Roberts and Termuehlen (2021) identified six core skills that affect the ability to recognize and manage ethical issues when they arise: ● The ability to identify ethical issues as they arise. This is intuitive for some, a feeling or sense that something is not right, and for others it is a more logical analysis. ● The ability to understand how one’s own values and beliefs impact their care of patients. The role of implicit bias has more recently been an area of focus. This involves understanding how attitudes and social stereotypes affect access to healthcare and equity in the provision of quality care. Implicit bias can adversely affect quality, safety outcomes, and health system policies. ● The objective awareness of the limits of one’s knowledge and competence and the willingness to practice within the boundaries of competence. ● The ability to recognize high-risk situations proactively before an ethical dilemma arises. These situations often happen when the psychologist moves beyond the typical treatment protocol, for example, when a report must be made to protect the patient or others from harm. ● The willingness to seek consultation and information when a situation arises that is clinically difficult or ethically challenging, as well as the willingness to use the guidance offered. ● The ability to proactively establish ethical safeguards. The General Principles and Ethics Code provide invaluable guidance but cannot address every specific situation or decision that may arise. Psychologists should then rely on models or frameworks for making ethical decisions. These models are designed to help guide the professional in a standardized manner when determining the best course of action when there is a dilemma. There are numerous models for ethical decision making, and psychologists must find one that fits with their own professional identity, theoretical orientation, personality, and risk tolerance. They fall into three general categories. Standard-based models are based on the assumption that laws, rules, and organizational polices provide the best guidance for making a decision. Once the dilemma is identified, a determination is made about whether there is a reason to deviate from those rules or policies. Principle- based models focus on the key ethical principles involved. The provider questions whether an ethical principle will be violated, facts are distinguished from theories and opinions, alternatives and consequences are reviewed, and an action is implemented to maximize benefit while reducing risk. Decision-making models As noted, there are numerous decision-making models that can be applied by the psychology professional when faced with an ethical dilemma. Riggin and Lack (2018) propose a virtue-driven model. It incorporates themes of openness, benevolence, justice, commitment, and prudence during six stages when making a decision about a course of action: ● Stage one: Observation : Recognize and define the situation that requires making a decision. Observe codes of conduct and local laws to see if the appropriate action is specified. ● Stage two: Identification : Identify the individuals, culture, value systems, and relevant ethical principles to help clarify how they all influence the potential course of action.
Ethical principles are prioritized. Finally, virtue-based models evaluate the potential action in terms of virtues. Above all, the psychologist asks themselves if the proposed action is consistent with their personal values. Johnson et al. (2022) reviewed the current literature on the use of ethical decision-making models by mental health professionals. They note that although professionals do not always use a model when analyzing a dilemma, using one has many benefits, including improved decision quality and better preparation for dealing with difficult situations. They identified 38 unique models for ethical decision making, reviewed the individual steps in the models, and categorized them into common themes. Based on this work, they identified core components of ethical decision-making models. These core characteristics can then be used by the professional to evaluate the decision-making model and select one that fits them best: ● Action : Taking action toward resolving the dilemma and accepting consequences. Select a course of action, implement the action, modify practices based on the action, and accept responsibility for the action. ● Review : Information gathering, including review of professional standards. Define the dilemma based on standards or principles, review ethical and legal standards, and review literature. ● Intrapersonal : Considering personal values and professional competencies. Self- reflect on personal values and beliefs, and assess boundaries of competence. ● Interpersonal : Discussing the decision with those involved and consulting with colleagues. Discuss with the client, consult with a colleague, and/or seek out additional training or supervision. ● Prediction : Thinking about the potential consequences of the action. Consider possible outcomes, estimate the probability of consequences for each option, and determine if the solution is feasible. ● Deliberation : Defining and judging all aspects of the situation. Identify and interpret the problem, consider possible courses of action, identify the ideal desired outcome, assess values, and determine if the action is acceptable. ● Self-monitoring : Monitoring the process, decision, and consequences. Monitor the outcome, review the process, and document the process. ● Perspective thinking : Reviewing the perspectives of all involved parties. Consider all parties affected, consider cultural factors, identify competing values, and adopt the perspective of each party involved. ● Stage three: Consultation : Consult with supervisors, colleagues, and current literature. Brainstorm potential solutions and evaluate each. ● Stage four: Balance : Consider the balance between personal beliefs and values and the accepted code of ethics. These must be balanced against each other, as well as with the values of the client. If not, the client may be minimized and/or boundary crossings may occur. ● Stage five: Action : Prepare, plan, and implement the course of action. ● Stage six: Reflection : This is a critical step in the model. Self-reflection, mindfulness, and documentation are completed. Document the details of the dilemma, the procedures followed, the reasoning for choosing a particular solution, and the final effect of the course of action.
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