Lecture 1 PDF

Course organiser: Prof Liz Gilchrist Ethics and Governance in Psychological Practice CMPS11091 Based on material prepared by Dr. Clara Calia Introduction- Course description This course will cover understanding and critical reflection on the principles of ethical and safe practice. You will be int...

Course organiser: Prof Liz Gilchrist Ethics and Governance in Psychological Practice CMPS11091 Based on material prepared by Dr. Clara Calia Introduction- Course description This course will cover understanding and critical reflection on the principles of ethical and safe practice. You will be introduced to the major ethical and practice bodies and regulations covering psychological work with young people and vulnerable adults. This course will support you to examine the ethical responsibilities in some specific area, such as: professional and personal boundaries, differences and similarities in private and public practice, confidentiality, conflicts of interest, trust and deception in the context of research. It will also include maintaining a safe working environment, setting boundaries, obtaining consent and agreement, safeguarding, managing data and confidentiality and managing things when things go wrong. Learning outcomes Structure of the course Date Time Topic Delivery Wednesday 5th October 10am - 12.30pm What is ethics? Professionalism in practice The Four Component Model Lister Learning and Teaching Centre 4.1 Wednesday 12th October 10am – 12.30pm BPS: Lister Learning and Teaching Centre 4.1 Code of Ethics and Conduct Legal and Professional obligations Safeguarding Teaching The course will be delivered in person through online webinars and tutorials delivered over 4 half day sessions supplemented by tasks and discussions. Informed Consent Wednesday 26th October 10am – 12.30pm BPS: Data Management and sharing Lister Learning and Teaching Centre 4.1 Confidentiality Legal Framework Governance Caldicott Assessment Online quizzes Wednesday 2nd November 10am – 12.30pm BABCP & HCPC- Standards of conduct G.03, Doorway 6. Topics What is ethics? Professionalism in practice The4 components model Professional issues scenarios What is Ethics? Norms for conduct that distinguish between acceptable and unacceptable behaviour Most people learn ethical norms at home, at school, in church, or in other social settings. One way of defining 'ethics' focuses on the disciplines that study standards of conduct or as a method, procedure, or perspective for deciding how to act and for analyzing complex problems and issues. For instance, in considering a complex issue like global warming, one may take an economic, ecological, political, or ethical perspective on the problem. While an economist might examine the cost and benefits of various policies related to global warming, an environmental ethicist could examine the ethical values and principles at stake. Many different disciplines, institutions, and professions have standards for behaviours that suit their particular aims and goals. These standards also help members of the discipline to coordinate their actions or activities and to establish the public's trust of the discipline. (Resnik, 2015 https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm) Considering professional relationships • In pairs- have a conversation about range of professional relationships you are likely to encounter over the course of your training- 10m • As a group- we will collate all the relationships identified10m Considering professional relationships In groups of three: Ø Think about the relationship from the perspective of : a trainee, supervisor and service user- 10m Ø What are the issues to do with power, responsibilities, boundaries and expectations?- 10m Considering professional relationships Individually- 10m, reflect on: Ø In the context of what you’ve just discussed, what will you want to be mindful of in the course of the training in terms of your relationships, e.g. supervisor, client? Ø Write down some of your reflections on this theme Ø Consider which of your existing/future relationships may provide a space to discuss this The Four Component Model (Rest, 1982) Ethical sensitivity Behaving ethically is based on ethical sensitivity. Noticing what ethical issues are raised by a course of action makes it more likely that ethical practice will follow. Instruction in ethics can increase ethical sensitivity (Harkrider et al., 2012). Examples: Ethical sensitivity amongst senior nursing students was greater than amongst new students who had yet to begin ethical instruction (Park et al., 2012) . High levels of variability in the number of issues identified by different students. As such, enhancing a capacity for ethical sensitivity is an important educational objective (Herbert et al., 1990). What ethical issues can be identified in the following vignette? Ethical sensitivity exercise 15 minutes discussion You visit an 82-year-old woman in her home. Previously she was healthy and independent. She has been deteriorating for five weeks, since her husband died. She has lost weight, is mildly delirious, and has taken to her bed. You think she needs to come into hospital for further investigations, but she adamantly refuses and insists that she will be better off at home. There are many potential issues raised here, all of which would be worthy of attention. I. Autonomy- Will our actions respect the client’s wishes? How do you judge the client’s competence to make decisions? How can we prioritise interventions that maintain independence? II. Beneficence- Does our plan make the situation better rather than worse? Does our plan prevent harm? Does our plan provide appropriate psychological or medical treatment? III. Justice - Does our plan balance the needs of the client with the needs of the wider society? Does our plan distribute health resources fairly and equitably? Does our plan balance the interests and wishes of the client, family and friends fairly? Ethical reasoning Ethical reasoning is the capacity to be able to consciously articulate the rationale for taking a particular course of action. The work of Daniel Kahneman and colleagues (Kahneman & Tversky, 1984) indicates that ethical reasoning is often subject to cognitive biases. They have explored the ways in which real decision-making deviates from rational models, arguing that moral judgements are often affected by various competing biases. Maintaining an awareness of such biases is clearly important when trying to think through ethical dilemmas. 1. Salience: People estimate how frequently something occurs based on Potential cognitive biases in research and data analysis how easily it comes to mind. If you rarely hear of researchers engaging in unethical research practices you might assume it never happens. However, surveys suggest that unethical practices are common. For example, Martinson et al. (2005) report that 33 per cent of researchers admitted to engaging in some unethical research practices. 2. Confirmation bias: There is a human tendency to look for evidence that confirms hypotheses and to ignore other evidence. This can lead researchers only to report data that confirms their favoured hypothesis. 3. Loss aversion: If a researcher feared losing grant money due to nonsignificant outcomes they might engage in risky behaviour by cherrypicking or even falsifying data. 4. Beliefs about disclosure: Data analysis that goes unsupervised and is not made available to others is more likely to be susceptible to unethical practice. 5. Dissonance reduction: A researcher might justify manipulating data if they considered that the importance of their work overrode ethical considerations The ethics of receiving gifts from clientsexample A service operates a policy under which gifts from clients need to be declared and passed on to the team as a whole. What cognitive biases might influence whether an individual accepts a ‘gift’– for example: 1. Salience: Hearing of a colleague who has been suspended for not declaring a gift might make it more likely that workers would refuse a gift. 2. Loss aversion: If a worker had the gift in their possession, and then considered giving it up, they might be influenced by loss aversion. This bias could make it harder for them to pass the gift on, as once they have it, they will be less likely to want to give it up. 3. Beliefs about disclosure: Under controlled conditions, people tend to be more honest when they believe their actions will be known by others (Ariely, 2012). So, for example, in an unobserved individual therapy the risk of dishonesty is higher than in a group situation. 4. Dissonance reduction: People justify their actions by rationalisations, which allow them to justify keeping the gift on the grounds that it was too small to be shared. Ethical motivation Ethical motivation links to the values we have (for example, if someone overly values publication productivity they may be more motivated to pursue unethical research practices). Social psychological factors may also impact on willingness to engage in actions that could carry a personal cost. For example, amongst people who work together as a team identifying with the group could outweigh ethical considerations, resulting in a reluctance to report unethical behaviour. As a result, individuals may be clear about the ethical question (sensitive to it) and they may also be able to reason through the most ethical course of action (ethical reasoning), but their motivation to act could be compromised. Ethical motivation – examples Conformity and resistance: Many studies have shown the extent to which we are all affected by social norms and our sense of group identity (Tajfel et al., 1971). People may find themselves obeying authority unthinkingly (Benjamin & Simpson, 2009), and if the ‘in-group’ with which they identify is engaged in unethical behaviour it may be hard for them to achieve sufficient psychological distance to resist this. Studies that look at resistance (Haslam & Reicher, 2012) suggest that the institutional context can play a critical role in encouraging motivation and facilitating the implementation of ethical action by fostering a sense of being part of a group that is committed to ethical practice. The Bystander Effect: This is the name given to the tendency for people to fail to act when they assume that others are in a position to take action (Levine & Crowther, 2008) and again would be likely to come into play in a team situation as, for example, in many healthcare settings. Ethical implementation Putting an ethical plan into action depends on many skills including a capacity for leadership, effective prioritising and risk management. Individuals may have to make a decision regarding which, of many competing ethically relevant actions, should come first. For example, informing a participant of a potential brain abnormality uncovered during research on (supposedly) healthy participants would be fulfilling the requirement to avoid potential harm to the participant. However, as researchers are not radiologists this action also contravenes the principal that psychologists should operate within their area of expertise (and so other systems would be needed to be in place). Organisational contexts often exert pressures to act in a variety of ways, each of which may be ethically justified on their own, but doing one may compromise another. For example keeping good records and recording risk may limit the time available to spend with patients in a clinical context. Dilemmas like this represent day-to-day decisions in some professional contexts, and skills at prioritising to minimize harm are essential. What psychological characteristics could influence the implementation of a plan to deal with examples of ethical misconduct? Ethical Implementation example 1. Fear: There are many contemporary examples of individuals raising questions of ethical misconduct. These accounts have many things in common: most people report there is some form of retaliation. Unsurprisingly, fear is a common reason for failing to implement ethical action. 2. Difficulty/Fatigue: Yong and Simonsohn (2012) uncovered three cases of fraudulent data that had been published in peer reviewed social psychology journals. In an interview for the journal Nature they reported having evidence for a fourth case that they may not pursue because the effort required to uncover misconduct is draining and time consuming. 3. Perverse reward systems: Behavioural ethics has started to develop a conceptual framework for understanding why people do not act ethically, particularly in business environments (see Bazerman & Tenbrunsel, 2011 for a review). The introduction of the target culture into the NHS illustrates how targeting can have perverse outcomes, leading to improvements in some areas but at substantial cost in others, as staff lose sight of broader implications for practice (Seddon, 2008). Exercise 15 minutes group discuss Why ethics is important in clinical practice? Identify your personal values. Could you please start identifying your own personal values and compare these ideals with ethical guidelines? Professional issues scenarios Professional issues scenarios Scenarios • Your client asks for a hug at the end of a session, so you give them a quick hug • Your client sends you a Friend request on social media. What do you do? • Your client’s wife phones 30 mins before you have a session with the client. She wants to tell you something important, but doesn’t want you to tell the client. You decide to speak to her.