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02/09/2004: "When Laws and Values Conflict"

At the end of class the week before last, I referred to a short article that involved a survey of 100 ethics experts. The "article" was a short, 2-page letter in American Psychologist:

Pope, K.S., & Bajt, T.R. (1988). When laws and values conflict: A dilemma for psycholgists. American Psychologist, 43(10), 828-829.

The authors mailed an anonymous survey to 100 senior psychologists, which included:

* 60 current or former members of state ethics committees
* 10 current or former members of the APA Ethics Committee
* 10 authors of textbooks on legal and ethical issues in psychology
* 20 diplomates of the American Board of Professional Psychology (ABPP)

So clearly this was an All-Star panel in terms of familiarity with ethical and professional issues. Even though the survey was anonymous, it's quite likely that many of these psychologists helped craft the APA or various states' ethics code.

Their return rate was 60%, so running that through my calculator because of the complicated math, I get approximately 60 surveys were returned.

Fifty-seven percent (57%) responded they had knowingly violated a law or ethical principle in answering this question: "In the most serious, significant, or agonizing instance, if any, what law or formal ethical principle have you broken intentionally in light of a client's welfare or other deeper value?"

And what was the breakdown? Here are the responses endorsed by more than one psychologist:

* 21 % refused to report child abuse (presumably as mandated by state law)
* 21 % illegally divulged confidential information
* 9 % engaged in sex with a client
* 6 % involved non-specified dual relationships (perhaps sexual, perhaps not)
* 6 % refused to make legally required warnings regarding dangerous clients

As you can see, in some cases these violations might be understandable decisions of conscience. For example, mandated reporting laws for child abuse are not popular among all psychologists because it is feared they keep abusers from seeking or remaining in treatment. The same type of argument has been made for Tarasoff laws: is public safety better served by keeping violent clients in treatment by protecting their confidential utterances or fantasies, or by warning potential victims, knowing our prediction algorithms for violence are far from perfect?

In other cases, it's difficult to imagine how violating the law or ethics code in service of a higher principle best serves the client. The 9 % who engaged in sex with a client is certainly consistent with other survey of client-therapist sexual relationships, at least male therapists with female clients. And what do we make of the 40 psychologists who didn't return surveys? Were they too embarrassed or ashamed to admit ethical wrongdoings, even on an anonymous survey, and even in the name of a higher-order value? Or were they less likely to return the survey because they didn't have anything to report in terms of their "civil disobedience"? Would the rate of therapist-client sex have been even higher if the silent 40 had returned their surveys?

So we return to the fundamental questions of how we teach psychologists to behave ethically. The psychologists in this survey clearly knew the ethics codes, and probably wrote them, too. Therefore, it doesn't seem like a simple matter of education. Somewhere between knowing what to do, and actually doing it, things get lost. And if these uber-psychologists had trouble adhering to the ethics code and law, what chance do the rest of us Average-Joe psychologists have?