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Steps in Ethical Decision-Making
The following excerpt is from chapter 9 in Ethics in Psychotherapy and Counseling: A Practical Guide (3rd edition) by Ken Pope & Melba Vasquez (Jossey-Bass/John Wiley, 2007). John Wiley, the book's publisher, holds the copyright to this material and questions about reprinting it or other uses involving copyright should be addressed to the publisher.
This chapter provides some steps helpful in thinking through how to respond to an ethical dilemma, taking action, and assuming personal responsibility for our response. These steps may help us to identify important aspects of a situation, consider positive and negative consequences of the ways in which we might respond, and discover better approaches.
The Canadian Psychological Association emphasized the value and importance of such steps by including 7 in their original ethics code (1986), and increasing the number to 10 in subsequent editions (1991, 2000). In the list below, asterisks mark steps that are versions of those that appear in the CPA code.
Although there are 18 steps listed below, not every step will be relevant to every situation, and the steps may need to be adapted to fit particular situations.
1. Identify the situation that requires ethical consideration and decision-making.
What is the clearest possible statement of the ethical question or issue? Are there other valid ways to define the situation? Do the definition's scope, perspective, assumptions, or wording make it needlessly hard for us to understand the situation and decide what to do? Do they hide or distort important aspects?
2.* Anticipate who will be affected by your decision.
No one lives in a vacuum. It is rare that our ethical decisions affect only a single client or a single colleague and no one else. A client may show up for a session drunk. How you define your responsibility may influence whether the client drives home drunk and kills a pedestrian. A colleague may begin to show signs of Alzheimer's. The choices you make may affect the safety and well-being of the colleague and the colleague's patients. An insurance claims manager may refuse to authorize additional sessions for a client you believe is at risk for killing his wife and children and then committing suicide. Your supervisor may agree with the manager that no more sessions are needed. How you determine the most ethical path may help decide whether the family lives or dies.
3. Figure out who, if anyone, is the client.
Is there any ambiguity, confusion, or conflict about who the client is (if it is a situation that involves a therapist-client relationship)? If one person is the client and someone else is paying your fee, is there any divided loyalty, any conflict that would influence our judgment?
4. Assess our relevant areas competence-and of missing knowledge, skills, experience, or expertise-in regard to the relevant aspects of this situation.
Are you well-prepared to handle this situation? What steps, if any, could you take to make yourself more effective? In light of all relevant factors, is there anyone else who is available that you believe could step in and do a better job?
5. Review relevant formal ethical standards.
Do the ethical standards speak directly or indirectly to this situation? Are the ethical standards ambiguous when applied to this situation? Does this situation involve conflicts within the ethical standards or between the ethical standards and other (e.g., legal) requirements or values? In what ways, if at all, do the ethical standards seem helpful, irrelevant, or misdirected when applied to this situation?
6. Review relevant legal standards.
Do legislation and case law speak directly or indirectly to this situation? Do the legal standards speak to this situation in a way that is clear? Are there conflicts within the legal standards or between the law and other requirements or values? Do the relevant laws seem to support-or at least allow-the most ethical response to the situation, or do they seem to work against or block the most ethical response? Would it be helpful to consult an attorney?
7. Review the relevant research and theory.
Is there new research or theory that helps us to conceptualize, understand, or respond to the situation? One occupational hazard of a field with such diverse approaches--cognitive, psychodynamic, behavioral, feminist, psychobiosocial, family, multicultural, existential, to name but a few--is that we often lose touch with the research and theory emerging outside our own theoretical orientation.
8.* Consider how, if at all, your personal feelings, biases, or self-interest might affect your ethical judgment and reasoning.
Does the situation make you angry, sad, or afraid? Do you find yourself eager to please someone (or an organization)? Do you desperately want to avoid conflict? Do you find yourself concerned that doing what you believe is most ethical will get you into trouble, will make someone mad at you, will be second-guessed by colleagues who disagree with you, or would be hard to square with the law? Will doing what seems ethically right cost you time, money, referrals, prestige, a promotion, your job, or your license?
9. Consider what effects, if any, that social, cultural, religious, or similar factors may have on the situation and on identifying ethical responses.
The same act may take on sharply different meanings in different societies, cultures, or religions. What seems ethical in one context may violate fundamental values in another society, culture, or spiritual tradition. Are you overlooking any relevant contexts? Does the situation include social, cultural, religious, or similar conflicts?
10. Consider consultation.
Is there anyone who would likely provide useful consultation for this specific situation? Is there an acknowledged expert in the relevant areas? Is there someone who has faced a similar situation and handled it well-or who might tell you what does not work and what pitfalls to avoid? Is there someone whose perspective might be helpful? Is there someone whose judgment you trust?
11.* Develop alternative courses of action.
What possible ways of responding to this situation can you imagine? What alternative approaches can you create? The initial possibilities that occur to us may strike you as "not bad" or "good enough," but much better responses may occur to you if we keep searching.
12.* Evaluate the alternative courses of action.
What impact is each likely to have--and what impact could each have under the best possible and worst possible outcome that you can imagine--for each person who will be affected by your decision? What are the immediate and longer-term consequences and implications for each individual--including yourself--and for any relevant organization, discipline, or society? What are the risks and benefits? Almost any significant action has unintended consequences--what might they be for each possible course of action?
13. Try to adopt the perspective of each person who will be affected.
Putting yourself in the shoes of those who will be affected by your decisions can change your understanding and help you discover what you believe will be the most ethical response to a difficult situation. You can ask yourself: what would each person consider the most ethical response? In this way you can try to to compensate for some of the distortion that may occur from seeing things only from your own perspective. One example is what Jones (1979; see also Gawronski , 2003; Gilbert & Malone , 1995; Weary, Vaughn, Stewart, Edwards, 2006) called "correspondence bias." Although we often explain our own behavior in specific situations as due to external factors, we tend to attribute the behavior of others to their dispositions. Another example is what Meehl (1977) called a "double-standard of morals" (p. 232). We tend to hold explanations provided by other people to much more scientifically and logically rigorous standards than we use for our own explanations.
14.* Decide what to do, and then review or reconsider it.
Once you have decided on a course of action, you can--if time permits--rethink it. Sometimes simply making a decision to choose one option and exclude all others makes you suddenly aware of flaws in that option that had gone unnoticed up to that point.
15.* Act on and assume personal responsibility for your decision.
In some cases, trying to weigh ethical options, reconcile ethical conflicts, and discover the most ethical response--the steps leading up to taking action--are the hard part. Once the decision is made, acting is relatively easier. In other cases, thinking through the situation may seem relatively easy-acting is hard. The most ethical response may seem to come at overwhelming personal risk or cost. When risks or costs overwhelm us, it is a natural temptation to blur or evade personal responsibility.
16.* Evaluate the results.
What happened when you acted? To what extent, if at all, did your action bring about the expected consequences? To what extent, if at all, were there unforeseen consequences? Knowing what you know now, would you have acted in the same way or chosen a different response to the situation?
17.* Assume personal responsibility for the consequences of your action.
If your response to the situation now seems-with the benefit of hindsight-to have been wrong or has caused negative consequences, what steps, if any, do you need to take to address the consequences of your decision and action? If it seems to have been incomplete, what else needs to be done to address the situation? Have your actions and their consequences brought about new ethical challenges?
18.* Consider implications for preparation, planning, and prevention.
Did this situation and the effects of your response to it suggest any useful possibilities in the areas of preparation, planning and prevention? Are there practical steps that would head off future problems or enable you and others to address them more effectively? Would changes in policies, procedures, or practices help?
Related Resources on This Site:
- 21 Cognitive Strategies To Justify Any Unethical Behavior
- Links to Ethics Codes & Practice Guidelines for Assessment, Therapy, Counseling, & Forensic Practice
- Links to Psychology laws & licensing boards in Canada & the U.S.
- Informed Consent in Psychotherapy & Counseling: New Standards, Sample Forms, & Resources
- A Practical Approach to Boundaries in Psychotherapy: Making Decisions, Bypassing Blunders, and Mending Fences
- Developing & Practicing Ethics for Psychologists
- Disability, Accessibility, & Ethics in Psychology: 3 Major Barriers
- National study of the ethical dilemmas encountered by APA members (American Psychologist)
- National study of the ethical beliefs & behaviors of psychologists as therapists (American Psychologist)
- National study of the ethical beliefs & behaviors of psychologists as professors (American Psychologist)
- Psychological Assessment:
Clinical & Forensic
IMPORTANT NOTE: The excerpt on this web pageis from chapter 9 in Ethics in Psychotherapy and Counseling: A Practical Guide (3rd edition) by Ken Pope & Melba Vasquez (Jossey-Bass/John Wiley, 2007). John Wiley, the book's publisher, holds the copyright to this material and questions about reprinting it or other uses involving copyright should be addressed to the publisher.