resolving ethical dilemmas liljedahl

7/24/2019 Resolving Ethical Dilemmas Liljedahl

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MODELS FOR MAKINGDECISIONS

Erika L. Liljedahl, Psy.D.The Chicago School of Professional Psychology


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Dr. Erika L. Liljedahl will be presenting four dierentethical decision !aking !odels which will assist!ental health professionals in trouble shootingethical dile!!as. These !odels help guide thethought process when one is faced with an issue

that is not clearcut. The objecti"es of this talk are topro"ide a brief history of ethics, to teach the stepsof the four !odels, and to help !ental healthprofessionals apply the steps in order to !oreco!petently handle the #gray# areas when !akingdecisions. Dr. Liljedahl highly reco!!ends using an

ethical decision !aking !odel and docu!entingthe steps in the thinking process. She belie"es thatthis is an essential step in forensic docu!entationand litigation pre"ention.


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Students will learn se"eral Ethical Decision$aking $odels.

Students will learn how to apply the !odelsto classes and in their careers with youth

and adults. Students will beco!e !ore fa!iliar with

how to handle the %gray areas& when!aking decisions using the Ethical Decision$aking $odels presented.


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'. (hat are ethics) *alues and ethics

+. rief history of ethics

-. (ho !akes unethical decisions)

. Presentation of Ethical Decision $aking$odels


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The (orld English Dictionary says %/naccordance with principles of conduct that areconsidered correct, especially those of a gi"enprofessional or group&

$erria!0(ebster says %Confor!ing to

accepted standards of conduct& 1nowing the dierence between right andwrong, and choosing the right

2a"ing "irtue, good !oral reasoning 2a"ing a positi"e, good "alue syste!, which

!ight include doing good things in the world,be hard working, be honest, treat others asyou want to be treated, be loyal to yourfa!ily.


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/t is possible that your "alues will opposewhat the ethics code or law states. E3a!ple4 5ou are attracted to your for!er

client and the client has "erbali6ed that theattraction is !utual. The 7P7 code states you !ust wait + years.

The 7C7 code states you !ust wait 8 years.

So do you de"elop a relationship after +

years) 8 years) 9r is ha"ing a se3ualrelationship with a for!er client altogetheragainst your "alue syste!)


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9rigin of ethics is in 7ncient :reece;


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learned fro! the 9racle of Delphi to%know thyself.& 1nowing thyself >and"alues? increases knowledge andwisdo!. (isdo! leads to increasedcritical reasoning and proble! sol"ing

skills.

1nowledge andwisdo!

leads to actingEthical.


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:reek philosophers set the stage forethical decision !aking throughe3a!ination of ideas that were

abstract, such as the "irtue ofwisdo!, critical thinking, Socratic@uestioning such as playing De"ilAsad"ocate, and e"en through ethical

dile!!as presented in :reektragedy on stage.


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So if ha"ing knowledge, wisdo! and

knowing thyself assist with !akinggood ethical decisions, then what

kind of a person in todayAs ti!e

!akes unethical decisions)


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%who obey authority BguresA unethicaldirecti"es or act !erely to a"oid

punish!ent, who !anipulate others to orchestrate theirown personal gain,

who fail to see the connection between

their actions and outco!es, who belie"e that ethical choices are dri"en

by circu!stance.& >1ish0:ephart, .., et al. +='=?


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Egotistic work places are!ore likely to pro!ote an

%e"eryone for the!sel"es&en"iron!ent, which pro!otes!ore unethical beha"iors.


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In this talk, I will review.

3 liniall!"relate# Ethial Deisi$nMakin% M$#els, and

& n$n"liniall! relate# Ethial Deisi$nMakin% M$#el


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Positi"e Ethical $odels The focus is on pursuing highest

idealsDefensi"e Ethical $odels The focus is on thinking of the

worst scenario, a"oidingpunish!ent


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S$'re( ush, S.S., Connell, $.7., Denney, F.L. >+==


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'. /dentify the proble!+. Consider the signiBcance of the conte3t

and setting

-. /dentify and utili6e ethical and legal

resources. Consider personal beliefs and "alues

8. De"elop possible solutions to the proble!


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oe is your '< year old client who ca!e totherapy because of ha"ing low self estee!

and being depressed about his parentAs

di"orce. oth the !other and father areBghting for custody of oe. /n the course oftherapy, oe reported that he has begunha"ing thoughts of self har!.

Let us e3a!ine this case using $odel J'.


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The proble!4 Suicidal thoughts. 2ospitali6e ornot.

ConBdentiality4 /s it your ethicalresponsibility to talk to the parents)Do you ha"e a duty to tell the

parents or because oe is a !inor) Should you !onitor his progressand not in"ol"e the parents at all)


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The client is a !inor. Do the parents knowabout his psychological status) Do theparents know their son is in therapy) (hatwould they do if they found out he is seeing

a counselor and is suicidal) (hich parent do you talk to) 2ow do you

deter!ine who has legal guardianship) (hat har! could co!e if you tell the

parents) 9r not tell the parents)


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Look at your ethics code >7P7, 7C7, etc? Look at the law about pri"acy and duty to

warn 2/P77 on conBdentiality

State laws4 /llinois $ental 2ealth ConBdentiality7ct

Look at journal articles, books, case studies Fe"iew Kposition state!entsA of your

rele"ant national association Consult with colleagues


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/n general, ethics codes will ha"ethe following co!ponents Do no har!.

o disclosure without consent >unless!andated by law?.

Li!itations to conBdentiality includesuicidal or ho!icidal ideationMintent.

ConBdentiality with !inors.


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%7ny !inor '+ years of age or older !ay re@uestand recei"e counseling ser"ices or psychotherapyon an outpatient basis withoutthe consent of the!inorAs parent or guardian. 9utpatient counseling

or psychotherapy pro"ided to a !inor under theage of 'H shall be li!ited to not !ore than 8sessions, a session lasting not !ore than 8!inutes, until the consent of the !inorAs parentor guardian is obtained. The !inorAs parentsshall not be infor!ed without the consent of the!inor unless the facility director belie"es suchdisclosure is necessary.&


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)er*itte# +ses an# Disl$s'res( Seri$'shreat t$ -ealth $r Saet!.

%Co"ered entities !ay disclose protectedhealth infor!ation that they belie"e isnecessary to pre"ent or lessen a serious andi!!inent threat to a person or the public,when such disclosure is !ade to so!eonethey belie"e can pre"ent or lessen the threat>including the target of the threat?.&


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2ow do you feel about breaking conBdentialityin this case) /s it necessary) 5ou belie"e thatyou !ight alienate oe if you brokeconBdentiality.

5ou "alue life and i!pro"ing relationshipsOi!!inent har! or not, you want to infor!fa!ily to inter"ene. /n other words, is your core"alue to in"ol"e fa!ily as !uch as possible)

5ou belie"e that !ore e!otional distress wouldenter the e@uation if the parents would knowthat oe is depressed and suicidal.


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t!ost i!portance4 Perfor! a suicide lethalityassess!ent.

/nfor! oe what your duties are as a therapist>your ethical duty of preser"ing life and the

possibility in"oluntary hospitali6ation?. Engage oe in a logical discussion about thepros and cons of telling his parents.

oe could in"ite his parents into the session andcould infor! the! with the therapist.

/f oe does not want to infor! his parents, ha"eoe check in with you during the week and callthe suicide hotline for additional support.


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During a suicide lethality assess!ent, youdeter!ine whether oe is passi"ely oracti"ely suicidal. oe could be hospitali6ed.

7fter discussing the pros and cons of telling

his parents, he can decide to tell the! ornot.

/f oe does not want to infor! his parents,oe !ight ha"e less support. 2is parents!ight continue Bghting without e"enconsidering oeAs psychological status.


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/f passi"ely suicidal4 Decision4 To continue !onitoring oe in therapy

sessions, to ha"e hi! call suicide hotlines forsupport. Encourage oe to tell his parents, seek

support for! trusted friends and fa!ily. /f acti"ely suicidal

Decision4 2ospitali6e. Encourage oe to tell hisparents, andMor infor! oe hat his parents will

be infor!ed. Seek support fro! trusted friendsand fa!ily.


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/f not acti"ely suicidal4 /s !onitoring oe intherapy sessions suQcient to ward osuicidal thoughts) Did he in"ol"ed fa!ily orfriends for support)

Does oe need a referral for possible!edicine !anage!ent)

/f acti"ely suicidal4 2ow did oe react to thehospitali6ation) 2ow did his parents react)

/s there anything !ore you need to do as anethical !ental health professional)


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S$'re4 1oocher, :.P. 1eith0Spiegel, P.>+==I?.Ethics in Psychology and the $ental2ealth Professions4 Standards and Cases.93ford ni"ersity Press4 ew 5ork. Chapter +4 $aking Ethical Decisions and Taking

7ction, written by Ed!und urke.


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'. Deter!ine whether the !atter truly in"ol"es ethics.

+. Consult guidelines already a"ailable that !ightapply as a possible !echanis! for resolution.

-. Pause to consider, as best as possible, all factorsthat !ight inRuence the decision you will !ake.

. Consult with a trusted colleague.

8. E"aluate the rights, responsibilities, and"ulnerability of all aected parties.


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7 student told a teacher about anotherstudent threatening her on Gacebook andthe school had to decide how to proceed.


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/s this an ethical issue for the teacher) Does this case in"ol"e your ethical

standards) >E.g., 7P74 :eneral Principles ofbeneBcence and non!aleBcence, Bdelity,

responsibility, integrity, justice? Does the teacher ha"e to do anything at all

since the threat was online)

/s there an ethical duty to protect thestudent because heMshe is a !inor)


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(hat are the schoolAs policies regardingcyber0bullying)

/s there a decision0tree in place at theschool to deal with cyber0bullying andharass!ent)

(hat does your ethical code state)

Do the parents need to be infor!ed) (hat are your "alues in such a case)


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Charater e#'ati$n. E"ery public schoolteacher shall teach character education,which includes the teaching of respect,

responsibility, fairness, caring,trustworthiness, and citi6enship, in order toraise pupils honesty, kindness, justice,discipline, respect for others, and !oralcourage for the purpose of lessening cri!e

and raising the standard of good character.Sec. +HU'+.


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>'? Safe and responsible use of socialnetworking websites, chat roo!s, electronic!ail, bulletin boards, instant !essaging, andother !eans of co!!unication on the /nternet.

>+? Fecogni6ing, a"oiding, and reporting online

solicitations of students, their class!ates, andtheir friends by se3ual predators. >-? Fisks of trans!itting personal infor!ation

on the /nternet. >? Fecogni6ing and a"oiding unsolicited or

decepti"e co!!unications recei"ed online. >8? Fecogni6ing and reporting online

harass!ent and cyberUbullying.


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Class !isde!eanor if person is con"ictedof harass!ent >H+= /LCS '-8M+? >fro! Ch.'-, par. '-V?, Class felony. /f there is a threat to kill, it is anauto!atic Class felony.


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(hat was the KthreatA said on G) (as it"ague or speciBc) 2ow !any ti!es has thishappened) /s it a one ti!e occurrence or

repeated) Consider the harassed studentAs safetyW

ability to concentrate in school. Consider if one student is being threatened,

other students could be in the sa!esituation.

Think the worst scenario could happen.


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Fead the law and policies appropriate tothis case.

Talk to your i!!ediate super"isor, thePrincipal of the school, your colleagues

about the school policies or lack thereof. Consult with books, journal publications, the

law for cases that are si!ilar. Possibly in"ol"e the police.


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Children ha"e the right to be safe and learnin a safe en"iron!ent.

The harassing child has the right to be

heard which !ay lead to be tried in a courtof law.Teachers ha"e the right to teach in a safe

en"iron!ent. They also ha"e the right to

pro"ide a character education co!ponentinto their curriculu!.


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So!e solutions4 7sk for the student to print the G page

So!eone >teacher, counselor, Principal,

Superintendent? would talk to each childseparately

Talk to both children together

/n"ol"e the parents

/n"ol"e the police


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7sk for the student to print the G page Decide if there is harass!ent.

/f harass!ent e3ists4 then go to the ne3t step.

/f harass!ent does not e3ist4 /f the wording

was !isconstrued by the student, thenpro"ide education on what constitutesharass!ent. 5ou !ight want to decide onwhat caused the !isinterpretation. Does the

student ha"e a learning disability) /s thestudent o"erly suspicious of people) Didso!eone else inRuence the student)


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So!eone >teacher, counselor, Principal,

Superintendent? would talk to each childseparately Each child could tell hisMher story without

hesitation. This conBdentiality would likely alloweach student to speak in an uninhibited !anner.

Talking to the harassed student separately wouldlikely shield the student fro! so!e additionalunnecessary grief. Showing the grief in front ofthe harasser !ight reinforce the harassing. Theharassing could beco!e !ore co"ert.

There !ight be so!ething going on in theharasserAs life that would be useful infor!ation tothe beha"iors.


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Talk to both children together Conduct a conRict resolution session without

in"ol"ing the police or higher authority, such asthe Superintendent.

/n"ol"e the parents

7ppraise the parents about the situation andin"ol"e the! in the conRict resolution.


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/n"ol"e the police

)r$s( 7 ju"enile record is created for the studentharasser in case that the harassing will beongoing. This record will likely lead topsychological inter"ention of forensic

psychologists, to assist the ju"enile to rehabilitatehis or her beha"iors.

C$ns( There is a record that will follow theju"enile, e"en if he or she rehabilitates, howe"ernote that this record is sealed and can only beaccessed by so!e law enforce!ent.


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(hat would you do)


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S$'re(7nderson, :ail >'H?. (o!en Therapy. /ntroduction4 Children,

7dolescents and Their Powerholders inTherapy Settings, +=, +, '0


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'. Fecogni6ing a proble!+. DeBning the proble!

-. De"eloping solutions

. Choosing a solution8. Fe"iewing process


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7 '+ year old girl is forced to go intotherapy because of acting out at school.During the Brst session with the adolescent,the therapist Bnds out that the girl is

acti"ely abusing !arijuana and possiblyecstasy with her friends. The parents donot know this infor!ation.

(hat do you do) Do you tell the parents)


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>'? Fecogni6ing a proble! and >+? DeBning theproble!4 5ou are uncertain what to do. (hatare your "alues that interfere with a decision)

/f you tell the parents, you run the risk of alienating thegirl. /f you do this, !ore har! can co!e.

/f you do not tell the parents, they will not be able tointer"ene and get the girl treat!ent. They can sue you

since the girl is still a !inor. 5ou also run the risk of thegirl getting arrested, creating brain da!age, and theworst is o"erdosing and causing death.


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5ou tell the parents

5ou tell the! to assist with !aintaining theirdaughterAs safety.

5ou do not tell the parents 7s cited in this article, Snyder belie"es children

are %of worth and full citi6ens that share the basicrights to life, safety, happiness, e@uality oftreat!ent, e@uality of opportunity, reasonableself0deter!ination and due process.& This is fro!a fe!inistic approach4 egalitarian.

The law is behind this decision4 /llinois law allows'+ year old to hold so!e power for !aintainingconBdentiality.


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%(hat is the best Bt both e!otionally andrationally) Does the solution !eete"eryoneAs needs, including !ine) Can /i!ple!ent and li"e with the eects)&

>7nderson, 'H, p.?

/f you do not tell the parentsO you shouldbe aware of the law4


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>-? the parent or guardian of a recipient who isat least '+ but under 'I years, if the recipientis infor!ed and does not object or if thetherapist does not Bnd that there areco!pelling reasons for denying the access.The

parent or guardian who is denied access byeither the recipient or the therapist !aypetition a court for access to the record.othing in this paragraph is intended to prohibitthe parent or guardian of a recipient who is atleast '+ but under 'I years fro! re@uestingand recei"ing the following infor!ation4 currentphysical and !ental condition, diagnosis,treat!ent needs, ser"ices pro"ided, andser"ices needed, including !edication, if any.


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(ould / want to be treated in this way) Does the decision feel right) (ould this decision withstand the scrutiny

of others) 2ow are !y "alues, personal characteristics

inRuencing !y choice) 2a"e / taken the clientAs perspecti"e into

account)These @uestions are fro! the article.


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Carry out the decision /s this solution the best / can do) 9bser"e conse@uences Feassess the decision 2ow has this decision aected the

therapeutic process)

These @uestions are fro! the article.


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(hat did / learn) 2a"e / changed as a result of this process)

2ow) (hat would / do dierently) 2ow !ight this e3perience aect !e in the

future)

These @uestions are fro! the article.


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M$#el( Ethial Deisi$nMakin% )lan

S$'re( nited States Depart!ent ofDefense


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'. DeBne the proble! >state the proble! ingeneral ter!s and decisions to be !ade?

+. /dentify the goals >short and long ter!goals?

-. List the appropriate laws or regulations

. List the ethical "alues at stake


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8. a!e all the stakeholders >identify

persons who are likely to be aected bya decision and what is at stake for eachperson?

take ti!e,

ask @uestions, de!and proof whenappropriate, check your assu!ptions?H. State all feasible solutions >list solutions

that ha"e already surfaced, produceadditional solutions by brain stor!ingwith associates, note how stakeholderscan be aected by each solution?


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I. Eli!inate unethical options >eli!inatesolutions clearly unethical, eli!inatesolutions with short0ter! ad"antages butlong0ter! proble!s?

. Fank the re!aining options according tohow close they bring you to your goal,and sol"e the proble!

'=.

Co!!it to and i!ple!ent the bestethical solution


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7ccording to $artin and ush >+==I?, 1nappand *andeCreek identiBed 8 co!!on stepsafter re"iewing se"eral Ethical Decision$aking $odels4

'. /dentiBcation of the proble!+. De"elop!ent of alternati"es

-. E"aluation of alternati"es

. /!ple!entation of the best option

8. E"aluation of the results


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Anderson, Gail (1997). Women & Therapy. Introduction: hildren,Adolescents and Their !o"erholders in Therapy #ettin$s, %, %, 1'.

erso**, +.. (%-). thical on*licts in !sycholo$y, /ourth dition.American !sycholo$ical Association: Washin$ton +..

ush, #.#., onnell, 0.A., & +enney, .2. (%). thical Issues in/orensic !sycholo$y: A #ystematic 0odel *or +ecision 0a3in$.Washin$ton +..: American !sycholo$ical Association

4ish'Gephart, 5.5., 6arrison, +.A. & Treino, 2.4. (%1). 5ournal o*Applied !sycholo$y. ad Apples, ase ases, and ad arrels: 0eta'Analytic idence A8out #ources o* nethical +ecisions at Wor3, 9, 1,1';1.

4oocher, G.!. & 4eith'#pie$el, !. (%-). thics in !sycholo$y and the0ental 6ealth !ro*essions: #tandards and ases.


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HIPAA: U.S. Department of Health & Human Services:http:@@""".hhs.$o@ocr@priacy@

Illinois General Assembly: School Coe:http:@@""".il$a.$o@le$islation@ilcs@ilcs?.asp+ocameB16ArtC%D%7&ActI+B1&hapterI+B17eE#tartB1?97eEndB1%

!ental Health an Developmental Disabilities Coe:http:@@""".il$a.$o@le$islation@[email protected]+B1?9&hapActB?C%n8spC;I2#C%n8spC;C%/&hapterI+B;?&hapterameB0TA2D6A2T6&ActameB0entalD6ealthDandD+eelopmentalD+isa8ilitiesDodeC%

"ational Conference of State #e$islatures on Cyber%harassment '() I#CS*+,-*(/: http:@@""".il$a.$o@le$islation@ilcs@documents@7%1;31'%.htm

State la0s: Illinois !ental Health Confientiality Act:http:@@""".il$a.$o@le$islation@ilcs@ilcs;.aspActI+B%?;&hapterI+B7

Unite States Department of Defense: 1thical Decision !a2in$ Plan:http:@@""".ryerson.ca@ethicsnet"or3@do"[email protected]*

U.S. Department of Health & Human Services on HIPAA:http:@@""".hhs.$o@ocr@priacy@hipaa@understandin$@summary@inde=.html


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1now your Ethics Code 1now what the law re@uires of therapistsTake the %higher road& Do what !ini!i6es har! to clients and

others, and to your person ethical "aluesThink clearly Docu!ent your thinking process and use of

an Ethical Decision $aking $odel /f there are any @uestions, consult consult

consultX


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resolving ethical dilemmas liljedahl

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