Case 1
During a combat deployment, a 47-year-old Army reservist engages in hostile fire while on patrol and fires back, only to learn afterward that one of the combatants who was shot and died appears to be a young boy. Upon return from the war zone several months later, the patient struggles when interacting with others, especially when being recognized by civilians as a “hero” for his military service. The patient now has guilt, shame, anger, irritability, intrusive thoughts, and nightmares. He is angry at his unit leadership for putting him in this position and presents to the clinic for your assistance.
1.1: Several issues that the patient describes at his initial visit involve ethical judgments for the treatment provider. Which of the following clinician behaviors is NOT an appropriate response to the patient’s account of his moral concerns?
A. Maintain a neutral position and attempt not to take sides with any interpretation.
B. As part of building a therapeutic alliance, agree with the patient that his commanding officer may have made a mistake and add that all people some- times make mistakes.
C. Over the course of treatment, perhaps at a later point, consider mentioning the possibility that his commander likely did not intend to put him in a morally difficult situation.
D. Initiate pharmacotherapy and recommend not exploring this set of issues until his anger symptoms are under better control.
E. Validate the patient’s experience of suffering.
1.2: Like others throughout society, providers may choose to use a variety of words to describe death. Do you ask him about when he had to “kill” versus “take out” versus “eliminate” the adversary? Do you alter the experience by referring to it as “when you had to protect your friends . . .”? What are the main ethical principles that guide your choice of words while working therapeutically with the patient?
A. Veracity and justice
B. Beneficence and nonmaleficence
C. Justice and autonomy
D. Confidentiality and veracity
E. Nonmaleficence and autonomy
