1. What is the problem or dilemma (state this is 2 to 3 sentences)

What I understood from this case study was that the client’s first language was not English, and the client did not English very well as she was a recent immigrant. Although the counselor took her time and explained the approaches she uses in addition to the informed consent information, and the client nodded, this was not clear indication that she was agreeing to the informed consent. She was also here after being referred to a doctor, possibly to get medication.

In the ACA Code of Ethics, what is one moral principle and are two standards that most apply to the case study? Summarize each briefly and how it applies to the case study.

As stated in the ACA Code of Ethics, A.2.a., counselors have an obligation to review in writing and verbally the rights and responsibilities of both parties. This standard definitely applies to this case, as the counselor should have not only verbally explained the situation and rules to the client but made sure she was able to read the information further and digest it, especially because it was extremely possible she didn’t understand what the clinician was saying, and the clinician should have taken extra precautions. The other standard in the ACA Code of Ethics is A.2.c, which discusses cultural sensitivity in specific and states that necessary services should have provided, such as an interpreter (which could even be the client’s brother in this scenario since he is aware of the situation and was the one who initially spoke to the clinician on the phone), when the client might have difficulty understanding. The moral principle that most applies to this case study in my opinion is veracity. This is because the client seems to be coming to the clinician after being referred by a doctor, in order to obtain medication for her sleep disorder. It is the clinician’s duty here to stay truthful to the client, make sure she has understood the services that are provided in the office, and explain whether or not medication will be involved after all. After the client was nodding, smiling and eventually wanted to speak about medication, it was clear that she could have been there solely for that reason and if another session with an interpreter needs to be held than the clinician would do this to thoroughly repeat the process again and then assess whether the client really wants to go through with it.

1. Who would you consult with about this dilemma?

I would consult with the physician whom which referred the female patient to me, and ask the reasoning as to why the client was referred to me and if she would eventually receive medication, if she would simultaneously receive medication while being treated by me, or if medication wasn’t in the picture. The client had assumed she would receive medication so I would want to make sure I understood the situation completely before I met with her again, and so that I could explain to her what the physician and I spoke about. I would also make sure I had the necessary accommodations for the patient in terms of the language barrier there, as it is my job to make every effort to communicate the process and consent to the patient in their own language. Also according to Barnett, Wise, Johnson-Greene and Bucky, it is not enough to simply ask if the client understands or if they have any questions, and would be better to have the clients repeat the information or even have a written consent form to read and sign.

1. What are two courses of action that would address this dilemma and increase the client’s autonomy?

One course of action here would be to find a translator to join the patient and I, repeat the information and informed consent to her, see if she has any questions, and then have her repeat information to me so that I know everything was fully understood and that she is making her own decisions based on what she knows. By this point she would hopefully have full comprehension, and I would also provide her with a written form which her and the translator could read together, and then sign. This is if she opts into the treatment after being informed of what it involves of, as I would not be able to prescribe medicine. We would also be in contact with her physician who I would discuss the situation further with and understand what they had agreed on in terms of medication. I believe this situation would be ideal and she would have full autonomy, being able to refuse treatment, and I would have fulfilled my duties of being truthful to her.

I could also refer the client to another clinician who speaks the same mother tongue and who might understand her situation better. They would most likely go through the same dilemma, but this does allow the client to explain herself further and have an improved sense of understanding from the clinician’s end, if she does not want a third party present to translate, as things can get lost in translation.