Discuss the benefits and limitations of ethical

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p t e r Introduction to Professional Ethics learning objectives 1. Identify common themes of ethics codes 2. Understand the limitations of codes of ethics 3. Describe three objectives fulfilled by codes of ethics 4. Explain the difference between law and ethics 5. Differentiate between aspirational ethics and mandatory ethics 6. Compare principle ethics and virtue ethics 7. Apply the six moral principles to ethical dilemmas 8. Recognize the steps in working through an ethical dilemma 9. Assess your attitudes and beliefs pertaining to a range of ethical and professional issues addressed in this book

Professional Codes of Ethics Various professional organizations (counseling, social work, psychiatry, psychol- ogy, marriage and family therapy, human services) have established codes of eth- ics that provide broad guidelines for their members. The codes of these national professional organizations have similarities and also differences. Publications by Common Themes of Codes of Ethics LO1 Each major mental health professional organization has its own code of ethics. Obtain a copy of the ethics code of the profession you are planning to enter and familiarize yourself with its basic standards for ethical practice. You do not need to memorize every standard, but lacking knowledge of the ethics code of your pro- fession is not an acceptable excuse for engaging in unethical behavior. The ethics codes are broad and general; they do not provide specific answers to the ethical dilemmas you will encounter. Although there are specific differences among the ethics codes of the various professional organizations, there are a number of sim- ilar themes: • Being interested in the welfare of clients • Practicing within the scope of one’s competence • Understanding and respecting the cultural values of clients • Distinguishing between personal values and professional values • Avoiding harm and exploitation • Establishing and maintaining appropriate professional boundaries • Protecting client’s confidentiality and privacy • Practicing within an ethical and legal framework • Avoiding discrimination in providing services to clients • Striving for the highest level of ethical practice • Recognizing the importance of self-care as a basis for competent practice

Common Themes of Codes of Ethics LO1 Each major mental health professional organization has its own code of ethics. Obtain a copy of the ethics code of the profession you are planning to enter and familiarize yourself with its basic standards for ethical practice. You do not need to memorize every standard, but lacking knowledge of the ethics code of your pro- fession is not an acceptable excuse for engaging in unethical behavior. The ethics codes are broad and general; they do not provide specific answers to the ethical dilemmas you will encounter. Although there are specific differences among the ethics codes of the various professional organizations, there are a number of sim- ilar themes: • Being interested in the welfare of clients • Practicing within the scope of one’s competence • Understanding and respecting the cultural values of clients • Distinguishing between personal values and professional values • Avoiding harm and exploitation • Establishing and maintaining appropriate professional boundaries • Protecting client’s confidentiality and privacy • Practicing within an ethical and legal framework • Avoiding discrimination in providing services to clients • Striving for the highest level of ethical practice • Recognizing the importance of self-care as a basis for competent practice

Using Ethics Codes as Guides Formal ethical principles can never be substituted for an active, deliberative, and creative approach to meeting ethical responsibilities (Pope & Vasquez, 2016). Eth- ics codes cannot be applied in a rote manner because each client’s situation is unique and may call for a different solution, which demands professional judg- ment. A rule-based approach to ethics is limited in providing meaningful assistance to clinicians who are concerned with practicing at the highest level of ethical functioning. Becoming a professional is somewhat like learning to adjust to a different culture, and both students and professionals experience an ethical acculturation process. From our perspective, practitioners are faced with assuming the respon- sibility of making ethical decisions and ultimately taking responsibility for the outcomes. This process takes time, and it should include consultation. Even with many years of field experience, consultation with colleagues provides an impor- tant check on our thinking about various ethical issues. Herlihy and Corey (2015a) suggest that codes of ethics fulfill three objectives. The first objective is to educate professionals about sound ethical conduct. Read- ing and reflecting on the standards can help practitioners expand their aware- ness and clarify their values in dealing with the challenges of their work. Second, ethical standards provide a mechanism for professional accountability. Practitioners are obliged not only to monitor their own behavior but also to encourage ethical conduct in their colleagues. One of the best ways for practitioners to guard the welfare of their clients or students and to protect themselves from malpractice suits is to practice within the spirit of the ethics codes. Third, codes of ethics serve as catalysts for improving practice. When practitioners interpret and apply the codes in their own practices, the questions raised help to clarify their positions on dilem- mas that do not have simple or absolute answers. You can imagine the chaos if people were to practice without guidelines so that the resolution of ethical dilem- mas rested solely with the individual clinician. We must never forget that the primary purpose of a code of ethics is to safe- guard the welfare of clients. Ethics codes are also designed to safeguard the public and to guide professionals in their work so that they can provide the best service possible. The community standard (what professionals actually do) is generally less rigorous than the ethical standard (what professionals should do). It is important to be knowledgeable of what others in your local area and subspecialties are doing in their practices. Ethics Codes and the Law Ethical issues in the mental health professions are regulated by both laws and professional codes. The Committee on Professional Practice and Standards (2003) of the American Psychological Association differentiates between ethics and law as follows: ethics pertains to the standards that govern the conduct of its profes- sional members; law is the body of rules that govern the affairs of people within a community, state, or country. Laws define the minimum standards society will tolerate, which are enforced by government. An example of a minimum standard is the legal obligation mental health professionals have to report suspected child abuse. The law can also encourage us to work toward changing societal attitudes, for example, to prevent child abuse rather than merely to report it. All of the codes of ethics state that practitioners are obligated to act in accor- dance with relevant federal and state statutes and government regulations. In a court case, the law generally overrules ethics. As ethical mental health practition- ers, however, we can advocate for social justice both with and on behalf of our cli- ents and the communities we serve. Practitioners should be able to identify legal problems as they arise in their work because many of the situations they encounter that involve ethical and professional judgment will also have legal implications. Remley and Herlihy (2016) note that counselors sometimes have difficulty determining when there is a legal problem, or what to do with a legal issue once it has been identified. To clarify whether a legal issue is involved, it is important to assess the situation to determine if any of the following apply: (a) legal proceedings have been initiated, (b) lawyers are involved, or (c) the practitioner is in danger of having a complaint filed against him or her for misconduct. When confronted with a legal issue, consult a lawyer to determine which course of action to take. Remley and Herlihy do not advise consulting with counselor colleagues about how to deal with legal problems because counselors rarely have expertise in legal matters. Many professional associations have attorneys who are familiar with both egal and clinical issues, and members of these associations can use this source of consultation. Establish a working, collegial relationship with a local attorney in your state whom you can consult regarding legal issues. Some professionals have both a law degree and a mental health degree, which can be a useful resource. Laws and ethics codes tend to emerge from what has occurred rather than from anticipating what may occur. Limiting your scope of practice to obeying statutes and following ethical standards is inadequate. We hope your behavior will not be determined by fear-based ethics. It is important to foster an attitude of concern-based ethics early in your training program, striving for the highest level of ethical care for your clients, a theme that is repeated many times throughout this book. Birrell and Bruns (2016) suggest that ethics is better viewed from a relational engagement rather than a risk management perspective. They contend that counselors need to release the fear of punishment and open themselves to authentic mutuality so that “ethics becomes relational and alive and fully integrated into each moment of the clinical encounter” (p. 396). Ethical standards serve as a form of protection for the client, but they also help clinicians ensure their own self-care. For example, counselors sometimes strug- gle with setting limits around being helpful to others. Having clear guidelines in place can help you establish healthy boundaries for yourself, both personally and professionally. At times you may encounter conflicts between the law and ethical princi- ples, or competing ethical standards may appear to require incompatible courses of action. In these cases the values of the counselor come into play (Barnett & Johnson, 2015). Conflict between ethics codes and the law may arise in areas such as advertising, confidentiality, and clients’ rights of access to their own files. If obeying one’s professional code of ethics would result in disobeying the law, it is a good practice to seek legal advice. A licensed mental health professional also may contact his or her professional organization’s legal department or state licens- ing board for consultation. When laws and ethics collide, Knapp, Gottlieb, Berman, and Handelsman (2007) state that practitioners need first to verify what the law requires and deter- mine the nature of their ethical obligations. Practitioners may not understand their legal requirements and may assume a conflict exists between the law and ethics when there is no such conflict. If there is a real conflict between the law and ethics, and if the conflict cannot be avoided, “psychologists should either obey the law in a manner that minimizes harm to their ethical values or adhere to their ethical val- ues in a manner that minimizes the violation of the law” (Knapp et al., 2007, p. 55). Apparent conflicts between the law and ethics can often be avoided if clinicians anticipate problems in advance and take proactive measures. One example of a potential conflict between legal and ethical standards involves counseling minors. This is especially true as it pertains to counseling chil- dren or adolescents in school settings. Counselors may be committed to following ethical standards in maintaining the confidentiality of the sessions with a minor, yet at times parents/legal guardians may have a legal right to information that is disclosed in these sessions. Practitioners may struggle between doing what they believe to be ethically appropriate for their client and their legal responsibilities to parents/legal guardians. When working with minors, it is necessary to be familiar both with state laws and with school policies. Some school districts may have rules regarding breaking confidentiality about substance abuse that differ from those of a private practitioner. Mental health providers in the military are likely to experience ethical dilemmas when obligations to clients and obligations to the military organi- zation conflict. Providers in military settings are occasionally forced to choose between client-centered therapeutic interests and organization-centered adminis- trative interests (Johnson et al., 2010). These competing obligations can generate challenging ethical dilemmas. Information that is viewed as confidential in the civilian sector may not be protected from disclosure in a military setting. A com- manding officer’s need to know about the fitness of a service member may appear to conflict with the ethical values of privacy and confidentiality. Licensed health care providers in the military may struggle with apparent conflicts between their mandated and commissioned roles as military officers and their duty to their clients (Johnson & Johnson, 2017). Strategies for successfully managing these situations can be found, and Johnson, Grasso, and Maslowski (2010) state that “genuine conflict between an ethical and legal course of action—when abiding by law will automatically violate the code of ethics or vice versa—are infrequent occurrences” (p. 552). In ethical dilemmas involving legal issues, a wise course is to seek advice from legal counsel and to discuss the situation with colleagues familiar with the law. When neither the law nor an ethics code seems to resolve an issue, therapists are advised to consider other professional and community standards and their own conscience as well. This subject is addressed more fully in Chapters 5 and 6. Evolution of Ethics Codes:

Codes of ethics are established by professional groups for the purpose of protecting consumers, providing guidelines for practitioners, and clarifying the professional stance of the organizations. Ethics codes undergo periodic revisions and are best viewed as living documents responsive to the needs of counselors, the clients they serve, and society in general. For example, the revised Code of Ethics of the Amer- ican Counseling Association (ACA, 2014) addresses evolving ethical issues per- taining to ethical decision making, professional values, managing and maintaining boundaries, technology, the nonimposition of counselor personal values, counselor education, and legal issues, to mention a few—all of which were in response to recent developments in the field (Kaplan et al., 2017). A new section of the code cov- ers informed consent, privacy, and security of electronic communications, distance counseling, online and research maintenance, and social media. Most professional associations revise their ethics codes every 5 to 10 years. It is necessary that the standards reflect changes in the profession and evolving social trends. However useful the ethics codes may be, they can never replace the informed judgment and goodwill of the individual counselor. We emphasize again the need for a level of ethical functioning higher than merely following the letter of the law or the code. For instance, you might avoid a lawsuit by not paying attention to cultural diversity, but many of your ethnically diverse clients would likely suffer from your insensitive professional behavior.

Professional Monitoring of Practice:

The legal and ethical practice of most mental health professionals is regulated in all 50 states. State licensing laws establish the scope of practice of profession- als and how these laws will be enforced by licensing boards. Some psychother- apy professions are regulated through registration and certification; others, such as social workers, marriage and family therapists, professional counselors, and psychologists, are regulated through licensure. The major duties of regulating boards are (1) to determine standards for admission into the profession, (2) to screen applicants applying for certification or licensure, (3) to regulate the prac- tice of psychotherapy for the public good, and (4) to conduct disciplinary pro- ceedings involving violations of standards of professional conduct as defined by law. Mental health professionals can lose their certification or license if their state regulating board finds that they have engaged in unethical practice or illegal behavior, whether personally or professionally. The topic of licensure is treated in more detail in Chapter 8. In addition to state regulatory boards, most professional organizations have ethics committees—elected or delegated bodies that oversee the conduct of mem- bers of the organization. The main purposes of ethics committees are to educate the association’s membership about ethics codes and to protect the public from unethical practices. These committees meet regularly to process formal complaints against individual members of the professional organization, and they also revise and update their organization’s code of ethics. When necessary, practitioners must explain to clients how to lodge an eth- ical complaint. When a complaint is lodged against a member, the committee launches an investigation and deliberates on the case. Eventually, a disposi- tion is reached. The complaint may be dismissed, specific charges within the complaint may be dismissed, or the committee may find that ethical standards have been violated and impose sanctions. Possible sanctions include a repri- mand; a recommendation that a specific course of remedial action be taken, such as obtaining ongoing supervision or personal therapy; probation or sus- pension for a specified period of time; a recommendation that the member be allowed to resign from the organization; or a recommendation that the member be expelled. Expulsion or suspension of a member is a major sanction. Members have the right to appeal the committee’s decision. Once the appeals process has been completed or the deadline for appeal has passed, the sanctions of suspension and expulsion are communicated in writing to the members of the professional organization. Practitioners who are expelled from the association also may face the loss of their license or certificate to practice, but only if the state board con- ducts an independent investigation. Cases that result in expulsion are often seri- ous enough to involve law enforcement and criminal charges. Many cases also result in civil court proceedings, which are usually published in the local press. Mental health professionals facing ethics violations may believe they were not given fair treatment by the ethics committee, and in such cases they can respond with their perspective. Ethical Decision Making:

health professional, practitioner, therapist, counselor, social worker, school counselor, reha- bilitation counselor, addictions counselor, community worker, couples and family ther- apist, helper, and clinician. Throughout this book, we generally use these terms interchangeably, reflecting the differing nomenclature of the various professions. Although values and ethics are frequently used interchangeably, the two terms are not identical. Values pertains to beliefs and attitudes that provide direc- tion to everyday living, whereas ethics pertains to the beliefs we hold about what constitutes right conduct. Ethics are moral principles adopted by an individual or group to provide rules for right conduct. Morality is concerned with perspectives of right and proper conduct and involves an evaluation of actions on the basis of some broader cultural context or religious standard. Ethics represents aspirational goals, or the maximum or ideal standards set by the profession, practiced through your professional behavior and interactions (Remley & Herlihy, 2016). Codes of ethics are conceptually broad in nature and generally subject to interpretation by practitioners. Although these minimum and maximum standards may differ, they are not necessarily in conflict. Community standards (or mores) vary on interdisciplinary, theoretical, and geographical bases. The standard for a counselor’s social contact with clients may be different in a large urban area than in a rural area, or between practitioners employing a humanistic versus a behavioral approach. Community standards often become the ultimate legal criteria for determining whether practitioners are liable for damages. Community standards define what is considered reasonable behavior when a case involving malpractice is litigated. Courts have consistently found that mental health care providers have a duty to exercise a reasonable degree of skill, knowledge, and care. Reasonableness is usually defined as the care that is ordinarily exercised by others practicing within that specialty in the professional community. Professionalism has some relationship to ethical behavior, yet it is possible to act unprofessionally and still not act unethically. For instance, not returning a client’s telephone calls promptly might be viewed as unprofessional, but it would probably not be considered unethical unless the client were in crisis. Some situations cut across these concepts. For example, sexual intimacy between counselors and clients is considered unethical, unprofessional, immoral, and illegal. Keep the differences in the meanings of these various concepts in mind as you read.

Levels of Ethical Practice:

One way of conceptualizing professional ethics is to contrast mandatory ethics with aspirational ethics. Mandatory ethics describes a level of ethical functioning wherein counselors act in compliance with minimal standards, acknowledging the basic “musts” and “must nots.” The focus is on behavioral rules, such as providing for informed consent in professional relationships. Aspirational ethics describes the highest standards of thinking and conduct professional counselors seek, and it requires that counselors do more than simply meet the letter of the ethics code. It entails an understanding of the spirit behind the code and the principles on which the code rests. Each section in the ACA’s Code of Ethics (2014) begins with an intro- duction, which sets the tone and addresses what counselors should aspire to with regard to ethical practice. Practitioners who comply at the first level, mandatory ethics, are generally safe from legal action in courts of law or professional censure by state licensure boards. At the higher level of ethical functioning, aspirational ethics, practitioners go further and reflect on the effects their interventions may have on the welfare of their clients. An example of aspirational ethics is provid- ing services for no fees (pro bono) for those in the community who cannot afford needed services. Positive ethics focuses not only on how professionals can harm clients but on how therapists can do better at helping clients. Instead of focusing on a reme- dial approach to dealing with an ethical matter, positive ethics requires “anchor- ing all professional behavior and decisions in an overarching ethical philosophy of what psychologists can be, not simply avoiding what they should not do” (Knapp et al., 2015, p. 7). The goal of positive ethics shifts the emphasis of mental health providers away from a focus on wrongdoing and disciplinary actions and toward an articulated vision of the highest level of practice (Knapp & Vande- Creek, 2012). When the word unethical is used, people think of extreme violations of estab- lished codes. In reality, most violations of ethics probably happen quite inadver- tently in clinical practice. The ethics codes of most professional organizations require practitioners to engage in self-monitoring and to take responsibility for misconduct. Welfel (2005) indicates that the professional literature focuses on pr

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