Decision-making models As noted, the psychology professional can apply numerous decision-making models 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 on a course of action. Stage One: Observation Recognize and define the situation that requires decision making. 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. 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 against the values of the client. If not, the client may be minimized and/or boundary crossings may occur. Stage Five: Action The balance stage allows one to move into the action stage, where the course of action is implemented. 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. Another popular model is the ETHICS model, which was introduced by Ling and Hauck (2016). It serves to simplify the ethical decision-making process into six steps that can be applied to a broad range of ethical dilemmas.
E Evaluate the dilemma : This is the most critical aspect of the model. Identifying and understanding the dilemma provide the framework for the decision-making process. The psychologist applies the Ethics Code and any applicable laws to help define the dilemma. Possible courses of action and the ethical codes that support or violate the option are evaluated, since by definition a dilemma cannot be resolved without potentially violating an ethical code. T Think ahead : Once the dilemma is defined, the psychologist must think ahead to the possible consequences, positive and negative, of each potential action. Consideration of all who are potentially affected by the action is necessary and may include the psychologist, client, colleagues, or profession. Psychologists have a duty to do no harm, so this step aligns with the General Principle of Beneficence and Nonmaleficence. H Help : It is important to receive help from others in the form of consultations. Receiving help is different than receiving a decision. Receiving help involves discussion of relevant factors to help determine a course of action, keeping the responsibility for the action with the psychologist. Help can be sought from different sources, for example, legal clarification from an attorney, risk- management clarification from a liability company, clinical clarification from a supervisor or colleague. The help received is then applied to each potential action and analyzed in conjunction with the information from other steps. I Information : Information should be sought from all available sources, including literature, laws, regulations, and agency policies. The information is then applied to each possible action to highlight the pros and cons. C Calculate risk : Assessing risk involves applying that calculation to each potential participant in the action. Decreasing risk to one party may increase risk to another. By considering risk for each participant separately, the psychologist can get a better understanding of the overall risk of each possible action. S Select an action : This is the final step, when the psychologist determines the most and least ethical courses of action. more in control, she has begun to reengage in activities that have provided her with support and comfort. One of these activities is church attendance. Dr. Smith was surprised when she saw Jane arrive alone at Dr. Smith’s church one Sunday morning, the only church of that denomination in the town. Jane came up to Dr. Smith and asked to sit next to her during the service. Although somewhat startled, Dr. Smith agreed. At their next therapy session Jane stated that she has now become a full member of their mutual church, has volunteered to work on the same outreach committee as Dr. Smith, but hasn’t attended a meeting yet. How should Dr. Smith proceed? ○ Is there an ethical dilemma? ○ What about the situation requires decision making? ○ If a decision is needed, what is the best course of action for resolution? 1. Identify the problem. This may be a multiple relationship. In addition to seeing Jane in therapy, they will also see each other on a consistent basis in social and volunteer situations. Incidental contact outside of therapy is not a dilemma (boundary crossing),
CASE EXAMPLE
Regardless of the specific decision-making model the psychologist chooses as a best fit for their practice, all models simplify down to the following steps: 1. Identify the problem. 2. Gather information: Review laws, rules, and codes of ethics; get consultation. 3. Identify potential courses of action. 4. Consider the potential consequences of all options, determine a course of action, and implement it. 5. Review the outcome. Apply the steps for ethical decision-making to this fictitious case example: Dr. Smith has a private practice in the small town where she lives. Jane has recently moved to the town and has been seeing Dr. Smith for weekly psychotherapy sessions over the past two months for symptoms of anxiety with panic episodes. They have a mutually agreed goal of reducing the frequency of panic attacks to one per week. Jane is making good progress in her ability to recognize symptoms and utilize cognitive and behavioral strategies, and the frequency of panic attacks has decreased from multiple times daily to an average of three per week. As she has been feeling
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