TOP FIVE ETHICAL DILEMMAS PRESENTED TO THE LACPA ETHICS COMMITTEE

Top Five Ethical Dilemmas Presented to the LACPA Ethics Committee

Kayleigh Hale, Psy.D., and Marcos Briano, MMFT

Many if not all clinicians battle sleepless nights sometime in their career as they deliberate over an ethical dilemma, particularly a dilemma that falls in the gray areas of the APA Ethics Code. Fortunately, the research literature suggests that “we are not alone” in this ethical decision making process (Knapp, Gottlieb, & Handelsman, 2015) and that the hallmark of our decision process should be supported by a “thorough consideration” of our actions (Bailey, 2004). The goal of this article is to highlight the top five ethical dilemmas that were most frequently reported to the LACPA Ethics Committee and the top five APA Ethics codes referenced, in an effort to provide a snapshot of some ethical dilemmas experienced by our colleagues and to introduce or reintroduce our consultation services.

The types of ethical dilemmas that clinicians identify as most challenging and central to their work vary among specialties and settings (Bush, Russo, & Cuesta, 2012), the nature of which has been examined via survey methods (Colnerud, Hannson, Salling, & Tikkanen, 1996; Lindsay & Colley, 1995; Odland & Dalen, 1997; Pope & Vetter, 1992; Sinclair & Pettifor, 1996), study of formal ethical complaints (Dalen, 1997; Report of the Ethics Committee 2002, 2003; Scherrer, Louw, & Moeller, 2002), and analysis of telephone consultations (Dalen, 2006). These studies have rendered important information regarding what may be considered some of the most common ethical issues faced within our field. However, no research has been conducted specifically pertaining to these matters within the Los Angeles psychology community.

LACPA Ethics Committee members provide free personal and confidential ethics consultation through education on the phone. Members include psychologists and a student representative. The members have significant experience with the application of the APA Code of Ethics. The student representative has interest in ethics, participates in meetings, and works on research. The Ethics Committee does not offer legal advice or suggest specific courses of action, and we recommend that the advice of an attorney or risk management insurance agency be sought before making any decision. In addition, the issues inherent in each consultation are routinely discussed during LACPA Ethics Committee meetings as a means of providing optimal consultation.

Conducting research through committee calls is particularly valuable as ethical dilemmas may be studied in advance, garnering information regarding what callers (including both LACPA and non-LACPA members) perceive as ethical issues during the course of clinical care as opposed to in retrospect (Dalen, 2006). Ultimately, by systematically analyzing data of these consultations, we sought to elucidate important information regarding the types of ethical dilemmas faced by clinicians within our Los Angeles psychological community and the respective APA ethical standards.

Licensed Ethics Committee members received phone-based consultations on a rotating basis. The on-call member completed forms regarding their consultation, including a LACPA Ethics Information and Education Committee Telephone Inquiry Log, and a LACPA Ethics Consult Topic Record, the latter of which was utilized for data collection. A primary objective of the record was to include a comprehensive list of ethics topics from which the on-call member could report, based on the central issues presented during the call. This list was developed in accordance with Pope and Vetter’s formative study (1992). In addition, the record included a section for documenting the APA ethics codes discussed during the call. This record was further revised during Ethics Committee meetings, during which members also practiced completing the form based on a number of scenarios. Data were then collated from clinical consultations received by the Ethics Committee over a one-year period, spanning March 1, 2015 through February 29, 2016.

There was a total of 42 telephone calls (i.e., LACPA Ethics Consult Topic Records) which identified 88 ethics topics and 83 APA ethics codes. The data was collated and descriptive statistics were used to report simple frequencies of the top five ethics topics/APA Ethics Codes (refer to Tables 1 and 2, respectively).

Table 1: Top Five Ethics Topics

Table 2: Top Five Consult APA Ethics Codes

By systematically coding and collating data based on these consultations, the five most common areas of ethical concern were identified as the following: 1) confidentiality/privacy, 2) multiple relationships (other than sexual), 3) informed consent and legal issues, 4) duty to warn/protect, and 5) dangerousness, disclosure/authorization to release/exchange information, fees/financial practices, student/trainee/supervisor dilemmas, subpoenas and termination.  It is possible that these represent not only the most common ethical consultations but also the most prevalent ethical issues faced by LACPA members and clinicians practicing within Los Angeles. The finding that confidentiality was much more common than any other dilemma is consistent with the research literature (Dalen, 2006; Pope & Vetter, 1992).

In terms of related APA ethics codes, the five most common codes were: 1) maintaining confidentiality (4.01), 2) disclosures (4.05), 3) discussing the limits of confidentiality (4.02), 4) informed consent to therapy (10.01), and 5) multiple relationships (3.05) & terminating therapy (10.10). As they correspond to the most frequent dilemmas, these particular APA codes may be especially pertinent to clinical practice.

Ethical dilemmas are often complex and multifaceted; therefore, consultation may provide a helpful resource in reviewing the factual information about the case, evoking greater insight, and mitigating the clinician’s emotional state, in an effort to assist in processing and thinking through the case more clearly (Knapp, Gottlieb, & Handelsman, 2015). In situations in which one may benefit from a discussion with colleagues, the LACPA Ethics Committee is available for free personal and confidential ethics consultation. Interested callers are encouraged to contact the LACPA office Monday through Thursday (9:00 a.m. - 4:00 p.m.) and Friday (10:00 a.m. - 2:00 p.m.) to request a consultation.

Acknowledgments

We wish to thank the members of the LACPA Ethics Committee for their assistance with data collection, with particular gratitude extended to Cheryl Kempinsky, Ph.D., and Carol Falender, Ph.D., for their contributions as members of the LACPA Ethics Committee Research Subcommittee.

Kayleigh Hale, Psy.D., is a recent graduate of Pepperdine University whose clinical and research interests include professional ethics, clinical neuropsychology, and serving the veteran population. 

Marcos Briano, MMFT, is the current student representative on the LACPA Ethics Information & Education Committee and graduate student at The California School of Professional Psychology at Alliant International University, Los Angeles.  His research interests include application of professional ethics and advocacy of marginalized communities, specifically LGBT.

References are available on request from the LACPA office, [email protected].