Running head: ETHICAL DECISON MAKING PRACTICE

Ethical Decision Making Practice Jaylene Bettcher APSY 603- Ethics in Applied Psychology Dr. Irene Estay August 9, 2011

ETHICAL DECISION MAKING PRACTICE Ethical Decision Making Practice Step 1. Identification of the individuals and groups potentially affected by the decision: The primary individuals that will be affected by any decision that I make are the boy and his

grandmother. Others that may be affected by my decision include a psychiatrist (if I deem that it is necessary for a psychiatric evaluation), the aboriginal community, and the boys school. For instance, if I decide not to refer the boy for a psychiatric evaluation and he has psychotic symptoms I may be placing community members and classmates at risk. Furthermore, my own credibility may also be affected by my decision. Step 2. Identification of ethically relevant issues and practices, including the interests, rights, and any relevant characteristics of the individuals and groups involved and of the system or circumstances in which the ethical problem arose: Respect for the Dignity of Persons General Respect I.1 Demonstrate appropriate respect for the knowledge, insight, experience, and areas of expertise of others Regardless of my decision I need to respect the boys grandma, any tribe members who may be involved, and the psychiatrist if I decide to refer the boy for a psychiatric evaluation. I.2 Not engage publicly (e.g., in public statements, presentations, research reports, or with clients) in degrading comments about others, including demeaning jokes based on such characteristics as culture, nationality, ethnicity, colour, race, religion, sex, gender, or sexual orientation.

ETHICAL DECISION MAKING PRACTICE

This is a very culturally sensitive issue as the boy is hearing voices singing and the voice of an old man speaking to him in the tribal dialect and the grandmother is traumatized from events experienced in residential school. Therefore, I need to approach this issue very seriously and carefully, and ensure that I do not make any degrading or stereotypical comments about their culture and/or psychotic symptoms that they are experiencing.

Non-discrimination I.9 Not practice, condone, facilitate, or collaborate with any form of unjust discrimination. Culture appears to have a large role in the boy and the grandmas life, and therefore it is important that I refrain from any practices that are disrespectful of their morals. Informed consent I.18 Respect the expressed wishes of persons to involve others (e.g., family members, community members) in their decision making regarding informed consent. This would include respect for written and clearly expressed unwritten advance directives. If the boy and his grandma are part of an aboriginal community (e.g., live on a reserve) they may wish to consult with and involve other community members in their decision making regarding informed consent, in which case I need to be respectful. Protection for vulnerable persons I.34 Carry out informed consent processes with those persons who are legally responsible or appointed to give informed consent on behalf of persons not competent to consent on their own behalf, seeking to ensure respect for any previously expressed preferences of persons not competent to consent. The boy is only 11 so he is not eligible for a mature minors status, and therefore his legal or appointed guardian must give informed consent for him. Since the boys parents are

ETHICAL DECISION MAKING PRACTICE

no longer a part of his life, I will have to investigate if the grandma is legally responsible for the boy. However, the grandma is currently experiencing hardship due to the loss of her husband so I will need to assess her competency as well, and perhaps I may need to call on a trusted member (e.g., tribal leader) to give informed consent. Privacy I.38 Take care not to infringe, in research, teaching, or service activities, on the personally developmentally, or culturally defined private space of individuals or groups, unless clear permission is granted to do so. I do not know a lot about aboriginal culture so I will need to engage in extensive research about their cultural beliefs and morals. In doing so I must ensure that I am not infringing on their cultural boundaries and that I am respectful of their privacy. Confidentiality I.44 Clarify what measure will be taken to protect confidentiality, and what responsibilities family, group, and community members have for the protection of each others confidentiality, when engaged in services to or research with individuals, families, groups, or communities. I may need to involve other members from the aboriginal community to gain a more complete picture of the boys needs. However, by doing so I need to ensure that the community members I choose to involve understand the importance of protecting the boys identity and identifying information. Responsible Caring General caring II.1 Protect and promote the welfare of clients, research participants, employees, supervisees, students, trainees, colleagues, and others.

ETHICAL DECISION MAKING PRACTICE I need to be concerned about protecting the welfare of the boy, the grandma, and the community members. I need to determine if it is essential for the boy to have a psychiatric evaluation and if it is in his best interest. Competence and self-knowledge II.8 Take immediate steps to obtain consultation or to refer a client to a colleague or other appropriate professional, whichever is more likely to result in providing the client with competent service, if it becomes apparent that a clients problems are beyond their competence.

I am uncomfortable about counselling the boy without obtaining a psychiatric evaluation, therefore I need to consult with colleagues or possibly refer the boy to another psychologist who is more competent in the area aboriginal communities. Furthermore, the most appropriate course of action may be to refer the boy to the psychiatrist if he/she has sufficient knowledge about aboriginal communities.

II.14 Be sufficiently sensitive to and knowledgeable about individual, group, community, and cultural differences and vulnerabilities to discern what will benefit and not harm persons involved in their activities. I need to be sensitive to the boy and his so called psychotic symptoms, he may just be grieving and recalling cultural rituals. Furthermore, the boy, his grandma, and the community may not approve of the boy travelling a long ways for a psychiatric evaluation, which I need to be sensitive to. Maximize benefit II.21 Strive to provide and/or obtain the best possible service for those needing and seeking psychological service... consulting with, or including service delivery, persons relevant to the

ETHICAL DECISION MAKING PRACTICE

culture or belief systems of those served; advocating on behalf of the client; and, recommending professionals other than psychologists when appropriate. Ultimately I need to provide the boy with the best service possible. Since I doubt my competence I may need to consult with my colleagues, members of the community who are knowledgeable about aboriginal culture, and/ or refer the boy to a competent psychiatrist. Offset/correct harm II.42 Be open to the concerns of others about perceptions of harm that they as a psychologist might be causing, stop activities that are causing harm, and not punish or seek punishment for those who raise such concerns in good faith. Integrity in Relationships Accuracy/honesty III.8 Acknowledge the limitations of their own and their colleagues knowledge, methods, findings, interventions, and views. I need to realize that I do not have extensive knowledge on the aboriginal community, and that I may misinterpret cultural rituals (e.g., hearing voices) for psychotic symptoms. Objectivity/lack of bias III.10 Evaluate how their personal experiences, attitudes, values, social context, individual differences, stresses, and specific training influence their activities and thinking, integrating this awareness into all attempts to be objective and unbiased in their research, service, and other activities.

ETHICAL DECISION MAKING PRACTICE I do not have strong cultural or religious views and therefore I may not be able to

comprehend or understand how one can be so in tune to their cultural/religious beliefs, as well as the teaching of their ancestors. Straightforwardness/openness III.16 Fully explain reasons for their actions to persons who have been affected by their actions, if appropriate and if asked. If I decide to refer the boy for psychiatric services before I begin counselling I need to explain to the boy and his grandma and possibly community members if they are involved, why I am doing so. Avoidance of conflict of interest III.38 Seek consultation from colleagues and/ or appropriate groups and committees, and give due regard to their advice in arriving at a responsible decision, if faced with difficult situations. I need to consult with colleagues to help me arrive at a responsible decision, as I am not sure what route I should take. Responsibility to Society Beneficial activities IV. 10 uphold the disciplines responsibility to society by promoting and maintaining the highest standards of the discipline If I move forward with counselling instead of referring the boy to a psychiatrist I may not be promoting and maintain the highest standards of the discipline, as I am not competent enough to make an informed decision as to if he is experiencing psychotic symptoms. Respect for society

ETHICAL DECISION MAKING PRACTICE IV.15 Acquire an adequate knowledge of the culture, social structure, and customs of a community before beginning any major work there. I may need to acquire more knowledge of the boys cultural heritage before I begin counselling, and therefore it may be in the boys best interest that I refer him to a colleague who has sufficient knowledge of the culture. Step 3. Consideration of how personal biases, stresses, or self-interest might influence the development of or choice between courses of action: I am neither of aboriginal descent, nor am I closely connected with my cultural heritage, and I am not religious. As a result, I may be a bit sceptical that the boy is in touch with his ancestors and is hearing their voices, and I may be biased towards thinking that they are psychotic symptoms. I have also not lost someone who was very close to me, and therefore, I do not fully understand the grieving process and how a painful event may trigger painful and emotional events from the past. I believe that I am incompetent in dealing with aboriginal populations;

however, I have never given it an honest attempt before so I may be creating excuses for myself. Step 4. Development of alternative courses of action: My analysis rules out several courses of action a) to do nothing; it would be unethical for me to either walk away from the case without referring the boy to a competent colleague, or for me to proceed with counselling sessions without consulting with colleagues. b) To request the boy have a psychiatric evaluation without consulting with colleagues and without consulting with the boys grandma, and if appropriate members from their community. Conversely there are a couple courses of action that are consistent with my analysis. Alternative 1

ETHICAL DECISION MAKING PRACTICE First of all I would research about the boys cultural/religious background and I would further probe what he and his grandmas current belief system are like. I would confidentially speak to members of their community to further assess what is considered to be normal with regards to hearing voices and their grieving process. Secondly I would consult with colleagues to gain a deeper understanding of the boys culture and if it would be beneficial or detrimental for him to obtain a psychiatric evaluation. I would also talk to the boy and the grandma, as well as members of their community (if appropriate) to find out their views on psychiatric testing and whether or not they are comfortable sending a young boy away to get evaluated. Thirdly, I would be very sensitive to everyones needs and beliefs involved and if I came to believe that it was in the best interest for the boy to obtain a psychiatric evaluation, and that grandma and the community members were accepting of it, I would refer the boy to a competent psychiatrist.

Lastly, when the evaluation was complete and the boys grandma (or appointed guardian if she is not deemed competent) agreed to let me see the results I would pursue counselling with the boy, given that he does not have psychotic symptoms as I am not competent in that area. If the boy has psychotic symptoms I would ensure that he was referred to a competent professional who could provide him with the support that he needs. Alternative 2 First of all I would research about the boys cultural/religious background and I would further probe what he and his grandmas current belief system are like. I would confidentially speak to members of their community to further assess what is considered to be normal with regards to hearing voices and their grieving process. Secondly I would consult with colleagues to gain a deeper understanding of the boys culture and if it would be beneficial or detrimental for him to obtain a psychiatric evaluation. I would also talk to the boy and the grandma, as well as

ETHICAL DECISION MAKING PRACTICE members of their community (if appropriate) to find out their views on psychiatric testing and whether or not they are comfortable sending a young boy away to get evaluated. Thirdly, I

10

would be very sensitive to everyones needs and beliefs involved and if I came to believe that the psychiatric evaluation is not in the boys best interest, and that grandma and the community members are not accepting of it I would refer the boy to a more competent psychologist. I do not believe that I am competent enough to decide whether the boys symptoms are cultural or if they are indeed psychotic symptoms, and therefore I would not be able to provide the boy with the support that he requires. Step 5. Analysis of likely short-term, ongoing, and long-term risks and benefits of each course of action on the individual (s)/ group(s) involved or likely to be affected (e.g., client, clients family or employees, employing institution, students, research participants, colleagues, the discipline, society, self): Alternative 1 Possible positive consequences In the short-term it would be confirmed as to whether the boy has psychotic symptoms, and the appropriate interventions could be put in to place to ensure that he is provided with the support he needs. A psychiatrist who specializes in psychotic symptoms is more competent than me or many of my colleagues. Possible negative consequences The boy, grandma, and community members may be upset and hurt that I would want to refer the boy to a psychiatrist to examine his psychotic symptoms, and it could ultimately create controversy if there are opposing views.

ETHICAL DECISION MAKING PRACTICE

11

The boy, grandma, and community members may not approve of the boy traveling to see a psychiatrist, and once again, this may create controversy if there are opposing views.

The psychiatrist believes that the boy has psychotic symptoms and insists that he is placed in a program with appropriate supports that does not permit his grandma to see him very often.

Alternative 2 Possible positive consequences The boy would receive the services that are in the best interest of him and his culture and interventions would be put into place by a competent psychologist. The boy would not have to leave his community or his grandma to attain further assessment or interventions, and instead he would be surrounded by supportive community members. Possible negative consequences The psychologist that I refer the boy to is unable to provide the support that the boy needs and it is discovered that the boy has psychotic symptoms and that he may be putting himself or others in danger. Step 6. Choice of course of action after conscientious application of existing principles, values, and standards: The actions and consequences for the second alternative more clearly support the values indicated in Principle I (Respect for the Dignity of Persons), Principle II (Responsible Caring), and Principle III (Integrity in Relationships). Alternatively, the actions and consequences for the first alternative more clearly support the values indicated in Principle IV (Responsibility to society). Although the first alternative supports Principle I, II, and III as well, I believe that the

ETHICAL DECISION MAKING PRACTICE

12

second alternative is a better reflection of these principles. The boy and his grandma seem to be very close and it may be detrimental to both of them to remove the boy from his community for a psychiatric evaluation. Furthermore, the boy may be able to receive all the support that he needs from a competent psychologist who is willing to work in his community. However, it is important to meet with the boy, the grandma, and appropriate community members to assess if there are other things that I need to consider before making my decision. Step 7. Action with a commitment to assume responsibility for the consequences of the action: I cannot delay my action, as the boy may be in dire need of support, and therefore I must carry out what I believe to be the best initial course of action. Step 8. Evaluation of the results of the course of action: I need to evaluate if it is the boys best interest to undergo a psychiatric evaluation. I need to weigh the benefits against the risks, and I need to consider the boy, the grandma, and the aboriginal community in doing so. Step 9. Assumptions of the responsibility for the consequences of action, including correction of negative consequences, if any, or re-engaging in the decision-making process if ethical issue is not resolved: It is possible that the course of action that I choose will not be sufficient. However, I believe that it is the most ethical decision, as I am not competent in aboriginal communities and I would not be able to provide the boy with the support that he needs regardless of whether or not he sees a psychiatrist. I believe that through consultation, I will be able to refer the boy to a very competent professional who can offer him the support he requires in his community.

ETHICAL DECISION MAKING PRACTICE Step 10. Appropriate action, as warranted and feasible, to prevent future occurrences of the

13

dilemma (e.g., communication and problem solving with colleagues, changes in procedures and practices): Facing this dilemma has made me realize that I need to engage in further research and obtain further education (informally and formally) on diverse populations, such as the aboriginal community. I am not competent in this area and as a psychologist I have a responsibility to society and to my profession to foster my growth and development to assist those in need.