Unit 8 - Consent, Confidentiality and Ethics PDF

CONSENT, CONFIDENTIALITY AND ETHICS UNIT 8 LEARNING OBJECTIVES 1. Explain the difference between ethics and law 2. Describe some of the legal obligations you have towards your clients 3. Outline the 4 principles that psychologists use to guide ethical practice 4. Utilize the 7 steps of ethic...

CONSENT, CONFIDENTIALITY AND ETHICS UNIT 8 LEARNING OBJECTIVES 1. Explain the difference between ethics and law 2. Describe some of the legal obligations you have towards your clients 3. Outline the 4 principles that psychologists use to guide ethical practice 4. Utilize the 7 steps of ethical decision making to determine ethical approaches In cases PERSONAL BOUNDARIES  Complete the Personal Boundaries Questionnaire ETHICS VS. LAW  Ethics codes are not produced by  Ethics: what one democratically- should or should not elected legislatures do, according to  Enforcement principles or norms of mechanisms are conduct usually informal, may be complex, even unconscious ETHICS VS. LAW  Laws are created by democratically- elected legislatures in  Law: what one must democracies such as or must not do, Canada according to legal  Laws come with dictates explicit penalties for infractions and a formal enforcement system LEGAL OBLIGATIONS CONFIDENTIALITY  Ontario public institutions must protect your personal information in their possession. You have the right to expect that your personal information will only be collected for legitimate, limited and specific purposes, that the collection of your personal information will be limited to only what is necessary for the specified purpose and that your personal information will only be used and disclosed for specified purposes.  An Ontario public institution must tell you:  under what legal authority they collect your personal information  how it intends to use the information it collects  who can answer any questions you may have about how your personal information will be used  Limits to confidentiality DUTY TO REPORT  Children: Everyone in Ontario, including members of the public and professionals who work closely with children, is required by law to report suspected child abuse or neglect.  If you have reasonable grounds to suspect that a child is, or may be in need of protection, you must immediately report the suspicion and the information on which it is based directly to CAS (or police if you are unable to contact CAS).  Older Adults: When an older adult resides in a Long-term Care Home or a Retirement Home and elder abuse is suspected or has occurred.  The abuse must be reported to the Registrar of the Retirement Homes Regulatory Authority (Tel: 1-855-ASK-RHRA (1-855-275-7472)) DUTY TO WARN  Do everything reasonably possible to stop or offset the consequences of actions by others when these actions are likely to cause imminent serious bodily harm to themselves or others. This may include, but is not limited to, the possibility of disclosing some confidential information to appropriate authorities (e.g., the police), an intended victim, or a family member or other support person who can intervene.  Based on Smith v. Jones, 1999 (S.C.C.) 1. Is there a clear risk to an identifiable person or group of persons? 2. Is there a risk of serious bodily harm or death? 3. Is the danger imminent? CONSENT  A person is capable with respect to a treatment, admission to a care facility or a personal assistance service if the person is able to understand the information that is relevant to making a decision about the treatment, admission or personal assistance service, as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision.  There is no general age of consent to treatment or counselling; instead, the issue depends on whether the young person is capable of consenting: 1. The consent must relate to the treatment. 2. The consent must be informed. 3. The consent must be given voluntarily. 4. The consent must not be obtained through misrepresentation or fraud  Review the limits of the consent BUT SOMETIMES THE APPLICATION OF LAW CAN BE AMBIGUOUS. WHAT DO YOU DO IF…  You are working with a client and they report a sexual attraction towards children?  You are working with a client and they make a vague threat – “All CAS workers should die.”  A client discloses a fantasy of harming their spouse. ETHICS AND DECISION MAKING CPA PRINCIPLE I: RESPECT FOR THE DIGNITY OF PERSONS.  In the course of their work as scientists, practitioners, or scientist-practitioners, psychologists come into contact with many different individuals and groups, including: research participants; clients seeking help with individual, family, organizational, industrial, or community issues; students; trainees; supervisees; employees; business partners; business competitors; colleagues; employers; third party payers; and, the general public… CPA PRINCIPLE I: RESPECT FOR THE DIGNITY OF PERSONS.  In these contacts, psychologists accept as fundamental the principle of respect for the dignity of persons; that is, the belief that each person should be treated primarily as a person or an end in him/herself, not as an object or a means to an end… CPA PRINCIPLE II: RESPONSIBLE CARING.  A basic ethical expectation of any discipline is that its activities will benefit members of society or, at least, do no harm. Therefore, psychologists demonstrate an active concern for the welfare of any individual, family, group, or community with whom they relate in their role as psychologists. This concern includes both those directly involved and those indirectly involved in their activities. CPA PRINCIPLE II: RESPONSIBLE CARING.  However, as with Principle I, psychologists’ greatest responsibility is to protect the welfare of those in the most vulnerable position. Normally, persons directly involved in their activities (e.g., research participants, clients, students) are in such a position. Psychologists’ responsibility to those indirectly involved (e.g., employers, third party payers, the general public) normally is secondary. CPA PRINCIPLE III: INTEGRITY IN RELATIONSHIPS.  Psychologists are expected to demonstrate the highest integrity in all of their relationships. However, in rare circumstances, values such as openness and straightforwardness might need to be subordinated to the values contained in the Principles of Respect for the Dignity of Persons and Responsible Caring. CPA PRINCIPLE III: INTEGRITY IN RELATIONSHIPS.  The relationships formed by psychologists in the course of their work embody explicit and implicit mutual expectations of integrity that are vital to the advancement of scientific knowledge and to the maintenance of public confidence in the discipline of psychology. These expectations include: accuracy and honesty; straightforwardness and openness; the maximization of objectivity and minimization of bias; and, avoidance of conflicts of interest. Psychologists have a responsibility to meet these expectations and to encourage reciprocity. CPA PRINCIPLE III: INTEGRITY IN RELATIONSHIPS.  In addition to accuracy, honesty, and the obvious prohibitions of fraud or misrepresentation, meeting expectations of integrity is enhanced by self-knowledge and the use of critical analysis. CPA PRINCIPLE IV: RESPONSIBILITY TO SOCIETY. Psychology functions as a discipline within the context of human society. Psychologists, both in their work and as private citizens, have responsibilities to the societies in which they live and work, such as the neighborhood or city, and to the welfare of all human beings in those societies. CPA PRINCIPLE IV: RESPONSIBILITY TO SOCIETY.  Two of the legitimate expectations of psychology as a science and a profession are that it will increase knowledge and that it will conduct its affairs in such ways that it will promote the welfare of all human beings. CPA PRINCIPLE IV: RESPONSIBILITY TO SOCIETY. Freedom of enquiry and debate (including scientific and academic freedom) is a foundation of psychological education, science, and practice. In the context of society, the above expectations imply that psychologists will exercise this freedom through the use of activities and methods that are consistent with ethical requirements. CPA PRINCIPLE IV: RESPONSIBILITY TO SOCIETY.  The above expectations also imply that psychologists will do whatever they can to ensure that psychological knowledge, when used in the development of social structures and policies, will be used for beneficial purposes, and that the discipline’s own structures and policies will support those beneficial purposes. Within the context of this document, social structures and policies that have beneficial purposes are defined as those that more readily support and reflect respect for the dignity of persons, responsible caring, integrity in relationships, and responsibility to society. CPA PRINCIPLE IV: RESPONSIBILITY TO SOCIETY.  If psychological knowledge or structures are used against these purposes, psychologists have an ethical responsibility to try to draw attention to and correct the misuse. Although this is a collective responsibility, those psychologists having direct involvement in the structures of the discipline, in social development, or in the theoretical or research data base that is being used (e.g., through research, expert testimony, or policy advice) have the greatest responsibility to act. Other psychologists must decide for themselves the most appropriate and beneficial use of their time and talents to help meet this collective responsibility. ETHICAL DECISION MAKING 1. Who are the individuals, groups, and organizations that are potentially affected by your decision? For whom do you have the greatest responsibility? 2. What is the nature of the dilemma, including consideration of the interests, rights, and characteristics of the persons and organizations involved? 3. How might personal biases, stresses, or self-interest influence your choices? 4. Consider whether any external or systemic issues have contributed to the problem and consider whether they can be addressed in a positive way. 5. Develop alternative courses of action and analyze the short-term, ongoing, and long-term risks and benefits of each course of action. 6. Based on relevant ethical principles, values, and standards, choose and act on what appears to be the best decision. 7. Evaluate the consequences of the course of action and assume responsibility for corrective action if it is needed EXAMPLE OF THIS PROCESS  You have a private practice with adult clientele, and are competent in serving your clients. You wish to expand your practice to include children. You work in a jurisdiction where the regulatory body does not have formal procedures for allowing psychologists to expand their practice, but does expect psychologists to ensure that they have developed the competencies needed through sufficient training and experience related to any new area of practice. A good friend of yours serves children and informs you that he is willing to provide you with supervision in exchange for your working for free two days a week for him, including doing some office work. You wonder why you are not feeling comfortable about this proposed arrangement. How can you determine how best to respond? WHO ARE THE INDIVIDUALS, GROUPS, AND ORGANIZATIONS THAT ARE POTENTIALLY AFFECTED BY YOUR DECISION? FOR WHOM DO YOU HAVE THE GREATEST RESPONSIBILITY?  The parties directly affected by my decision are my clients, my potential supervisor (who also is my good friend), and me. I believe my greatest esponsibility in this situation is to ensure that I serve my clients competently  (Responsible Caring). WHAT IS THE NATURE OF THE DILEMMA, INCLUDING CONSIDERATION OF THE INTERESTS, RIGHTS, AND CHARACTERISTICS OF THE PERSONS AND ORGANIZATIONS INVOLVED?  In examining my discomfort, I believe that I am concerned that our personal friendship may interfere with my openness and objectivity in supervision, with the quality of the supervision I receive, and with my friend’s ability to provide me with an objective evaluation of whether I have developed the necessary skills and expertise to work with children (Responsible Caring, Integrity in Relationships).  I also question whether my friend is expecting too much in return for providing supervision, especially the office work (Respect for the Dignity of Persons).  However, I am hesitant to clarify the issue with him. I also am beginning to question whether supervised experience alone is sufficient for me to become competent in serving this younger population. HOW MIGHT PERSONAL BIASES, STRESSES, OR SELF- INTEREST INFLUENCE YOUR CHOICES?  As for personal biases, I have to admit that I would prefer to work with a friend rather than a stranger.  I believe that my friend is competent.  I am very alert, perhaps overly alert, to the potential of being exploited, and may be wrong in judging his proposal to be unfair.  However, I know that my feelings are easily hurt and that I avoid confrontations.  Is it possible that I should become a full-time student to ensure my competence in this new area? If so, my family situation at this time makes this impossible. CONSIDER WHETHER ANY EXTERNAL OR SYSTEMIC ISSUES HAVE CONTRIBUTED TO THE PROBLEM AND CONSIDER WHETHER THEY CAN BE ADDRESSED IN A POSITIVE WAY.  I also am influenced by external circumstances over which I have little control. There are very few resources in my community for obtaining this type of experience and this makes my friend’s offer appealing.  A major new facility for the treatment of children is in the planning stages and I wish to be qualified to provide services to children when it opens. DEVELOP ALTERNATIVE COURSES OF ACTION AND ANALYZE THE SHORT-TERM, ONGOING, AND LONG-TERM RISKS AND BENEFITS OF EACH COURSE OF ACTION.  Some alternative actions I could consider (taking into account their potential risks and benefits) are: a) Define as specifically as possible what I need to achieve before exploring options for getting there. b) Accept the arrangement for supervision from my friend and see how it goes. c) Ask my friend to recommend someone else who is competent in the area to supervise me. d) Explore the possibility of part-time employment in an agency where supervision would be provided. e) Explore possibilities of specialized training from the local university or through distance education. f) Decide not to expand my area of practice, at least not for now. g) Others? BASED ON RELEVANT ETHICAL PRINCIPLES, VALUES, AND STANDARDS, CHOOSE AND ACT ON WHAT APPEARS TO BE THE BEST DECISION.  Act on what appears to be the best ethical approach regarding my wish to expand my practice.  Which do you think of the previous options? EVALUATE THE CONSEQUENCES OF THE COURSE OF ACTION AND ASSUME RESPONSIBILITY FOR CORRECTIVE ACTION IF IT IS NEEDED  Reflective practice  Mentorship  Supervision PRACTICE VIGNETTES  In small groups at your table, you will be given an ethical dilemma. Read the vignette, discuss with your group, and use the seven questions in the decision making to provide an ethical response to the situation.  Your group will present your situation and response to the class. You may be asked questions or to defend your response.