1. Ethical and Legal Issues
Chapter 15
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2. Ethical Standards “Ethical Standards” are enforceable rules.
Failure to follow these rules could result in sanctions, including loss of membership in APA and loss of a state professional license.
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3. APA Ethics Code Resolving ethical issues Competence Human relations
Privacy and confidentiality
Advertising and other public statements
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4. APA Ethics Code Record keeping and fees Education and training
Research and publication
Assessment
Therapy
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5. Competence Psychologists have the competence to: Expert testimony
Assess, conceptualize, provide interventions for clients
Expert testimony
Evaluations in child protection
Guardian ad litem
Guidelines
To ensure that mental health professionals meet the standards of competence, they are expected to conduct regular self-scrutiny.
Expert testimony - Providing testimony about the limits of eyewitness memory or the nature of a psychiatric diagnosis.
Task of conducting evaluations in child protection cases are necessary in situations in which there are concerns about the child’s welfare.
Guardian ad litem: Appointed by the court to represent or make decisions for a person who is legally incapable of doing so in a civil legal proceeding.
To assist psychologists in evaluating their competencies in areas that may be outside of their areas of expertise, APA has developed guidelines in specific areas of treatment.
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6. Informed Consent
Clinicians should provide clients with a written statement
Written statement outlines:
The goals of treatment
Process of therapy
Client’s rights
Therapist’s responsibilities
Treatment risks
Techniques that he or she will use
What the client should pay
The limits of confidentiality
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7. Confidentiality Privileged communication Exceptions to confidentiality
Limits in cases involving abuse
Purpose of mandated reporting
Duty to warn (or otherwise protect)
Privileged communication - Clinician may not disclose any information about the client in a court of law without the client’s expressed permission.
Exceptions - Custody cases, trials in which a defendant is using mental disability as a defense in a criminal trial, and when a court appoints a psychologist to determine whether the defendant is competent to stand trial.
Purpose of mandated reporting is to:
Protect victims from continuing abuse and neglect.
Initiate steps toward clinical intervention with the abused individual.
Deter, punish, and rehabilitate abusers.
Duty to warn (or otherwise protect): Clinician’s responsibility to notify a potential victim of a client’s harmful intent toward that individual.
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8. RELATIONSHIPS WITH CLIENTS
Multiple relationships
Boundaries
Avoiding harm to others
Refraining from conflict of interest
Exploiting other people with whom they have a professional relationship
Most extreme form of violation of the therapeutic relationship involves sexual intimacy with clients.
Multiple relationships: Unethical relationships occurring when a psychologist is in a professional role with a person and has another role with that person that could:
Impair the psychologist’s “objectivity, competence, or effectiveness in performing his or her functions as a psychologist” or otherwise risks exploiting or harming the other person.
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9. Record Keeping
Health Insurance Portability and Accountability Act of 1996
Title I of HIPAA
Title II
Health Insurance Portability and Accountability Act (HIPAA): U.S. legislation intended to ensure adequate coverage and protect consumers from loss of insurance coverage when they change or lose their jobs.
Title I of HIPAA protects workers and their families from loss of health care insurance when they change or lose their jobs.
Title II is intended to regulate the ways in which providers and insurance companies maintain and transmit medical records, called protected health information.
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10. Ethical and Legal Issues in Providing Services
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11. Commitment of Clients
Commitment: An emergency procedure for involuntary psychiatric hospitalization
Parens patriae
Assisted outpatient treatment
Parens patriae: State’s authority to protect those who are unable to protect themselves.
“Kendra’s Law,” provides for the state’s court-ordered involuntary outpatient commitment program, termed assisted outpatient treatment (AOT).
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12. Right to Treatment
Legal right of person entering psychiatric hospital to receive appropriate care
Related right is that of liberty and safety
Court ruled that mental health professionals cannot commit people to an institution that is supposed to help them unless they can guarantee that institutionalization will help them.
Right is that of liberty and safety which includes the right to move about the ward and receive protection from violent patients.
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13. Refusal of Treatment and Least Restrictive Alternative
Substituted judgment
Least restrictive alternative
Clients may regard as harsh the application of aversive noise or unpleasant shock and therefore refuse such treatment if they are capable of giving or withholding informed consent.
Substituted judgment: Subjective analysis of what the client would decide if he or she were cognitively capable of making the decision.
Least restrictive alternative: Treatment setting that provides the fewest constraints on the client’s freedom.
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14. Forensic Issues
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15. INSANITY DEFENSE
Argument, presented by a lawyer acting on behalf of the client
Because of the existence of a mental disorder, the client should not be held legally responsible for criminal actions
M’Naghten Rule
Durham Rule
American Law Institute’s (ALI) guidelines
Insanity Defense Reform Act
Insanity: Individual’s lack of moral responsibility for committing criminal acts.
M’Naghten Rule: The “right-wrong test” used in cases of the insanity defense to determine whether a defendant should be held responsible for a crime.
Durham Rule: Based on determining that the individual was not criminally responsible if the unlawful act was due to the presence of a psychological disorder.
American Law Institute’s (ALI) guidelines: Proposing that people are not responsible for criminal behavior if their mental disorder prevents them from appreciating the wrongfulness of their behavior.
Insanity Defense Reform Act: Meant that people with personality disorders would no longer be able to plead insanity.
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16. COMPETENCY TO STAND TRIAL
Prediction by a mental health expert of the defendant’s:
Cognitive and emotional stability during the period of the trial
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17. Understanding the Purpose of Punishment
Question of whether a mentally ill person who is convicted of a capital offense:
Is able to understand the nature and purpose of a death sentence
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18. Concluding Perspectives
Mental health professionals playing an important role in the legal system:
Must familiarize themselves with an array of forensic issues
The intersection between psychology and law will continue to grow
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