Ethical and Professional Issues

Qn.1 

My Ethical Decision Making Model 

An ethical model provides a moral framework to reflect on when faced with a dilemma or conflicting ethical obligation. They are like a point of reference emphasizing on one specific approach to be taken in decision making. I strongly believe in communitarianism as the best way to go. The model is greatly useful when faced with the complexity of most current moral situations because of its neutrality, simplicity and practical approach. 

Communitarianism 

This theory assumes that the right action is derived from community values, goals and cooperative virtues. Ethical decisions are dependent on the common good of the community and collaborative virtues. communitarianism theory gives priority to the individual than the group by valuing individual autonomy, privacy, property, free speech and freedom of religion as the pillars that hold the society. However, some form of communitarianism tend to value the welfare of the group/ members of the community at the expense of an individual’s right. It can reject the idea that ethical decisions are applied universally among communities. 

Communitarianism also tends to look at a policy’s relevance in producing a common good for all individual within the society. It seeks to answer the question of whether the policy will make the community productive for everyone or not. Since there are always key persons that often highly valued within a given community, the model ensures that the key informants are well represented in ethical decision making. It, therefore, does not go with the majority rule where the values of the majority are more important than the values of the vulnerable minority to avoid health disparities and inequality of the marginalized groups. On the contrary, sometimes the idea may fail to adequately serve all the members who are truly in need. 

Communitarianism model defines a community as a group of representatives in the design of the evaluation of educational and social programs. Psychologists can apply the model in their daily tasks by conceiving the ideas of members of a larger community, assuming that the pursuit of knowledge is for the common good, positive results are essentially valuable and considering positive consequences of operation that will ensure positive change within the community. 

Impacts of Communitarianism to Clinical Practice 

Communitarianism creates a balance between the individuals and the values of the community and thus making more people satisfied with the ethical decisions made. The model focuses on how relevant policy can be of common good to individuals and the entire community. The approach will have an effect of creating a better and healthier world for further progress of the profession. Since the theory focuses on the common good, people will highly regard profession for its nature of consideration of everyone. This has a direct impact in creating trust between the professionals and the community which is an essential factor in clinical practice. Communitarianism further instills a great sense of responsibility in the clinical practice. Individuals have the obligation to work diligently to fulfill community’s wellbeing. This is achieved through the constant awareness that the interests of everyone within the community need to be valued. 

Communitarianism theory relies on the community as a source of moral guidance and promise. Professionals, therefore, have the best platform to draw a set of morally right practices from the things that benefit the community and what the community values the most. This guidance strengthens the profession more by providing a source of reference. Therefore, there will be reduced incidence of a dilemma on how to act when faced with stressful situations. The theory also aims at promoting social justice since everyone is treated as a member of the community including the clinical practitioners. The community is more united under the principles of equality. The advantage of this equal treatment is that it provides a good working environment for clinical practitioners. There will be no excessive demand, unrealistic expectation, manipulation and unnecessary influence that may impair the moral judgment of a clinician. Because communitarianism emphasizes on social responsibility, everyone takes into consideration the welfare of other individuals to the best they can. This can be evidenced by the community's offer of self-support to their families and friends thus making the practice of emotional, physical and psychological treatment to be fast and more efficient hence facilitating the work of most medical practitioners. 

Qn. 2 

Ethical Dilemma 

The ethical dilemma is a situation where a psychologist or any other medical practitioners find themselves at crossroads , and they have to choose between commitments to different ethics of their practice 

Ethical Dilemma in Case Study I 

According to standard 1.04, in situations when a psychologist learns about the violation of ethics of another psychologist, he or she is required to resolve the situation informally first but by ensuring confidentiality rights are maintained. However, standard 1.05: Reporting Ethical Violation requires the psychologist to formally report an offense that has already caused damage or has the potential of creating substantial damage/ harm to the patients as long as the reporting does not violate anyone’s confidential rights. 

Dr. G is a professional psychologist who made an oath to not harm patients by covering and lying. She learns of Mr. T’s misconduct and decides to solve the situation informally because that is what is required of her. However, failing to write down clinical notes and their confusion is direct misrepresentation of work. It is dangerous to the patients and may cause significant harm. Knowing this fact, ethics requires Dr. G to act morally right by reporting the issue directly to the hospital committee which would ensure an excellent resolution. 

Psychologists are not allowed to file or encourage the filing of ethics complaints that are made with reckless disregard for the willful ignorance of facts that would disapprove the allegation. However, psychologists are protected from unfair discrimination against individuals accused of misconduct but not found to have committed the misconduct. Complainants may be denied employment, professional or academic advancement or admission into programs for reasons that are based on the outcome of the complaints. 

The fact could give Dr. G a dilemma on whether to go ahead and file the case or not. The reason is, no substantial evidence will support her claim because she learnt about the issue on the phone some few days after it happened. Mr. T, on the other hand, is well protected by the same code, and he stands a better chance of being proved to be without an offense. So there is a probability of the case turning out to the favor of Mr. T and disadvantaging Dr. G and thus inconveniencing her career progress or some privileges she is set to enjoy. 

Basing on standard 2.0, the psychologists through scientific and professional should establish method that provides professional opinions. The judgments should be grounded in the knowledge base of psychology. In this case, Dr. G has a responsibility of providing an opinion that is firmly ground towards the clinical reports made by Mr. T. However, the dilemma is Dr. G is required to observe the ethical principle B that requires her to be faithful by maintaining a professional and teaching relationship in avoiding conflict of interest that will jeopardize trust between her and Mr. T. 

Ethical Dilemma in Case Study Two 

There is a dilemma between adherence to the principle B: Fidelity and Responsibility and principle E: Respect for People’s Rights and Dignity. Dr. K realizes that the staff in the institution uses an outdated means of analyzing the risk levels on patients which is likely to cause potential harm to patients. In following principle E, Dr. K is required to be honest and disclose the test takers the details of the dangers of the test methods they use for assessment. He is torn between being faithful to the organization that believes in the outdated mean of analysis and observation of the rights of the test takers. 

Principle A requires psychologists to strive to promote the welfare of others by avoiding harm by guiding against behaviors that may that would lead to exploitation of people through bad assessment methods. Dr. K therefore is responsible for opposing the method used in the organization for risk assessment. However, in observance of principle E: Respect for People’s Rights and Dignity, psychologists need to respect the dignity and worth of all people by being aware of individual differences. The board’s opinion differs significantly with Dr. K’s opinion. The dilemma is whether Dr. K should keep quiet and respect the board’s opinion or whether he should oppose the opinions of the board by pushing for a reform in the method of assessment. 

Standards of APA Ethics Code 

These are ethical principles that are essential for the general conduct of The American Psychological Association (APA) with the aim of guiding the psychologists to the highest ideals in the practice of their psychological duties. Psychologists use these codes as a manual to arrive at an ethical course of action when faced with a deadlock situation. The following are standards of APA ethics code that are applicable in the two case studies. 

Standards of APA Ethics Codes Applicable in Case Study One 

Standard 1.01 (APA 2010, b) Misuse and Misrepresentation of Work 

Psychologists have the responsibility both professional and scientific, to the society and to specific individual, organizations, and communities with whom they are working with to ensure the products of their work are not misused or misrepresented. Psychologists are allowed to write letters to inform interested parties of any situations of misrepresentation or misuse requesting for withdrawal of deceit with the appropriate corrective measures. 

When Dr. G discovered that Mr. T had not been writing down the necessary documentation possibly confusing records, she had a responsibility of a) not relying on Mr. T’s word of mouth by ordering for the reports he claimed to have completed, b) confirm where misrepresentation of the report had happened and immediately requested for the withdrawal of the misrepresented statement replacing it with the correct one. She should not have accepted a claim of ignorance from Mr. T as the defense for the misrepresentation of his work, and d) immediately ensure Mr. T corrects the error to avoid similar problems in the future. 

Standard 1.04 Informal Resolutions of Ethical Violations 

When psychologists believe that there are situations of an ethical violation by another psychologist, they need to tell the individual, if the informal resolution does not restrict available confidentiality rights. The importance of this resolution is to is to avoid causing harm to the profession or causing distrust from the public. When the resolution proves not to be feasible, or ineffective, the offending psychologist can be made to leave the position he/ she has committed the offense. 

Dr. G successfully initiated an informational approach when she initially heard issues concerning Mr. T’s practice. She went to him and silently had a conversation with him requesting him to change for the better. However, Mr. T promised to change, but he did not deliver. He ignored Dr.’s plea and kept repeating the same mistakes. He went to the extent of lying to keep the doctor off. Mr. T was therefore non co-operative. Dr. G being his supervisor, she had a mandate of reassigning a new psychologist to the patient who was complaining and assigns Mr. T to other roles. 

Standard 1.05 Reporting Ethical Violation 

This standard requires a psychologist to report to the hospital administration any situations of ethical violations conducted by the psychologist if it has already caused damage or if it has a potential of causing harm. From the case study, since Mr. T had proved to be stubborn and kept recurring the same ethical malpractices by refusing to keep records, of which Dr. G was well aware of, she could report to the committee within the hospital for further action and to avoid further damage. Dr. G also has to inform the committee that Mr. T has indirectly or directly led to the suicide of the patient by his unethical practices. 

Standard 2.10 Boundaries of Competence 

Psychology aims to benefit people they work with and to avoid harming people in the course of the application of their knowledge. Psychologists, therefore, need to provide services in areas they are competent in based on their education level, training, supervised experience, consultation, study or professional experience. In situations that appear more challenging, they need to refer to another competent psychologist except in cases of emergencies. This standard code gives psychologists three principal obligations: to familiarize themselves with professional and scientific knowledge, to gather appropriate skills before handling a task and to have the knowledge on when to refrain and refer their duties. Mr. T violates this code by ignoring key skills when handling his assignments. He does not keep records for the therapy sessions. 

Standard 2.04 Bases for Scientific and professional Judgements 

Psychologists’ work is based on established scientific and professional knowledge of the discipline. Dr. G is supposed to provide a firmly grounded opinion on the clinical reports that Mr. T is supposed to write. 

Standard 3.04 Avoiding Harm 

Psychologists should try to take care of the welfare of the people they work with by minimizing or entirely avoiding harm as a result of the conflict in their professional obligation. 

Dr. G’s could be acting out of concern for the Mr. T by protecting his profession when she received many cases of professional malpractices done by Mr. T from various sources. 

Standards of APA ethics codes that apply in Case study two 

Standard 1.03(APA, 2010c) conflict between ethics and organizational Demand 

This code states that if the demand of the organization with which the psychologists practice conflict with the code of ethics, psychologists need to clarify the nature of the conflict, their commitment to the laws of ethics and device the reasonable steps in finding solutions to the problem. If the organization refuses to make changes, the psychologist should carry on with his responsibility of protection of human rights 

Dr. K intends to make a contribution to the board he just joined concerning their practice gap. None of the board members appeared to be concerned. Instead, they emphasize that Dr. K has to make a note about the review of risk levels they must be based on the factors required by the law. The chair of the board's primary concern is to follow procedures and go by the book which conflicts with the ethical codes well known by Dr. K. He, therefore, needs to try and take actions that resolve the problem, or if it gets more difficult, he should refrain from the organization's demand and concentrate on the protection of human rights. 

The code also provides for psychologist working in and to consulting organizations to address the needs of multiple stakeholders who differ regarding ideas, privileges, and power within the organization. In this case, the board appears to be powerful and un-accommodative to open and new ideas as evidenced by the reaction after the preposition of Dr. K's opinion. He should, therefore, address the need of increasing the number of stakeholders with varied power and knowledge to ensure fairness and justice in finding solutions to most problems in the future. 

Standard 1.05 Reporting Ethical Violation 

If an ethical violation problem does not appear to be appropriately solved, the psychologist can take further action like reporting to the state or national committee on professional ethics especially if the problem has a possibility of causing substantial harm. However, the reporting should not violate confidentiality rights of anyone. 

In this case, the organizational committee appears reluctant to make changes to a decision that directly violates the human rights by refusing to accept that their method of review of the risk levels is outdated. Dr. K is allowed to go ahead and report the matter to the higher authority like state licensing board or the national professional ethics committee. However, he must ensure that the intervention would not by any chance interfere with the confidentiality of others, 

Standard 1.02 Conflicts between ethics and law, regulations, or other governing legal authority. 

If the ethical responsibilities of the psychologist conflicts with the law, regulations and other governing legal authorities, the psychologist are required to clarify the nature of the conflict, reveal their commitment to the ethics code and take reasonable steps relevant to solving the conflict. If the authority does not respond to the recommendations by the psychologist or the specific actions taken, it means the principal of justice will be conflicting with the principle of human rights. The psychologist is allowed to decide to comply with the legal or regulatory authority under circumstances that their actions cannot be used to defend or justify human rights. He is also permitted to decide on whether to obey or defy a court order 

After appointment to the state board, Dr. K detects a problem in the assignment of risk levels to the offenders by the staff. The law no longer reflects the best practices as the law is already outdated. According to him relying on it alone will be an act against the standard of care. He, therefore, has an option of involving the relevant lawmaking authority about if for the necessary changes. If they are not resolved as expected, he has a duty of ethically practicing his profession by protecting the interests and the rights of the patients. 

Standard 6.6 Conflict of Interest 

Psychologists refrain from taking on professional roles when personal, scientific, professional or legal relationships impair their objectivity, competence or effectiveness in practicing their profession, or expose the professional to harm or exploitation. 

In this case study, the doctor has a fiduciary responsibility to avoid actions that would create public distrust in the integrity of the psychological fields when addressing the problem at hand. He should try to be confidential and follow the right professional channel that would not expose the institutions to the public. He also has the option of refusing to work with the institution due to their conflicting interests. 

Resolving the Dilemma Using the Communitarian Model 

In addressing problems using this model, it is important to note that the model does not support the autonomy of a particular group that is regarded as superior. The models take a Social mechanism that emphasizes that a belief needs to be non-absolute but it should be relative an accommodative 

Case Study One 

The public has the legitimate authority to determine what they want. The primary concern of communism is attaining freedom and justice. Therefore, the burden of injury from negligence should not heavily lie on one individual within the community but should be equally shared. The communitarian model relies on the combination of common sense, observation, and practical techniques. Dr. G, therefore, had the responsibility to reason out the situation and determine the best course of action to follow by taking into consideration the needs of the society instead of the needs of the individual psychologist. In addressing the dilemma of whether to report the case when the client complained of poor physiological care, she had a duty to report the matter immediately because the misconduct posed a danger not only to the patient’s life but too many other patients who would fall into the hands of Mr. T in the future if corrective action is not taken. 

Case study 2 

Dr. K's biggest dilemma is the different principles and standards, since he is the only psychologist professional in the organization. According to Standard code 1.03: Conflicts between ethics an organizational demand, a commitment to human rights within the organization setting places a new ethical obligation to the psychologist to uncover the wrongs. He is also allowed to recommend changes in institutionally entrenched rights’ violations of he bears the burden of informing others as well as steering for change however hard it may appear. The following steps are a proposition of the method he is likely to use in handling the situation, creating awareness and pushing for change while putting into consideration the fundamental principles of the communitarian model 

Step 1 : Ethical commitment for the common good . Communitarianism argues that a human being is a social being that can only thrive in stable associations and communities. Meaning she/ he cannot exist without a group. In this case to address the dilemma of quitting the job or not to basing on the different moral ethics, Dr. K should consider transcending his interests by staying in the situation to fight for the interests of the community. This will be a direct pursuit of the common good of everyone which is fundamentally preached by communitarians advocates. In case the policies prove hard to be changed, Dr. K should be tolerant, act with respect towards other board members and act neutrally in his career. 

Step 2: Dr. K, in addressing the issue of using an outdated means of risk assessment of the level of mental health, he should first peruse knowledge for the common good adhering enough information on the issue and trying to teach the staff who conduct the tests on the risks involved in using an outdated method. 

Step 3: He should also conduct a dialogue with the board members and stakeholders. Communitarianism emphasizes on the conventional interpretation through discussion to analyses the situations’ disadvantages and the risks involved. Since the board appears not to be interested in his idea, he may include other professional experts in his field since most of the board members are not a psychologist to exert more influence. In the course of their analysis, all community values should be brought into focus and well represented. The 

Step 4: Consultation with the state representatives is also important. This is a national policy, therefore the authority of amendment lies within the state. Just like in the board meeting, Dr. K with some of his professional colleagues will need to brainstorm, explain and highlight the consequences of the outdated laws to the community. 

Step 5: Generating of alternatives. The process of law formation is a long process and if the amendment is to be considered is likely to take more time than expected. In the meantime, Dr. K needs to influence the institution towards finding temporary alternatives by devising a policy that will be healthier for the community. The new plans should be strictly of higher value to the community than the individuals. 

Step 6: Monitoring. To measure how effective, the devised alternatives are, Dr. K will need to monitor them. The underlying goal was to reduce the risks in the assessment of the risk levels of the offenders within the community as well as. Part of the evaluation will be to ascertain if this objective had been met. The proposition of future changes will also be relevant, 

In situations when there are no changes, the communitarian model allows the psychologist to make a reasoned decision on whether to engage in the role he has been given on the board or not.