Revising the APA Ethics Code

315 Pages·2017·2.97 MB·English

by  Young

Gerald Young
Revising
the APA
Ethics Code
Revising the APA Ethics Code
Gerald Young
Revising the APA
Ethics Code
Gerald Young
Glendon College
York University
Toronto, ON, Canada
ISBN 978-3-319-60001-7 ISBN 978-3-319-60002-4 (eBook)
DOI 10.1007/978-3-319-60002-4
Library of Congress Control Number: 2017943511
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Preface
Ethics is essential to effective and moral practice in mental health. All major mental
health organizations have ethics codes that help practitioners practice, undertake
research and teaching, and engage in other professional functions. The leading psy-
chological organization in this regard is the American Psychological Association
(APA). It has a professional ethical code dated 2002 with minor modifications in
2010 (as certified in 2016). For the psychiatric field, the American Medical
Association (AMA) published an ethics code in 2017 that applies to psychiatry.
Other psychological ethics codes include that of the Canadian Psychological
Association (CPA) code of 2017. At the international or universal code level, there
is the Universal Declaration of Ethical Principles for Psychologists (International
Union of Psychological Science, 2008). The present book attempts an integration of
these various sources of mental health ethical codes in order to improve the one of
the APA, in particular, and toward developing a universal mental health ethics code
applicable to psychology, psychiatry, and other mental health professions.
Typically, mental health ethics codes include principles and standards. Normally,
the principles are aspirational and the standards are obligatory. In reading the various
sources just mentioned, I found that there was no coherent structure or theory that
integrates any one list of principles in any one ethics code, which makes the task of
their comparison difficult. Also, the standards in any one of the ethics codes were not
necessarily inclusive such that all ethical situations were covered. Moreover, some
were written in ambiguous ways that made them difficult to use in cases of presumed
ethical violations. I realized that both for the principles and standards in the APA
ethics code and in the other ethics codes under review, a broad critical analysis was
required in order to avoid a piecemeal and partial approach to the revision process.
At the level of theory and structure for the mental health ethical principles,
although this was not the original intention, I found that my own theoretical work in
Young (2011, 2016a), especially its Neo-Maslovian component, with its five levels,
could help in creating a viable way of rewriting the five ethical principles in the APA
ethics code. As for the standards in the APA ethics code, my approach was to group
them into five domains that helped reorganize them and show how they could be
modified. Finally, for both the principles and the standards recommended for inclusion
v
vi Preface
in a revised APA ethics code, I suggested sub-categories, such as sub-principles and
sub-domains of standards. Other contributions in this regard included presenting
supplementary principles, meta-principles, and meta-domains. Also, I suggested the
use of more examples to clarify the principles and the standards.
The most controversial recommendations for some readers that I have made
toward revising the APA ethics code probably relate to placing science and law in
their proper perspective in the code. These recommendations are found in the sup-
plementary principles mentioned above. Other readers hopefully will agree with me
that a proper mental health ethics code must consider these aspects as central to its
contents. Another controversial aspect for some readers might relate to the recom-
mendation to write each standard both at a basic level and one that is more legally
informed and capture all nuances and possibilities in order to ensure better adjudi-
cation of alleged ethical violations.
To be more specific, the five proposed revised core ethical principles for the APA
ethics code include (1) Life Preservation, (2) Caring Beneficence/Nonmaleficence,
(3) Relational Integrity, (4) Respect for the Dignity and Rights of Persons and
People, and (5) Promoting and Acting from Justice in Society. As indicated, they
were partly informed by and are consistent with the Neo-Maslovian model pre-
sented in Young (2016a). The principle of Life Preservation allows for placing the
torture/enhanced interrogation technique controversy at the forefront of the revised
principles for the APA ethics code.
The five proposed supplementary ethical principles for the APA ethics code (Young,
2016b) include (1) Adopting a Systems Perspective (Ethics as System), (2) Adopting a
Scientific Perspective (Ethics as Science/Science as Ethics), (3) Adopting a Legal and
Governing Authority Perspective (Ethics and Law), (4) Abiding by Ethical Standards
in Mental Health Testing and Evaluation (Ethics and Assessment Procedures), and (5)
Screening and Detecting Symptom Under- and Overreporting (Ethics in Symptom/
Performance Validity). The supplementary principles related to Assessment might be
controversial for some readers, too. However, their emphasis is consistent with my
approach that mental health ethics needs to be scientifically informed.
The five domains that serve to group the ten categories of standards in the APA
ethics code include (1) Preclinical/Pre-professional Contact, (2) Clinical Contact,
(3) General and Nonclinical Contact, (4) Research and Training-Teaching Contact,
and (5) Professional Governing Contact. By organizing the standards this way, in
terms of types of work task and client/contactee, it is more likely that the standards
in any revision of the APA or other mental health ethics codes will cover all possible
ethical situations that might arise.
Aside from dealing how to best conceptualize and write the principles and stan-
dards in a revised APA ethics code, the present book considers other matters related
to psychological ethics. On the one hand, for example, it elaborates a new model of
ethical decision making that consists of multiple phases and steps. Also, on the other
hand, it elucidates concepts such as participatory ethics and relational engagement.
The book concludes with vignettes that point to ethical quandaries and even issues
in internal organization that the APA ethics committee should consider.
Toronto, ON, Canada Gerald Young
Acknowledgments
This book could not have been written without the support of several valuable
resources. First, in particular, Sharon Panulla and Sylvana Ruggirello in the edito-
rial office of the publisher Springer have provided constant encouragement and rel-
evant advice. The production team headed by H. Sarumathi and Vinodhini Srinivasan
has been both precise and careful. I cannot say enough about Jenny X. Wang who
has been an exceptional aid in organizing the book and finding all the resources
needed to complete it. Joyce Chan has been her hardworking aid in all these endeav-
ors. My colleagues at Glendon College at York University have supported my work.
I have had great mentors over the years, and great students whom I have tried to
mentor in turn. My family has been a constant source of motivation. The fields of
psychology and psychiatry are steeped in ethics and deserve accolades for their
efforts, which hopefully the present book has improved. Springer has published all
my books over the years, including Young (2011, 2014, 2016), and I greatly appreci-
ate their support.
vii
Contents
1 Introduction to Revising the APA Ethics Code . . . . . . . . . . . . . . . . . . 1
1.1 Chapter Summary ...................................... 1
1.2 Book Introduction ...................................... 2
1.3 Chapter Summaries ..................................... 4
1.3.1 An Introduction .................................. 4
1.3.2 On New Ethical Principles and Domains of Standards .... 5
1.3.3 On 10 Ethical Psychological Principles
and 50 Sub-principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.4 On Revising the APA Standards ..................... 6
1.3.5 More on Standards, Domains, and Principles
and Proposing Meta-principles . . . . . . . . . . . . . . . . . . . . . . 6
1.3.6 Three Commentaries on the APA Ethics
Code and on Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.3.7 Learning from the 2017 AMA Medical Ethics Code ...... 7
1.3.8 Ethical Decision Making: Fallacies/Biases and Models ... 8
1.3.9 On Recommendations, Participatory Ethics,
and Psychological Co-regulation . . . . . . . . . . . . . . . . . . . . . 8
1.4 Principles, Definitions, and Assumptions .................... 9
1.4.1 Principles ....................................... 9
1.4.2 Definitions ...................................... 9
1.5 Assumptions in Creating a General Framework
of Mental Health Ethical Principles . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.6 Current Literature Review on Ethical Codes in Mental Health .... 14
1.6.1 Ethics and Ethics Codes ............................ 14
1.6.2 APA Approaches ................................. 16
1.6.3 Criticisms ....................................... 17
1.6.4 Revisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.6.5 APA Ethics Code Highlights ........................ 22
1.6.6 Complaints ...................................... 23
1.6.7 Other Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
1.6.8 Science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
ix
x Contents
1.6.9 Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
1.6.10 Forensics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
1.6.11 Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1.7 Chapter Conclusion ..................................... 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2 Comparing the APA and CPA Ethics Codes . . . . . . . . . . . . . . . . . . . . 37
2.1 Chapter Summary ...................................... 37
2.2 Reworking the Core Ethical Principles into Revised Principles ... 38
2.2.1 Comparing the APA and CPA Ethics Codes ............ 38
2.2.2 Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
2.3 General Framework of Mental Health Ethical Principles ........ 40
2.3.1 A Neo-Maslovian Model of Core Ethical Principles ...... 42
2.3.2 The CPA Code and the Neo-Maslovian Model .......... 45
2.3.3 The APA Code and the Neo-Maslovian Model .......... 46
2.4 Finding Common Cause on Terms for Principles
in the APA and CPA Ethics Codes . . . . . . . . . . . . . . . . . . . . . . . . . . 47
2.4.1 Principle Names .................................. 47
2.4.2 Relationship of the Principles ....................... 50
2.5 Reworking the Categories of the Core Ethical Standards
into Domains of Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
2.5.1 Introduction ..................................... 52
2.5.2 Domains of Standards ............................. 53
2.5.3 APA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
2.5.4 Five Domains of Ethical Standards ................... 56
2.5.5 Sub-domains .................................... 57
2.5.6 CPA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
2.6 Chapter Conclusion ..................................... 60
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
3 T he Five Core and the Five Supplementary Ethical
Principles and Their Sub-principles . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
3.1 Chapter Summary ...................................... 63
3.2 The Five Proposed Core Psychological Ethical Principles
and Their Sub-principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
3.2.1 Life Preservation ................................. 65
3.2.2 Caring Beneficence/Nonmaleficence .................. 66
3.2.3 Relational Integrity ............................... 67
3.2.4 Respect for the Dignity and Rights of Persons
and People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.2.5 Promoting and Acting from Justice in Society .......... 73
3.3 The Five Proposed Supplementary Psychological Ethical
Principles and Their Sub-principles . . . . . . . . . . . . . . . . . . . . . . . . . 75
3.4 Adopting a Systems Perspective (Ethics as System) ............ 75
3.5 Adopting a Scientific Perspective
(Ethics as Science/Science as Ethics) . . . . . . . . . . . . . . . . . . . . . . . 78
Contents xi
3.6 Adopting a Legal Perspective (Ethics and Law) ............... 80
3.7 Abiding by Ethical Standards in Mental Health Testing
and Evaluation (Ethics and Assessment Procedures
(and Their Limits)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
3.8 Screening for and Detecting Problem Over- and Underreporting
Biases (Ethics in Symptom/Performance Validity) . . . . . . . . . . . . . 84
3.9 Chapter Conclusion ..................................... 87
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
4 Toward Revising the APA Ethics Code Standards . . . . . . . . . . . . . . . 93
4.1 Chapter Summary ...................................... 93
4.2 Introduction ........................................... 93
4.2.1 Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
4.2.2 Domains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.2.3 Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.3 Critiquing Extant Standards ............................... 98
4.3.1 APA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
4.4 First APA Ethics Code Category of Standards: Resolving
Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
4.4.1 Introduction ..................................... 99
4.4.2 Minor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
4.4.3 Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
4.5 Standard 2: Competence ................................. 109
4.6 Standard 3: Human Relations ............................. 110
4.7 Standard 4: Privacy, Confidentiality [and Informed Consent] ..... 113
4.8 Standard 5: Advertising/Public Statements ................... 115
4.9 Standard 6: Record Keeping/Fees .......................... 116
4.10 Standard 7: Education/Training ............................ 116
4.11 Standard 8: Research/Publication .......................... 117
4.12 Standard 9: Assessment .................................. 119
4.13 Standard 10: Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
4.14 Chapter Conclusions .................................... 121
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
5 Examining Standards, Domains, Principles, and Meta-principles. . . 125
5.1 Chapter Summary ...................................... 125
5.1.1 CPA Standards ................................... 126
5.1.2 Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
5.2 Domains and Principles .................................. 140
5.2.1 Comment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
5.3 Meta-principles ........................................ 144
5.3.1 Introduction ..................................... 144
5.3.2 Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
5.3.3 Responsibility ................................... 147