Ethics and Culture in Mental Health Care

This article examines the complex relationship between culture, values, and ethics in mental health care. Cultural competence is a practical, concrete demonstration of the ethical principles of respect for persons, beneficence (doing good), nonmaleficence (not doing harm), and justice (treating people fairly)—the cornerstones of modern ethical codes for the health professions. Five clinical cases are presented to illustrate the range of ethical issues faced by mental health clinicians working in a multicultural environment, including issues of therapeutic boundaries, diagnosis, treatment choice, confidentiality and informed consent, and the just distribution of limited health care resources.     

Protecting confidentiality rights: the need for an ethical practice model

All psychologists must uphold the same ethical standards about confidentiality even though each state imposes different legal limits on their ability to protect clients' confidences. The resulting ethical-legal confusion is exacerbated by legally based confidentiality training that treats legal exceptions as if they were the rule and fosters the impression that attorneys are now the only real experts about this aspect of practice. This article provides an ethics-based confidentiality practice model that clarifies the ethical rule and puts its legal exceptions into ethical perspective. Like the Confidentiality section of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct, this outline would apply to all psychologists regardless of state laws, but the details of its implementation would vary according to role and setting. It can be used as a universal training outline, a consultation and supervision tool, a guide to professional practice, and a basis for clearer ongoing conversation about the ethics of "conditional confidentiality." Psychologists can use this practice model to regain their status as experts about the confidentiality ethics of their own profession.     

Managed Mental Health Care: Intentional Misdiagnosis of Mental Disorders

Managed health care regulations affect the manner in which counselors provide and deliver services. Counselors are challenged by ethical and legal dilemmas when diagnostic codes in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) are not honored for insurance reimbursement. In this article, the authors examine violations of codes of ethics and legal statutes and the consequences related to intentional misdiagnosis of mental disorders for reimbursement. They explore implications for counselors and offer suggestions for professional conduct.     

Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals With Serious Mental Illness

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy.     

Militarism,Human Welfare,and the APA Ethical Principles of Psychologists

A case study is presented of the American Psychological Association (APA), as a health care organization that promotes human welfare. APA includes policies on human welfare in its Ethical Principles of Psychologists and even lists the advancement of psychology "as a means of promoting human welfare" on its letterhead. Nevertheless, APA has other policies and activities based on military and weapons work that appear to conflict with its promotion of human welfare. Although military work in and of itself may not necessarily be problematic, work that contributes to people purposely being harmed or killed should be squared with the association's ethical guidelines. The results presented here show that this may not be the case: There currently appears to be little justification in the Ethical Principles for work intended to harm people. APA's active lobbying, research, and development for the military are documented here, in relation to an analysis of the Ethical Principles. APA's uncritical support for Operation Desert Storm is examined specifically, with regard to weapons technology and therapeutic treatment of U.S. soldiers on the battlefield. This one-sided support for victims of the war is not in keeping with a Hippocratic health care ethic to treat patients needing care, and to do so with neutrality and impartiality. Similarities to a historical example of nationalistic mental health ethics are discussed, with a review of the development of the German Institute for Psychological Research and Psychotherapy and of the German Society for Psychology in the Nazi wartime effort and the Holocaust. The results here show similar deficiencies in APA's ethical standards, not the least of which is that the code applies to individual members but not to APA policies, committees, or activities. This article concludes with suggested criteria for the Ethical Principles that would at least (a) recognize the ambiguities in systematically developing and using weapons to hurt people and (b) provide an initial rationale of potential justifications.     

Against over-estimating the role of ethics in technology development

The role of ethics in technology development has been often questioned, especially in the early days of societal reflection of technology. However, the situation has changed dramatically. Ethical consideration now is generally declared to be indispensable in shaping technology in a socially acceptable and sustainable way. The expectations of ethics are large; often even a kind of “New Ethics” is postulated. In the present paper an over-estimation of the role of ethics for technology development is rejected. It is argued that ethical reflection is, indeed, indispensable in certain problem areas and situation types; but there is, on the other hand, space for technology development free from the requirement for ethical reflection. The absence of a requirement for ethical reflection, however, always has to be considered relative to some “morale provisoire” (provisional morality) as an accepted normative framework within which technology development may occur without explicit ethical reflection. If this framework, however, is doubted or is shown to be insufficient the situation changes completely. Ethical reflection in this case becomes necessary, to consider this normative framework in order to offer modifications or supplements.     

Psychological Ethics Codes: A Comparison of Twenty-four Countries

Codes of ethics from 19 countries, representing a total of 24 countries, were compared to the United States using the American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct. Canada's code of ethics was most similar to the US/APA code and China's the most dissimilar. Ten individual standards may be approaching universal agreement, while eight others were unique to the APA ethical code. The relationship of ethical codes to cultural values, and future research suggestions, are discussed.     

Militarism, human welfare, and the APA Ethical Principles of Psychologists

A case study is presented of the American Psychological Association (APA), as a health care organization that promotes human welfare. APA includes policies on human welfare in its Ethical Principles of Psychologists and even lists the advancement of psychology "as a means of promoting human welfare" on its letterhead. Nevertheless, APA has other policies and activities based on military and weapons work that appear to conflict with its promotion of human welfare. Although military work in and of itself may not necessarily be problematic, work that contributes to people purposely being harmed or killed should be squared with the association's ethical guidelines. The results presented here show that this may not be the case: There currently appears to be little justification in the Ethical Principles for work intended to harm people. APA's active lobbying, research, and development for the military are documented here, in relation to an analysis of the Ethical Principles. APA's uncritical support for Operation Desert Storm is examined specifically, with regard to weapons technology and therapeutic treatment of U.S. soldiers on the battlefield. This one-sided support for victims of the war is not in keeping with a Hippocratic health care ethic to treat patients needing care, and to do so with neutrality and impartiality. Similarities to a historical example of nationalistic mental health ethics are discussed, with a review of the development of the German Institute for Psychological Research and Psychotherapy and of the German Society for Psychology in the Nazi wartime effort and the Holocaust. The results here show similar deficiencies in APA's ethical standards, not the least of which is that the code applies to individual members but not to APA policies, committees, or activities. This article concludes with suggested criteria for the Ethical Principles that would at least (a) recognize the ambiguities in systematically developing and using weapons to hurt people and (b) provide an initial rationale of potential justifications.     

Sexual Orientation and Human Rights in the Ethics Code of the Psychology and Counseling Organization of the Islamic Republic of Iran (PCOIRI)

The aim of this study is to investigate the necessity of revising the Ethics Code of the Psychology and Counseling Organization of the Islamic Republic of Iran (PCOIRI) with respect to people’s rights and dignity and to avoid unfair discriminations toward sexual orientation and gender identity. It is said that confused diagnoses; wrong decision making; unethical practice; and the subsequent harm caused to lesbian, gay, bisexual, and transgender clients result from the lack of a clear code and relevant guidelines. In addition, certain conditions in Iran (such as religious perspectives, laws, cultural biases, misunderstandings, a lack of local academic and scientific resources, and Western conspiracy theories) lead professional psychologists and researchers to avoid researching sexual minorities and gender identity, which negatively impacts the Ethics Code of the PCOIRI. Iranian and Western researchers have identified four primary sources to which psychologists and counselors can refer when faced with ethical dilemmas: developmental psychology, professional ethics codes, philosophy of psychology literature, and available researches and compilations on professional ethics. Finally it is suggested that, when dealing with homosexual clients and the related ethical dilemmas, Iranian psychologists and counselors need clear and specific guidelines and a professional ethics code developed from more appropriate reference points than legal and religious sources.     

Mental health professionals and assisted death: perceived ethical obligations and proposed guidelines for practice

I have three purposes in this article: (a) to briefly review the legal obligations a mental health professional has when working with a client who is talking about taking some action that could lead to his or her death, (b) to clarify the positions of the 4 major national mental health organizations regarding the acceptable roles of their members with clients who are discussing the possibility of receiving assisted death, and (c) to propose a set of guidelines for practice for mental health professionals working with clients who are considering assisted death that comport with the various laws and codes of ethics.     

The Concerned Mental Health Practitioner

Summary

A discussion is provided regarding a fundamental principle of psychology, a concern for other's welfare, as set out in the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct. Although the principle concern for others' welfare is essentially aspirational in nature, this is an ethical principle that is at the core of the mental health professions' stated values, and that must be positively put into operation in a variety of professional contexts. Unlike so much else in professional ethics codes that involves injunctions of what not to do, or which attempts to limit the self-serving tendencies of professionals, this general principle is essentially positive, pointing to the need to approach others and to consider their welfare first.     

伦理豁免刍议

伦理豁免,是在一定的伦理尤其是亲属关系(一定程度上包括朋友关系)中,在究竟是履行伦理的义务、还是履行法律的义务之间,人们陷入紧张冲突甚至两难的情况下,被法律赋予一定的特殊权利,得依法免除法定的义务、责任甚至罪责。中华伦理、中华法系以伦理豁免来解决伦理、法律的矛盾,有宝贵的理论和实践;其中蕴涵的基本价值是,通过维护伦理,从根本上维护社会秩序。伦理豁免对今天解决伦理、法律之两难,仍是宝贵的智慧。     

Workplace ethics culture and work engagement: The mediating effect of ethical leadership in a developing world context

This study examined the mediating effect of ethical leadership on the relationship between workplace ethics culture and work engagement among employees in a railway transport organisation in the Democratic Republic of the Congo (DRC). The sample consisted of permanently employed staff in a railway organisation in the DRC (n = 839; females = 32%). The employees were required to complete the Ethical Leadership Scale (ELS), the Ethical Corporate Virtue model (ECV) and the Utrecht Work Engagement Scale (UWES). Mediating regression analyses were conducted to predict work engagement from workplace ethics culture, partialling out ethical leadership. The results show that workplace ethics culture had a significantly positive effect on work engagement. The results further indicated that workplace ethics culture, through the mediation of perceived ethical leadership, had a significantly positive effect on the work engagement dimensions of vigour, dedication and absorption. The findings provide evidence that ethical leadership plays a crucial role in shaping workplace ethics culture and employees’ level of work engagement in an emerging country work setting.     

"易"论医学之道

"易"作为中国古代便形成的通俗唯物主义哲学,在指导社会及科技发展过程中,始终发挥着极其重要的作用.而历代医学先贤,无不对"易"有着深刻的理解."不知易,不足为大医"之论也始终是历代医者所遵循的至理名言.的确如此,人类社会的发展,无不体现在"变"的过程之中,传统哲学"易"的形成及发展,不仅本身是变的展示,而且对变化之道进行了精确的阐述,而祖国医学的形成及发展正是在这种理论的指导之下产生并逐步发展完善的.因而,"易"对传统医学而言,是根,是本,是原动力.     

Authorship Ethics: Issues and Suggested Guidelines for the Helping Professions

The authors review the literature and explore common ethical dilemmas related to publishing research. Varying standards are presented to assist professionals and students in their publication endeavors. Joint research collaboration in many graduate programs is encouraged and appears inevitable. Joint research activities may involve student–faculty collaboration or professional peer collaboration. Although many helping professions have ethics codes that address publication issues, there is no standard among them regarding the issue of authorship. Although it appears necessary to follow minimal codes of ethics regarding authorship, consideration of suggested guidelines and aspirational ethics may enhance the professional growth of mental health professionals and students in mental health programs.     

Medical Ethics Research Between Theory and Practice

The main object of criticism of present-day medical ethics is the standard view of the relationship between theory and practice. Medical ethics is more than the application of moral theories and principles, and health care is more than the domain of application of moral theories. Moral theories and principles are necessarily abstract, and therefore fail to take account of the sometimes idiosyncratic reality of clinical work and the actual experiences of practitioners. Suggestions to remedy the illnesses of contemporary medical ethics focus on re-establishing the connection between the internal and external morality of medicine. This article discusses the question how to develop a theoretical perspective on medical ethical issues that connects philosophical reflection with the everyday realities of medical practice. Four steps in a comprehensive approach of medical ethics research are distinguished: (1) examine health care contexts in order to obtain a better understanding of the internal morality of these practices; this requires empirical research; (2) analyze and interpret the external morality governing health care practices; sociological study of prevalent values, norms, and attitudes concerning medical-ethical issues is required; (3) creation of new theoretical perspectives on health care practices; Jensen's theory of healthcare practices will be useful here; (4) develop a new conception of bioethics that illuminates and clarifies the complex interaction between the internal and external morality of health care practices. Hermeneutical ethics can be helpful for integrating the experiences disclosed in the empirical ethical studies, as well as utilizing the insights gained from describing the value-contexts of health care practices. For a critical and normative perspective, hermeneutical ethics has to examine and explain the moral experiences uncovered, in order to understand what they tell us.     

Seven issues in Conducting Forensic Assessments: Ethical Responsibilities in Light of New Standards and New Tests

The publication of a new ethics code for the American Psychological Association (1992), new guidelines (Committee on Ethical Guidelines for Forensic Psychologists, 1991), and two new versions of the Minnesota Multiphasic Personality Inventory (the MMPI-2, Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; and the MMPI-A, Butcher et al., 1992) provide an opportunity to review ethical aspects of forensic assessment. Seven major issues-appropriate graduate training, competence in the use of standardized tests, using tests that fit the task, using tests that fit the individual, administering tests correctly, using computers appropriately in forensic assessment, and assessing and reporting factors that may affect the meaning of test findings—are discussed. The revision of the MMPI is used to illustrate some of these issues.     

Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.     

Improving fairness in coverage decisions: performance expectations for quality improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.