Ethics Rounds

APA's new Ethics Code, which went into effect on June 1, 2003, was more than five years in the making. The task force revising the code, chaired by Celia Fisher, PhD, explicitly identified as a priority making the revision process as inclusive and participatory as possible.

The practice community played a large, significant and ongoing role in shaping the revised code. A review of the new code shows many examples, three of which are discussed below, of how the practice community exercised its influence in developing the Ethics Code as a document that protects both the public and the profession.

The formal title of what we commonly call the "Ethics Code" is the "Ethical Principles of Psychologists and Code of Conduct," a title that conveys both the code's aspirational (preamble and five principles) and enforceable (ethical standards) aspects. The distinction between aspirational and enforceable is central to the code's structure and differentiates between the ideals and goals to which psychologists aspire and the rules by which psychologists must abide. When adjudicatory bodies blur this distinction, psychologists may inappropriately be held responsible and possibly disciplined for not fulfilling the profession's ideals and striving toward its highest goals. As central as these goals and ideals are to our profession, the Ethics Code is clear that, standing alone, they are not to be the basis for sanctions in disciplinary settings:

...General Principles, as opposed to Ethical Standards, are aspirational in nature. Their intent is to guide and inspire psychologists toward the very highest ethical ideals of the profession. General Principles, in contrast to Ethical Standards, do not represent obligations and should not form the basis for imposing sanctions. Relying upon General Principles for either of these reasons distorts both their meaning and purpose.

Language that elaborates and emphasizes the distinction between the code's aspirational principles and enforceable standards grew out of a concern of the practice community that adjudicatory bodies could misapply the code's general principles as if they were enforceable rules for conduct.

A second example of the practice community's involvement in drafting the Ethics Code is the unusual repetition of language in the code's "Introduction and Applicability" and "Ethical Standards" sections. Both sections address the relationship between legal and ethical obligations. The Ethics Code Task Force did not want psychologists to be in the position of having to choose between the law and the Ethics Code, such that by adhering to one set of obligations a psychologist would violate the other.

To address conflicts between law and ethics, the task force included the language below, which allows psychologists to adhere to a legal obligation in the face of a competing ethical obligation:

...If psychologists' ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to this Ethics Code and take steps to resolve the conflict in a responsible manner. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing authority in keeping with basic principles of human rights.

Nearly the same language is contained in an ethical standard:

1.02: CONFLICTS BETWEEN ETHICS AND LAW, REGULATIONS, OR OTHER GOVERNING LEGAL AUTHORITY                                                                                                                                        If psychologists' ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority. These paragraphs ensure that psychologists will not be placed in an untenable bind between the law and the profession's ethics. Note two additional points. First, when a conflict arises between ethics and law, psychologists "make known their commitment to the Ethics Code." Thus, even though an obligation under the Ethics Code may ultimately yield to a legal obligation, psychologists must nonetheless indicate in some fashion that they have a contrary obligation under their profession's code of ethics. How psychologists make known their commitment to the Ethics Code will depend largely upon the context in which the conflict arises.

Second, language from the "Introduction and Applicability" section, "in keeping with basic principles of human rights," places limits on the extent to which psychologists may follow the law in the face of a competing ethical obligation. As an example, a psychologist acting in a professional capacity could not invoke the law to justify an abuse of human rights.

A third example of the practice community's involvement in the revision process is Ethical Standard 10.10(b), which states:

10.10 TERMINATING THERAPY                                                                                                        (b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.

The task force wanted to address the problem that arises in certain instances when a patient threatens or endangers a psychologist. The psychologist may give the patient the alternative of stopping the behavior or terminating treatment, at which point the patient threatens to file a complaint against the psychologist for abandonment. Standard 10.10(b) makes clear that it is ethically appropriate for a psychologist who is threatened or endangered by a patient to terminate the therapy.

It is not uncommon for the APA Ethics Office to receive calls from psychologists whom patients are threatening or harassing. Often, psychologists in this situation feel anxious and disempowered. In addition to Standard 10.10(b), the Ethics Office may call the psychologist's attention to Standard 2.01(a):

2.01 BOUNDARIES OF COMPETENCE                                                                                                (a)Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.

The relevance of Standard 2.01(a) is that the psychologist may have such strong feelings about a patient or treatment that he or she no longer feels able to offer services that are competent. In such a circumstance, a referral may not only be ethically appropriate under Standard 10.10(b), it may be ethically mandated under 2.01(a).

In assessing whether the countertransference has reached a level that significantly interferes with the treatment, psychologists may consult with supervisors and colleagues and, under appropriate clinical circumstances, may discuss the situation with the patient as well. Following this process, if the psychologist concludes that he or she can no longer conduct the treatment in a competent fashion, the psychologist will consider a termination process.

In this manner, ethical standards 10.10(b) and 2.01(a) work together to ensure that practitioners remain safe and are not in the position of having to provide services of questionable competence. The Ethics Code makes it clear that safety and competence are ethically appropriate considerations for psychologists deciding whether a treatment should continue.

The Ethics Code Task Force crafted an Ethics Code for psychologists engaged in professional activities across the broad range of our profession. The Ethics Code was designed to protect both the public and members of our profession who serve the public. The practice community was invaluable in helping to ensure that the code met both of these goals, each of which is central to the practice of psychology.

Further Reading

The full text of APA's Ethics Code is at APA Ethics.

Please send questions or comments about this column or suggestions for future "Ethics Rounds" columns to Vignettes (without identifying information) may be submitted for discussion in "Ethics Rounds."