ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
August 24, 2001
"Experience is the name everyone gives to his mistakes."
- Woodrow Wilson
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The Red Cross Disaster Mental Health Services-I (DMHS-I) course will
be offered in Casper, WY on Friday-Saturday, September 14-15, 2001.
If you want to take this course as a Disaster Mental Health
Professional, please send an email for further details on how to
register to: larlion@callatherapist.com The enrollment is limited to 20
participants. APA has approved this course for 12 CEUs. Other
mental health professions have also approved it for continuing
education.
* * * * * * * * * *
CRITICAL INCIDENT STRESS WORKSHOP sponsored by The University of Wyoming Counseling Center
and The Rocky Mountain Region Disaster Mental Health Institute will be held in Laramie, WY
on November 16, 17, 2001. There will be two workshops. One will be in Basic Critical Incident
Stress Management (CISM) on 11/16-11/17 and will be a certification course taught by
International Critical Incident Stress Foundation (ICISF) certified trainers. The Advanced
Issues in Critical Incident Stress Debriefing will be taught by U.S. Navy Psychologist
CDR Bryce Lefever, PhD, ABPP. Enrollment in both workshops is limited. There is an early bird
registration period. If you wish to receive a printed brochure, please email:
larlion@callatherapist.com with your name and mailing address.
Online Brochure can be accessed at: https://www.angelfire.com/biz3/news/cismuw.html
THOUSANDS HOMELESS AFTER VOLCANIC EXPLOSIONS
Although the Philippines Institute of Vulcanology and
Seismology has now lowered the alert around the Mount
Mayon volcano on Luzon Island, further violent
eruptions are considered imminent by the volcano which
has erupted several times during the past few weeks.
The most recent eruptions on 26 and 27 July displaced
nearly 47,000 people - around 4,460 of them
permanently.
Lying some 330 km south east of Manila, Mount Mayon is
one of the Philippines' most active volcanos. It rises
majestically 2,462 metres in a near-perfect conical
shape from the landscape on Luzon island. There have
been at least 45 eruptions recorded, the worst in 1814
when an entire town was buried, killing about 1,200
people.
More at: http://www.ifrc.org/Docs/News/01/080901/
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AN OVERVIEW OF ETHICS
Major themes in ethical philosophizing initially involved the development of schemes for
moral justification of action. Many of these schemes are still used as the foundations of
modern ethical frameworks. Twentieth century ethical theory focused on the analysis of
linguistic elements in moral reasoning, largely consisting of the attempt to demonstrate
that many moral dilemnas were actually just linguistic mistakes or confusion.
More recently, "applied ethics" has become popular. This branch of moral philosophy
attempts to apply ethical principles to real-world problems. Professional ethics as
a subspecialty of ethics can be considered within the applied tradition. Surprisingly,
until fairly recently philosophers of ethics had little interest in the kind of
decision-making problems typically emphasized in practice. Professional ethics is a
branch of ethical theory best located within normative applied ethics.
A useful way to distinguish between ethics and other major standards for determining
whether an action is right, good, or proper is to contrast it with those frameworks.
Law (especially criminal law) and etiquette can be thought of as domains similar to
ethics because each focuses on aspects of proper or good behavior and each specifies
penalties for deviation.
Though each set of standards is in some respects the consensus of the society or culture
that promotes it, moral frameworks are (or should be) developed largely through rational
processes. Legal standards, on the other hand, are primarily developed through political
processes. Norms of etiquette are developed for the most part by historical precedent.
Ethical standards, at least theoretically, focus on behavior and on motivations aimed
at the highest ideals of human behavior. Criminal law focuses primarily on behavior
which may harm other members of society. Etiquette focuses on behavior that establishes
one's standing within a subgroup. Actions that violate moral or ethical standards can
result in censure, guilt, or social criticism. Illegal behavior results in actual
punishment, at least in theory. Impolite behavior results in social ostracism, or
perhaps mild social criticism.
Many moral philosophers distinguish ethics by three main features:
1. It is based on principles;
2. The principles are universalizable;
3. Proper behavior may be deduced from the principles by reasoning.
Therefore, ethics proper should involve adherence to a consistent set of principles
assumed to be relevant for all actors in similar situations, which result (deductively)
in obligations to take particular actions. Two relevant facts follow from this. First,
professional ethics in mental health professions is not pure ethics. Rather, it is a
combination of ethics, law, and etiquette. Second, no existing ethical theory
(especially no theory of professional ethics) meets the standard set out above. It
is therefore an ever evolving topic.
Moral philosophy can be divided into three major areas: descriptive ethics, meta-ethics
and normative ethics. The emphasis of most ethical issues in mental health will be in
the third area. Descriptive ethics is most closely related to anthropology. At present
it is not a prominent subfield in the discipline. Its emphasis is empirical. For example,
what types of behavior are considered right and wrong, and by whom? Meta-ethica is most
closely related to the already described moral philosophy. The focus is conceptual. For
example, why is a particular action considered ethical? What do we mean by the term
"ethical"? Normative ethics focuses on prescriptions for action in particular
circumstances. It attempts to resolve dilemnas. For example, what is the ethical
course of action in this situation?
ETHICAL JUSTIFICATION
Meta-ethics can also be considered as the study of justification for calling certain
actions ethical or unethical. It involves adopting one of two basic positions:
1. The justification for considering an action ethical rests on the nature
of the act itself, or
2. The justification for considering an action ethical rests on the
consequences produced by the act.
The first position is known as deontological justification or deontology. The second
position is called teleological justification or teleology.
Deontology can be characterized by Kant's famous epigram, "Let justice be done though
the heavens fall." (Kant, 1949). What makes deontological approaches appealing is that
they are internally consistent. Once a characteristic of an act has been identified,
determination of its ethical value unequivocally follows.
Criticisms of deontology are of two major types:
1. If more than one characteristic is considered to mark an act as ethical
and two contrary courses of action each has one of those characteristics
an unresolvable dilemna results.
2. Deontology seems to make it too easy for an intuitively immoral action
(e.g. one that demonstrably harms someone) to be justified as ethical.
Some classic examples of these types of problems might include:
1. A youth considers stealing medicine needed to save his severely ill but impoverished
mother. Since it is unethical to steal, he decides against it and allows his mother
to die.
2. A hospital administrator in Nazi Germany is asked by the Gestapo whether the hospital
has any Jewish patients. Since it is unethical to lie, he tells the truth.
Some examples that more directly relate to mental health practice include:
1. A mental health professional is asked to evaluate the "parental fitness" of a father
suspected of child abuse and pedophilia. When the father asks if the testing is
voluntary (which it is), the counselor answers truthfully. The man thereupon refuses
further testing.
2. A subject in a social psychological experiment provides test results that suggest a
thought disorder. Since it is ethical to be honest, the psychologist informs her of
the results.
Utilitarianism (Bentham, 1823; Mill, 1863) is probably the best known teleological
approach. This approach can be characterized by Mill's epigram, "the greatest good for
the greatest number." Western society and, particularly American society, is strongly
utilitarian. The appeal of this approach is that acts are judged by their outcomes.
Major criticisms of the teleological (utilitarian) approach are:
1. The ends can too easily justify the means.
2. The calculation of benefits (or of costs) can be subjective and can
change depending on who does the calculating.
One classic example used to criticize this type of approach is that of the dropping of
the atomic bomb on Hiroshima. Its use was justified by the argument that ending the
war quickly would ultimately save a great many more lives, both American and Japanese,
than would be lost in the bombing.
Some examples more closely related to the mental health professions which illustrate
means-ends problems are:
1. In order to "shake up the defenses" of a client whom he considers resistant, the
counselor tells the client that his wife is having an affair with a close friend
as a result of the client's persistent alcohol abuse. To the best of the counselor's
knowledge, this is a lie.
2. The counselor receives a call from an unidentified male who asks for treatment for
his incestuous behavior, but indicates that he will refuse to enter treatment if
the counselor abides by the state's mandatory child sexual abuse reporting statute.
After discussing the case with the caller, the counselor agrees not to abide by the
law if the man will agree to a minimum of six months of therapy.
In practice, most individuals use some mixture of the teleological and deontological
approaches. Because there are good arguments for and against each approach toward
ethical justification, it is useful to understand the difference between them and to
describe the major criticisms of each.
Regardless of the justification system used, any moral framework eventually arrives
at a set of prescriptions or proscriptions. Though they may vary in specificity,
they usually fall within one of two types of moral rules. These two types of ethical
rules or obligations are known as mandatory and aspirational (Gerts, 1981).
MANDATORY ETHICAL OBLIGATIONS
Mandatory obligations establish a "floor" or minimal criteria for ethical behavior.
They can typically be identified by their proscriptive elements. They indicate what
behavior is to be avoided. The Ethical Principles of Psychologists (APA, 1992),
contains a number of mandatory obligations or mandatory principles, such as:
testimonials from clients are unethical, sexual intimacies with clients are unethical,
and fee-splitting is unethical. Three features of mandatory or "thou shalt not" rules
are important to point out:
1. Upholding them is minimally ethical, and no praise is due the
professional who does uphold them.
2. Violating the mandatory obligations does involve censure or liability
of punishment.
3. Confusing mandatory ethics with aspirational ethics (e.g., aspiring to
the minimal level of ethical behavior) results in a very low standard
of professional conduct.
ASPIRATIONAL ETHICAL OBLIGATIONS
Aspirational ethics constitutes the "ceiling" of ethical conduct. It denotes the ideals
to which the ethical person aspires. The Ethical Principles of Psychologists contains
a number of aspirational obligations as well as mandatory obligations. For example, "in
providing services psychologists maintain the highest standards pf their profession".
Psychologists work to actively and objectively inform the public to help them make choices
in their best interest. Psychologists make efforts to avoid relationships that could
impair their professional judgment. There are three important features of aspirational
or "thou shalt" obligations:
1. It is difficult clearly to establish violations of aspirational
obligations, although not impossible. Thus, it is rare for censure to
be applied to a professional who "violates" them.
2. Professionals who are especially skillful at achieving aspirational
objectives (although they are never completely achieved) are frequently
commended.
3. Confusing aspirational with mandatory obligations - that is, assuming
the minimal requirements for ethically appropriate conduct involve
achieving the highest ideals of the profession - can lead to paralysis
and pervasive feelings of inadequacy.
SOME CONTROVERSIES IN PROFESSIONAL ETHICS
Professional vs Ordinary Morality
Are professionals bound by a different set of moral obligations than ordinary citizens?
An example of this type of conflict is the counselor who decides that a chronically
depressed client is "bringing him down". He notifies the client that the counselor's
services are no longer available. The issue here is the private individual's freedom
of choice versus the professional's obligation not to abandon his/her client.
Another example is the counselor who is routinely late to client appointments. Her
response to clients who express concern about this is that "everybody makes mistakes".
The issue here is whether a counselor is "allowed" to make the kind of mistakes that
the private individual can make or whether the professional has additional obligations
to persons who are clients.
Moral Reasoning vs Moral Behavior
Blasi (1980) has questioned the relationship of moral action to moral reasoning. The
issue of concern is: does instruction in moral reasoning lead to more ethical
behavior? This issue should be of concern to practitioners because the link between
what one does and how one justifies it immediately brings up the question of ethical
justification.
Following are some case examples illustrating these type problems:
1. A counselor agrees to provide organizational consultation to a paramilitary white
supremacy organization. When it is pointed out that his presence in the organization
may legitimize it, he replies that he will attempt to reform the group from within.
This type of case illustrates the line between sophisticated moral reasoning and
self-serving rationalization. The question for discussion here is whether the
counselor's reasoning or his actions are morally questionable.
2. A counselor who is a devout member of a religious sect routinely informs church
authorities about the nature of clients' problems if the clients belong to the group.
The clients are not informed about this practice. The counselor justifies the practice
by claiming that it is in the clients' best spiritual interests. Though this example
doesn't cut across the reasoning versus behavior controversy, it does bring up the
issue of whether a counselor can justify behavior that would be considered professionally
unethical by appeal to a "higher code".
3. A counselor falsifies research data when testifying about the funding for a new
child abuse prevention center. The counselor justifies the behavior by claiming that
the benefits of building such a center outweigh the problems potentially emerging if
the data falsification is discovered. This case points out the difference between
moral justification and rationalization.
4. A counselor faithfully upholds each of the proscriptions in the Ethical Principles
of Psychologists and the ethical guidelines of the American Counseling Association.
When asked how she manages to do this, she replies, "I'm so afraid of being caught and
having my license revoked that I monitor myself scrupously." This case points out the
issue of moral reasoning as a justification for moral behavior and raises the question
of whether there are "better" or "worse" reasons for behaving ethically.
Analsis
Probably the most popular tool used for resolving utilitarian ethical dilemnas is
cost-benefit analysis. This involves three questions:
1. Who calculates the cost and who calculates the benefits?
2. Over what period of time are the costs and benefits calculated?
3. Do the costs and benefits fall on different target groups and is this
distribution equitable?
Religion, Ethics, Science and Identifying Proper Conduct
This controversary brings up two related questions:
1. the relationship of scientific to non-scientific methods of
establishing proper conduct, and
2. within the realm of ethics, the role of religious versus non-religious
frameworks for establishing proper action.
The first concerns issues of whether science or scientifically based professional
activity is value-laden or value-free. This is most familiar in the form of criticisms
of therapist-directed behavior change versus the values underlying psychological
diagnosis.
The second controversy involves the role of religious values and is concerned with the
place of religiously motivated standards or religiously derived standards in ethical
theory. Though there is some disagreement on this point, most religiously derived
frameworks are considered subcategories of deontological ethics. In other words, it
is the nature of the behavior (e.g., commanded by God) that determines whether or not
it is ethical.
ETHICAL PRINCIPLE APPLICABLE TO ALL PROFESSIONALS
Regardless of the specific roles in which they function, mental health professionals are
bound to a set of general ethical obligations codified in the Ethical Principles of
Psychologists, The American Counseling Association's Code of Ethics, or other relevant
professional ethical code. These constitute the highest ideals of the professions as a
whole.
Reduced to one principle, the highest ideal of the mental health professions is the
promotion of human welfare. In pursuit of this ideal, mental health professionals take
on themselves the general obligations to be responsible, competent, honest, respectful
of colleagues, cooperative with duly constituted committee of their professional
association, and aware of community, moral, and legal standards.
The obligation of mental health professionals to be responsible implies accountability
and autonomy. As mental health professionals they are considered to be free to choose
and to accept responsibility for their choices and the consequences of those choices.
Particularly, when mental health professionals are functioning in an institutional
context, they are accountable for the use to which their services and products are put.
Given the primary principle noted above, this further implies that mental health
professionals accept the responsibility to attempt to correct practices that diminish
human welfare. They do not condone illegal, discriminatory, deceptive or injurious
practices.
Mental health professionals bear the burden of maintaining and monitoring their own
competence. They only provide services or operate as mental health professionals
within the boundaries of that competence. Within such domains, mental health
professionals recognize the need for continuing education and maintain awareness of
developments in their fields. Maintaining competence also implies obligations to
recognize when one is not capable of delivering effective service and taking
steps to become more effective, whether this involves seeking personal assistance,
developing greater awareness of differences among people, or changing customary
procedures.
Mental health professionals also take on themselves the obligation to be accurate and
honest in making public statements. This honesty includes the presentation of personal
qualifications and characteristics; the obligation to correct others who misrepresent
one's services, qualifications and so forth; and the avoidance of situations or
manipulations that might compromise the fair and accurate presentation of information.
Mental health professionals have an obligation to be respectful of colleagues. in part,
this implies that they do not act in ways that make professional activities for other
mental health professionals more difficult. Consideration of colleagues does not, however,
include condoning their inappropriate behavior. The mental health professional has an
obligation to bring ethical violations to the attention of colleagues if it seems
appropriate, or to bring more serious cases to the attention of appropriate ethics
committees.
Finally, mental health professionals incur an obligation to be aware of prevailing
community standards and an obligation to conform to those standards if violating them
would compromise their own or their colleagues' ability to function professionally.
In part, this obligation refers to the standards imposed on mental health professionals
by various legislative bodies that have jurisdiction over their activities. It refers
to general community standards. With regard to either set of standards, if they are
discriminatory or injurious, mental health professionals are obliged not to conform
to them and not to condone them.
SOME CLEAR EXAMPLES OF ETHICAL VIOLATIONS
1. A psychologist's research assistant coerces research participants to submit to a
harmful aversive stimulus. The psychologist excuses herself from responsibility,
since the research assistant made this decision on his own. (Problem of denying
responsibility).
2. A mental health professional trained in psychodynamic psychotherapy is a guest on
a radio call-in talk show and a caller describes continual problems with headaches.
The counselor assures him that headaches are in no way physically based but rather
are related to suppressed hostility. (incompetent service).
3. A psychologist prescribes psychedelic drugs for his clients in group psychotherapy.
(Violatin law; incompetent service).
4. A mental health professional treating a depressed housewife suggests forcefully
that she adjust herself to her role and "count her blessings." (Imposing values on
client).
5. A mental health professional in solo independent practice describes himself in
advertisements as "The Personal Growth Institute, Dr. _______, Director," and includes
in his advertisements, "testimonials from satisfied customers." (Misleading or
fraudulent advertising).
6. Dr. X has turned to the bottle for comfort since his office was vandalized and
burned. When it is suggested that he has a drinking problem, he refuses to acknowledge
this. (Offering services when incapacitated).
SOME RELATED LEGAL PRINCIPLES
It is useful to differentiate between legal notions of responsibility and mental health
professions' concepts of responsibility. Legal concepts of responsibility imply
causation and bear on issues of liability and negligence. Some court cases, especially
those having to do with wrongful death and alienation of affection, turn on the
notion of legal responsibility for the consequences of one's actions.
The obligation of being competent brings up the legal question of usual, customary,
and reasonable professional practices. Malpractice law and concepts of professional
liability typically involve issues of what is nationally seen as the standard duty to
clients or consumers ("feasance") and what is seen as the ordinary and minimally
competent fulfillment of this duty in a particular branch of mental health practice.
The obligation of honesty is related to legal principles of contract law. The mental
health professional should become familiar with the notions of fraud, false advertising
and breach of contract.
The general obligation to promote human welfare touches on the legal issue of civil
rights. Though it might be far afield from many professional ethics issues, the mental
health practitioner should have some understanding of the protection granted to him/her,
clients, and colleagues through the Civil Rights Act, the Bill of Rights, equal opportunity
guidelines, or related statutes.
SOME CURRENT CONTROVERSIES
1. In moral philosophy, it is sometimes suggested that when more than one actor is
involved, "responsibility multiplies, rather than divides." This concept brings up
questions related to joint activities with other professionals or other mental health
professionals. Mental health professionals must balance their ethical duties with the
need to maintain harmonious working relationships.
2. The concept of competence can be elusive. Competence to practice may be considered
competence in a given area of knowledge. More generally, it can mean competence to
produce a particular result. As the psychotherapy "marketplace" becomes increasingly
competitive, how can mental health professionals "market" themselves while remaining
ethically appropriate?
3. The obligation to attempt to correct ethical or moral violations that one encounters
may have some repercussions for one's personal well-being. How much personal risk
should mental health professionals take in attempting to "police themselves"?
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REFERENCES
American Psychological Association (1992). Ethical principles of psychologists and code of
conduct. Washington, D.C.: Author.
American Psychological Association ( ). Guidelines for computer based tests and
interpretations. Washington, D.C.
Bentham, J. (1863/1948). An introduction to the principles of morals and legislation.
New York: Hafar Publishing.
Blasi, A. (1980). Moral reasoning and moral action: A critical review. Psychological Bulletin, 31, 1-21.
Kant, I. (1949). Critique of practical reason and other writings in moral philosophy. Chicago:
University of Chicago Press.
Mill, J.S. (1863). Utilitarianism.
Public Law 93-380 (1974). The family educational rights and privacy act (The Buckley Amendment).
United State Code.
Public Law 94-142 (1975). The education for all handicapped children act. United States Code.
To search for books on this and other topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
