Unlearning Ethics: Ethical Memes and Moral Development

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Recent presentation on moral development, moral reflection, acculturation to the community of psychology, principle-based ethics of psychology, and false ethical memes for psychologists

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Unlearning Ethics: Ethical Memes and Moral Development

  1. 1. UNLEARNING ETHICS ETHICAL MEMES & MORAL DEVELOPMENT By Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPP October 31, 2013 – Pennsylvania Psychological Association
  2. 2. WWW.PAPSYBLOG.ORG MORE ON ETHICS EDUCATION
  3. 3. COURSE OBJECTIVES • List common beliefs that are not based on overarching ethical principles • Describe the methodology to be used to identify false or unhelpful ethical or risk management principles
  4. 4. GENERAL OUTLINE • Personal Moral Development • Acculturation Model • Principle-based ethics • Memes in Professional Life • Unhealthy or Unhelpful Strategies
  5. 5. GENERAL OUTLINE • The Unlearning Experience** • Examples of “Received Wisdom”** **This is the time for the most group interaction. However, we want to make this fun and informative, so feel free to contribute at any time during the presentation.
  6. 6. PARTICIPANT SAFETY • Creating a safe environment • Avoid the word “unethical” • We are all learning in this process • Demonstrate courtesy and respect for others
  7. 7. EXERCISES • Handout 1: The Dumb Exercise • Handout 2: Wisdom to contemplate • Handout 3: Bloom’s Educational Taxonomy
  8. 8. I. PERSONAL MORAL DEVELOPMENT 1. Religion/Family of Origin 2. Education: College and CE 3. Personal Education: Reading and Experience 4. Honest self-reflection
  9. 9. MORAL FOUNDATIONS Care - Harm Fairness – Cheating Loyalty-Betrayal Authority – Subversion Sanctity (Purity) – Degradation Liberty - Oppression
  10. 10. WHAT IS YOUR MORAL CODE? • How did it develop? • How often do you use it to reflect on professional life? • How often do you use it to reflect on personal life? • How do you integrate morals into ethics?
  11. 11. WHAT IS YOUR MORAL CODE? • Do you use it “before the fact”? • Is it intuitive and unconscious? • Is it more cognitive? • Is it written down?
  12. 12. WHAT IS YOUR MORAL CODE? • Is it acceptance of another person’s code in full? • If yes, why? • If not, why?
  13. 13. WHAT IS YOUR MORAL CODE? • Do you use it “after the fact”? • Fundamental Attribution Error • Actor-Observer Bias • Motivated Moral Reasoning
  14. 14. II. AN ACCULTURATION MODEL One way of remaining a life-long learner Provides another way to discuss ethical behaviors and decisions
  15. 15. ACCULTURATION 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.
  16. 16. ETHICS ACCULTURATION MODEL • 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.
  17. 17. ACCULTURATION AS A PROCESS • 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
  18. 18. ETHICAL ACCULTURATION Identification with personal value system (higher vs. lower) Identification with value system of psychology (higher vs. lower)
  19. 19. Acculturation Model of ethical development Higher on Professional Ethics Lower on Professional Ethics Integration Separation Assimilation Marginalization Higher on Personal Ethics Lower on Personal Ethics
  20. 20. MARGINALIZED 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
  21. 21. ASSIMILATION Matrix: Higher on professional ethics Lower on personal ethics Risks: Developing an overly legalistic stance Rigidly conforming to certain rules while missing broader issues
  22. 22. SEPARATION Matrix: Lower on professional ethics Higher on personal ethics Risks: Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
  23. 23. INTEGRATED Matrix: Higher on professional ethics Higher on personal ethics Reward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
  24. 24. III. PRINCIPLE-BASED ETHICS Autonomy Beneficence Nonmaleficence Fidelity Justice
  25. 25. RESPECT FOR AUTONOMY • Does not mean promoting autonomy (individuation or separation) • Means respecting the autonomous decision making ability of the patient
  26. 26. AUTONOMY • 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
  27. 27. AUTONOMY & CONSENT 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 ……”
  28. 28. BENEFICENCE • The principle of benefiting others and accepting the responsibility to do good underlies the profession. - Providing the best treatment possible - Competency - Referring when needed
  29. 29. BENEFICENCE 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.”
  30. 30. NONMALEFICENCE The principle is doing no harm. - Demonstrating competence - Maintaining appropriate boundaries - Not using an experimental technique as the line of treatment - Providing benefits, risks, and costs first
  31. 31. NONMALEFICENCE 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.”
  32. 32. FIDELITY 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.)
  33. 33. FIDELITY Foundational Standard 4.01 “Psychologists have a primary obligation and take reasonable precautions to protect confidential information.”
  34. 34. JUSTICE 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)
  35. 35. IV. UNHEALTHY OR UNHELPFUL STRATEGIES THESE STRATEGIES CAN BE READILY TIED BACK INTO THE ACCULTURATION MODEL AND PRINCIPLE-BASED ETHICS
  36. 36. UNHEALTHY OR UNHELPFUL STRATEGIES • Overemphasis on rules or The Code • Interpreting rules without understanding overarching ethical principles • Setting a low bar for professional behavior
  37. 37. UNHEALTHY OR UNHELPFUL STRATEGIES • Intrusive advocacy • Lack of understanding boundaries and the “therapeutic frame” • Allowing personal values to trump professional boundaries (without self-reflection and/or consultation)
  38. 38. V. MEME THEORY REMEMBER, IT’S ONLY A THEORY
  39. 39. MEMES 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"
  40. 40. THE POWER OF MEMES • Evolutionary Psychology and Heuristics • Bottom-up approach to moral reasoning (although we think the opposite is true) • The “Bad” outweighs the “Good” in moral reasoning
  41. 41. VI. THE UNLEARNING EXERCISE 10 EXAMPLES OF “RECEIVED WISDOM” THAT MAY NOT BE SO WISE
  42. 42. WHAT ABOUT THE FOLLOWING EXAMPLES OF “RECEIVED WISDOM”? More Group Discussion On Memes (of sorts)
  43. 43. INFORMED CONSENT • Informed consent only occurs at the beginning of treatment • Informed consent mainly involves the patient to sign forms for risk management purposes
  44. 44. SELF-DISCLOSURE • Self-disclosure is never appropriate by the psychologist during psychotherapy or assessment • Self-disclosure is clearly a boundary violation that is always wrong
  45. 45. PSYCHOTROPIC MEDICATION • Psychologists cannot talk with patients about medication. • Technically, it is practicing medicine without a license.
  46. 46. SUICIDAL & HOMICIDAL PATIENTS • When dealing with high risk patients, it is better to not document a great deal of information. • If you do not document much detail, then you have greater legal protection from an attorney indicating that you did something wrong. Attorneys can twist words easily, so the less the better.
  47. 47. NO SUICIDE CONTRACT • This is an important risk management strategy • This is the standard of care • This strategy helps the patient from actually harming him or herself.
  48. 48. ALWAYS GIVE 3 NAMES WHEN REFERRING A PERSON FOR TREATMENT • It is the standard of care. • Co-pay, insurance, ability to access the referral is immaterial. • Relationship with the patient or referral is not a high priority
  49. 49. NEVER TALK WITH PATIENTS ABOUT RELIGION • Psychotherapy is like other polite conversations, so it is improper to talk about religion. • Psychologists are not sufficiently trained in religious matters. • The best strategy is to refer patients to their priest, pastor, rabbi or spiritual guide
  50. 50. HIPAA APPLIES IN EVERY SITUATION • HIPAA applies to pre-employment evaluations • HIPAA applies to security evaluations. • HIPAA applies to fitness for duty evaluations. • What about forensic evaluations?
  51. 51. IF YOU HAVE NOT BEEN INVESTIGATED, THEN YOU ARE ACTING ETHICALLY. • Only people engaging in marginalized behavior get caught. Therefore, if I am not being investigated, my behavior must be appropriate. • I follow all the rules strictly, therefore, I must be acting ethically.
  52. 52. IF YOU KNOW OF ANOTHER PSYCHOLOGIST ENGAGING IN MARGINALIZED BEHAVIOR, THEN IT IS BEST TO NOT DO ANYTHING. • Someone else should bring it up • “I am not supervising the psychologist, so I cannot bring it up.”
  53. 53. OTHER PEARLS OF WISDOM THAT SEEM SKETCHY? OTHER ETHICAL DILEMMAS?
  54. 54. QUESTIONS AND ANSWERS COMPLETE COURSE EVALUATIONS

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