Ethical decision making with clients and stakeholders

Notions clés

A decision process

The CPA Code's process asks the psychologist to identify those affected and the ethical issues, consider personal biases and self-interest, develop and weigh alternatives, choose and act, then evaluate the results, take responsibility for the consequences and act to prevent a recurrence.

Informed consent

APA Standards 3.10 and 10.01: inform clients as early as feasible about the nature and course of services, fees, involvement of third parties and limits of confidentiality. For persons legally unable to consent, seek their assent and the permission of a legally authorized person.

Limits of confidentiality

Standard 4.02 requires discussing the limits of confidentiality at the outset and as new circumstances warrant. Standard 4.05 allows disclosure without consent only as the law mandates or permits, for purposes such as protecting someone from harm.

Record keeping

Standard 6.01 requires documentation that supports later services, accountability and legal requirements. APA's Record Keeping Guidelines (2007) add that the nature and extent of a record vary with the purpose, setting and context of the service.

Multiple relationships

Under Standard 3.05, a multiple relationship is to be avoided if it could reasonably be expected to impair objectivity, competence or effectiveness, or risks exploitation or harm. One that would not reasonably be expected to do so is not unethical.

Technology

The 2024 telepsychology guidelines carry these duties into technology: consent that covers the risks of electronic communication, secure handling and disposal of data, and documentation of services delivered through technology.

Exemple commenté

In the third meeting of a psychologist's therapy group for chronic pain, one member realizes that another member is her daughter's schoolteacher. Afterward the teacher asks the psychologist privately whether she should quit, saying she worries about what the parent might repeat at the school.

1. Identify who is affected and the issues: both members and the rest of the group, confidentiality between members, which the psychologist cannot guarantee, and an outside relationship between two members.
2. Check personal bias: the psychologist wants to keep the group full, which could tilt the decision toward playing down the concern.
3. Develop options: meet each member separately, restate the group's confidentiality agreement, offer the teacher another group or individual care, or continue with a specific agreement between the two.
4. Choose with the members, act, and check again in later sessions. Standard 10.03 already required stating at the outset each person's role and the limits of confidentiality in a group.

A decision process turns a vague worry into named people, named duties and options that can be compared.