Integrating ethics and values


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Integrating ethics and values

  1. 1. John Gavazzi, PsyD ABPP November 1, 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 and Positive Ethics is more than a Slogan
  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.  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
  19. 19.  Broadensa psychologist’s understanding of ethics in a larger context Sensitizepsychologists to ethical implications of decisions on a daily basis
  20. 20.  Heighten awareness related to ethics beyond our offices Assist psychologists in balancing competing ethical demands
  21. 21. Remedial: Acquiring and maintaining minimal formal qualificationsPositive: Striving for highest standards Includes self-awareness and self-care Emotional competence
  22. 22. 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
  23. 23. Remedial: Fulfilling legal responsibilities to get consent forms or Privacy Notices signedPositive: Working to maximize client participation with goals and treatment processes
  24. 24. Remedial: Avoiding prohibited disclosure Emphasis legal requirementsPositive: Striving to enhance trust Understanding nuances when working with families
  25. 25. 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.
  26. 26.  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.
  27. 27.  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.
  28. 28.  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
  29. 29.  Ethics Autobiography Exploring religious upbringing Exploring interpersonal relationships
  30. 30. 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"
  31. 31. 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.
  32. 32. Acculturation Model of Ethical Decision-making Higher on Professional Ethics Lower on Professional Ethics Integration SeparationHigher on PersonalEthics Assimilation Marginalization Lower on Personal Ethics
  33. 33. 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
  34. 34. Style: Lower focus on professional ethics Higher focus on personal ethicsRisks: Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
  35. 35. Style: Higher focus on professional ethics Lower focus on personal ethicsRisks: Developing overly legalistic stance Rigidly conforming to individual rules while missing broader issues
  36. 36. Style: High focus on professional ethics High focus on personal ethicsReward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
  37. 37. Our level of acculturation and our style of ethical decision-making
  38. 38.  Mandatory “floor” Minimum standards adopted by the profession Focus on the law or standards to protect the public
  39. 39.  Overemphasis on regulations and enforceable standards Incomplete view of ethics Ethics is more than just a code
  40. 40.  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)
  41. 41.  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
  42. 42. What are some options?
  43. 43. Rational Psychologist Learn the rules Apply the rules Outcomes will follow
  44. 44. Learn the rules Understand patientApply the rules dynamicsOutcomes will follow Understand the relationship
  45. 45. Psychologist Patient Variables Therapeutic Alliance
  46. 46.  Looking at how well a psychologist integrates his/her values and behaviors into the ethical culture of psychology Psychology has a set of normative principles and behaviors related to ethical behavior and appropriate conduct
  47. 47.  APA’s Code of Conduct Commonwealth Psychology regulations found in the Psychology Law and Practice Act Federal Regulations, such as HIPAA Court decisions aka case law
  48. 48. The APA Ethical Principles and Code of Conduct do not include a model of ethical decision-makingOther resources dictate behavior, but do not highlight how to work through dilemmas
  49. 49.  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
  50. 50.  Autonomy Beneficence Nonmaleficence Fidelity Justice
  51. 51. Often ethical dilemmas involve apparent conflicts between respect for patient autonomy versus beneficence or Respect for autonomy versus general or public beneficence
  52. 52.  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
  53. 53. S ScrutinizeH HypothesizeA AnalyzeP PerformE Evaluate
  54. 54. 1. Goal is to define the problem by identifying the conflicting ethical principles2. 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
  55. 55. “integrative framework” steps two and three generate solutions thatmaximize your personal values within the context of your professional role
  56. 56. 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.
  57. 57.  Malcolm Gladwell’s book “Blink” Jonathan Haidt’s book on Moral Intuition Jay Mills article on emotions in ethical decision- making
  58. 58.  Fear  Passion Anxiety  Calmness/Centered  Empathy Disgust  Respect/Sympathy Disrespect Positive emotions related to our goodNegative emotions related to ethics decision-making skills and ethicaland moral decision-making knowledge
  59. 59. Why do psychologists (still and continue to) have sex with their patients?
  60. 60.  The Fundamental Attribution Error Availability Heuristic Trait Negativity Bias Confirmation Bias
  61. 61.  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.
  62. 62.  Knowledge base: APA code, Pennsylvania law, regulations Become Aware of emotional factors Cognitive biases/situational factors Outcomes are uncertain