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Unlearning Ethics“Received Wisdom” and Principle-Based Ethics
By Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPPJune 2013 – Pennsylvania Psychological Association
www.papsyblog.org
More on ethics education
Great resource
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
General Outline
•Acculturation Model
•Three simple strategies
•Principle-based ethics
•Unhealthy or Unhelpful Strategies
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.
Participant Safety• Creating a safe environment• Avoid the word “unethical”• We are all learning in this process• Demonstrate courtesy and respect for
others
ExercisesHandout 1: The Dumb Exercise
Handout 2: Wisdom to contemplate
I. An Acculturation Model
One way of remaining a life-long learner
Provides another way to discuss ethical behaviors and decisions
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.
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.
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
Ethical Acculturation
Identification with personal value system(higher vs. lower)
Identification with value system of psychology
(higher vs. lower)
Acculturation Model of ethical development
Integration Separation
Assimilation Marginalization
Higher on Professional Ethics
Higher on Personal Ethics
Lower on Personal Ethics
Lower on Professional Ethics
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
Assimilation
Matrix: Higher on professional ethicsLower on personal ethics
Risks: Developing an overly legalistic stance
Rigidly conforming to certain rules while missing broader
issues
Separation
Matrix: Lower on professional ethicsHigher on personal ethics
Risks: Compassion overrides goodprofessional judgment
Fail to recognize the unique role of psychologists
Integrated
Matrix: Higher on professional ethicsHigher on personal ethics
Reward: Implement values in context of professional roles
Reaching for the ethical ceiling
Aspirational ethics
II. Three simple strategies
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?
AutonomyBeneficence
NonmaleficenceFidelityJustice
III. Principle-Based Ethics
Respect for Autonomy
•Does not mean promoting autonomy (individuation or separation)
•Means respecting the autonomous decision making ability of the patient
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
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 ……”
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
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.”
Nonmaleficence
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
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.”
FidelityThis 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.)
Fidelity
Foundational Standard 4.01
“Psychologists have a primary obligation and take reasonable precautions to protect confidential information.”
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)
IV. Unhealthy or Unhelpful StrategiesThese strategies can be readily tied back into the Acculturation Model and Principle-based Ethics
Unhealthy or Unhelpful Strategies
•Overemphasis on rules or The Code
•Interpreting rules without understanding overarching ethical principles
•Setting a low bar for professional behavior
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)
V. The Unlearning Exercise10 examples of “Received Wisdom” that may not be so wise
VI. What about the following examples of “Received Wisdom”?
More Group Discussion
Informed Consent
•Informed consent only occurs at the beginning of treatment
•Informed consent mainly involves the patient to sign forms for risk management purposes
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
Psychotropic medication
•Psychologists cannot talk with patients about medication.
•Technically, it is practicing medicine without a license.
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.
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.
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
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
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?
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.
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.”
Other pearls of wisdom that seem sketchy?
Other ethical dilemmas?
Questions and Answers
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