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Unlearning Ethics
This document outlines a presentation on unlearning received wisdom in ethics. It discusses using an acculturation model to integrate personal and professional ethics through higher identification with both. Three strategies are presented: asking patients, focusing on patient flourishing, and honest self-reflection. Five ethical principles - autonomy, beneficence, nonmaleficence, fidelity, and justice - provide a framework. Unhealthy strategies like overemphasizing rules without principles are discussed. The presentation involves examining examples of received wisdom that may not be helpful, like assumptions about informed consent, self-disclosure, and referral practices. It aims to have participants thoughtfully evaluate common beliefs through discussion.
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Unlearning Ethics
- 1. Unlearning Ethics “Received Wisdom”and Principle-Based Ethics By Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPP June 2013 – Pennsylvania Psychological Association
- 2. www.papsyblog.org More on ethicseducation Great resource
- 3. Course Objectives • Listcommon 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. General Outline • AcculturationModel • Three simple strategies • Principle-based ethics • Unhealthy or Unhelpful Strategies
- 5. General Outline • TheUnlearning 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. Participant Safety • Creatinga safe environment • Avoid the word “unethical” • We are all learning in this process • Demonstrate courtesy and respect for others
- 7. Exercises Handout 1: TheDumb Exercise Handout 2: Wisdom to contemplate
- 8. I. An AcculturationModel One way of remaining a life-long learner Provides another way to discuss ethical behaviors and decisions
- 9. Acculturation A process tochange 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.
- 10. 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.
- 11. Acculturation as aProcess • 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
- 12. Ethical Acculturation Identification withpersonal value system (higher vs. lower) Identification with value system of psychology (higher vs. lower)
- 13. Acculturation Model ofethical development Integration Separation Assimilation Marginalization Higher on Professional Ethics Higher on Personal Ethics Lower on Personal Ethics Lower on Professional Ethics
- 14. Marginalized Matrix: Lower onprofessional ethics Lower on personal ethics Risks: *Greatest risk of harm *Lack appreciation for ethics *Motivated by self-interest *Less concern for patients
- 15. Assimilation Matrix: Higher onprofessional ethics Lower on personal ethics Risks: Developing an overly legalistic stance Rigidly conforming to certain rules while missing broader issues
- 16. Separation Matrix: Lower onprofessional ethics Higher on personal ethics Risks: Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
- 17. Integrated Matrix: Higher onprofessional ethics Higher on personal ethics Reward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
- 18. II. Three simplestrategies 1. Ask the patient first (if and when appropriate) 2. Does the intervention or issue help the patient flourish? 3. Honest self-reflection: Will this satisfy your needs/values or the patient’s?
- 19.
- 20. Respect for Autonomy •Does not mean promoting autonomy (individuation or separation) • Means respecting the autonomous decision making ability of the patient
- 21. Autonomy • It encompassesfreedom 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
- 22. Autonomy & Consent FoundationalStandard 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 ……”
- 23. Beneficence • The principleof benefiting others and accepting the responsibility to do good underlies the profession. - Providing the best treatment possible - Competency - Referring when needed
- 24. Beneficence Basis of foundationalstandard 2.01 “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence.”
- 25. Nonmaleficence The principle isdoing no harm. - Demonstrating competence - Maintaining appropriate boundaries - Not using an experimental technique as the first line of treatment - Providing benefits, risks, and costs
- 26. Nonmaleficence Foundational Standard 3.04 “Psychologiststake 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.”
- 27. Fidelity This principle refersto 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.)
- 28. Fidelity Foundational Standard 4.01 “Psychologistshave a primary obligation and take reasonable precautions to protect confidential information.”
- 29. Justice Justice primarily refersto 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)
- 30. IV. Unhealthy orUnhelpful Strategies These strategies can be readily tied back into the Acculturation Model and Principle-based Ethics
- 31. Unhealthy or UnhelpfulStrategies • Overemphasis on rules or The Code • Interpreting rules without understanding overarching ethical principles • Setting a low bar for professional behavior
- 32. Unhealthy or UnhelpfulStrategies • Intrusive advocacy • Lack of understanding boundaries and the “therapeutic frame” • Allowing personal values to trump professional boundaries (without self-reflection and/or consultation)
- 33. V. The UnlearningExercise 10 examples of “Received Wisdom” that may not be so wise
- 34. VI. What aboutthe following examples of “Received Wisdom”? More Group Discussion
- 35. Informed Consent • Informedconsent only occurs at the beginning of treatment • Informed consent mainly involves the patient to sign forms for risk management purposes
- 36. Self-disclosure • Self-disclosure isnever appropriate by the psychologist during psychotherapy or assessment • Self-disclosure is clearly a boundary violation that is always wrong
- 37. Psychotropic medication • Psychologistscannot talk with patients about medication. • Technically, it is practicing medicine without a license.
- 38. Suicidal & HomicidalPatients • 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.
- 39. 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.
- 40. Always give 3names 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
- 41. Never talk withpatients 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
- 42. HIPAA applies inevery situation • HIPAA applies to pre-employment evaluations • HIPAA applies to security evaluations. • HIPAA applies to fitness for duty evaluations. • What about forensic evaluations?
- 43. If you havenot 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.
- 44. If you knowof 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.”
- 45. Other pearls ofwisdom that seem sketchy? Other ethical dilemmas?
- 46. Questions and Answers Completecourse evaluations