Thinking and Doing: Ethics Workshop

1. Thinking and Doing: Ethics Workshop Rosie Phillips Bingham, Ph.D. Vice President for Student Affairs The University of Memphis

2. Ethics Workshop Overview • Introduction • Ethical Decision Making • Small Group Discussion as an Ethics Committee • Large Group Report out • Multicultural Nature of Ethics Code • Small Group Case Discussion • Large Group Report Out • Summary and Lingering Questions

3. APA Ethical Principles of Psychologists & Code of Conduct • Adopted August 21, 2002 • Effective June 1, 2003 • 2010 Amendments adopted on February 20, 2010 • Effective June 1, 2010

4. Introduction Preamble—Aspirational 5 General Principles—Aspiration 103 Specific Ethical Standards— Enforceable but not exhaustive Agenda

5. Beneficence and Non-maleficence—Benefit & Do No Harm Fidelity and Responsibility—Trustworthy Integrity—Truth Justice Respect for People’s Rights & Dignity 5 General Principles

6. Ethical Standards Group into 10 Areas • Resolving Ethical Issues (1.02 & 1.03 Amended in 2010) • Competence • Human Relations • Privacy & Confidentiality • Advertising & Public Statements • Recording Keeping & Fees • Education & Training • Research & Publication • Assessment • Therapy http://www.apa.org/ethics/code/index.aspx

7. Dr. Baker and Applicant Elizabeth Dr. Baker is a tenured professor who teaches in a master’s program in counseling psychology. The university where Dr. Baker teaches is located in a small community and is renowned for its mission to build and fortify rural areas in the United States. The University’s program in agricultural engineering is known and well respected throughout the country. Complementing the university’s mission, the counseling psychology program specializes in training counselors to work in rural areas. Recruiting applicants to the counseling program has been a perennial challenge for the department. In fact, the possibility of cutting the entire program has been considered as budgets have tightened in recent years. Dr. Baker’s partner, Elizabeth, has been working as an advocate at a women’s shelter in the area. She has a bachelor’s degree in social work, but would like to obtain further training in counseling psychology so that she can help to address the unmet needs that she sees every day in her work. Dr. Baker encourages Elizabeth to apply to the counseling program. Dr. Baker’s colleagues review Elizabeth’s application and begin to agonize about whether to admit her, given her relationship with Dr. Baker. The opportunity to provide further training to an individual with such stellar work experience is appealing, as is the idea of investing in someone who will be able to make an important contribution to their seriously underserved community. Yet, some faculty express concern that their department is small, and Dr. Baker is the only one who teaches at least one of the core courses. Dr. Baker argues that another faculty member could be appointed to review and evaluate Elizabeth’s academic work, and that this would obviate the problem of a multiple relationship. The situation is causing considerable distress in the department.

8. Exercise… • Decide if an ethical violation has occurred • If a violation has occurred summarize the facts that lead you to your conclusion and cite the appropriate standard to be charged • Tell us what you will put in the letter to the psychologist who is being complained about. • If there is no violation what will you tell the person making the complaint • If you have decided there is a legitimate case and you have decided on the relevant standards to cite; now you must argue for and against the violation • Make a recommendation about what should happen in this case

9. Exercise Recommendations… • Violation or No Violation • Dismiss/Close Case • Drop for insufficient evidence • Sanction: • Reprimand • Censure • Drop from Membership or Expulsion • Stipulated Resignation • Available Directives • Cease and Desist Order • Supervision Requirement • Education, Training, or Tutorial Requirement • Evaluation and/or Treatment Requirement • Probation

10. Case Study Doctor N., an accomplished child psychologist, sends a letter to local family court judges noting that he is available for appointment as an evaluator in divorce child custody cases. Dr. N. soon receives his first appointment and begins a series of interviews with the separated parents and their child. Believing that the custody dispute could be resolved through mediation, Dr. N. suspends the evaluation process and initiates a process of mediation. Dr. N. uses common mediation practice and indicated to each parent that anything disclosed in the mediation process will be confidential unless a mandated reporting obligation were triggered. The mediation includes negotiation of financial issues and disclosure of complication about the visitation schedule arising from an ongoing affair about which the other parent was unaware. Unfortunately, the mediation effort fails. When Dr. N. resumes the custody evaluation he informs the judge and the attorneys that the information disclosed in the course of mediation is confidential, but the judge firmly instructs him to respond to the court and reminds Dr. N. of his obligation to be forthcoming with the court. Dr. N. realizes that he has acted without clearly identifying for himself four vital issues: (a) who his client was; (b) to whom, if anyone, he owed confidentiality; (c) the purpose of a custody evaluation versus mediation; and (d) what his own role would be and what his role would entail.

11. Three Kinds of Cases • Show Cause • SuaSponte • Complainant

12. Sanctions • Reprimand: Violation of a kind unlikely to cause harm to another person or substantial harm to the profession • Censure: Violation of a kind likely to cause harm to another person by not substantial harm to another person or the profession. • Stipulated Resignation: Violation of a kind that would normally lead to expulsion but the respondent’s circumstances warrant mitigation. • Expulsion: Violation of a kind likely to cause substantial harm to another person or the profession. (**See also Consistency of Sanction Policy) Mitigating decreases or Aggravating increases

13. Other Behavior Likely to Cause Substantial Harm/Consideration of Loss of Membership • Of a kind similar to: • Sexual misconduct; • Felony conviction; • Insurance fraud; • Plagiarism; • Noncooperation; and • Blatant, intentional misrepresentation.

14. Mitigating Factors in Recommending Sanctions • Adequacy of, compliance with, and completion of a rehabilitation program; • Severity of penalties from other bodies; • Behaviors that reduce harm to person/profession; • Quality of response (e.g. remorse and recognition of ethical issues and principles involved; • Acceptance of responsibility for behaviors); and evidence of lasting change

15. Aggravating Factors in Recommending Sanctions • Inadequate rehabilitation program; • Inadequate cooperation with required rehabilitation program; • Inadequate penalty from other body; • Recognizable vulnerability of person involved; • History of violation/unethical behaviors; and • Inadequate response (e.g., lack of remorse or awareness of ethical issues and principles; disowning responsibility).

16. Available Directives (For All Cases) • Cease and desist order • Supervision • Continuing education credits* • Tutorial* • Writing a paper • Evaluation • Therapy • Probation until directives completed* • Other Corrective Action (except monetary)

17. Complainant and SuaSponte Cases • Ethics Committee is “court of first impression” • Burden of proof is on the Ethics Committee • Charges must be proven by a preponderance of the evidence • If sanction is recommended, respondent can request an independent adjudication or formal hearing.

18. Show Cause • Show Cause cases arise from the action of another authoritative body (e.g., a state board). • Felony or commensurate* offense; • Been expelled or suspended; • Been denied a license, decertified, deregistered; • Had license revoked, suspended or voluntarily surrendered; • Had any of the above actions stayed or postponed. *Commensurate refers to instances in which a respondent has been convicted of a criminal offense with a possible incarceration term exceeding one year.

19. Sanctions if Has Shown Cause why they should not be expelled: • Stipulated resignation • Censure • Reprimand • Dismiss (Ends Case) Mitigating decreases or Aggravating increases

20. Sanction if has Not Shown Cause • Expulsion • Stipulated Resignation • Censure • Reprimand Mitigating decreases or Aggravating increases

21. Ethics Violation Worksheet • Summarize the Problem • Standard(s) that is Violated • In that Statement • Pro • Con • Decision • Sanction • Insufficient Evidence • No Violations

22. Multicultural or Diversity Nature of the Ethics Code

23. APA Ethics Code • General Principles: Aspirational in Nature • Principle D: Justice • Recognize that fairness and justice entitle all person to access and benefit from psychological services • Exercise judgment and take precautions to ensure that bias, boundaries of competence and limitations of expertise does not lead to unjust practices. Ethics Committee Presentation 2009

24. Principle E: Respect for People’s Rights and Dignity “Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity or culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups…”

25. Diversity Variable List • Age • Gender • Gender identity • Race • Ethnicity • Culture • National origin • Religion • Sexual Orientation • Disability • Socioeconomic Status Ethics Committee Presentation 2009

26. Competence—2.01b Boundaries of Competence “Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services, or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals…”

27. Human Relations—3.01 Unfair Discrimination “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, language, or socioeconomic status, or any basis proscribed by law.”

28. Human Relations—3.03 Other Harassment “Psychologists do not knowingly engage in behavior that is harassing or to persons with whom they interact in their work based on factors such as those persons’ age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status.”

29. Assessment-9.06 Interpreting Assessment Results “When interpreting assessment results, including automated interpretations, psychologists take into account the purpose of the assessment as well as the various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, personal, linguistics, and cultural differences, that might affect psychologists judgments…”

30. APA Ethics Code: Summary • Code articulates relationships between cultural factors and competence • Code acknowledges relationship between cultural factors and assessment • Culture, competence and assessment are intertwined • Code is clear that we cannot ignore culture when evaluating our own or others’ competence • Creates complex ethical dilemmas for us Ethics Committee Presentation 2009

31. Practice Guidelines • General Guidelines • Specific Groups • Girls and Women • LGB Clients • Persons with Disabilities • Older Adults • Multicultural Education

32. Questions • As you review the guidelines what do you see are areas of strength for you and what are challenges? • How might the guidelines be useful in ethical dilemmas? • How might not being up-to-date on various diversity matters help to move an issue to an ethics case?

33. Case Study Dr. M. has been asked to provide an evaluation of a child’s parents after the parents were reported by hospital staff to child welfare authorities. The parents are relatively new immigrants to the country and are not able to communicate understandably with the hospital staff. The hospital staff reports that the parents are overly reliant on traditional healing methods practiced in their country of origin, to the detriment of caring for their child's fragile medical condition. In the hospital staff’s view, this constitutes medical neglect, and the child welfare authorities are considering whether to take custody of the child. Unless Dr. M. is able to explain to the child welfare authorities why the parents’ failure to provide medical care at home consistent with instructions from medical staff at the hospital does not constitute medical neglect, the child will ultimately be removed and placed in medical foster care pending the filing of a child abuse case in court. The child welfare authorities decide to give Dr. M. and the parents 3 weeks until they make that decision, and they place the child in the home of a relative until the decision is to be made. Dr. M promptly recognizes that there may be several factors under these circumstances that could jeopardize his ability to provide a reliable evaluation of the parents. Dr. M takes very seriously the ethical commitment to become culturally competent in professional work and to successfully accomplish training toward competence in multiple areas of diversity; as a result, Dr. M. does feel competent in several area of practice, In this case, Dr. M. is not confident of competence, because Dr. M. is not versed in nontraditional healing practices, and realizes that the critical time factor determining the parameters of the evaluation required efficient and accurate decision making.

34. Exercise… • Decide if an ethical violation has occurred • If a violation has occurred summarize the facts that lead you to your conclusion and cite the appropriate standard to be charged • Tell us what you will put in the letter to the psychologist who is being complained about. • If there is no violation what will you tell the person making the complaint • If you have decided there is a legitimate case and you have decided on the relevant standards to cite; now you must argue for and against the violation • Make a recommendation about what should happen in this case

35. Exercise Recommendations… • Violation or No Violation • Dismiss/Close Case • Drop for insufficient evidence • Sanction: • Reprimand • Censure • Drop from Membership or Expulsion • Stipulated Resignation • Available Directives • Cease and Desist Order • Supervision Requirement • Education, Training, or Tutorial Requirement • Evaluation and/or Treatment Requirement • Probation

36. Diversity Guidelines Worksheet • Summarize the Problem • Which Diversity Guidelines might influence your thinking? Which Section? • How does this diversity information inform your understanding of the problem and your thinking about a possible ethics violation? • Is there an ethical violation? If yes, use the Ethics Violation Worksheet. Is there a moral violation? Explain

37. Learning the Process of Ethical Decision Making • Know the Ethics Code • Know the applicable state laws & federal regulations • Know the rules and regulations of the institution where you work • Engage in continuing education in ethics • Identify when there is a potential ethical problem • Learn a method for analyzing ethical obligations in often complex situations • Consult with professionals knowledgeable about ethics • Know the treatment guidelines for dealing with special populations