-old with severe depression refuses antidepressants, saying they’re poison, despite impaired judgment. Ethical Question: Should his refusal be respected?

A. Yes, it’s his right.
B. No, he lacks capacity.
C. Yes, if he understands risks.
D. No, unless he improves.

Forced Medication Case Description: A 35-year-old with bipolar disorder, involuntarily admitted, refuses medication that stabilizes him, citing side effects. Ethical Question: Is forced medication ethical?

A. Yes, for his benefit.
B. No, it violates autonomy.
C. Yes, if court-ordered.
D. No, unless he’s dangerous.

Adolescent Confidentiality Case Description: A 16-year-old in therapy admits to drug use but begs the therapist not to tell her parents. Ethical Question: Should the therapist keep this confidential?

A. Yes, to build trust.
B. No, parents should know.
C. Yes, unless she’s at risk.
D. No, if illegal.

Electroconvulsive Therapy Consent Case Description: A 50-year-old with severe depression lacks capacity and can’t consent to ECT, but his family approves it. Ethical Question: Is proceeding with ECT ethical?

A. Yes, with family consent.
B. No, without his consent.
C. Yes, if beneficial.
D. No, unless he regains capacity.

Suicide Risk Disclosure Case Description: A 20-year-old college student admits suicidal thoughts in therapy but asks for secrecy. He has a plan. Ethical Question: Should the therapist disclose this?

A. Yes, to save his life.
B. No, it’s confidential.
C. Yes, if imminent danger.
D. No, unless he acts.

Restraint Use in Crisis Case Description: A 45-year-old with psychosis becomes violent in the ER. Staff restrain him physically to prevent harm. Ethical Question: Is this restraint ethical?

A. Yes, for safety.
B. No, it’s dehumanizing.
C. Yes, if minimal force.
D. No, unless he consents.

Therapy Boundary Violation Case Description: A 30-year-old patient flirts with her therapist, who responds warmly to build rapport, blurring boundaries. Ethical Question: Is this response ethical?

A. Yes, for therapeutic alliance.
B. No, it crosses boundaries.
C. Yes, if not sexual.
D. No, unless she initiates.

Medication Over Objection Case Description: A 60-year-old with dementia and agitation is given sedatives over his objections, per his family’s request. Ethical Question: Is this administration ethical?

A. Yes, for his safety.
B. No, without consent.
C. Yes, if family agrees.
D. No, unless court-ordered.

Psychiatric Advance Directive Case Description: A 35-year-old with bipolar disorder has a directive refusing hospitalization, but he’s now manic and dangerous. Ethical Question: Should the directive be followed?

A. Yes, it’s his prior wish.
B. No, he’s a risk now.
C. Yes, if not dangerous.
D. No, unless updated.

Research on Psychiatric Patients Case Description: A trial tests a new antipsychotic on patients with schizophrenia, some with questionable capacity to consent. Ethical Question: Is this trial ethical?

A. Yes, with proxy consent.
B. No, without full capacity.
C. Yes, if beneficial.
D. No, unless all consent.

Dual Relationships Case Description: A therapist treats a 25-year-old who’s also his neighbor, risking bias but providing convenient care. Ethical Question: Is this dual role ethical?

A. Yes, if he’s competent.
B. No, it risks objectivity.
C. Yes, if disclosed.
D. No, unless unavoidable.

Social Media Disclosure Case Description: A 40-year-old posts about his therapy online, identifying his psychiatrist, who then discusses it with colleagues. Ethical Question: Is the psychiatrist’s discussion ethical?

A. Yes, it’s public now.
B. No, it’s still confidential.
C. Yes, if anonymized.
D. No, unless he consents.

Competency in Legal Cases Case Description: A 50-year-old with delusions is evaluated for trial competency. His psychiatrist pushes treatment to make him fit. Ethical Question: Is this push ethical?

A. Yes, for justice.
B. No, it prioritizes law over health.
C. Yes, if he agrees.
D. No, unless voluntary.

Refusal of Therapy Case Description: A 20-year-old with anxiety refuses therapy, preferring to cope alone, despite worsening symptoms. Ethical Question: Should his refusal be respected?

A. Yes, he’s competent.
B. No, he needs help.
C. Yes, if not severe.
D. No, unless improved.

Parental Consent for Minors Case Description: A 15-year-old seeks therapy for depression, but her parents refuse, citing stigma. Ethical Question: Should the therapist proceed?

A. Yes, for her health.
B. No, parents decide.
C. Yes, if she’s mature.
D. No, unless court-ordered.

De-escalation vs. Medication Case Description: A 30-year-old with agitation is offered sedatives instead of de-escalation, calming him quickly but bypassing talk. Ethical Question: Is this approach ethical?

A. Yes, it’s efficient.
B. No, it skips alternatives.
C. Yes, if he’s violent.
D. No, unless he agrees.

Stigma in Diagnosis Case Description: A 45-year-old avoids a schizophrenia label due to stigma, asking his doctor to omit it from records. Ethical Question: Should the doctor comply?

A. Yes, to reduce stigma.
B. No, it’s dishonest.
C. Yes, if not critical.
D. No, unless legal.

Group Therapy Confidentiality Case Description: A 35-year-old in group therapy shares abuse, but another member leaks it outside, breaching trust. Ethical Question: Is the therapist responsible?

A. Yes, for group oversight.
B. No, it’s the member’s fault.
C. Yes, if not warned.
D. No, unless complicit.

Suicide Contract Ethics Case Description: A 25-year-old with suicidal ideation signs a no-harm contract, but later attempts suicide. Ethical Question: Was the contract ethical?

A. Yes, it’s a tool.
B. No, it’s unreliable.
C. Yes, if monitored.
D. No, unless enforced.

Cultural Beliefs vs. Treatment Case Description: A 50-year-old believes his depression is spiritual, refusing meds for prayer, despite worsening. Ethical Question: Should his belief be respected?

A. Yes, it’s his culture.
B. No, he needs treatment.
C. Yes, if not severe.
D. No, unless effective.

Overmedication Risk Case Description: A 60-year-old with anxiety is prescribed multiple sedatives, risking dependency, per her request. Ethical Question: Is this prescribing ethical?

A. Yes, she consented.
B. No, it risks harm.
C. Yes, if monitored.
D. No, unless minimal.

Therapist Burnout Case Description: A therapist, overwhelmed, gives a 30-year-old poor care, missing his suicidal cues. Ethical Question: Is this lapse ethical?

A. Yes, burnout happens.
B. No, duty persists.
C. Yes, if unintentional.
D. No, unless reported.

Competency in Addiction Case Description: A 40-year-old with alcoholism refuses rehab, claiming control, despite recent binges. Ethical Question: Should his refusal be respected?

A. Yes, he’s competent.
B. No, addiction impairs him.
C. Yes, if not severe.
D. No, unless sober.

Teletherapy Privacy Case Description: A 20-year-old uses teletherapy, but his family overhears, breaching privacy due to his living situation. Ethical Question: Is teletherapy ethical here?

A. Yes, it’s accessible.
B. No, without privacy.
C. Yes, if he agrees.
D. No, unless secure.

Child Custody Evaluation Case Description: A psychiatrist evaluates a 35-year-old’s mental health for custody, potentially biasing therapy goals. Ethical Question: Is this dual role ethical?

A. Yes, if objective.
B. No, it conflicts.
C. Yes, if disclosed.
D. No, unless separate.

Refusal of Antipsychotics Case Description: A 45-year-old with psychosis refuses antipsychotics, preferring natural remedies, despite delusions. Ethical Question: Should his refusal be respected?

A. Yes, it’s his choice.
B. No, he lacks capacity.
C. Yes, if not dangerous.
D. No, unless effective.

Family Pressure for Treatment Case Description: A 25-year-old with OCD resists therapy, but his family insists, pressuring the doctor to intervene. Ethical Question: Should the doctor act?

A. Yes, family knows best.
B. No, he’s competent.
C. Yes, if he’s a risk.
D. No, unless he agrees.

Discharge Against Advice Case Description: A 50-year-old with mania demands discharge from the hospital, though unstable, claiming he’s cured. Ethical Question: Should he be discharged?

A. Yes, it’s his right.
B. No, he’s unstable.
C. Yes, if supervised.
D. No, unless safe.