Ethical Vignettes In Rehabilitation

Ethical Dilemma

The following vignette describes a situation that has ethical implications. Carefully read the vignette and then consider the questions that follow.

Eric is a 29-year-old man with a history of many psychiatric hospitalizations. He has been referred to a number of PsyR programs in the past, but has been difficult to engage. Eric's symptoms typically include restlessness, confusion, and paranoia, and while he seems to respond well to antipsychotic medications, he frequently refuses to take them. Following a hospital discharge, Eric returns home to live with his mother and is assigned to an assertive community treatment program in which a team of staff provides services for Eric at his home. Eric is reluctant to talk with the team members when they visit and more often than not, despite pleas from his mother, refuses to take medication. The team decides to implement the following plan: Eric's mother, who is the payee for his monthly disability check, will give him a weekly allowance of spending money if he complies with the following conditions: (1) taking his medication as prescribed twice a day, and (2) talking with the team members when they visit. Each time Eric refuses to take a dosage or talk to the staff, he will be docked a specific amount of money. The staff's rationale is that coercion is necessary to both prevent exacerbation of symptoms and to establish a relationship with Eric. Eric resents the plan, but needs money for cigarettes so he goes along with it.


1. From the team's point of view, how can their plan help Eric achieve the PsyR goals of recovery, community integration, and a better quality of life?

2. From Eric's point of view, what are the negative implications of the team's plan? Can the plan interfere with the achievement of the PsyR goals mentioned above?

3. Is the plan consistent with PsyR values such as self-determination?

4. If the answer to Question 3 is no, can you think of a plan that would be helpful to Eric and be more consistent with PsyR values?

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