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 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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  • Both Part I and Part II of Ethical Decision Making are excellent. I highly recommend this series.
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Ethical Decision-Making (Part 2)

  1. 1. By John Gavazzi, PsyD ABPP
  2. 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. 3.  We reviewed that ethical decision-making can be complex
  4. 4. Rational Psychologist: Know the Code!! Psychologist Patient Learn the rules Apply the rules Outcomes will follow
  5. 5. PatientPsychologist Learn the rules Apply the rules Outcomes will follow Understand patient dynamics Understand the relationship Know the Code + Know your patient
  6. 6.  Distinguish ethical decision-making from clinical decisions, risk management, and legal questions (even though there is overlap)
  7. 7.  We reviewed the Acculturation Model both as ways to acculturate to psychology as well as how ethical decisions are made
  8. 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. 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. 10. Autonomy Beneficence Nonmaleficence Fidelity Justice
  11. 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. 12. Often ethical dilemmas involve apparent conflicts between respect for patient autonomy versus beneficence
  13. 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. 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. 15. S Scrutinize H Hypothesize A Analyze P Perform E Evaluate
  16. 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. 17. “integrative framework” steps two and three generate solutions that maximize your personal values within the context of your professional role
  18. 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. 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. 20.  Malcolm Gladwell’s book “Blink”  Jonathan Haidt’s book on Moral Intuition  David Pizarro’s work on motivated moral reasoning
  21. 21.  Top down approach  Start with ethical principles  Work from those principles to make good decisions about our work
  22. 22.  Intuitive  Automatic  Emotional  Rapid
  23. 23. Why do psychologists (still and continue to) have sex with their patients?
  24. 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. 25.  The Fundamental Attribution Error  Actor Observer Bias  Availability Heuristic  Trait Negativity Bias  Confirmation Bias  Competence Bias
  26. 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. 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. 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. 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. 30.  The cognitive style in which psychologists look for evidence to confirm their beliefs about the patient or the situation.  Motivated moral reasoning
  31. 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. 32.  Length of time in treatment  Patient complexity  Emotional intensity/therapeutic relationship  Current focus (or lack thereof) in treatment
  33. 33. A Brief Review
  34. 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. 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. 36. Why study ethics and ethical decision- making as a part of clinical practice?
  37. 37.  Fiduciary Responsibility  Providing the highest quality of care possible  Reinforcing doing the best possible for your patient  Better treatment outcomes
  38. 38. Independent Actions Help from others  Self Reflection  Documentation  Transparency  Continuing Education  Self-care  Consultation  Supervision  Psychotherapy  Continuing Education
  39. 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. 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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