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Ethical Decision-Making (Part 2)
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Ethical Decision-Making (Part 2)

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In Episode 5, John continues to outline relevant factors related to ethical decision-making. The psychologist's fiduciary responsibility is emphasized. Additionally, John outlines one ethical …

In Episode 5, John continues to outline relevant factors related to ethical decision-making. The psychologist's fiduciary responsibility is emphasized. Additionally, John outlines one ethical decision-making model as well as cognitive biases and emotional factors involved with ethical decision-making. John will make suggestions on how to improve ethical decision-making.

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  • 1. By John Gavazzi, PsyD ABPP
  • 2.  Describe one decision-making model  Identify one cognitive bias and one emotional factor that can adversely affect ethical decision-making  Outline three strategies to aid with ethical decision-making
  • 3.  We reviewed that ethical decision-making can be complex
  • 4. Rational Psychologist: Know the Code!! Psychologist Patient Learn the rules Apply the rules Outcomes will follow
  • 5. PatientPsychologist Learn the rules Apply the rules Outcomes will follow Understand patient dynamics Understand the relationship Know the Code + Know your patient
  • 6.  Distinguish ethical decision-making from clinical decisions, risk management, and legal questions (even though there is overlap)
  • 7.  We reviewed the Acculturation Model both as ways to acculturate to psychology as well as how ethical decisions are made
  • 8. Acculturation Model of ethical development Integration Separation Assimilation Marginalization Higher on Professional Ethics Higher on Personal Ethics Lower on Personal Ethics Lower on Professional Ethics
  • 9.  We reviewed the five foundational principles on which the APA ethics code is founded  We touched on the idea that the APA ethics code does not have an ethical decision- making strategy  Ethical dilemmas are usually a function of two competing foundational principles
  • 10. Autonomy Beneficence Nonmaleficence Fidelity Justice
  • 11.  Psychologist is the expert and has greater power in the relationship  Patient is vulnerable  Psychologist is ultimately responsible for what happens in treatment
  • 12. Often ethical dilemmas involve apparent conflicts between respect for patient autonomy versus beneficence
  • 13.  Identify the competing ethical principles  Help to determine which principle has precedence and why  The importance of emotion in ethical decision-making and moral judgments  Cognitive biases are also important to consider
  • 14. The APA Ethical Principles and Code of Conduct do not include a model of ethical decision-making Other resources may aid with decision- making, but do not highlight how to work through dilemmas
  • 15. S Scrutinize H Hypothesize A Analyze P Perform E Evaluate
  • 16. 1. Goal is to define the problem by identifying the conflicting ethical principles 2. Generate a wide range of possible solutions and identify pros and cons 3. Merge or knit the possible solutions together in a way that maximizes the benefits and limits the disadvantages 4. Implement 5. Look back or evaluate
  • 17. “integrative framework” steps two and three generate solutions that maximize your personal values within the context of your professional role
  • 18. Avoid dichotomous thinking– either I have to do x or y. Duty to Warn example: either I have to warn the potential victim of a threat or I have to protect confidentiality.
  • 19. 1. We have to train ourselves to think about larger ethical principles first 2. We need to have the ability to slow ourselves down prior to making good, ethical decisions Why?
  • 20.  Malcolm Gladwell’s book “Blink”  Jonathan Haidt’s book on Moral Intuition  David Pizarro’s work on motivated moral reasoning
  • 21.  Top down approach  Start with ethical principles  Work from those principles to make good decisions about our work
  • 22.  Intuitive  Automatic  Emotional  Rapid
  • 23. Why do psychologists (still and continue to) have sex with their patients?
  • 24. Negative emotions related to ethical and moral decision-making Positive emotions related to our good decision-making skills and ethical knowledge  Fear  Anxiety  Disgust  Disrespect  Passion  Calmness/Centered  Empathy  Respect/Sympathy  Elevation
  • 25.  The Fundamental Attribution Error  Actor Observer Bias  Availability Heuristic  Trait Negativity Bias  Confirmation Bias  Competence Bias
  • 26.  This cognitive style places an undue emphasis on the patient’s behavior in the therapeutic relationship  Overemphasis on the patient  Psychologist may lack insight into what s/he is doing to promote those responses
  • 27.  This cognitive style places an undue emphasis on external factors for the psychologist’s behavior  In an attempt to avoid responsibility, the psychologist can overemphasize the patient’s role in the ethical dilemma.
  • 28.  This cognitive error leads one to use information that readily comes to mind or easiest to access  Easiest to go with that which is most representative of the patient or scenario
  • 29.  When the psychologist more readily recalls unpleasant characteristics of the patient as compared with positive characteristics of the patient  It is common for psychologists to work with individuals they do not like or enjoy
  • 30.  The cognitive style in which psychologists look for evidence to confirm their beliefs about the patient or the situation.  Motivated moral reasoning
  • 31.  Dunning-Kruger Effect: a cognitive bias in which unskilled individuals suffer from illusory superiority, mistakenly rating their ability as much higher than average.  Poor performers fail to learn from their mistakes.  And, they fail to internalize direct feedback from others.
  • 32.  Length of time in treatment  Patient complexity  Emotional intensity/therapeutic relationship  Current focus (or lack thereof) in treatment
  • 33. A Brief Review
  • 34.  Knowledge base: APA code, foundational principles, state law, regulation, case law  Become aware of emotional factors  Remain aware of cognitive biases/situational factors  Patient/relationship factors  Outcomes are uncertain – Ambiguity remains
  • 35. Emotions Decision- making Skills Cognitive Biases External Rules Personal Ethics Psychologist Complexity Length of time in treatment Current focus in treatment Boundaries Patient Variables Therapeutic Alliance
  • 36. Why study ethics and ethical decision- making as a part of clinical practice?
  • 37.  Fiduciary Responsibility  Providing the highest quality of care possible  Reinforcing doing the best possible for your patient  Better treatment outcomes
  • 38. Independent Actions Help from others  Self Reflection  Documentation  Transparency  Continuing Education  Self-care  Consultation  Supervision  Psychotherapy  Continuing Education
  • 39.  Good general basis to contemplate and discuss ethical issues in psychological practice  Look at vignettes as training tools  Remain aware of ethical issues in your practice and work on skill building
  • 40.  Future podcasts will look at ethical-decision making, clinical issues, and risk management with vignettes on the Ethics and Psychology website  I will have guests to help review clinical vignette using the Acculturation Model, the foundational principles, personal biases (personal ethics and morality) and give possible options to resolve the dilemma

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