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Ethical Decision-Making (Part 2)
The document outlines a decision-making model for ethical considerations in psychology, emphasizing the importance of understanding both cognitive biases and emotional factors that can affect judgment. It discusses the complexity of ethical decision-making, highlighting foundational principles, competition between ethics, and the need for psychologists to be aware of personal biases and the dynamics of patient relationships. Strategies for improving ethical decision-making through structured frameworks and continual self-reflection are also presented.
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Ethical Decision-Making (Part 2)
- 1. By John Gavazzi,PsyD ABPP
- 2. Describe onedecision-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. We reviewedthat ethical decision-making can be complex
- 4. Rational Psychologist: Knowthe Code!! Psychologist Patient Learn the rules Apply the rules Outcomes will follow
- 5. PatientPsychologist Learn the rules Applythe rules Outcomes will follow Understand patient dynamics Understand the relationship Know the Code + Know your patient
- 6. Distinguish ethicaldecision-making from clinical decisions, risk management, and legal questions (even though there is overlap)
- 7. We reviewedthe Acculturation Model both as ways to acculturate to psychology as well as how ethical decisions are made
- 8. Acculturation Model of ethicaldevelopment Integration Separation Assimilation Marginalization Higher on Professional Ethics Higher on Personal Ethics Lower on Personal Ethics Lower on Professional Ethics
- 9. We reviewedthe 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.
- 11. Psychologist isthe expert and has greater power in the relationship Patient is vulnerable Psychologist is ultimately responsible for what happens in treatment
- 12. Often ethical dilemmasinvolve apparent conflicts between respect for patient autonomy versus beneficence
- 13. Identify thecompeting 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
- 15. The APA EthicalPrinciples 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
- 16. S Scrutinize H Hypothesize AAnalyze P Perform E Evaluate
- 17. 1. Goal isto 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
- 18. “integrative framework” steps twoand three generate solutions that maximize your personal values within the context of your professional role
- 19. 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.
- 20. 1. We haveto 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?
- 21. Malcolm Gladwell’sbook “Blink” Jonathan Haidt’s book on Moral Intuition David Pizarro’s work on motivated moral reasoning
- 22. Top downapproach Start with ethical principles Work from those principles to make good decisions about our work
- 23. Intuitive Automatic Emotional Rapid
- 24. Why do psychologists(still and continue to) have sex with their patients?
- 25. Negative emotions relatedto 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
- 26. The FundamentalAttribution Error Actor Observer Bias Availability Heuristic Trait Negativity Bias Confirmation Bias Competence Bias
- 27. This cognitivestyle 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
- 28. This cognitivestyle 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.
- 29. This cognitiveerror 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
- 30. When thepsychologist 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
- 31. The cognitivestyle in which psychologists look for evidence to confirm their beliefs about the patient or the situation. Motivated moral reasoning
- 32. 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.
- 33. Length oftime in treatment Patient complexity Emotional intensity/therapeutic relationship Current focus (or lack thereof) in treatment
- 34.
- 35. 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
- 36. Emotions Decision- making Skills Cognitive Biases External Rules Personal Ethics Psychologist Complexity Length of time in treatment Current focusin treatment Boundaries Patient Variables Therapeutic Alliance
- 37. Why study ethicsand ethical decision- making as a part of clinical practice?
- 38. Fiduciary Responsibility Providing the highest quality of care possible Reinforcing doing the best possible for your patient Better treatment outcomes
- 39. Independent Actions Helpfrom others Self Reflection Documentation Transparency Continuing Education Self-care Consultation Supervision Psychotherapy Continuing Education
- 40. Good generalbasis 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
- 41. Future podcastswill 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