Ethics Rounds

A good ethics code serves as an arbiter when primary values conflict. Primary values are those values that are inherently good. Examples of primary values in psychology are safety, confidentiality, advancing science and fairness. As psychologists, we unequivocally endorse each of these values. The "General Principles" section of APA's Ethics Code sets out and describes our primary values.

An ethical dilemma arises when two primary values conflict. When a patient poses a threat of danger to himself or to another, for example, an ethical dilemma arises because the psychologist may have to break confidentiality in order to protect safety. The psychologist cannot give priority to both confidentiality and safety; one value must yield to the other. When a social psychologist engages in deception research, an ethical dilemma arises between the values of truthfulness and advancing science; truthfulness yields to the advancement of science in this very circumscribed context and under the very specific conditions set out in the code.

In writing the new code, the Ethics Code Task Force addressed an ethical dilemma posed by the release of test data. The dilemma, like all ethical dilemmas, arose by virtue of a conflict between values. While this dilemma is complex and implicates various values, a clear conflict arises between Beneficence (doing good; General Principle A), on one hand, and Respect for People's Rights and Dignity (General Principle E), on the other.

Beneficence is implicated by virtue of how the term "test data" is defined. Note how the definition will sometimes include what otherwise would be defined as test materials, such as test questions or test items. When, for example, an individual's responses are placed on a scoring sheet, then that scoring sheet, which was formerly "test materials," now becomes test data, which psychologists provide "pursuant to a client/patient release." The release of test materials may, at times, compromise a test's validity and render the test less useful to individuals who are then inappropriately exposed to the test items. To the extent that the integrity of the test is compromised, a psychologist's ability to do good may be compromised as well.

Respect for people's rights and dignity is implicated because Principle E calls for psychologists to "respect...the rights of individuals to...self-determination." Respecting the right to self-determination entails promoting an individual's right to exercise autonomy. Promoting autonomy entails providing the individual with information related to their mental health, such as test data, that the individual desires and requests.

The Ethics Code Task Force exercised its responsibility to arbitrate between these conflicting values in order to resolve the dilemma: The task force gave priority to self-determination. This decision--to give priority to the exercise of client autonomy over beneficence--is consistent with trends in the law and ethics over approximately the past quarter-century, a trend seen on the federal level, in HIPAA, and on the state level, in state statutes and court rulings. Put another way, the movement in both law and ethics over the past two decades has been toward an expansion of client autonomy, notwithstanding what may be in the patient's best clinical interest. The work of the APA Ethics Code Task Force in revising the code is consistent with, and firmly in the context of, this trend, which can be seen in laws that give greater client access to records.

Assigning priority to one value--self-determination in this case--does not completely resolve an ethical dilemma, however. Because a dilemma arises when inherently good values conflict, resolving the dilemma entails preserving as much as we reasonably can of the value that did not receive priority. In the context of test data, preserving beneficence entails taking steps to limit the distribution of test items or questions. In this manner, psychologists who release test data pursuant to a client release (and thus promote client self-determination) preserve their ability to do good (beneficence) by taking steps to ensure that individuals are not inappropriately given access to the test, so that the integrity of the test is not compromised any further than is necessary.

Concrete steps available to psychologists seeking to protect test integrity include asking a court to issue a protective order (when the court orders that certain material not be disclosed to parties not involved in a legal matter) and requesting a letter of agreement (that the individual to whom the test data is released not further distribute the data). Psychologists may also consider asking the client to discuss the reasons for the request to release test data (often such a discussion will allay the need to provide the data) and offering to send the test data to a psychologist of the client's choosing, so that another professional will have control over the data. Note that these steps, taken in the context of our obligation to provide test data pursuant to a client's release, are intended to promote client self-determination and at the same time, by protecting the integrity of psychological tests, preserve as much of our ability to do good (beneficence) as we reasonably can.

While the psychologist cannot make the client agreeing to any of the steps above a condition of release, it is important to remember that Standard 9.04, "Release of Test Data," contains two discretionary exceptions, the first of which involves substantial harm to the client. By virtue of this exception, the standard serves both to promote client self-determination and protect a client from harm. In the language of ethical dilemmas, the task force determined that protecting a client from substantial harm is more important than promoting client self-determination. Ethical standard 9.04 thus negotiates between competing values by first giving priority to self-determination over beneficence and then, through an exception, giving priority to nonmaleficence over self-determination.

Psychologists, especially those whose work involves psychological testing, are highly concerned about protecting the integrity of our instruments and tests, a concern that has clear ethical aspects. The APA Ethics Committee and Office are therefore very interested in helping psychologists protect test integrity as psychologists adhere to the new release of test data standard.

Future "Ethics Rounds" columns will offer practical suggestions for psychologists who release test data pursuant to Standard 9.04, and we hope to work collaboratively with test publishers in this regard, whose strong interest lies in protecting the integrity of tests as well.

9.04 RELEASE OF TEST DATA

(a) The term test data refers to raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during an examination. Those portions of test materials that include client/patient responses are included in the definition of test data. Pursuant to a client/patient release, psychologists provide test data to the client/patient or other persons identified in the release. Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test, recognizing that in many instances release of confidential information under these circumstances is regulated by law. (See also Standard 9.11, Maintaining Test Security.)

APA's Ethics Code is at www.apa.org/ethics. Send questions or comments about this column or suggestions for future "Ethics Rounds" columns to Ethics Rounds.

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