I would second most of what @FlorianH said, though not necessarily the specific procedure. The general idea of actually weighing the relative harms and their likelihoods, and comparing the results, is the key to resolving these kinds of conflicts. Although you probably shouldn’t keep records of doing that, since most people and legal systems don’t like anyone explicitly assigning lives a specific finite value.
In your suicidal young girl scenario, what does it actually mean, specifically, to not be technically competent? Is there a particular certification you’re required to have to perform some specific therapy? That seems plausible, but also, as a professional you’re well aware that there are many approaches to helping any given person that are all better than nothing, and you can avoid ones you’re not comfortable with. Even having a conversation with a non-professional is well known, in the literature, to be significantly better than nothing, and in many cases close to as good as talking to a professional (for any number of reasons).
Is there some certification required to work with such a person at all? That seems… implausible? Odd? It seems like any rule that says something like that is more like how you should see a dermatologist instead of having your primary care doctor treat a rare skin condition. If every local dermatologist has a six month waiting list for an appointment, your regular doctor should absolutely be willing to help you, and make a phone call to consult with colleagues as needed. Even if there’s no one else in your town or remotely available to actually care for this person, there’s nothing preventing you, the professional, from consulting with more distant colleagues between sessions, with patient approval.
You may also be legally required to report this to the girl’s parents, whether you treat her or not.
You may have a way to involuntarily commit this girl, in which case there is likely to be some authority that has the resources and obligation to move her to a place that can provide more intensive care.
Beyond that, even if you’re motivated primarily by professional self-interest and lawsuits, consider the two scenarios, where a girl has died and you’re being sued or charged. In which case would you expect the judge or jury to be more lenient? The one where you turned her away out of fear of impacts on your career? Or the one where you exhausted all of the known-to-be inadequate options available?
And I would also say, take a really close look at how the ethical standards you’re officially held to are actually written, but without getting lost in the weeds of vague wording. Consider the APA’s Code of Ethics. Consider that things were written in a specific order, for a reason. Right in the Preamble: “This Ethics Code is intended to provide specific standards to cover most situations encountered by psychologists.” Most, not all. Also in the Preamble: “The development of a dynamic set of ethical standards for psychologists’ work-related conduct requires a personal commitment and lifelong effort...to consult with others concerning ethical problems.” Then, before getting into any specific guidelines, you also have a set of general principles that are the standard kinds of Virtue Ethics exhortations to be caring and humane. The actual rules that attempt to operationalize all of this come after that. Usually, this means what came before is intended as the frame through which you’re meant to interpret and adjudicate what comes later.
Also also, if you go way back to the early days of LessWrong, EY wrote a post, Prices or Bindings?, as part of a longer ethics sequence (you may want to read that sequence and the comments). It gets into when ethical injunctions should be absolute, and when not, and why. Ideally you consider not just the implications of your actions for yourself and this girl, but on all other people, everywhere, forever. Humans can’t actually compute that, but we can try to approximate it using fundamental values as guideposts. What is it you, personally, actually care most about? And why? What plans and choices actually, in practice, are likely to lead to a world where whatever you care about flourishes?
I would second most of what @FlorianH said, though not necessarily the specific procedure. The general idea of actually weighing the relative harms and their likelihoods, and comparing the results, is the key to resolving these kinds of conflicts. Although you probably shouldn’t keep records of doing that, since most people and legal systems don’t like anyone explicitly assigning lives a specific finite value.
In your suicidal young girl scenario, what does it actually mean, specifically, to not be technically competent? Is there a particular certification you’re required to have to perform some specific therapy? That seems plausible, but also, as a professional you’re well aware that there are many approaches to helping any given person that are all better than nothing, and you can avoid ones you’re not comfortable with. Even having a conversation with a non-professional is well known, in the literature, to be significantly better than nothing, and in many cases close to as good as talking to a professional (for any number of reasons).
Is there some certification required to work with such a person at all? That seems… implausible? Odd? It seems like any rule that says something like that is more like how you should see a dermatologist instead of having your primary care doctor treat a rare skin condition. If every local dermatologist has a six month waiting list for an appointment, your regular doctor should absolutely be willing to help you, and make a phone call to consult with colleagues as needed. Even if there’s no one else in your town or remotely available to actually care for this person, there’s nothing preventing you, the professional, from consulting with more distant colleagues between sessions, with patient approval.
You may also be legally required to report this to the girl’s parents, whether you treat her or not.
You may have a way to involuntarily commit this girl, in which case there is likely to be some authority that has the resources and obligation to move her to a place that can provide more intensive care.
Beyond that, even if you’re motivated primarily by professional self-interest and lawsuits, consider the two scenarios, where a girl has died and you’re being sued or charged. In which case would you expect the judge or jury to be more lenient? The one where you turned her away out of fear of impacts on your career? Or the one where you exhausted all of the known-to-be inadequate options available?
And I would also say, take a really close look at how the ethical standards you’re officially held to are actually written, but without getting lost in the weeds of vague wording. Consider the APA’s Code of Ethics. Consider that things were written in a specific order, for a reason. Right in the Preamble: “This Ethics Code is intended to provide specific standards to cover most situations encountered by psychologists.” Most, not all. Also in the Preamble: “The development of a dynamic set of ethical standards for psychologists’ work-related conduct requires a personal commitment and lifelong effort...to consult with others concerning ethical problems.” Then, before getting into any specific guidelines, you also have a set of general principles that are the standard kinds of Virtue Ethics exhortations to be caring and humane. The actual rules that attempt to operationalize all of this come after that. Usually, this means what came before is intended as the frame through which you’re meant to interpret and adjudicate what comes later.
Also also, if you go way back to the early days of LessWrong, EY wrote a post, Prices or Bindings?, as part of a longer ethics sequence (you may want to read that sequence and the comments). It gets into when ethical injunctions should be absolute, and when not, and why. Ideally you consider not just the implications of your actions for yourself and this girl, but on all other people, everywhere, forever. Humans can’t actually compute that, but we can try to approximate it using fundamental values as guideposts. What is it you, personally, actually care most about? And why? What plans and choices actually, in practice, are likely to lead to a world where whatever you care about flourishes?