Identify any potential ethical issues related to the case.

I have attached the three case files that are needed for this assingment..

For this assignment, you will read three forensic case examples and  apply your understanding of the APA ethics code as well as the specialty  guidelines for forensic psychology. The three case examples are found  in this week’s resources.

For each case, after reviewing your resources and reading the case example carefully, you will:

  • Identify any potential ethical issues related to the case.
  • Identify what APA guidelines apply to the case and explain how they apply to the case.
  • Identify what Specialty Guidelines for Forensic Psychology apply to the case and explain how they apply to the case.
  • Give a description of how you would resolve this ethical dilemma. Use your guidelines and resources to explain your solutions.

Finally, you will write a 1-2 page reflection on the process of  working through these ethical dilemmas and your impression of the  ethical struggles of a forensic psychologist.

Length: 4-5 pages total; 1 page each per dilemma, 1-2 page reflection

Your paper should demonstrate thoughtful consideration of the ideas  and concepts presented in the course by providing new thoughts and  insights relating directly to this topic. Your response should reflect  scholarly writing and current APA standards. 

Ethics Case #1

For this case, please read the case history below. In this scenario, you are a forensic psychologist working in a correctional facility. Your role is as the treating psychologist for this patient. You have been working with him for one year and have developed a solid rapport with him despite his distrust of others, particularly mental health professionals. You meet with him for weekly therapy sessions. In this time, while he is willing to speak with you, he avoids topics which he feels may cause him to be forcibly medicated; and you have been unable to get him to try psychotropic medications voluntarily. Recently, the prison has decided to attempt to get a court order to medicate the patient due to concern related to dangerousness and increasing psychiatric instability. They would like your cooperation in the court process. As you read this scenario and develop an understanding of the patient, also consider what ethical concerns you may have—particularly related to the specialty guidelines for forensic psychology and multiple relationships—and how you might resolve these issues.

INMATE NAME: DOE, JOHN

Reason for Referral

Mr. Doe was referred for this psychological evaluation due to this the patient’s continued refusal to take psychiatric medication, continued active psychosis, and history of risk to others. This assessment was also conducted in order to get a better understanding of Mr. Doe’s emotional functioning, identify his strengths and weaknesses, provide suggestions that may aid in treatment planning, and help determine risk factors for his potential future violent behavior. He is currently being referred for 402.10 commitment to CPC.

Legal History

Mr. Doe is serving his first bid for Murder 1, Burglary 1, and Grand Larceny, with a life sentence. He is also accused of two murders in Canada, which charges are still pending. In the IO, it is reported that the patient first murdered two men in Canada before crossing the border with one of the victim’s vehicles. Per his parents’ report, the crimes in Canada were fairly graphic, involved a knife, and one of the victims was almost decapitated. In the U.S., it was reported that he shot a man in the back at his hunting camp before tying him to a four-wheeler and dragging him around. He then fled to the Mexican border in Texas. He was apprehended by a Border Patrol officer after he was noticed to have a rifle. Mr. Doe then assaulted the Border Patrol officer and has pending charges in Texas for this assault.

Personal Profile and Relevant History

Mr. Doe was born on 03/05/81, with no known complications. He had an unremarkable childhood, graduating high school in 1999. He was noted to have done well academically, had many friends in high school, although not in junior high, and was the co-captain of his high school football team. Records note a history of depression in junior high school.

After high school, he attended Alpha University in Canada, pursuing a degree in Engineering. He completed two years of school and was involved with a fraternity and other similar pro-social activities. He was noted to have had two girlfriends in the past, one of whom he had a sexual relationship with. Mr. Doe has one younger brother, Douglas, with whom he is very close. He is also supported by his parents, Bob and Mary Doe. Prior to Mr. Doe’s incarceration, he resided with his parents when he was not hospitalized.

During the summer of 2000, Mr. Doe went to Taipei as an English teacher. His parents reported that, when he returned home for the fall semester, his mental deterioration began. Records indicate that he was initially believed to be suffering from a depressive episode during the fall/winter of 2000 to 2001. He reported using marijuana daily between August 2000 to August 2001. He was noted to have gone on a drug binge in August of 2001, using cocaine, marijuana, ecstasy, and mushrooms for approximately one week while on a trip to Montreal with his fraternity brothers. Records from the family indicate that he had his first admitted hallucination of fighting a dragon at this time.

When he returned to school in fall 2001, he was further isolating himself, and had also become paranoid. Records from his family indicate that he was destroying and/or burying in the woods his personal belongings, including taking all of his clothes to a thrift store. He reported a need to “cleanse himself.” His family reported that he decreased his food intake to a half a piece of bread daily for the purpose of “ritual cleansing,” and to examine/overcome the concept of “what is need and what is want.” In September 2001, he locked himself in his room for five days, turning off the lights, unplugging the phone, TV, etc., and minimally drinking in an effort to “do well with control and self-discipline.” Between August and November of 2001, he lost 40 pounds. His family records note that he fell into a deep depression, which continued to occur the following years during the fall and winter months.

After Mr. Doe refused treatment and medication, he continued to deteriorate. In October 2001, he was reported to be mute often; and he overate to the point of physical pain. The patient reported that he was punishing himself. His parents reported that he often eloped to the woods for days at a time. He was brought, involuntarily, by police to Canada Hospital on 11/02/01. Hospital records indicated that he eloped on 11/05/01, was returned by his parents within hours, and subsequently eloped again on 11/06/01. He was found a week later by police, seeming to have lived in the streets for the duration of his absence. At this time, it was noted that he was not showering, for several weeks to months. Records indicate that he received intravenous medication for approximately one month due to his refusals to take oral medication. This was discontinued in December 2001 when Mr. Doe agreed to accept oral medication. His symptoms were noted to improve; however, he eloped on 01/14/02, and was not found by police.

According to his family, he then lived at home for the next few years, continuing to exhibit bizarre behaviors including: outings to the woods, sleeping with knives, having beliefs about a “troop” being after his family, paranoia regarding vampires, demonstration of poor hygiene including not showering or brushing his teeth for one year, and further isolation. In 2003, there was an episode noted in which he painted himself all white, as well as everything in his room, indicating that he had been enlightened. He then left the home to try to enlighten others, but scared a homeless man and the police were called. He was not charged with anything due to his parents’ intervention and their subsequent report of his mental condition to police.

In March 2005, his parents reported that he unlawfully entered a dwelling. His parents indicate that he was not intending to harm anyone or steal anything, but that he was trying to get out of the elements after spending time in the woods. He was hospitalized at Canada Forensic Hospital in April 2005 due to unlawfully entering a dwelling and resisting arrest. Records indicate that he was found competent and capable of attending trial. His parents reported that the case was dismissed due to his psychiatric issues.

In July 2005, his family moved to another town in Canada. Records from the family note that he began using marijuana heavily again in the summer of 2005, often isolating himself behind the garage listening to rave music and “communicating with the stars.” In November 2005, he was admitted to the burn unit at a hospital after he burned his chest and back while burning the clothes he was wearing. His family records note that he was very psychotic during this episode and that the burns were intentional. His family noted “lashing” marks, as though he hit himself with a flaming article of clothing. Records indicate that he left the hospital AMA, and peeled off and ate all of his dead skin from the burns.

Records sent by his parents from his hospitalizations note Mr. Doe being involuntarily admitted, with the last occurrence in December 2005, due to being “acutely psychotic, delusional, without any insight into his illness, with periods of agitation, with high risk to act on his delusions if left untreated, with potential of danger to his own safety or safety of others.” It was noted that he “presented with significant disorganization in thought process with tangentially to loosening of association with persecutory delusions believing his family and himself being in life threatening danger including rape and murder. Up until recently, in his hospital room, he was keeping lots of garlic ‘to keep demons and vampires away.’ During most of his interviews he has been quite agitated with verbal aggression and body posturing and staring intently to intimidate others especially nursing and medical staff. On many occasions he has gestured to ‘curse’ the staff. He believes he has the ability to curse people and make them suffer.” Additionally it is noted that, prior to this hospitalization, he “was brought by police, after he had called two different police detachment units and reported life threatening danger to his parents. His family reported that he was extremely paranoid before his admission, often sleeping with a knife. Mr. Doe reported having an overwhelming ‘intuition’ or ‘sense’ that his parents were going to be murdered and his mother raped. At the time, he eloped from home, hitchhiked, he became insomniac, extremely agitated, his behavior became very paranoid (e.g. carrying a knife with him at all times, telling parents to take their lives if an attack is going to be imminent). His parents feared that he could act on his thoughts, e.g., ‘he could attack us.'” He was noted to have escaped in January 2006.

He was captured by police in January 2006 and returned to the hospital. He was later transferred to the Canada Hospital. At that time, he agreed to take Clozapine; and after his symptoms diminished, he was released in July 2006. Records from the family indicate that Mr. Doe was doing well and was believed to be taking the medication until December 2006. During this time when he was medication compliant, he was noted to be less isolated, to have enjoyed some activities, and that the entire family reported they had “a really great Christmas.”

In January 2007, he again began to isolate himself and become depressed. He was noted as becoming very persistent in seeking and using marijuana in early 2007. His family reported that he listened to rave music on headphones, sometimes for 6-8 hours straight. He was noted to laugh, scream, and make strange noises, which appeared to be related to internal stimuli. In March 2007, he was noted to present with grandiose delusions of being the next Messiah, and having direct relations with God, Jesus, and “the Archangel.” His family reported that he regularly had conversations with these individuals. An incident is noted in which he threw a book into a fire, then retrieved it and placed it underwater, and then took it outside to the river. According to Mr. Doe, he believed the book to have turned into a demon and then into the Archangel (thus his need to save it). He also believed that the river behind the family home was sacred. He was noted to have gone to the river in the winter, disrobe, and get entirely under the water, in order to “cleanse” himself from demons.

Between March and May of 2007, he was noted to take multiple cold showers throughout the day to “cleanse” himself, leave food outside to “feed the spirits,” and holding his breath all day long to “avoid letting demons enter him.” He was noted to not be speaking and spending most of his day underneath a blanket holding a knife. In April 2007, his brother moved from the family home. In late April, Mr. Doe reported a desire to move to Halifax, secured a room and a job, and moved there on 05/01/07.

The crimes occurred in the beginning of May 2007. According to the patient’s own report, he went to a known location for prostitution in Halifax. He reported being commanded there, and that he was the “angel of judgment.” He reported getting into a vehicle with a man and driving to a secluded location where the man made sexual advances at Mr. Doe. Mr. Doe’s reports indicate that he cut the man’s throat and that he believed he was fighting the devil. He reported a similar experience during his second crime, in which he waited for hours in a known location for homosexual activity “while being tortured by vampires.” He reported that he was prepared to leave when a car drove up and “it was Satan himself.” He again reported cutting the individual’s throat. Records note that he then fled by car to the U.S. where he shot and killed another man, an act for which the motive appears to have been to secure another vehicle. He reported that he was told to do so by an angel. According to Mr. Doe he was attempting to flee to Mexico “to find safety in the forest.” He was apprehended at the Texas border and returned to the county of his original crimes in the U.S.

Since his incarceration, he has not taken any psychiatric medications and continues to demonstrate psychotic processing. He attempted suicide once at the county jail, in September 2007 by biting his wrist because he “believed that he was a spirit and could walk through the wall.”

Mr. Doe is currently housed at Correctional Facility in General Population; however, he is on a unit that is largely populated by inmates with serious mental illness. He does not speak often about having a mental illness currently, but does indicate that he had Schizophrenia in the past. He is known to sleep minimally, is paranoid, and demonstrates strange mannerisms in his speech and movement. Officers note that he is often fighting imaginary people in his cell, particularly at night. His eye contact is often poor and is threatening in nature. He currently takes all meals in his cell so that he can spend more time “meditating.” He has significant support from his family, whom he calls on a regular basis. His family reports that he remains psychotic and he believes that he is a higher religious being. While he has had no disciplinary infractions during his incarceration, he has needed officer intervention several times to avoid any major trouble with other inmates. He remains focused on not hurting himself or others as he is strongly against forced medication and remains unwilling to do anything to risk such.

He is receiving mental health services and carries a diagnosis of Schizophrenia–Paranoid Type, and Personality Disorder NOS.

Behavioral Observations and Mental Status

Mr. Doe has been interviewed on multiple occasions since January 2009; the following is a summary of his general behavior and mental status.

Mr. Doe is a 35-year-old Caucasian male, who walks with a stiff gait, similar to a military style. In addition, he is noted to position himself when walking or seated such that no one is behind him. Related to this, officers note that he will not let other inmates hold the door for him and instead insists that they walk in front of him. He was dressed in institutional clothing and appeared in good hygiene. He is noted to have a goatee, and his hair is styled with gel. He has not cut his hair since his incarceration, although he grooms his facial hair regularly. Of note, on one occasion he shaved lightning bolts into his facial hair, claiming that “the earth made me do it.” He appeared his stated age. He is oriented times three. There were no signs of depression or agitation today, although he was noted during initial interviews to appear more hostile, often with a threatening yet avoidant glance at the interviewer (as well as other staff). His eyes are often squinted, with his forehead lowered as though he is almost trying not to make any eye contact. When he meets the gaze of someone, he is often noted to look away. Mental health records note that he believes that “demons can see inside you through your eyes.”

In more recent meetings with this interviewer, the patient’s gaze has become softer and less threatening. He consistently denies suicidal or homicidal ideation, intent, or plan, and in fact discusses at great length his desire not to demonstrate anything similar to those ideas due to his fear of forced medication. His affect is usually flat, except for a few moments when he demonstrated some emotional response during an interview. The most noticeable affective response was following Rorschach testing when he demonstrated some anxiety, but also joked briefly with this writer. He is generally calm during interviews, although he is noted to be uncomfortable when the door is closed, when there are unfamiliar people in the interview, or when there is significant activity outside in the hallway. He generally gets anxious at some point in most interviews and requests to leave; it often appears abrupt and awkward and is usually related to a topic he would not like to discuss. He has never shown any signs of hallucinations or delusions during interviews; however, he is noted by officers to appear to be responding to such in his cell. Thought content is mostly reality-based; however, it is extremely pseudo-philosophical in nature. He is very difficult to follow due to his manner of speech, difficulty responding directly to questions, and tangentiality. He often becomes tangential but does always return to the original question asked. He presents as intelligent and is deliberate in his speech such that he does not reveal any information that could be directly linked to psychotic processing. When he nears this topic area he often stops and states that he does not want to discuss that issue. During testing, he readily attempted all tests and worked in an effortful manner. He completed testing very rapidly, which will be discussed further as it relates to specific testing. He demonstrated no problems related to attention and concentration. Speech was of normal rate and prosody. He had many questions about his success and failure on the test, which appeared reflective of decreased self-esteem.

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