Ethics hell

download Ethics hell

of 45

  • date post

    15-Jul-2015
  • Category

    Healthcare

  • view

    137
  • download

    0

Embed Size (px)

Transcript of Ethics hell

Ethics Hell

The road to hell is paved with good intentions - Virgil

In Hell there will be nothing but law and due process will be meticulously observed. ~ Grant GilmoreEthics HellSamuel K. Knapp, Ed.D., ABPP PsychologistJohn D. Gavazzi, PsyD, ABPP Psychologist

Annual Convention of the Pennsylvania Psychological AssociationJune, 2015Ethics education in general

Dual Systems/Ethics Code

Foundational Principles & Acculturation Model

Rings of Hell

Experiential Exercises

OverviewDescribe fear or avoidance based theories of ethicsIdentify ways to incorporate overarching ethical values in to their practices; and,Apply positive approaches to real life clinical situations.Learning ObjectivesNegative Expectations

Moral emotions like guilt, fear, & shame

Can ethics education pave the way to ethics hell?Midway in our lifes journey, I went astrayFrom the straight road and woke to find myself Alone in a dark wood. How shall I say

What wood that was! I never saw so drearSo rank, so arduous a wilderness!Its very memory gives shape to fear.

Death could scarce be more bitter than that place!

Canto 1: lines 1-7

Inscription at the entrance to Hell

Abandon all hope ye who enter here.

Dantes Divine ComedyProscriptive: Those beliefs, behaviors, or actions that avoid harm

Prescriptive: Those beliefs, behaviors, or actions that seek beneficial outcomesDual Systems & EthicsAspirational Ethics: Reaching for the ethical ceiling by promoting patient well-being

Enforcement Ethics: Standing on the ethical floor as to avoid doing harmDual Systems & Ethics CodeResearch shows that bad has a much stronger punch than good

Loss aversion

Defensive practiceBad is stronger than goodRespect for Patient AutonomyBeneficenceNonmaleficenceFidelityJustice

Principle-Based Ethics9AutonomyIt 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 treatment10BeneficenceThe principle of benefiting others and accepting the responsibility to do good underlies the profession.

- Providing the best treatment possible

- Competency

- Referring when needed11NonmaleficenceThe 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 costs12FidelityThis 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.)13JusticeJustice primarily refers to treating people fairly and equally.

-Treating patients equally regardless of insurance-Providing high quality of service regardless of gender, ethnicity, orientation, etc.

14Setting the Stage for our Descent into HellLooking at how well a psychologist integrates his/her values and behaviors into the ethical culture of psychology

Psychology has a set of normative principles and behaviors related to ethical behavior and appropriate conductThe Acculturation ModelAcculturation 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.17Acculturation ModelProvides a model to track our descent into hell

A different vantage point to address ethical behaviors and decisions18Acculturation as a ProcessCan be a complex process

Some parts of a psychologists practice and lifestyle may be easily acculturated while others not

19Ethics Acculturation ModelPsychology has a system of shared and distinctive norms, beliefs, and traditions.

This set of beliefs is reflected in our ethics code.

20Ethical AcculturationIdentification with personal value system(higher vs. lower)

Identification with value system of psychology

(higher vs. lower)21Acculturation Model of ethical developmentIntegrationSeparationAssimilationMarginalizationHigher on Professional EthicsHigher on Personal EthicsLower on Personal EthicsLower on Professional Ethics22Rings of hellAssimilation First Ring of HellMatrix: Higher on professional ethicsLower on personal ethics

Risks: Developing an overly legalistic stance

Rigidly conforming to certain rules while missing broader issues24Assimilated StrategiesAssimilated strategies are often fear based where motive to avoid harming another or incurring punishment for oneself, causes the psychologist to adopt legalistic stances.

Assimilated strategy attempts to be prevention focused

Fail to give adequate attention or weight to the overarching ethical principles that guide or should guide professional behavior25A psychologist receives a phone message from a former patient. The former patient is asking for the psychologist to be a character witness as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

The psychologist pulls the former patients chart. The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy. The psychologist remembers the former patient as a likeable person.Vignette 9: Psychologist as Character WitnessSecond Ring of Hell - SeparationMatrix:Lower on professional ethicsHigher on personal ethics

Risks:Compassion overrides goodprofessional judgment

Fails to recognize the unique role of psychologists27Separated strategies are often benefits-based where the motive for promoting the well-being of the patient causes the psychologist to be blind to ways that well-meaning people can cause harm

Separated strategy attempts to be promotion focused

Fails to give adequate attention or weight to the overarching ethical principles that guide or should guide professional behavior

SeparationA psychologist receives a phone message from a former patient. The former patient is asking for the psychologist to be a character witness as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.

The psychologist pulls the former patients chart. The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy. The psychologist remembers the former patient as a likeable person.Vignette 9: Psychologist as Character WitnessType I ReasoningType 2 ReasoningRule-based

Deliberate

Analytic

SlowerIntuitive

Automatic

Emotional

RapidThird Ring: Emotional ReasoningCognitive BiasesUnhealthy Emotional ResponsesFear or Anxiety

Sexual Attraction

Guilt

Disgust

AngerAvailability Heuristic

Confirmatory Hypothesis Testing

Fundamental Attribution Error

Actor Observer BiasType 1 Reasoning can lead to errorsProfessional isolation is correlated with:

Lower quality workJob dissatisfactionBurnoutInterpersonal defensiveness

Professional isolation can happen in group practices.Fourth Ring: IsolationDenial of Emotions

Lack of self-compassion or adequate self-care

Failure to achieve work-life balance

Working harder than your patients are

Fifth Ring: Emotional Pain/BurnoutSixth Ring: MarginalizationMatrix:Lower on professional ethicsLower on personal ethics

Risks:*Greatest risk of harm*Lack appreciation for ethics*Motivated by self-interest*Less concern for patients34Upon seeing Satan:

[Virgil] made me stop, and stepping aside he said. . . This is the placeWhere you must arm your soul against all dread!

Do not ask, Reader, how my blood ran coldAnd my voice choked up with fear. I cannot write it.This is the terror that cannot be told.

I did not die, and yet I lost lifes breath,Imagine for yourself what I became, Deprived at once of both my life and death.

Canto XXXIV, lines 19-27. Sinners are ironically positioned to demonstrate their sin

Satan is frozen in waist-deep ice, trying to fly away from God. The beating of the wings keeps the water frozen, preventing his escape.

Marginalization is the antithesis of the psychologys values and ethics a professional who is upside downIn Dantes HellFeeling Sufficiently Uncomfortable?What can I do?Independent ActionsHelp from othersSelf Reflection

Documentation

Transparency

Continuing Education

Self-careConsultation

Supervision

Psychotherapy

Continuing EducationIntegratedMatrix:Higher on professional ethicsHigher on personal ethics

Reward:Implement values in context of professional roles

Reaching for the ethical ceiling

Aspirational ethics

39Unhelpful Habits Commonly found with Assimilation Strategies

Overemphasis on rule