Models Of Ethical Decision Making

Models Of Ethical Decision Makingpsych660page 2012 University Of Ph

Models of Ethical Decision Making PSYCH/660 © 2012 University of Phoenix, Inc. | All rights reserved Ethical Decision Making According to Koocher & Keith-Spiegel (2008). Model 1 © 2012 University of Phoenix, Inc. | All rights reserved Model 2 Ethical Decision Making According to Fisher (2005). * © 2012 University of Phoenix, Inc. | All rights reserved Model 3 Ethical Decision Making According to Fisher (2013). Case 10. Handling Unexpected Disruptive Member Behavior During Group Therapy Esther Hernandez, Ph.D., a specialist in the psychology of addictions, conducts group therapy sessions for patients treated at a local methadone Medicaid clinic. She has been meeting with a group of 12 women on a weekly basis for 2 months and has been pleased that, for the most part, members attend the meetings regularly.

Although the women take methadone as a substitute for their heroin habits, many also take other illicit drugs. At the initial session, Dr. Hernandez and group members agreed on a rule that members should not come to a session if they are high or intoxicated. The rule has been enforced several times during the past 2 months. At the beginning of the most recent session, Angela, one of the group members, walks in late and is obviously intoxicated.

Dr. Hernandez reminds Angela about the rule, noting that Angela must leave but will be welcome back at the next meeting if she is sober. Angela starts crying and begs to stay. Dr. Hernandez expresses sympathy and then restates the rule.

Angela stands up and states that a drug dealer to whom she owes money has found out where she lives and she is afraid for her life. Then as she rushes out of the building, she tells the group “You will all be sorry when I’m dead.” The other group members are obviously shaken by Angela’s behavior. Some feel Dr. Hernandez should end the group meeting and try to find Angela to make sure she is okay. Others think Dr. Hernandez should call the police. Still others believe Angela is trying to manipulate Dr. Hernandez into permitting her to break the rule, noting her past behavior of trying to circumvent rules. Ethical Dilemma Dr. Hernandez is shaken and does not know how best to handle this situation.

Discussion Questions 1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma? 2. Who are the stakeholders and how will they be affected by how Dr. Hernandez resolves this dilemma? 3. Is Angela’s current situation one that Dr. Hernandez should have anticipated in establishing group therapies designed to treat addiction and substance dependence? Does Dr. Hernandez have a professional responsibility for Angela’s safety outside the group therapy context? 4. How should Dr. Hernandez immediately address the group members’ concerns, keeping in mind that group members have voiced different opinions about the situation? 5. From a treatment perspective, how important is it for Dr. Hernandez to uphold the group’s self-generated and agreed-upon rules regarding intoxication? Do group members have the same confidentiality obligations as Dr. Hernandez? 6. What legal concerns should Dr. Hernandez consider? 7. How are APA Ethical Standards 2.01a, 2.01e, 4.01, 4.05, 4.06, 10.03, and 10.10 and the Clinical Practice Guidelines for Group Psychotherapy relevant to this dilemma? Which other standards might apply? 8. What are Dr. Hernandez’ ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principles and enforceable standards, legal standards, and obligations to stakeholders? Can you identify the ethical theory (discussed in Chapter 3) guiding your decision? 9. What steps should Dr. Hernandez take to implement her decision and monitor its effect?

Paper For Above instruction

In the realm of psychological practice, ethical dilemmas often challenge practitioners to balance competing principles, stakeholder interests, and legal obligations. The case of Dr. Esther Hernandez highlights such a dilemma, where her role in managing group therapy sessions intersects with concerns for client safety, group integrity, and professional responsibility. This analysis explores the ethical dimensions of her situation, the stakeholders involved, and potential courses of action grounded in ethical standards and theories.

Understanding why this is an ethical dilemma begins with recognizing conflicting principles, notably beneficence, nonmaleficence, autonomy, confidentiality, and justice, as outlined in the American Psychological Association (APA) Ethical Principles. The dilemma centers on whether Dr. Hernandez should prioritize immediate safety concerns—such as Angela’s threats and expressed fears—or uphold established group rules and confidentiality agreements. Her decision impacts multiple stakeholders: Angela herself, the group members, the clinician, and the broader community affected by the potential consequences of her actions.

Angela is visibly distressed and expresses fears for her life, suggesting she might be at genuine risk. Conversely, her past behaviors hint that her current threats could be manipulative or exaggerated. The group members are affected by Angela’s disclosures, which shake their trust and sense of safety during sessions. The clinician’s professional obligations include ensuring client safety, maintaining confidentiality, and upholding the integrity of the therapeutic process. Legal concerns—such as mandated reporting laws if abuse or threats are credible—also influence her response strategy.

Anticipating Angela’s vulnerability is essential in designing effective addiction treatment groups. Risk factors, including her legal and emotional instability, should have been addressed during treatment planning. Dr. Hernandez has a duty to consider her responsibility for Angela’s safety beyond the session, especially if threats are credible, implying a potential obligation to intervene more assertively. This raises questions about the scope of her professional responsibilities and the limits of confidentiality when imminent harm is evident.

Immediately addressing the group requires sensitivity and clarity. Dr. Hernandez should acknowledge the group's concerns and validate their feelings, fostering a supportive environment while providing reassurance about her commitment to safety. To allay fears, she might clarify her role and outline steps she will take. It’s crucial that she emphasizes that safety is paramount without dismissing or escalating tensions within the group.

Upholding the group’s rules about intoxication remains critical in preserving the integrity of the therapeutic environment. These rules help ensure the safety and effectiveness of the treatment. While group members have confidentiality obligations, they are generally not bound by the same professional standards as Dr. Hernandez, who must protect client confidentiality as mandated by law and ethical standards, but also navigate limits where safety is concerned.

Legal concerns encompass mandatory reporting laws related to threats of harm or danger, especially when the client is facing credible risks of violence or death. Failure to act appropriately could result in legal repercussions and harm to the client. It’s essential that Dr. Hernandez considers these legal standards along with APA ethical standards such as 2.01a (boundaries of competence), 2.01e (confidentiality), 4.01 (scientific and professional knowledge), 4.05 (disclosures), 4.06 (consultation), 10.03 (informed consent), and 10.10 (therapy with minors and at-risk populations).

Relevant guidelines for group psychotherapy, including those from the American Group Psychotherapy Association, emphasize balancing confidentiality, safety, and ethical boundaries. Standards such as 2.01e and 4.06 underscore the importance of responsibly managing disclosures and consulting with colleagues when faced with complex cases. Alternative ethical responses include brief crisis intervention, involving appropriate authorities, or arranging for immediate safety assessments.

From an ethical perspective, the most appropriate course of action aligns with a combination of the principle of nonmaleficence—preventing harm—and beneficence—promoting well-being. The ethical theory guiding this decision can be linked to virtue ethics, emphasizing the character strengths of compassion and prudence, to act in the client's best interest while respecting their dignity. Implementing the chosen course involves clear communication, documentation, and follow-up assessments to monitor Angela’s safety and emotional state.

In conclusion, Dr. Hernandez’s response must be guided by a careful consideration of ethical principles, legal obligations, and stakeholder interests. By prioritizing safety, maintaining professional standards, and utilizing ethical decision-making frameworks, she can navigate this complex dilemma effectively while safeguarding her client's well-being and the integrity of the therapeutic process.

References

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• American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. American Psychologist, 65(1), 33–41.
• Bernard, H., Burlingame, G., Flores, P., Greene, L., Joyce, A., Kobos, J. C., & others. (2008). Clinical practice guidelines for group psychotherapy. International Journal of Group Psychotherapy, 58(4), 455–542.
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• Koocher, G. P., & Keith-Spiegel, L. (2008). Ethical principles in psychology and the dilemmas they create. In G. P. Koocher & L. Keith-Spiegel (Eds.), Ethics in Psychology and the Mental Health Professions (pp. 3–25). Oxford University Press.
• Fisher, C. B. (2005). Deciding to be ethical: A framework for decision making. Journal of Empirical Research on Human Research Ethics, 1(4), 13–26.
• Fisher, C. B. (2013). Deciphering ethical dilemmas: Using the ethical decision-making framework. Journal of Empirical Research on Human Research Ethics, 8(4), 43–52.
• American Group Psychotherapy Association. (2014). Ethical standards and guidelines for group psychotherapy. AGPA.