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 © Springer International Publishing AG 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland 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