Episode 4: Ethical Decision-making (Part 1)

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This is a companion Powerpoint to Ethics & Psychology Podcast on ethical decision-making.

The importance of this podcast and Episode 5 is to set up vignette analysis in future podcasts. Everyone needs to be on the same page in order to apply ethical decision-making in instructional or real life situations.

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Episode 4: Ethical Decision-making (Part 1)

  1. 1. John Gavazzi, Psy.D. ABPP
  2. 2.  Describe the difference among ethical and clinical decision-making  Outline the Acculturation Model  List the five foundational principles for ethical decision-making
  3. 3. The process is often ambiguous
  4. 4. 1. Move away from the “ethical” versus “unethical” decision. 2. In some ethical decisions, there is not “right” or “correct” answer for everyone. 3. Most clinicians make ethical decisions on a daily basis
  5. 5. Rational Psychologist: Know the Code!! Learn the rules Apply the rules Outcomes will follow
  6. 6. Learn the rules Apply the rules Outcomes will follow Understand patient dynamics Understand the relationship Know the Code + Know your patient
  7. 7.  Clinical Decision-making  Risk management  Legal Decision-making  Ethical Decision-making ◦ Professional Ethics ◦ Personal Ethics, Values, or Morality
  8. 8.  What is the best clinical intervention for this patient in this situation?  What are the best psychological instruments to answer the referral question?  Am I conceptualizing this patient correctly?  My patient continues to struggle after eight sessions. What should I do?
  9. 9.  How do I work with a patient to minimize risk or liability?  Avoid types of work that have high liability risks, such as custody evaluations or clinical complex patients.  Do I have essential paperwork signed? Informed Consent or practice policies current
  10. 10.  Always have a suicidal patient sign a “no suicide” contract  Never touch a patient  Always remain at a professional distance emotionally and socially  Boundary crossings vs. boundary violations
  11. 11.  Am I compliant with state laws and regulations?  Is my practice HIPAA compliant?  Am I aware of relevant case law in my state?  Questions are usually asked of an attorney
  12. 12. Professional Ethics Do I follow the American Psychological Association’s Code of Conduct? Am I aware of and do I comply with the APA’s Guidelines for treatment? Am I performing at the minimum or reaching for the aspirational ceiling?
  13. 13. Personal values, ethics, and morality Is what I am doing consistent with my values? What is my emotional response to the patient, lifestyle, or behavioral issue?
  14. 14.  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
  15. 15. One way of remaining a life-long learner Provides another way to discuss ethical behaviors and decisions
  16. 16. 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.
  17. 17.  An outgrowth of positive ethics that integrates personal ethics and professional obligations.  Psychology has a system of shared and distinctive norms, beliefs, and traditions.  This set of beliefs is reflected in our ethics code.
  18. 18.  Can be a complex process  Some parts of a psychologist’s practice and lifestyle may be easily acculturated while others not  Process that will likely continue throughout the education or career as a psychologist
  19. 19. Identification with personal value system (higher vs. lower) Identification with value system of psychology (higher vs. lower)
  20. 20. Acculturation Model of ethical development IntegrationIntegration SeparationSeparation AssimilationAssimilation MarginalizationMarginalization Higher on Professional Ethics Higher on Personal Ethics Lower on Personal Ethics Lower on Professional Ethics
  21. 21. Matrix: Lower on professional ethics Lower on personal ethics Risks: *Greatest risk of harm *Lack appreciation for ethics *Motivated by self-interest *Less concern for patients
  22. 22. Matrix: Higher on professional ethics Lower on personal ethics Risks: Developing an overly legalistic stance Rigidly conforming to certain rules while missing broader issues
  23. 23. Matrix: Lower on professional ethics Higher on personal ethics Risks: Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
  24. 24. Matrix: Higher on professional ethics Higher on personal ethics Reward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
  25. 25. Autonomy Beneficence Nonmaleficence Fidelity Justice
  26. 26.  Does not mean promoting autonomy (individuation or separation)  Means respecting the autonomous decision making ability of the patient
  27. 27.  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
  28. 28. Foundational Standard 3.10 “When psychologists conduct research or provide assessment, therapy, counseling or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person ……”
  29. 29.  The principle of benefiting others and accepting the responsibility to do good underlies the profession. - Providing the best treatment possible - Competency - Referring when needed
  30. 30. 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.”
  31. 31. 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
  32. 32. 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.”
  33. 33. 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.)
  34. 34. Foundational Standard 4.01 “Psychologists have a primary obligation and take reasonable precautions to protect confidential information.”
  35. 35. 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)
  36. 36.  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
  37. 37.  We reviewed that ethical decision-making can be complex  Distinguish ethical decision-making from clinical decisions, risk management, and legal questions, while there is likely overlap  We reviewed the Acculturation Model both as ways to acculturate to psychology as well as how ethical decisions are made
  38. 38.  We reviewed the five foundational principles on which the APA ethics code is founded  We touched on the idea 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

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