Running head: ETHICAL DILEMMA IN LEARNING TASK TWO
The Ethical Dilemma in Learning Task Two Jacqueline Munroe EDPS 604: University of Calgary Dr. Irene Estay
2 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO
The Ethical Dilemma in Learning Task 2
You are a graduate student doing your doctoral dissertation on the experiences of women who have been sexually involved with previous therapists. The women have been referred to the project by their current therapists, have consented to share their experiences, and have been assured of confidentiality. In conducting your interviews, you are told the names of two of the previous therapists who had become sexually involved. You had not asked for this information and, in fact, had asked that the women not reveal the identities of the therapists with whom they had been sexually involved. You now wonder what your responsibilities are. Should you report the two therapists to their respective regulatory bodies? Should you persuade and assist the women to make formal complaints themselves? Assuming this issue is outside your research mandate, should you do nothing? (Companion Manual Vignette Research #38). As an aside to the 10 Steps of Ethical Decision Making Process (Canadian Psychological Association, 2001) my first question in the following vignette would be to determine whether the women who had mentioned names of their therapist had been sexually involved with their therapists at the time of therapy, or at some point in time after therapy had completely concluded. The Professional Standards (CPA, 2000) state that psychologists must refrain from sexual relationships with clients for at least 2 years after termination of professional services or for as long as the client is vulnerable to the psychologists influence (Truscott & Crook, 2004, p. 91). The later statement can be found under the ethical principle of Responsible Caring; Value, Minimizing Harm (CPA, 2000) and would indicate that if the time after treatment has been less than two years, the responsibility must be on the psychologist (therapist) to ensure the following: 3 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO that a clear contract of terminated services has been addressed, the emotional bond established between a psychologist and client has disappeared and that the relationship is not based on a power imbalance, inherent in a psychologist client professional relationship (Truscott & Crook). Best case scenario, if it has been two years since termination of contract for both women, the graduate student could possibly have no ethical dilemma, however, realistically this would not have been the case. Therefore, Step 1. Identification of the Individuals and Groups Potentially Affected by the Decision The individuals I see who may be potentially affected by any decision I might come to are the research participants, the named therapists, and on a broader perspective, any current clients of the therapists, as well as myself (and my future within the CPA). Lastly, the discipline of psychology may be impacted as the social contract held by these therapists and mentioned in the values statement for Principle I, Respect for the Dignity of Persons, is based on public trust (CPA,2000). Step 2. Identification of Ethically Relevant Issues and Practices, Including the Interests, Rights, and Any Relevant Characteristics of the Individuals and Groups Involved and of the System or Circumstances in Which the Ethical Problem Arose. A chart which outlines the Code of Ethics for Canadian Psychologists, and includes the The Four Ethical Principles with their Respective Values and Standards (CPA, 2001, p. 107) will be used to highlight the key ethical values at play in this dilemma. I have identified 10 ethical values needed to further examine my dilemma; three each under Respect for the Dignity of Persons (I) and Responsible Caring (II) and two each under Integrity in Relationships (III) and Responsibility to Society (IV). 4 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO The Four Ethical Principles with their Respective Values and Standards as Found in the Canadian Code of Ethics for Psychologists (2000)
I. Respect for the Dignity of Persons
II. Responsible Caring
III. Integrity in Relationships
IV. Responsibility to Society
1. General Respect (I.1.-1.4)
1. General Caring (II.1-II.5)
1. Accuracy/ Honesty (III.1-III.9)
1. Development of Knowledge (IV.1- IV.3) 2. General Rights (I.5-I.8)
3. Risk/ Benefit Analysis (II.13- II.17) 3. Straightforwardness/ Openness (III.14- III.22) 3. Respect for Society (IV.15- IV.18)
4. Fair Treatment/ Due Process (I.12- I.15)
4. Maximize Benefits ( II.18- II.26)
4. Avoidance of Incomplete Disclosure (III.23- III.30)
4. Development of Society (IV.19- IV.29)
5. Informed Consent (I.16-I.26)
5. Minimize Harm (II.27-II.36)
5. Avoidance of Conflict of Interest (III.31-III.35)
5. Extended Responsibility (IV.30-IV.31)
6. Freedom of Consent (I.27-I.30)
6. Offset/ Correct Harm (II.37-II.44)
6. Reliance on the Discipline (III.36- III.38)
7. Protection for Vulnerable Persons (I.31-I.36)
7. Care of Animals (II.45- II.48) 7. Extended Responsibility (III.39-III.40)
8. Privacy (I.37-I.42)
8. Extended Responsibility (II.49-II.50)
9. Confidentiality (I.42-I.45)
10. Extended
5 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO Responsibility (I.46- I.47)
Principle / Value
PRINCIPLE I: RESPECT FOR THE DIGNITY OF PERSONS
Value: Informed Consent
1.16 Seek as full and active participation as possible from others in decisions that affect them, respecting and integrating as much as possible their opinions and wishes.
I.21 Establish and use signed consent forms that specify the dimensions of informed consent or that acknowledge that such dimensions have been explained and are understood, if such forms are required by law or if such forms are desired by the psychologist, the person(s) giving consent, or the organization for whom the psychologist works.
Value: Privacy
I.37 Seek and collect only information that is germane to the purpose(s) for which consent has been obtained.
I.40 Respect the right of research participants, employees, supervisees, students, and trainees to reasonable personal privacy.
My Thoughts
I am aware that before a decision is reached that will affect the two women involved, there participation in the decision making process will be needed.
I have established consent forms that assured the women that what they disclosed would remain confidential. Those were the grounds to which they understood the experiment. It would be unethical of me to disregard what has already been discussed and assured.
I know that the two women were specifically asked not to disclose the names of the therapists involved; however, I did not think to delve into or divulge the consequences of doing so. Therefore, when consent was signed in an agreement to participate in this research, it was for the purpose of obtaining the thoughts and experiences of women who have been in a sexual relationship with their therapist and not for the purpose of gathering names and potentially identifying those who have committed an act of professional misconduct.
Again, the two women were assured that confidentiality would be protected and that their affairs with the therapists would remain private. Given the very private nature of this information and the fact that these women are 6 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO
Value: Confidentiality
I.43 Be careful not to relay information about colleagues, colleagues clients, research participants, employees, supervisees, students, trainees, and members of organizations, gained in the process of their activities as psychologists, that the psychologist has reason to believe is considered confidential by those persons, except as required or justified by law. (Also see Standards IV.17 and IV.18.)
I.45 Share confidential information with others only with the informed consent of those involved or in a manner that the persons involved cannot be identified, except as required or justified by law, or in circumstances of actual or possible serious physical harm or death. (Also see Standards II.39, IV.17, and IV.18.)
PRINCIPLE II: RESPONSIBLE CARING
Value: General Caring
II.1 Protect and promote the welfare of clients, research participants, employees, supervisees, students, trainees, colleagues, and others.
receiving therapy currently (were referred by current therapists) I feel that I should be respecting their rights to keep this to themselves. I feel that I can bring to their attention the process of filing a complaint perhaps by referring them to the Concerns about a Psychologist section of the Alberta College of Psychologists site; however, I feel that I should go no further than this. Although specific names were disclosed, should I still be respecting the right of my participants to retain their personal privacy?
If I were to go ahead and report to the College of Psychologists, I would in fact be relaying information about research participants that I have gained during my research as a graduate student in psychology. I know that the information is confidential, that informed consent was signed and participants were assured of information remaining confidential, however, this may be a situation where relaying information is justified by the Canadian Code of Ethics (CPA, 2000) or the law of registered psychologists (reporting misconduct).
I am aware that before I share this information with others, if that is what will be decided, I must obtain informed consent from the two women involved. However, should I even be sharing this confidential information? There is no threat of physical harm or death. The women are currently in therapy and have been referred by their therapists to discuss these matters. This value statement, while it doesnt fully apply to my dilemma, makes me feel like disclosing this confidential information is unnecessary.
I have a responsibility to protect my research participants, and I feel that encouraging them to make a complaint against the psychologists would be in their own best interest. Because therapists inherently hold a position of power over their clients, it could be that exploitation 7 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO
II.2 Avoid doing harm to clients, research participants, employees, supervisees, students, trainees, colleagues, and others.
Value: Offset/Correct Harm
II.40 Act to stop or offset the consequences of seriously harmful activities being carried out by another psychologist or member of another discipline, when there is objective information about the activities and the harm, and when these activities have come to their attention outside of a confidential client relationship between themselves and the psychologist or member of another discipline. This may include reporting to the appropriate regulatory body, authority, or committee for action, depending on the psychologists judgment about the person(s) or body(ies) best suited to stop or[Third Edition] [20] offset the harm, and depending upon regulatory requirements and definitions of misconduct.
PRINCIPLE III: INTEGRITY IN RELATIONSHIPS
Value: Straightforwardness/ Openness
III.17 Honour all promises and commitments included in any written or verbal agreement, unless serious and unexpected circumstances (e.g., illness) intervene. If such circumstances occur, then the psychologist would make a full and honest explanation to other parties involved. has occurred in these situations and steps must be taken to correct the situation in some way.
It could be that by reporting these incidents to the college could result in some form of emotional distress to the women involved. It could be that they truly care for the therapist mentioned and do not want anything to come from this disclosure. It may be best to leave it at directing them to the Alberta College of Psychologist site, and possibly presenting a brochure to file a complaint. This would leave it entirely up to the women, as they would be armed with the knowledge of how to proceed if they so desired.
I am aware that I have a responsibility to offset harm done by another psychologist, however, the women do not report being harmed by the activities and our relationship is one of confidentiality. I also must be aware of the time frame of the sexual relationship. Was it within 2 years of termination of service or was it not? Likely, it was not and the dilemma persists. If I report to a regulatory body will this offset whatever harm may have been done to the women? Will it prevent/protect other women from facing the same issue? I must further examine, what exactly constitutes reporting misconduct. There is a possibility that armed with some knowledge, the women will decide to report independently and this would stop any future harm from occurring, if harm in fact has occurred.
The women were assured (verbally or written Im not sure) that confidentiality would be kept during the process of sharing their experiences. I know I should honour what was said in regards to confidentiality, however, if I can conclude that harm has been done to these women, the circumstances may be serious 8 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO
Value: Reliance on the Discipline
III.37 Familiarize themselves with and demonstrate a commitment to maintaining the standards of their discipline.
III.38 Seek consultation from colleagues and/or appropriate groups and committees, and give due regard to their advice in arriving at a responsible decision, if faced with difficult situations.
PRINCIPLE IV: RESPONSIBILITY TO SOCIETY
Value: Beneficial Activities
IV.13 Uphold the disciplines responsibility to society by bringing incompetent or unethical behaviour, including misuses of psychological knowledge and techniques, to the attention of appropriate authorities, committees, or regulatory bodies, in a manner consistent with the ethical principles of this Code, if informal resolution or correction of the situation is not appropriate or possible.
enough to be intervened upon. If this is the route I take, the decision must be explained in detail to the women as to why it had to be so, and why my assurance of confidentiality was not kept.
Responsibility of the individual psychologists in the Canadian Code of Ethics for psychologists, states the following To bring concerns about possible unethical actions of a more serious nature to the person(s) or body(ies) best suited to investigating the situation and to stopping or offsetting the harm (CPA,2000, p. 4). Again, should this be more heavily considered than confidentiality and upholding promises? I do not think so as Respect for the Dignity of Persons (I) and values around privacy and confidentiality outweigh Integrity in Relationships (III).
I will talk to my professor about this situation and show her the values and principles I have identified thus far in the process. I will seriously consider the advice I am given.
This value seems quite relevant in resolving this dilemma. I know that informal correction of the situation is neither appropriate nor possible. However, after reviewing the relevant ethical principles and values statement, I am not convinced that bringing this information forward at this time would be consistent with the ethical principles of the code. There is always the chance that the information may be requested by court and an investigator at a later date, however, whatever decision is made, I will need to ensure that this document, and my steps taken are included in relevant client folders.
9 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO IV.18 Consult with colleagues, if faced with an apparent conflict between abiding by a law or regulation and following an ethical principle, unless in an emergency, and seek consensus as to the most ethical course of action and the most responsible, knowledgeable, effective, and respectful way to carry it out.
I will ask a select few, trusted fellow graduate students, and maybe ask for their input and then review the relevant principles and values statements I have come up with, to see if we can reach a consensus. I would like to resolve this is a way that is most responsible as a psychologist, and most respectful to the women involved.
Step 3. Considerations of How Personal Biases, Stresses, or Self-Interests Might Influence the Development of or Choice Between Courses of Action I am finding this dilemma very challenging to navigate because I have essentially created my own ethical dilemma, perhaps by not clearly stating previously potential consequences of naming the therapists involved. I perhaps should have structured it in a written format to ensure that no names would slip out during a discussion. I have also assured these women confidentiality (which is a main and recurring theme in my relevant principles and values statements) and I do not want them to lose trust in psychologists by disclosing their personal information. I also find this dilemma challenging because it is not necessarily obvious that any harm has come to these two women in particular. I am aware of my personal biases in this situation which takes the form of two adults being equally involved in this dilemma; however, only one of them is made to suffer extreme consequences. I need to shift my thinking so that is more in line with the Professional Standards and Code of Ethics (CPA, 2000) as being law for psychologists. These therapists have essentially broken the law. However, in knowing that this research was of a particularly sensitive and private subject, I did assure confidentiality (I). Not abiding by what I assured, may also be breaking the law. Since confidentiality (I) outweighs misconduct (III), is it the lesser law to break? I am also aware of feeling resentful towards these therapists for not controlling their actions in a more mature way. I have no doubt that they were 10 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO aware of what is involved in professional conduct as well as the implications of misconduct. With full knowledge of such dire consequences for becoming sexually involved with clients, I feel that these men may be lacking in self-control, which I pride myself so strongly in. My preference would truly be to ignore the fact that I now know the names of two therapists guilty of professional misconduct, as that information is not germane to the research itself (I.37). I need to keep my personal biases in consideration as I approach a decision in this dilemma. Step 4. Development of Alternative Courses of Action Further inspection and dissection of the Code of Ethics (CPA, 2000) points towards these three outcomes: 1) Report the two therapists to their appropriate regulatory bodies, 2) suggest the two women make formal complaints of professional misconduct, and 3) behave as though this information was never disclosed and keep on with the research as intended. I believe that the outcome ruled out in my careful review of the Code of Ethics (CPA, 2000) is to simply go ahead and report the therapists to their respective regulatory bodies. The two women entered into this experiment, with the perception that what they disclosed would not be revealed. To reveal their private information anyways would be synonymous with changing the terms of their consent after the fact. These actions would be unethical on my behalf. However, two options remain which would be appropriate in following my ethical review of this dilemma. Alternative 1. I would meet with the two women individually and disclose the issue that has arisen, specifically with the unintentional disclosure of the therapists names. I would explain that my role will be simply to provide them with relevant information and knowledge as to the complaints process and provide a direction for future decisions. As we are in Alberta, I would 11 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO direct them towards the College of Alberta Psychologists site, and mention that there are steps outlined for filing an official complaint if they so deicide. I would also hand them a brochure of how to do so, ensuring appropriate information has been covered and all options are understood. I will present this information in a factual way and ensure that my own biases do not come into consideration while doing so. I should tell them to take their time in digesting the information and then allow for open communication should they have any more information or questions regarding the process of filing a complaint. Otherwise, I will not reschedule a time to review their decision. Alternative 2. I will do nothing and try to remain secure in the thought that if these documents are even ordered by court to be disclosed, I will know that I have consulted with both colleagues and my professor and the decision to remain silent, will have been founded on the most heavily weighted ethical principle Respect for the Dignity of Persons (I) and grounded in values of confidentiality. According to Truscott and Crook (2004) upholding the right to privacy is essential in maintaining individuality and selfhood. In many ways the loss of the power to make such decisions is the loss of ones true self (p.67). I must be very cautious in relaying information about research participants (I.40) as I do not want the women to feel betrayed, knowing they are currently seeking therapy with another professional. I must not cause either participant to lose faith in the discipline of psychology (Truscott & Crook, 2004). I feel that my decision is also supported by Principle I, where the Code of Ethics (CPA,2000) states that confidential information is only disclosed to others with consent of those involved if there may be circumstances of actual or possible serious physical harm or death (I.45). A second value statement, found in Principle II, revolves around offsetting the consequences of actions by others 12 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO which may cause serious physical harm or death (II.39). However, because my dilemma has not appeared to cause serious harm to the women involved, nor does it appear to have the potential of causing physical harm (or death) I do not believe that it would be ethical for me to disclose any information at this time. Step 5. Analysis of Likely Short-term, Ongoing and Long-term Risks and Benefits of Each Course of Action on the Individual(s) / groups(s) Involved or Likely to Be Affected (e.g., Participants, Colleagues, the Discipline, Society, Self Possible Positive Consequences Possible Negative Consequences
Alternative 1
Both women may gain a sense of power in their situation, as they now feel that they have the knowledge and direction needed to file a complaint. The matter can be taken into their own hands. Control and faith in the discipline of psychology may be somewhat restored.
One or both women decide to report the therapists named to the College of Alberta Psychologists.
One or both women report to the College of Alberta Psychologists and harm that may be yet to come is removed possibly through further ethical education, for any current or future female clients of the named therapists.
Alternative 2
I maintain my initial assurance that
The act of taking time to review information may seem that I am interested in seeing that they do file a complaint. A complaint may be filed due to the fact that I have physically put something in their hands (complaint brochure). They may wish to carry out the complaint, thinking that my stance is that is the correct thing to do. I do not wish to impact the decision and must tread carefully.
Women may have to deal with issues of guilt and remorse, if a severe order is issued at the end of the proceedings.
The investigation may be considered severe and the license of the therapists could be suspended during the investigation process. The therapists are found to be guilty of professional misconduct. The therapists will be faced with whatever order the Hearing Tribunal believes to be appropriate to protect the public including suspension. If this were to happen, clients of the named therapists will be negatively impacted.
Because I did not provide the information to 13 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO confidentiality would be protected, and focus on the knowledge that these women agreed upon participating in this research in order to share their experiences. Just because I did not appropriately structure the research in a way meant to guard confidentiality of the therapists, does not mean that the terms of informed consent to which these women agreed should so drastically change.
The women feel empowered simply by sharing their past experiences and are driven to seek information regarding professional conduct of therapists (psychologists) and what that entails.
My research continues as planned, however, I have learned how critical it is to fully understand the ethical code of psychologists for my own future.
Discuss my decision to keep the information confidential with my professor and fellow graduate students.
the two women, one of the two named therapists repeats the misconduct with another client. This time, harm does come to the client in some form which could possibly have been prevented if I had decided upon Alternative 1.
The women feel let down by the process of participating (and in therapists in general as they were referred by one who has also kept the information confidential) as they were hoping it would lead to actions being taken that they would not have to initiate themselves.
If the therapists are exploiting patients and this record is subpoenaed given the nature of my research, will I be held accountable for not doing more to protect the public?
They disagree and our thoughts and opinions remain on different pages. I review the process again, this time, highlighting the principles and values they believe were neglected and should have been attended to. Step 6. Choice of Course of Action after Conscientious Application of Existing Principles, Values, and Standards I believe that my second alternative is the better approach for resolving this dilemma. It takes into account the respect of privacy and confidentiality that I had assured the women involved in my research. It leaves the participants feeling that psychologist can be trusted to uphold their word and all is as it seems in terms of voluntary participation and informed consent. I believe it could potentially be difficult for these women to trust in psychologists to protect their best interests after feeling that they participated in research for one purpose; but it actually seemed to be for another. I will proceed with presenting this alternative to my professor to 14 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO determine if we have come to the same conclusion or if I need to go back and rethink my first alternative of educating the two women on the complaints process. After thoroughly reviewing the Canadian Code of Ethics (CPA, 2000) I feel that this option is in keeping with the code and specific values statements. I feel confident that this decision is the most ethical and will cause the least amount of harm for those involved. Step 7. Action with a Commitment to Assume Responsibility for the Consequences of the Action I have discussed this with my professor and will proceed with my research as planned. Since the women in the vignette, have been assured of confidentiality, I will assume that informed consent (I.20) must have been gathered before the research began revolving around the protection of privacy and gathering information germane to the purpose for which consent has been obtained (CPA, 2000, I.38). I will take responsibilities for my own actions (or inactions) and present exactly how I came to this conclusion if these documents are ever requested. I do believe that this is the correct course of action to take as it most strongly abides by the highest principle of Respect for the Dignity of Persons (I) and I believe the main value to be at play here is the value of confidentiality. I must be extremely careful not to divulge information gathered in the process of conducting psychological research with the exception being documentation and information required by law (I.43). Secondly, confidential information is only to be shared under informed consent, so this would have to be another value (I.45) to be considered before making a decision to disclose the names of the therapists implicated and the values involving informed consent (I.12-I.26), privacy (I.31-I.36) and confidentiality (I.42-I.45). Step 8. Evaluation of the results of the Course of Action 15 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO Although, my research will continue on as planned and the participants will have no idea of the ethical dilemma I have had to resolve, I must remain aware of any unforeseen negative consequences my inaction may have caused. Step 9. Assumption of Responsibility for the Consequences of Action, Including Correction of Negative Consequences, If Any, or Re-engaging in the Decision-making Process If Ethical Issue is not Resolved If for some unforeseen reason, my chosen course of action has become inappropriate, possibly due to new information that may be disclosed (relating to harm coming in some way to my participants) I must then revaluate my course of action based on the new information. Step 10. Appropriate Action, as Warranted and Feasible, to Prevent Future Occurrences of the Dilemma (e.g., Communication and Problem Solving with Colleagues, Changes in Procedures and Practices) Being presented with this dilemma has really increased my awareness of how heavily psychologists must rely on the Canadian Code of Ethics (CPA, 2000). I feel that whatever the result of my decision, I can be sure that I have carefully weighed my options and appropriately applied ethical principles along with my own reasoning and the reasoning of trusted others. I suspect if I had impressed upon my participants the importance of keeping names to themselves, this issue would never have arisen. This may have taken the form of written responses, with a reminder at the end to double check that real names have not been used. As the nature of my research was so highly sensitive to begin with, I should have predicted this outcome. I believe that in the future, I must be more aware of situations that may arise and plan accordingly.
16 Running head: ETHICAL DILEMMA IN LEARNING TASK TWO Works Cited Asscoiation, C. P. (2001). Companion Manual to the Canadian Code of Ethics for Psychologists (3rd ed.). (C. Sinclair, & J. Pettifor, Eds.) Ottawa, Ontario: Second Printing. Association, C. P. (2000). Canadian code of ethics for psychologists (3 ed.). Ottawa: Author. Truscott, D. C. (2004). Ethics for the practice of psychology in Canada. Edmonton, AB: The University of Alberta Press. College of Alberta Psychologists. (2005). Standards of practice. Edmonton: Author.