Ethics in Psychology and the Mental Health Professions

CH 2. Making Ethical Decisions and Taking Action

Koocher
When ethical conditions arise, the best possible outcome becomes far more likely
if several other conditions pertain. These include the following:
o Sufficient time available for the systematic collection of all pertinent
information necessary to consider strategies, consultation, intervention,
and follow-up
o Proper identification of the person or entity to whom one owes primary
allegiance
o An opportunity to involve all relevant parties
o Operating under low stress and a mindset that maximizes objectivity
o The maintenance of an ongoing evaluation that allows for midcourse
corrections or other changes to satisfactorily resolve the dilemma
Professional ethics codes consist primarily of general, prescriptive guideposts
with inherent gaps when it comes to deciding what specific action to take
Indeed, ethics codes were never intended to cover every conceivable act.
Therefore, all mental health professionals should internalize a decision-making
strategy to assist in coping with every ethical matter as it arises.
Must stress at the outset that the application of ethical decision making strategies
does not actually make a decision. However, a systematic examination of the
situation will likely have a powerful influence on a final decision.
A Suggested Ethical Decision-Making Strategy
People differ in their ability to perceive that something they might do, or are
already doing, could directly or indirectly affect the welfare of others.
Suggested model of ethical decision making:
1. Determine whether the matter truly involves ethics. First, the situation must
involve an ethical issue as described previously. The distinction between the
merely unorthodox or poor professional etiquette and unethical behavior
may become clouded, especially if one feels emotionally involved or under
attack.
a. A helpful starting point focuses on identifying the general moral or
ethical principle applicable to the situation at hand. Overarching
ethical principles such as respect for autonomy, nonmaleficence (doing
no harm), justice, and according dignity and caring towards others
rank among those often cited as crucial for the evaluation of ethical
concerns.
2. Consult Guidelines already available that might apply as a possible mechanism for
resolution. Be prepared to do some homework by finding the resources that
represent the moral responsibilities of mental health providers. Ethics codes
and policy statements from relevant professional associations, federal law, or
local and state law, research evidence, and general ethics writings are among
the materials that one might consult.
a. Collecting relevant information constitutes a critical step to take
conscientiously. A disregard for extant policy or relevant ethical
obligations may result in unwarranted consequences
b. Early in the process, you should collect information from all relevant
parties involved. Sometimes this step reveals that a simple
misunderstanding led to an improper interpretation, or the new data
may reveal the matter as far more grave as first suspected.
3. Pause to consider, as best as possible, all factors that might influence the decision you
will make. An extremely common reason for poor ethical decisions arises from
the inability to see the situation objectively because of prejudices, biases, or
personal needs that distort the perception of the dilemma. Recommend
pausing to introspect and gain awareness of any rigid mind-sets that could be
affecting your judgment.
a. Other personal characteristics that influence decisions include criteria
used to assign innocence, blame, and responsibility; personal goals
(including level of emotional involvement); s need to avoid censure; a
need to control or to power; and the level of risk one is willing to
undertake to get involved.
b. Finally, considerations of any culturally relevant variables becomes
important
4. Consult with a trusted colleague. Because ethical decision making involves a
complicated process influenced by our own perceptions and values, we can
usually benefit by seeking input from others. We suggest choosing
consultants known in advance to have a strong commitment to the profession
and a keen sensitivity to ethical matters.
5. Evaluate the rights, responsibilities, and vulnerability of all affected parties,
including, if relevant, an institution and the general public. All too frequently a
flawed decision results from failing to take into account a stakeholders right
to confidentiality, informed consent, or evaluative feedback.
6. Generate alternative decisions. This process should take place without focusing
on the feasibility of each option and may even include alternatives otherwise
considered too risky, too expensive, or even inappropriate.
7. Enumerate the consequences if making each decision. Whenever relevant, attempt
to identify the potential consequences of a decision. These include
psychological and social costs; short-term, ongoing, and long-term effects; the
time and effort necessary to implement the decision; any resource limitations;
any other risks, including the violation of individual rights; and any benefits.
a. Consider any evidence that the various consequences or benefits
resulting from each decision will actually occur
8. Make the Decision. Rachels (1980) has observed that the right to action us the
one backed by the best reasons. If the above phases have been completed
conscientiously, perhaps with the ongoing support of a consultant, a full
informational display should now be available.
9. Implement the Decision. Mental health professionals will remain strong and
respected only to the extent that their members willingly take appropriate
actions in response to ethical dilemmas.
a. According to Rest (1982), executing and implementing a plan of
action involves figuring out the sequence of concrete actions, working
around impediments and unexpected difficulties, overcoming fatigue
and frustration, resisting distractions and other allurements, and
keeping sight of the eventual goal (p. 34)
b. The ideal resolution results when a decision can be made prior to the
commission of an ethical infraction that would otherwise have
untoward consequences. But, often enough, the decision occurs in
response to an ongoing problematic situation
c. Unfortunately, the implementation phase also becomes a point at
which this entire process can derail. Research tells us that most
therapists can formulate what they should do. However, they will
more likely respond to their own values and practicalities when
determining what they would actually do, which is less than they
know they should do.
i. Tenbrunsel and Messick (2004) used the term ethical fading to
describe the tendency to move the ethical or moral implications
of implementing a decision into the background. Ethical fading
is enabled by such factors as language euphemisms (assigning a
label to an act that is less serious or benign) and errors in
perceptual causation (letting the offender off the hook, perhaps
by blaming the victim)
ii. We must also note that the organizational culture in which one
works plays a significant role when ethical decisions must be
followed by an action. Conflicts are unlikely to arise when the
integrity of the employer parallels more general ethical
guidelines and employees feel confident that their decisions will
be supported up the line. Dilemmas can prove problematic,
however, when an employers policy does not support or seems
contradictory to general moral principles, professional ethics
codes, and ones own moral commitments.
iii. The bad barrels (situational and systemic factors bad
barrels that can cause even good, decent people to carry out,
support or tolerate evil acts.) argument holds that characteristics
of an organizations culture can inhibit ethical behavior, even
among individuals with otherwise high moral standards.
iv. So, here is the hard question. Is it unethical to stay on the job
when an employers action or policies are contrary to the
professionals ethical guidelines? The APA ethics code
mandates that its members should clarify any conflicts with
organizations with which they affiliate, declare their
commitments to the APA ethics code, and if feasible attempt to
resolve the matter in ways that uphold the disputed provision
in the ethics code. The code does not, however, impose any
penalty should the matter remain unresolved.
v. When requirements in the ethics code clash with laws,
regulations, or other governing legal authorities and reasonable
attempts to resolve the matter fail, psychologists are released
from the demands of the code if they so choose (APA 02: 1.02)
Ethical Decision Making Under Crisis Conditions
Ethical dilemmas demanding an immediate response can and do unexpectedly
arise. With no time to prepare a carefully reasoned decision using a procedure
such as the one we have just presented, therapists may feel anxious and become
prone to react less than satisfactorily.
Mental health providers rank high among the professions vulnerable to ethical
and legal requirements when making decisions and acting under crisis
conditions
Crises requiring some decision that is bound to have ethical implications occur
most often when an element of ongoing harm or immediate danger appears to be
present
The most ethical response under conditions of possible calamity- especially those
involving matters of life and death- might conceivably involve ministering to
distraught family members, breaking a confidence that would have remained
secure under usual circumstances, showing more patience or engaging in more
than the usual non-erotic touching, or even actively searching for the
whereabouts of clients or their significant others
Clients at Special Risk for Crises
Some clients wait until their situation reaches urgent proportions before
consulting a mental health professional. In such instances, therapists may have to
make critical judgments with potentially significant consequences about people
with whom they have not yet formed a professional relationship or gathered
sufficient information.
Assessing and responding to a client who poses a risk of suicide carries a heavy
and stress-provoking responsibility. Becoming well versed in the clues that
suggest a risk of suicide should be an essential part of all psychotherapists
training. These include s verbal statement of intent, suicidal ideation, a history of
past attempts, a precipitating event, deterioration in social or vocational
functioning, a plan of action, intense affect, and expressed feelings of
hopelessness and despair
An important step therapists should take in such cases involves carefully
documenting concerns and decisions when working with potentially suicidal
patients. Such records will prove critical to a later defense should a therapist be
sued, and the quality of such documentation may determine whether a defense
attorney will take the case.
o The wise therapist will become well versed in legal aspects of suicide in
advance of being forced to learn them
Informal peer monitoring
We have some responsibility to watch out for each other
Unethical activity often persists, totally unchecked, unless someone takes notice
and intervenes. Observing or learning of an ethically questionable act constitutes
the front-line opportunity for a corrective intervention
What should you do when you observe an ethical violation or hear about an
alleged unethical act committed by a colleague?
Oddly, how to respond to the unethical behavior of others is rarely discussed in
any detail in the professional literature
More commonly, colleagues come for advice before a contemplated action
occurs. More often than not, gaining your approval of the contemplated act is the
primary motive for soliciting you as a confidant. In such situations, you have
been presented with an exceptional opportunity to be a part of upholding the
integrity of the profession by setting your colleague straight.
When an informal resolution may fail
Sometimes attempting an informal resolution with a colleague may not be a
sound option. Possible indicators include the following:
o The colleagues contentious or abrasive personality would likely cause an
informal approach to fail
o The possible infraction is so serious that if should not be dealt with
informally
o The colleague is addicted to drugs or alcohol
o The colleague is acutely stressed, emotionally disturbed, or mentally ill
o A great deal is at stake, such as the welfare of many clients or the
reputation of the institution
o Preexisting bad feelings already exist toward the suspected colleague,
making an informal approach more likely to be confrontational and
unbeneficial
o A status or power differential vis--vis the suspected violator is not in
your favor
o Overall incompetence is at issue
o Others, significant to validating or resolving the incident, will not allow
their identities to be known
Currently, and partially because of reported incidents of harassment and
intimidation, the APA ethics code gives its members the option of deciding the
appropriateness of dealing with the matter directly. If an informal solution seems
unlikely, and substantial harm has already occurred, psychologists should take
formal action-such as contacting a licensing board or ethics committee- as long as
any client confidentiality rights or other conflicts do not preclude reporting.
If the colleague appears generally incompetent, informal intervention will not
resolve the problem. Such individuals rarely have insight into their shortcomings
and could cause considerable harm to clients. However, if the incompetence
seems restricted to a single technique or application that could benefit from
either remediation or discontinuation, informal intervention remains a viable
option.
Mental health professionals may be requested by another colleague or a client to
assist in confronting an alleged violator, but the requester also insists on
concealing his or her identity. Often such people fear reprisal or feel inadequate
to defend themselves.
When the alleged unethical behaviors are extremely serious, possibly putting yet
others in harms way, and when the fearful but otherwise credible individuals
making the charges adamantly insist on remaining anonymous, therapists may
not feel comfortable ignoring the situation altogether.