Ethical Issues in Working with Children in the Consultation-Liaison Context

Abstract

Children needing input from a mental health professional in a general hospital setting is on the increase in India, with the advances in awareness among paediatricians and the willingness of parents to follow through on a referral that is made. In this context, unique ethical issues while working with this group are emerging and need to be kept in mind while planning intervention (APA 1990). Some general ethical principles when working with children are relevant to the consultation-liaison setting as well—issues regarding confidentiality, informed consent, respecting boundaries, data recording and protection of data, communication with the stake holders and considerations when using email or the telephone. In addition, some unique issues are relevant to the general hospital setting. This includes issues with documentation—access of medical records to multiple medical professionals, the physical setting where the therapeutic work is undertaken—sometimes at the bedside, sometimes in the corridor, and other times, at the intensive care unit. Issues with regard to time constraints—there may just be one session before discharge, consultation with the physician in charge—who may or may not be sensitive to the psychological needs, are all relevant. In addition, child variables—physically not being able to handle long therapy sessions, not having a say in the decision-making and family variables—multiple decision-makers and lack of psychological sophistication all need to be kept in mind. All the above issues are discussed in detail and an overview of its relevance and utility in the Indian setting is provided.