Ethical dilemmas in psychological practice: Results of a national survey.

Surveyed 294 randomly selected psychologists who were members of Division 29 (Psychotherapy) of the American Psychological Association (APA) on the choices they would make in the face of specific ethical dilemmas. Ss were presented 10 vignettes, each representing a potential problem of professional ethics. They were asked to indicate their preferred resolution to the dilemma and their primary reason for choosing this alternative. Ss were also asked to rate the frequency with which they encountered each of 17 ethical/legal issues in their clinical practices and to rate each issue's severity. Ss also described dilemmas that they themselves had experienced in practice. Results show that the degree of consensus on the appropriate response to the 10 dilemmas varied considerably. Highest consensus was achieved on such issues as duty to warn potential victims of violence and avoidance of difficult bartering relationships. Lowest consensus was achieved on such issues as advertising practices and the boundaries of competence. Assessments of their own and their colleagues' competence and propriety were among the most troubling issues to Ss. It is suggested that work to further develop graduate course work in ethics should be pursued, with attention to real-world ethical problems involving confidentiality, competence, and colleagues' behavior. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current aspects and problems relating to medical ethics in oncology

A case history of a breast cancer patient is used to exemplify ethical dilemmas in medical oncology: information of a cancer patient and his family, ethical problems with genetic testing, ethical issues with do-not-resuscitate-orders, ethical dilemmas with limited resources, problems with insurance companies, ethical issues in clinical trials and questions in dying patients including physician-assisted suicide and active euthanasia. Medical oncologists have to develop skills in recognizing ethical dilemmas in patient care and must prepare to cope with the many and complex ethical issues in the care of oncology patients.     

The rehabilitation ethic and ethics.

A set of evolving ethical models is presented to illuminate key issues and provide decision-making guidance to rehabilitation staff regarding admission and termination of rehabilitation treatment. Roles, goals, and guiding principles are outlined for the paternalistic, contractual, and educational models and a deliberative model is offered as an alternative for use in preventing and resolving ethical dilemmas. This model redefines the rehabilitation process in terms of patients and providers acting in community. Recent observations have reemphasized the importance of empathy and communal interests in facilitating human development. Emphasizing these principles, which are fundamental to therapeutic relationships, may prove instrumental in resolving ethical dilemmas that arise in rehabilitation. Recommendations for training in therapeutic principles and ethical models throughout the psychologist's career are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ethical practice of psychology in a managed-care framework.

With the rise of managed healthcare, psychologists face new challenges to their professional ethics. This article examines the dilemmas posed by managed care in 3 areas: client care, the handling of patient data, and issues surrounding membership in a managed-healthcare organization. Case examples of ethical dilemmas and strategies for dealing with these challenges are presented. In an attempt to summarize the strategies used to cope with the ethical dilemmas presented in the case examples, global solutions for the ethical practice of psychology in a managed-care framework are also reviewed. These strategies include understanding managed-care policies, clear communication with the client, additional training, increased advocacy by clinicians, and ultimately, psychologists' involvement in the formation of these organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender-related ethical dilemmas and ethics education.

After a summary of the current approaches to the ethics education offered in psychology training programs, various assessment techniques and results are presented. On the basis of the summary of the usefulness of such ethics education, three fictional ethical dilemmas involving sexual intimacy with a client, a dual relationship with a graduate student, and a biased child custody evaluation are examined from the perspective of gender. For each situation, possible ethical, unethical, and poor judgment responses are given. Suggestions are given on ways to educate or sensitize graduate students so that they will be prepared to recognize the dilemmas and face the issues involved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subject, project or self? Thoughts on ethical dilemmas for social and medical researchers

In this paper we address an important but sadly neglected area; namely some of the ethical issues which arise for social and medical researchers in the course of their work. Our concern is for a wide spectrum of researchers using the full range of social research methods from small-scale in-depth qualitative work through to large scale quantitative studies. The unifying factor is that they all have an element of contact and hence the potential for interaction between the researcher and the subject. In our experience (with the exception of some ethnographers) few if any social researchers will have had adequate training about the interactional aspects of their work. As a result they are unprepared for the ethical dilemmas and conflict of loyalties which they might experience. To understand these issues it is important to look at the context within which such research is undertaken.     

Teaching ethical principles by means of value confrontations.

Presents an approach to teaching ethical standards and principles to graduate psychology students. Students are asked to respond to critical incidents involving ethical dilemmas. Existing values and beliefs are confronted and the student is challenged to seek solutions to the dilemmas. Topics range from ethical issues in psychotherapy research to values inherent in major theories of personality. Sample discussions from several topics are presented. The position is taken that the teaching of ethical principles is facilitated by value confrontations. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mandatory reporting of child abuse: Legal, ethical, and clinical implications within a Canadian context.

Focuses on the legal, ethical, and clinical implications for Canadian psychologists of the child protection legislation that makes it mandatory to report suspected and known instances of child abuse. Provincial and territorial statutes and Canadian case law dealing with the duty to report are examined. The Canadian Code of Ethics for Psychologists of the Canadian Psychological Association (1991) and its proposed decision-making process for resolving ethical dilemmas in this area are applied to a review of the issues associated with this type of duty to report. Guidelines are proposed regarding how psychologists can best negotiate these dilemmas. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS: Ethical implications for psychological intervention.

Examines the ethical issues facing psychologists working with people who are infected with AIDS (acquired immune deficiency syndrome) and individuals in high-risk groups. Duty to treat is examined with a consideration of homophobia and biases about intravenous drug users. Confidentiality is discussed in the context of record keeping, in cases of conflict with duty to warn, and in cases of suicide. Psychologists are urged to consider possible ethical dilemmas before they arise, to ensure that the best decisions are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fostering ethical willingness: Integrating emotional and contextual awareness with rational analysis.

Ethical dilemmas are inherently challenging. By definition, clinicians decide between conflicting principles of welfare and naturally confront competing pulls and inclinations. This investigation of 258 students' responses to an ethical scenario highlights how emotions and concerns can interfere with willingness to implement ethical knowledge. Clear-cut rules are the exception in psychotherapy, and clinicians must judge ethical issues on the basis of the unique context of each case. As such, subjectivity and emotional involvement are essential tools for determining ethical action, but they must be integrated with rational analysis. Strategies for attending to influential emotions and contextual factors in order to mobilize ethical commitment are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical dilemmas in clinical supervision. 2: Need for guidelines

In this, the second half of this two-part article, the authors focus on ethical dilemmas in clinical supervision. Referring to the case vignettes included in the first part of this article (Vol 7(15): 920-3), the authors highlight how ethical dilemmas can arise and then provide some discussion on how they might be handled. As a result of the discussion, the authors conclude that there is a clear need for a specific set of guidelines to be produced that would help safeguard best practice within clinical supervision and ensure it remains an opportunity to help and support nurses in reflecting on their dilemmas, difficulties and successes (Cutcliffe and Proctor, 1998a). This would prevent supervision from becoming another form of management monitoring which might inadvertently prevent the resolution of intra- and interpersonal issues affecting the care of clients.     

Focus on ethics April 2010 correction.

Reports an error in "Ethical dilemmas in sport psychology: A dialogue on the unique aspects impacting practice" by Amy B. Stapleton, Douglas M. Hankes, Kate F. Hays and William D. Parham (Professional Psychology: Research and Practice, 2010[Apr], Vol 41[2], 143-152). Due to a production error, the name of Amy B. Stapleton was substituted for the name of Jeffrey E. Barnett as the editor. (The following abstract of the original article appeared in record 2010-06890-009.) The multidisciplinary field of applied sport psychology, a specialty area of psychology practice, has been acknowledged as a proficiency area by the American Psychological Association (APA, 2007). This unique discipline often requires the psychologist to work outside the realm of traditional practice. In doing so, sport psychologists frequently encounter unique ethical dilemmas. In an effort to promote awareness and dialogue, this article describes some of the more commonly faced ethical considerations in applied sport psychology. Issues related to developing and maintaining competence in the field, confidentiality, and boundary issues are discussed, and case examples are provided to illustrate the relevant ethical consideration. Subsequently, three applied sport psychology experts respond to the lead article’s discussion and offer poignant reflections on ethical issues presented. In addition, suggestions for successfully resolving ethical dilemmas related to competence, confidentiality, and boundary issues in sport psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mixed agency in military psychology: Applying the American Psychological Association ethics code.

Military psychology can diverge significantly from traditional psychological practice. Mixed-agency conflicts--those arising when a military psychologist's obligations to individual patients compete with obligations to the Department of Defense or federal regulations--can generate challenging ethical dilemmas. This article explores the notion of mixed agency within the military setting and addresses the most pertinent aspects of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct related to this ethical challenge. Case vignettes are presented as a means of illustrating key mixed-agency dilemmas and the effective navigation of these conflicts. The article concludes with several recommendations for military psychologists as they work to anticipate and effectively manage ethical dilemmas bearing on their dual identities as officer and health care provider. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Independent practice in child and adolescent psychotherapy in small communities: Personal, professional, and ethical issues.

This article addresses issues faced by independent practicing child and adolescent psychotherapists in small-town settings. A community approach to delivering services is stressed. Personal, professional and ethical dilemmas are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient-therapist boundary issues: An integrative review of theory and research.

Boundary issues, which regularly arise in therapy, can present difficult dilemmas for clinicians. The purpose of this article is to help clinicians resolve these dilemmas by integrating some of the theoretical positions with empirical evidence reported in the literature on boundary issues in counseling and psychotherapy. The authors review the concept of treatment boundaries and the ethical principles that underpin them. They also review common boundary violations and provide recommendations to attenuate harm done to clients when such boundary violations occur in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical issues in pediatric rehabilitation: Exploring an uneven terrain.

Discusses issues that arise during the stages of the pediatric rehabilitation process as they relate to such ethical principles as patient autonomy, provider beneficence/nonmaleficence, and fairness/justice.These include initial decision making in rehabilitation, information sharing and negotiation, treatment consent/refusal, transitioning from rehabilitation to community, and long-term planning. Case examples are used to illustrate potential resolution of specific dilemmas. Future directions for pediatric rehabilitation psychologists are outlined. Among these are rationing of care, integration of systems, research on pediatric rehabilitation outcomes, training, and responsible use of technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training interns to respond to sexual dilemmas.

Previous research has documented that psychologists receive little training in responding to sexual dilemmas in psychotherapy. The authors describe 2 training experiences focusing on the personal, professional, ethical, and legal issues involved in sexual attraction between psychologists and clients. Small group discussions were particularly useful as trainees were able not only to receive educational material but also to examine their feelings and behaviors when they experienced sexual attraction. A conference format providing didactic information was especially helpful to new psychology trainees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The rural mental health worker as public servant: Challenge or conflict of interest.

Discusses ethical dilemmas resulting from the conflicting expectations of professional standards and bureaucratic regulations in the delivery of rural mental health services. Three cases are presented to illustrate ethical issues and practical problems of rural mental health professionals. (French abstract) (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)