Interactive Ethics

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Use vignettes from www.papsyblog.org

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Interactive Ethics

  1. 1. John Gavazzi, PsyD ABPP January 13, 2012
  2. 2.  Learning Objectives Online Information: Ethics blog and other sites Structured information sharing Vignette analysis and case discussions
  3. 3. 1. List at least three ethical principles related to APA’s code2. Compare and contrast positive ethics and risk management3. Describe the Acculturation Model4. Explain one ethical decision-making model5. Analyze one ethical vignette by identifying conflicting principles
  4. 4. www.papsyblog.orgWhere Ethics is More Than a Code
  5. 5.  Ethics Blog Self-education Connecting with others: Blogs & other sites Becoming politically active
  6. 6.  Introduction and Applicability Preamble and General Principles (Aspirational and based on principle-based ethics) Ethical Standards (Enforceable and represent minimum standards)
  7. 7.  The ethics code does not include federal laws, such as HIPAA The ethics code does not include case law, though influence is noted The ethics code is distinct and separate from guidelines approved by the APA Council of Representatives Quiz Question: How many are there?
  8. 8. Autonomy BeneficenceNonmaleficence Fidelity Justice
  9. 9.  Does not mean promoting autonomy (individuation or separation) Means respecting the autonomous decision making ability of the patient
  10. 10. It encompasses freedom of thought and action. Individuals are at liberty to behave as they chose. - Determining goals in therapy - Making life decisions (e.g., marriage, divorce) - Scheduling appointments and terminating treatment
  11. 11.  The principle of benefiting others and accepting the responsibility to do good underlies the profession. - Providing the best treatment possible - Competency - Referring when needed
  12. 12. Basis of foundational standard 2.01“Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence. . . “
  13. 13. The principle is doing no harm. - Demonstrating competence - Maintaining appropriate boundaries - Not using an experimental technique as the first line of treatment - Providing benefits, risks, and costs
  14. 14. Foundational Standard 3.04“Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm when it is foreseeable and unavoidable.”
  15. 15. This principle refers to being faithful to commitments. Fidelity includes promise keeping, trustworthiness, and loyalty. - Avoiding conflicts of interests that could compromise therapy - Keeping information confidential - Adhering to therapeutic contract (e.g., session length, time, phone contacts, etc.)
  16. 16. Foundational Standard 4.01“Psychologists have a primary obligation and take reasonable precautions to protect confidential information.”
  17. 17. Justice primarily refers to treating people fairly and equally.In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law. (3.01)
  18. 18. A process to change the cultural behavior of an individual through contact with another culture. The process of acculturation occurs when there is an adaptation into an organization or society.The process involves developing relationships with those within the culture to learn the traditions, rules, roles, and behaviors to become part of that group or community.
  19. 19.  Our system of common beliefs, shared meanings, norms and traditions that distinguish psychologists as professionals. It is a learned set of skills, bases of knowledge and ethical beliefs, as described in our ethics code.
  20. 20.  Our culture of ethics moves beyond ourselves as individual psychologists. Expands into our ability to become connected with the profession of psychology as well as other professionals. Our ethical culture “happens” everyday when we relate to our patients, peers, or general population.
  21. 21.  Can be a complex process Some parts of a psychologist’s behaviors, practice, and lifestyle may be easily acculturated; while others will not Process that may continue throughout the education or career as a psychologist
  22. 22.  Ethics Autobiography Exploring religious upbringing Exploring interpersonal relationships
  23. 23. Meme: a cultural unit (an idea or value or pattern of behavior) that is passed from one person to another by non-genetic means (as by imitation);"memes are the cultural counterpart of genes"
  24. 24. Identification with personal value system (high vs. low)Identification with value system of psychology (high vs. low)These are on a continuum more so than boxes.
  25. 25. Acculturation Model of Ethical Decision-making Higher on Professional EthicsLower on Professional Ethics Integration SeparationHigher on PersonalEthics Assimilation Marginalization Lower on Personal Ethics
  26. 26. Style:Lower focus on professional ethics Lower focus on personal ethicsRisks: Greatest risk of harm Lack appreciation for ethics Motivated by self-interest Less concern for patients
  27. 27. Style:Lower focus on professional ethics Higher focus on personal ethicsRisks:Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
  28. 28. Style: Higher focus on professional ethics Lower focus on personal ethicsRisks: Developing overly legalistic stance Rigidly conforming to individual rules while missing broader issues
  29. 29. Style:High focus on professional ethics High focus on personal ethicsReward:Implement values in context of professional roles Reaching for the ethical ceilingAspirational ethics
  30. 30. Our level of acculturation and our style of ethical decision-making
  31. 31.  Mandatory “floor” Minimum standards adopted by the profession Focus on the law or standards to protect the public
  32. 32.  A means to reduce risk in an uncertain situation Decision-making strategies to avert problems or liability of the psychologist False risk management strategies (memes, such as the No Suicide Contract)
  33. 33.  No evidence to indicate that it helps reduce suicidal behavior Cannot be used an part of an assessment Contract implies a legal tool to reduce risk May actually harm the therapeutic alliance, not promote it
  34. 34.  Overemphasis on regulations and enforceable standards Incomplete view of ethics Ethics is more than just a code
  35. 35.  Ethics as a movement away from the punishment and anxiety-producing components of ethics Fulfill their highest ideals A means to help interpret and apply ethics standards
  36. 36.  An avoidance of ethical codes, case law, regulations, and statutes A rationalization to explain inappropriate behaviors or decisions
  37. 37.  Broadens a psychologist’s understanding of ethics in a larger context Sensitize psychologists to ethical implications of decisions on a daily basis
  38. 38.  Heighten awareness related to ethics beyond our offices Assist psychologists in balancing competing ethical demands
  39. 39. Remedial: Acquiring and maintaining minimal formal qualificationsPositive: Striving for highest standards Includes self-awareness and self-care Emotional competence
  40. 40. Remedial: Avoiding boundary violations Focus on sexual boundaries Adhere to strict interpretationPositive: Striving to enhance quality of all professional relationships Understand issues related to multiple relationships
  41. 41. Remedial: Fulfilling legal responsibilities to get consent forms or Privacy Notices signedPositive: Working to maximize client participation with goals and treatment processes
  42. 42. Remedial: Avoiding prohibited disclosure Emphasis legal requirementsPositive: Striving to enhance trust Understanding nuances when working with families
  43. 43. What are some options?
  44. 44. The APA Ethical Principles and Code of Conduct do not include a model of ethical decision-making
  45. 45.  The means to comply with a standard may not always be readily apparent Two seemingly competing standards may appear equally appropriate Application with of a single standard or set of standards appear consistent with one or more aspirational principle, but not another
  46. 46. Often ethical dilemmas involve apparent conflicts between respect for patient autonomy versus beneficence orRespect for autonomy versus general or public beneficence
  47. 47. S ScrutinizeH HypothesizeA AnalyzeP ProceedE Evaluate
  48. 48. 1. Goal is to define the problem2. Generate a wide range of possible solutions and identify pros and cons3. Merge or knit the possible solutions together in a way that maximizes the benefits and limits the disadvantages4. Implement5. Look back or evaluate
  49. 49. “integrative framework”steps two and three generate solutions that maximize your personal values within the context of your professional role
  50. 50. Avoid dichotomous thinking– either I have to do x or y.For example, either I have to warn the potential victim of a threat or I have to protect confidentiality.
  51. 51.  Overemphasis on regulations and enforceable standards “Thou shall not” oriented Minimum standards or the “ethical floor” Incomplete view of ethics
  52. 52.  Ethics as a movement away from the punishment and anxiety-producing components of ethics Fulfill their highest ideals A means to help interpret and apply ethics standards
  53. 53.  Knowledge base: APA code, Pennsylvania law, regulations Emotional factors Cognitive biases/situational factors Outcomes are uncertain
  54. 54.  Ethics occurs within the therapeutic relationship Commitment to the relationship and high quality of care Pulling together the code, your training, and current professional role within the context of the relationship with patient
  55. 55.  Ethics happens within the relationship Active approach to ethics, the relationship, and decision-making Combines psychologist factors (which includes emotions and biases) with clinical features and the patient

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