Ethics Rounds

One of the great pleasures of working in the APA Ethics Office is the opportunity to travel throughout the country and discuss ethics with psychologists and psychology students. This year the Ethics Office will offer 40 ethics programs in 21 states. A challenge in leading ethics workshops is to present the Ethics Code as more than a mere laundry list of ethical obligations and prohibitions.

Central to the code are enforceable standards that mandate certain behaviors and identify other behaviors as always unacceptable. To read the code as nothing other than a list of enforceable rules, however, is to miss a nuance, richness and insight the code can bring to our professional lives. Viewing the code in such a limited manner also risks losing the importance of psychologyto our ethics.

In the formal title of our Ethics Code--the Ethical Principles of Psychologists and Code of Conduct--"of psychologists" is not an afterthought or an add-on: It is an essential component of the ethics of our profession. Ours is a code that belongs to psychology, not to any other profession. Three metaphors I have used in an effort to move discussions beyond mere compliance, and to emphasize the centrality of psychology to our ethics involve a stop light, the moon and an airplane ride.

A stop light

A stop light communicates a message: stop, proceed with caution, or go. The purpose of a stop light is to allow traffic to move in an efficient manner and to avoid harm. It is interesting to note that we rarely hear the objection, "It's not necessary to have a stop light there." There is a general consensus among drivers that stop lights are good things and that everyone is safer with them around.

The Ethics Code serves as a stop light. In certain circumstances the code communicates that psychologists may not engage in a behavior because the risk of harm is so great. The prohibition against sexual involvements with patients is an example: Given the likelihood of harm, psychologists are always prohibited from engaging in this behavior.

A yellow communicates that if one proceeds, one must proceed in a thoughtful and cautious manner. The reason for caution is that a heightened risk of harm is present--although, unlike in a red light situation, the risk of harm is not prohibitive. An example of a yellow light is found in Ethical Standard 3.05,"Multiple Relationships." Ethical Standard 3.05 first defines a multiple relationship and then provides a test for when a psychologist refrains from a multiple relationship:

3.05 multiple relationships

....A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists....

A common misconception is that the Ethics Code prohibits all multiple relationships--a red light. Rather, Standard 3.05 draws upon the history of our profession in alerting psychologists to the increased possibility of harm that may be present in the context of a multiple relationship, and invokes our psychological insight to determine whether a particular multiple relationship would compromise our objectivity, competence or effectiveness as psychologists. Standard 3.05 follows this yellow light cautionary moment with a green light: "Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical." The code tells us when we must come to a full stop, when we must move forward with caution and thoughtfulness, and when we may proceed apace.

The moon

For most of us, who do not travel beyond earth's atmosphere, the moon is unattainable. We nonetheless "reach for the moon" in aspiring to achieve our maximum potentials. The principles in the Ethics Codes set aspirational goals: We seek always to do good and to avoid harm, to respect people's rights and dignity, to practice with integrity and in a fair and responsible manner. These lofty principles, toward which we strive, are given to us at a high level of abstraction in the five principles with which the Ethics Code begins.

In contrast to ethical principles, enforceable standards in the Ethics Code are at a lower level of abstraction, somewhere beneath the moon, perhaps in the clouds. Standards put the principles into practice. Through indicating how we exercise beneficence and nonmaleficence--doing good and avoiding harm--for example by ensuring that we are competent when we provide services or that we use deception in research only under strict conditions--the standards help psychologists apply the principles in their day-to-day professional lives. While standards bring the principles closer to earth, there is nonetheless a space between the language of the standards and ground level where we practice.

The gap between the clouds and the ground becomes apparent when reading the standards. Ethical Standard 6.05, on barter, illustrates how the ethical standards, while more specific than the principles, nonetheless do not specify what exactly a psychologist should do in a given situation:

6.05 Barter with clients/patients

Barter is the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative.

Principle A, Beneficence and Nonmaleficence, is the principle behind Standard 6.05: Psychologists do not barter if barter would interfere with the psychologist's ability to provide a helpful clinical service or if barter risks exploiting the client. Standard 6.05 thus brings the principles closer to earth, but there remains a space between the standard and the ground level where a psychologist must decide what to do. This space--between the clouds and the ground--is filled by the psychologist's clinical judgment. The psychologist will consider the language of the standard and then use psychological insight, training, and expertise to determine what the standard means in a given situation. Note that this endeavor is uniquely psychological. Ours is an ethics code for psychologists, and we are inevitably most ethical when we are most psychologically minded.

An airplane ride

APA wrote its first ethics code in 1953.The current version of the code, adopted at APA's 2002 Annual Convention, is our 10th revision. The forces behind the Ethics Code are always churning, which explains the energy and thought that goes into each code revision process. As we read the words of the code, in a well-written and organized bound text that seems settled and firm, the dynamic quality of the currents underneath the code may not be readily apparent to us. A deeper understanding of the code will therefore entail being mindful of the forces and trends that will emerge to shape the next revision. From 35, 000 feet, in the comfort of an airliner, the ocean below seems calm and settled. Descend close to the surface, however, and the waves and troughs are seen and felt. These churning forces do not signal a problem. Rather, they tell us that as we understand our work, the people whom we work with and ourselves more deeply, our understanding of ethics will grow, deepen and evolve as well.

All metaphors for teaching the APA Ethics Code have limitations which we must take care to respect. I have nonetheless found these three metaphors helpful in thinking about the code as more than a catalogue of what psychologists must and must not do in their professional lives. I welcome comments from readers concerning their experiences teaching the code, whether these metaphors seem helpful, and what other metaphors may move psychologists beyond mere compliance.

Further Reading

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Previous "Ethics Rounds" columns can be found at APA Ethics, in the "From the Director" section.