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Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Monday, May 13, 2013

Vignette 25: A Questionable Letter

Dr. Betty Frances has been treating Peggy Olson for anxiety and depression related to job stress and intermittent spousal bullying.  During their course of treatment, Mr. Olson physically abused Mrs. Olson to the point where the police arrested him on charges of domestic violence and terroristic threats.  Because of the seriousness of his threats and prior criminal behavior, Mr. Olson’s family could not bail him out of prison.

After this event, Mrs. Olson became more forthcoming with Dr. Frances.  His behavioral history includes stalking, assault, battery, public disturbance, public intoxication, and other out of control behaviors.  Dr. Frances continues to treat Mrs. Olson for anxiety and depression on a weekly basis.

Dr. Frances arrived at her office one day and found a letter with the return address of Mr. Olson at the local detention facility.  Dr. Frances feels an anxiety reaction in her body.  Trying to calm down, Dr. Frances writes out a list of questions.

1.      Should I open the letter now (as it is addressed to me)?
2.      Should I tell the patient about the letter before I open it?
3.      What are the benefits of telling the patient about the letter?
4.      What are the drawbacks of telling the patient about the letter?
5.      If the letter contains threatening information toward Mrs. Olson, or me, am I able to turn the letter over to the District Attorney?
6.      Am I required to turn the letter over to the DA if there is threatening information in it?
7.      How much control does the patient have over the letter and its contents?
8.      Is the letter automatically part of the treatment record or does it depend on the contents of the letter?
9.      Do I need a self-care plan as I am stressed out about this situation?

Having calmed down and written out these questions, Dr. Frances calls you for an ethics consultation about the letter.

What are your responses to her questions about the letter?
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