Ethical Decision-Making Models and Application
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This document provides an overview of ethical decision-making models and their application in clinical practice. It discusses how moral judgments are influenced by both rational and non-rational processes. Automatic thinking, emotions, and cognitive biases can complicate clinical ethics and decision-making. The document outlines several models for conceptualizing ethical development, including the acculturation model which involves integrating personal and professional ethical values. It emphasizes using a principle-based approach focused on concepts like autonomy, beneficence, and justice when making ethical decisions.
![Moral Foundations & Intuitions
Care - Harm
Fairness – Cheating
Loyalty-Betrayal
Authority – Subversion
Sanctity (Purity) – Degradation
[Liberty – Oppression]](https://image.slidesharecdn.com/philhavenpresentation-170207195157/85/Ethical-Decision-Making-Models-and-Application-23-320.jpg)
Ethical Decision-Making Models and Application
- 1. Ethical Decision-Making Models and Application John Gavazzi, PsyD, ABPP WellSpan/Philhaven Group January 2017 john.gavazzi@gmail.com @Dr_Gavazzi
- 3. Primitive Brains v. Modern Problems How Irrational Tendencies Complicate Ethics Codes & Decision-making Alternate Titles
- 4. One potentially scary aspect is that we are not always consciously aware of how we make decisions. Fortunately, we are highly trained professionals, with a great deal of education, expertise, and ongoing self- reflection. But, these factors do not inoculate us from errors in decision-making.
- 6. Some examples…. • Automatic reasoning • Emotions in Psychotherapy • False Risk Management Strategies • Morality in Psychotherapy
- 7. www.ethicalpsychology.com Easy to sign up Easy to follow and FREE • More ethics education • Daily stories on the nexus of healthcare, psychology, morality, philosophy, and public policy. • Daily email, tweet, Tumblr on ethics • Podcasts • Ethics Vignettes • Audio/video files • Articles
- 9. Learning Objectives 1. List four of the five foundational ethical principles. 2. Describe how moral decisions are typically made. 3. Explain the clinical implications of a separated or assimilated strategy. 4. Write two important components to integrating professional ethics with personal values. 5. Explain the underlying principle of a false risk management strategy.
- 10. General Outline •The New Wave of Moral Psychology •Acculturation Model •Principle-based Ethics •Cognitive Biases and ethical dilemmas
- 11. Participant Safety • Creating a safe environment • Avoid the word “unethical” • We are all learning in this process • Demonstrate courtesy and respect for others • We are all fallible
- 12. Assumptions in this presentation • We all have different tolerances, biases, and methods of making moral judgments • We are all subject to biases, heuristics, and erroneous thought processes. We do not think in algorithms. • We can arrive at different solutions to dilemmas, meaning there are more than one correct solution.
- 14. Morality • Typically, individuals think about morality as equivalent to religion or religious beliefs. • At the most general level, morality is a person’s ability to determine right from wrong, or • Good from Bad • Please note the dichotomous thinking
- 16. Moral Philosophers • Hegel: Believed human ability to self-reflect and imagine helped with developing a strong moral compass. • Nietzsche: Believed that ethics and morals were tied up language, which helped us navigate the world. However, language binds us to certain ways of thinking, including accepting our positions in life.
- 17. Moral Philosophers v. Moral Psychologists • Moral philosophers typically look for the right answer to a moral dilemma via writing and debate. • Moral psychologists study the way in which people make moral decisions, and other types of decisions.
- 18. Morality, Emotions & Psychology • In the early 2000s, moral psychology changed from the Kohlberg paradigm (more cognitive) and began to research moral emotions. • Moral reasoning is not just a top-down process, but typically a bottom-up process starting with automatic, emotional, and intuitive experiences. • Looking for the role of moral emotions like disgust, fear, elevation, and mirth.
- 19. The New Wave of Moral Psychology Social Psychology Experimental Philosophy Behavioral Economics
- 20. Moral Foundations Theory Jon Haidt, PhD • There are specific innate, universally available moral foundations • These foundations are “intuitive” in that these are automatic, rapid, affective, and non-rational • These foundations can be used to judge how moral or immoral an action or activity is.
- 21. Intentional, non-conscious processing • The process that binds us blinds us and encourages cooperation/tribalism. • Price paid for the automatic process: accuracy • A second limitation: rigidity • The unconscious is swift, less flexible, and not always accurate. Should I trust my gut or not?
- 22. Kahneman & Tversky Type 1: More rapid, intuitive Type 2: More deliberative, Slower Possibly more accurate, but not always Energy intensive
- 23. Moral Foundations & Intuitions Care - Harm Fairness – Cheating Loyalty-Betrayal Authority – Subversion Sanctity (Purity) – Degradation [Liberty – Oppression]
- 25. Some Disgusting Examples Moral Emotion of Disgust Moral Dumbfounding
- 26. Application of Moral Foundations • Ethics – How do these develop? • Politics – Partisanship • Clinical Psychology - Countertransference • Social Psychology – WEIRD research
- 27. Other Concepts in Moral psychology • Bad is Stronger than Good ▫ The Knobe Effect (Assigning responsibility) ▫ Just World Belief (blame the victim) • Priming & Nudging: Subtle Influence • Moral Licensing: Balancing behavior • Sunk Cost Fallacy – When to terminate?
- 28. What does this mean? • The “self” is essentially moral • Evidence supports we understand the self and others through morality (more so than memories) • Morality is a core source of self, which has greater influence than memories and behaviors
- 29. Personal moral compass-Believe it to be right Knowing the difference between right and wrong Emotional responses to dilemmas and actions Implicit/rapid/automatic/internal/affective Research shows people judge themselves and others based on moral characteristics – evolutionary and social reasons to judge “character” Morality
- 30. Rules of Conduct – Profession/society More external – Community (of peers) Easier means to judge others’ actions Can constrain individual choices or create dilemmas Explicit/cognitive/external/measured Ethics
- 31. Psychotherapy is inherently a moral enterprise - Beneficence - Of good moral character - Value-free psychotherapy does not exist
- 32. The Acculturation Model One way of remaining a life-long learner Provides another way to discuss ethical behaviors and decisions
- 33. Acculturation A process to change the cultural behavior of an individual through contact with another culture. The process of acculturation occurs when there is an adaptation into an organization or society.
- 34. Ethics Acculturation Model • An outgrowth of positive ethics that integrates personal ethics and professional obligations. • Each mental health profession has a system of shared and distinctive norms, beliefs, and traditions. • This set of beliefs is reflected in our ethics code; especially the overarching ethical principles.
- 35. Acculturation as a Process • Can be a complex process • Some parts of a psychologist’s practice and lifestyle may be easily acculturated while others not • Process that will likely continue throughout the education or career as a psychologist
- 36. Ethical Acculturation Identification with personal value system (higher vs. lower) Identification with value system of psychology (higher vs. lower)
- 37. Acculturation Model of ethical development IntegrationIntegration SeparationSeparation AssimilationAssimilation MarginalizationMarginalization Higher on Professional Ethics Higher on Personal Ethics Lower on Personal Ethics Lower on Professional Ethics
- 38. Marginalized Matrix: Lower on professional ethics Lower on personal ethics Risks: *Greatest risk of harm *Lack appreciation for ethics *Motivated by self-interest *Less concern for patients
- 39. Assimilation Matrix: Higher on professional ethics Lower on personal ethics Risks: Developing an overly legalistic stance Rigidly conforming to certain rules while missing broader issues
- 40. Separation Matrix: Lower on professional ethics Higher on personal ethics Risks: Compassion overrides good professional judgment Fail to recognize the unique role of psychologists
- 41. Assimilated Strategies • Assimilated strategies are often “fear based” – where motive to avoid harming another or incurring punishment for oneself, causes the psychologist to adopt legalistic stances. • Assimilated strategies are also known as risk management strategies.
- 42. False Risk Management Assimilated Strategies
- 43. What is a False Risk Management Strategy? A False Risk Management Strategy is an action or intervention on the part of psychologist that is meant to reduce liability or harm, but does not. Ironically, some of these actions or interventions likely hinder the psychologist’s ability to provide high quality of care.
- 44. False Risk Management strategies do not connect to overarching ethical principles Hollow attempt
- 45. • Informed consent only occurs at the beginning of treatment • Informed consent mainly involves the patient to sign forms for risk management purposes Informed Consent
- 46. • Self-disclosure is never appropriate by the psychologist during psychotherapy or assessment • Self-disclosure is clearly a boundary violation that is always wrong Self-disclosure
- 47. • This is an important risk management strategy • This is the standard of care • This strategy helps the patient from actually harming him or herself. No suicide contract
- 48. Separated Strategies • Separated strategy attempts to be promotion focused • Separated strategies are often “benefits-based” – where the motive for promoting the well- being of the patient causes the psychologist to be blind to ways that well-meaning people can cause harm
- 49. Lack of Balance But both fail to give adequate attention or weight to the overarching ethical principles that guide or should guide professional behavior
- 50. Integrated Matrix: Higher on professional ethics Higher on personal ethics Reward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
- 52. Principle-Based Ethics and the Acculturation Model Mental Health Professionals using integrated strategies are able to incorporate overarching ethical principles into their practices
- 53. Respect for Autonomy • Does not mean promoting autonomy (individuation or separation) • Means respecting the autonomous decision making ability of the patient
- 54. Autonomy • It encompasses freedom of thought and action. • Individuals are at liberty to behave as they chose. - Determining goals in therapy - Making life decisions (e.g., marriage, divorce) - Scheduling appointments and terminating treatment
- 55. Beneficence • The principle of benefiting others and accepting the responsibility to do good underlies the profession. - Providing the best treatment possible; think about evidence-based treatment - Competency - Referring when needed
- 56. Nonmaleficence The principle is doing no harm. - Demonstrating competence - Maintaining appropriate boundaries - Not using an experimental technique as the first line of treatment - Providing benefits, risks, and costs
- 57. Fidelity This principle refers to being faithful to commitments. Fidelity includes promise keeping, trustworthiness, and loyalty. - Avoiding conflicts of interests that could compromise therapy - Keeping information confidential - Adhering to therapeutic contract (e.g., session length, time, phone contacts, etc.)
- 58. Justice Justice primarily refers to treating people fairly and equally. In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law. (3.01)
- 59. Ethical and Clinical Decision- making We think like defense attorneys rather than court justices Bottom up vs. Top Down
- 60. • Identify the competing ethical principles • Help to determine which principle has precedence and why • The importance of emotion in ethical decision- making and moral judgments • Cognitive biases are also important to consider Important points to remember
- 61. In certain situations, we need to construct or create a solution instead of looking up the answer in a sacred psychology text
- 62. Other resources may aid with ethical decision- making, but do not highlight how to work through dilemmas
- 63. Rational MHP: Know the Code!! Overly Simplistic Model Learn the rules Apply the rules Outcomes will follow
- 64. Relational Model Learn the rules Apply the rules Outcomes will follow Understand patient dynamics Understand the relationship Know the Code + Know your patient
- 65. 1.We have to train ourselves to think about larger ethical principles first 2.We need to have the ability to slow ourselves down prior to making good, ethical decisions Why? Major Point to this Training
- 66. Decision-making skills • Top down approach • Start with ethical principles • Work from those principles to make good decisions about our work
- 67. • Intuitive • Automatic • Emotional • Rapid How people make moral, ethical and professional decisions
- 68. There is an intuitive, non-rational process in ethical decision-making Why do mental health professionals continue to have sex with their patients?
- 69. Research shows when emotions run high, our judgments are more likely to be extreme than when our emotions are weak. As mental health professionals, we know individuals reason emotionally. We, as MHPs, need to pay attention to our emotions during ethical & clinical decision-making.
- 71. Emotional Components Negative emotions related to ethical and moral decision- making Positive emotions related to our good decision-making skills and ethical knowledge • Fear • Anxiety • Disgust • Disrespect • Passion • Calmness/Centered • Empathy • Respect/Sympathy • Elevation
- 72. • The Fundamental Attribution Error • Actor Observer Bias • Availability Heuristic • Trait Negativity Bias • Confirmation Bias • Competence Bias Cognitive biases
- 73. How do you view your world?
- 75. Why is any of this important? Why study ethics and ethical decision-making as a part of clinical practice?
- 77. What can I do? Independent Actions Help from others • Self Reflection • Documentation • Transparency • Continuing Education • Self-care • Consultation • Supervision • Psychotherapy • Continuing Education
- 81. Questions and Answers Complete course evaluations