Presentation on theme: "PSYCHOLOGY ETHICS IN THE VA: A Starting Point"— Presentation transcript:
1 PSYCHOLOGY ETHICS IN THE VA: A Starting Point Developed by the VAPTC - Clinical and Executive Committees and VISN 19 MIRECC
2 IMPORTANT RESOURCES VA Integrated Ethics http://vaww.ethics.va.gov APA EthicsNational Center for Ethics in Health CareVeterans Health Administration (10E) 810 Vermont Avenue, NW Washington, DC Tel: 202–501–0364 Fax: 202–501–2238Add in local resources
3 VA Integrated EthicsEthics – what is right or what should be done in uncertain situations when values conflict.Healthcare professionals should consider ethics in every decisionShare ethical commitment with your peers, supervisors, and organizationConsult with supervisor and VHA ethical consultation service
4 How to Recognize Ethical Dilemmas Feelings of discomfortConflict with values, personally and professionallyDissonance with virtuesDissonance with moral reasoning
5 Self Awareness Exercise What are your personal values and virtues?How do these values and virtues coincide with your professional values?What are your professional motivations?This should be discussion or please fill this out ahead of time….or create a classroom activities slide at the end. Also add - How would your values and virtues be in conflict with personal values…?
6 Ethical Decision-Making Ethical DecisionsIdentify the situationGather all relevant informationIdentify ethical standards & legal policiesDevelop and weigh alternative approaches using ethical standards & legal policiesConsult with professionalsImplement the approach, evaluate the outcomeMight want to add BASICs approach….for VA Integrated Ethics website
7 Ethical Question:As an intern, you are convinced that your supervisor is encouraging his trainees to participate in unethical behavior, you would:First discuss the matter with the supervisorReport the supervisor to the director of the departmentIgnore the situationReport the situation to the ethics committee of the state professional associationConsult with a trusted professionalAdapted from Issues and Ethics in the Helping Professions,Corey, Corey, & Callanan, 2003
8 Using Consultation for Ethics in the VA VA Integrated Ethics provides an ethics consultation service to help with research regarding an ethical dilemma.Example 1: Are Veterans with PTSD considered a vulnerable population in research?Example 2: What are the ethical challenges of coordinating care between the VA & Department of Defense?Investigate these examples using this website:
9 APA Code of EthicsProvides principles and standards to guide psychologists professional and scientific workAPA members should comply with the standards of the Ethics Code & the rules & procedures used to enforce themThe Ethics Code applies to psychologist activities including administration, education, professional, policy & scientific activitiesAdapted from APA 2002
10 APA Code of Ethics 5 Principles: Beneficence & Nonmaleficence Do Good; Avoid HarmFidelity & ResponsibilityDevelop trust; accept responsibility of work; uphold professional standards of conductIntegrityMaximize benefits & minimize harm through accuracy, honesty & truthfulnessJusticeExercise competence & reasonable judgmentRespect for People’s Rights & DignityRespect autonomy; maintain professional boundaries; preserve confidentiality & privacyAdapted from APA 2002
11 APA Code of Ethics 10 Standards Resolving Ethical Issues Competence Human RelationsPrivacy & ConfidentialityAdvertising & Public StatementsRecord Keeping & FeesEducation & TrainingResearch & PublicationAssessmentTherapyAdapted from APA 2002
12 Ethical PitfallsAvoid ethical pitfalls by applying the APA Ethical Code & Deborah Smith’s 10 pointers:Understand Multiple RelationshipsProtect ConfidentialityRespect AutonomyKnow Supervisory ResponsibilitiesIdentify Client & RoleDocumentPractice in Area of ExpertiseAbandonment vs. TerminationStick to the EvidenceBe Accurate in BillingFrom 10 Ways Practitioners Can Avoid Frequent Ethical Pitfalls, Smith, 2003
13 10 Ways to Avoid Ethical Pitfalls Understand what constitutes a multiple relationship.A multiple relationship occurs when:Participating in two or more relationships or roles with another personA multiple relationship can:Happen simultaneously or at different timesCause harm or be exploitative
14 Ethics Question:What should you do if you are scheduled to work with a Veteran you know personally?
15 APA Ethics Code on Multiple Relationships “A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.”
16 10 Ways to Avoid Ethical Pitfalls Multiple relationships (continued)What does this mean?Power differentialsDuration of relationshipsSexual relationships are never permissibleGifts & barteringSupervisor/superviseeAdd intro slides – please edit based on local standards and regulations
17 Ethical Question:If a patient evidenced strong feelings of attraction or dislike for me, I think I would:Help the client work through these feelings and understand them.Enjoy these feelings if they were positive.Refer my patient to another therapist.Direct sessions into less emotional areas.Other:Adapted from Issues and ethics in the helping professionsCorey, Corey, & Callanan, 2003
18 Ethical Question:A sexual relationship between a former patient and a psychologist is:Ethical if the patient initiates it.Ethical only 2 years after termination of therapy.Ethical only when client and therapist discuss the issue and agree to the relationship.Never ethical, regardless of the time that has elapsed.Adapted from Issues and ethics in the helping professionsCorey, Corey, & Callanan, 2003
19 10 Ways to Avoid Ethical Pitfalls ConfidentialityPsychologists are asked to provide information about their patients to family members, other healthcare professionals, and other agencies.APA Ethics Code states that only the minimum information necessary should be disclosed in order to provide needed services, obtain appropriate consultations, protect the client, psychologist or others from harm, or obtain payment for services from a client.
20 10 Ways to Avoid Ethical Pitfalls ConfidentialityDiscuss limits of confidentiality with patientProtecting confidentiality by safeguarding confidential recordsKnow state and federal lawsHIPAAThe Privacy Rule sets Federal standards for protecting the privacy of individually identifiable health information and identifies the rights of all parties involved.Know organizational policies (e.g.,VA Handbook )
21 Ethics Questions:In what situations is confidentiality not guaranteed?How would you communicate this to the patient?
22 Ethics Question:If a patient asks you to send a report to another healthcare agency, what steps should you take?
24 Informed Consent Competence Disclosure Patient Understanding Practice only within your limits of expertise, experience & trainingDisclosureIf you are a trainee under supervision, this must be disclosed to the patient (e.g., need to explain your role and goal of the interaction)Patient UnderstandingClearly discuss confidentiality, privacy, treatment options, documentation procedures, and emergency contact informationVoluntarinessThe patient has the right to terminate therapy at any time, therapy is a voluntary serviceAuthorizationObtain documented authorization of patient consentFrom Kitchner 1992
25 Ethics Questions:Regarding disclosure, when should you (or the VA) tell patients that a mistake was made in the course of their treatment?
26 Informed Consent in the VA All VHA patients have the right to accept or refuse any medical treatment or procedure.All VHA patients must provide voluntary, informed consent for any treatment/procedure, or if the patient lacks decisional-making capacity, the patient’s authorized surrogate.Informed consent may cover a one-time or multiple-visit treatment.New consent must be obtained if there is a deviation or change in the treatment plan and/or there is a change in the patient’s condition or diagnosis that alters the initial consentFrom VHA Handbook
27 Informed Consent in the VA Informed consent process ( Handbook )Informing the patientProvide information clearly and in a language understandable by the patient regarding treatment details, options/alternatives, risks & benefitsEnsure the patient understands and encourage the patient to ask questionsPromote voluntary decision-makingDocument the processFrom VHA Handbook
28 10 Ways to Avoid Ethical Pitfalls Know Supervisory ResponsibilitiesInform patients about supervisionUtilize VA supervisory agreement formGoals of supervision:Protect the patientFacilitate supervisee’s professional developmentFoster supervisee’s assessment of their competenceAssess supervisee competence
29 10 Ways to Avoid Ethical Pitfalls Identify Client and RoleWho, What, WhereCompensation and pension evaluations & confidentialitySpecial confidentiality limits (e.g. Tricare insurance)
30 10 Ways to Avoid Ethical Pitfalls DocumentationContact log, history, dates, impressions, informed consent, follow-up contactNEVER alter a record after the factAppend information to the health record per local policyRecord only pertinent information as related to the treatment and health services
31 10 Ways to Avoid Ethical Pitfalls Practice ONLY in Area of ExpertiseCompetencyKnowledge, Skills & AbilitiesBe aware of your own impairment/limitationsInternal or external factors may interfere with your knowledge, skills and abilities to appropriately treat patientsStay informedContinue professional education through seminars, conferences, workshops, researchKnow when to refer
32 10 Ways to Avoid Ethical Pitfalls Abandonment Vs. TerminationTermination utilizes competencyGoals of beneficence & patient’s autonomyBe aware when therapy is:not benefiting the patientthe patient may be harmed from continuing treatmentthe patient no longer needs therapyToo SoonJust RightToo LateTherapistAbandonmentTherapist & ClientPerfection!ClientDependenceTable adapted from Anderson & Handelsman 2010
33 Ethical QuestionA therapist should terminate therapy with a patient when:The patient decides to terminate.The therapist decides to terminate.The patient is not benefiting from treatment.Adapted from Issues and ethics in the helping professionsCorey, Corey, & Callanan, 2003
34 10 Ways to Avoid Ethical Pitfalls Stick to the EvidenceBe mindful of what you do and do not knowKnow the referral questionEvaluate, interview and assess thoroughlyBe Accurate in BillingDocument every session and contact accurately to ensure proper agency billing
35 Five Principles for Research Ethics APA article by Deborah Smith Discuss intellectual property franklyBe conscious of multiple rolesFollow informed consent rulesRespect privacy & confidentialityUtilize ethics resourcesThe Belmont Report. Released by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1979, the report provided the ethical framework for ensuing human participant research regulations and still serves as the basis for human participant protection legislation (see Further Reading).APA's Ethics Code, which offers general principles and specific guidance for research activities, available at
36 Risk ManagementBy focusing on identifying, evaluating, and treating problems that may cause undue harm to the patient, such preventative measures may reduce the practice of unethical behavior, minimize litigation, and reduce the chance of malpractice.Adapted from Issues and ethics in the helping professionsCorey, Corey, & Callanan, 2003
37 Research Ethics Questions: How do you know that a research subject understands the informed consent?How do you decide authorship hierarchy (i.e., who should be listed first)?
38 Risk Control Strategies Use informed consent & professional disclosure formsPresent information clearly & check to make sure patient understands the informationUphold the VA’s standards of careKeep up-to-date on ethical and legal standardsExplain diagnosis, treatment plan, and risks and benefits of treatmentContinue professional educationMonitor self-competencyRefer patients when necessaryCarefully document patient interactionsAvoid multiple relationships, or consult with supervisor if unavoidableKnow how to assess & intervene when patient poses danger to self or othersKnow limits of confidentiality and clearly communicate these to the patientTreat your patients with respect and develop a trusting relationshipFrom Issues and Ethics in the Helping Professions, Corey, Corey, & Callanan, 2003
39 Additional Websites:State of Colorado Department of Regulatory Agencies, Mental Health Licensing Section.United States Office of Government Ethics:Dept. of Veterans Affairs - Public and Intergovernmental Affairs:The Center for Ethics and Human Rights:Biomedical and Health Care Ethics Resources:
40 ReferencesAmerican Psychological Association. (2002). American Psychological Association ethical principles of psychologists and code of conduct. Retrieved fromAnderson, S.K., & Handelsman, M.M. (2010). Ethics for psychotherapists and counselors: A proactive approach. West Sussex, UK: Wiley-Blackwell.Campbell, L.., Vasquez, M., Behnke, S., Kinscherff, R. (2009). APA Ethics Code Commentary and Case Illustrations. Washington, D.C.: American Psychological Association.Corey, G., Corey, M.S., & Callanan, P. (2003). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole.Kitchner, K.S. (2000). Foundations of ethical practice, research, and teaching in psychology. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Smith, D. (2003). 10 ways practitioners can avoid frequent ethical pitfalls. APA Monitor, 34, 50.Smith, D. (2003). Five principles for research ethics. APA Monitor, 34, 56.VHA HandbookVHA HandbookVHA Integrated Ethics