Health Care Ethics For Psychologists: A Casebook explores the ethical questions encountered most often by practitioners in health care settings. Ethical challenges occur almost routinely in health care. Issues of informed consent, respect for patients' dignity and confidentiality, the balance between patient and family rights, and billing for services under managed care are just a few of the topics that challenge psychologists to uphold their ethical obligations across the health care continuum.

This casebook offers a real-life view of ethical situations as they unfold, including case-by-case consideration of critical background information, key stakeholders, the direct relevance of specific APA principles and standards, and suggested steps to resolve ethical issues. Case examples in settings from the emergency room to long-term care vividly illustrate the complexities of ethical dilemmas, and case commentaries helpfully explicate the quandaries presented. These detailed cases allow the reader to acquire a true understanding of the patients' specific contexts and the challenges to clinical decision-making. This dynamic view affords readers the opportunity to critically evaluate the resolutions offered or, alternately, to craft their own resolutions.

This engrossing casebook will be required reading for psychologists and other mental health practitioners working in health care settings.

Table of Contents


Introduction: Values and the Practice of Psychology

  1. Crisis and Emergency Care
    • Case 1.1 Do the Rules Still Apply? Crisis Response to 9/11
    • Case 1.2 Provider Conflicts in Managing Mild Traumatic Brain Injury
    • Case 1.3 Professional Boundaries and the Unwanted Psychologist
  2. Acute Care
    • Case 2.1 Managing Documentation in the Medical Record: The Impact of the Health Insurance Portability and Accountability Act Guidelines
    • Case 2.2 Truth Telling: The Disclosure of Emotionally Difficult Information
    • Case 2.3 Malingering and the Management of Chronic Pain
    • Case 2.4 Overriding Treatment Refusals During Early Recovery From Catastrophic Injury
  3. Inpatient Rehabilitation
    • Case 3.1 Opportunities and Challenges in Using Nonstandardized Testing
    • Case 3.2 The Overwhelmed Psychologist's Responsibility Toward Very Sick Patients
    • Case 3.3 Using Placebos and Deception in Treatment
    • Case 3.4 When the Team and Family Disagree: Incorporating Family Beliefs and Values Into Treatment
    • Case 3.5 Accommodating Questionable Patient Preferences
    • Case 3.6 Responding to Mixed Messages About Treatment Refusal (Continuation of the Fergus MacGonagle Series)
  4. Outpatient Services
    • Case 4.1 Managing a Patient's Risk-Taking Behavior
    • Case 4.2 Resolving Requests for Third-Party Observers
    • Case 4.3 Responding to Patients Working the System
    • Case 4.4 Return to Work After Catastrophic Injury: Implications of the Americans With Disabilities Act (Conclusion of the Fergus) MacGonagle Series)
  5. Subacute and Long-Term Care
    • Case 5.1 Serving the Patient Who Is Totally Incapacitated
    • Case 5.2 Difficult Behavior and the Perception of Incompetence
    • Case 5.3 Assent in Decision Making and the Role of Same-Sex Partners
    • Case 5.4 Quality of Life and the Right to Die


Author Index

Subject Index

About the Authors

Author Bios

Stephanie L. Hanson, PhD, ABPP (Rp), received PhDs in developmental and clinical psychology from Vanderbilt University.

From 1986 to 1991 she was a clinical assistant professor at the University of Missouri School of Medicine, during which time she directed inpatient psychology services at Rusk Rehabilitation Center and helped establish their first postdoctoral psychology training program. She also established psychological services at the University's Women's Health Center. In 1991, she moved to North Carolina, where she led the development of the first comprehensive outpatient brain injury program at Charlotte Institute of Rehabilitation. She subsequently worked as the neuro program development coordinator for Whitaker Rehabilitation Center in Winston-Salem. Since 1996, Dr. Hanson has held the position of associate dean of the University of Florida's College of Public Health and Health Professions.

Dr. Hanson chaired the Ethics Committee for APA Division 22 (Rehabilitation Psychology) for seven years (1993–2000) and served as a Division 22 Executive Committee member (1998–2001). She was one of the first women board certified in rehabilitation psychology by the American Board of Professional Psychology and was on the board of directors of the American Board of Rehabilitation Psychology from 1999 to 2002. She has chaired multiple APA-sponsored continuing education workshops and symposia, published, and taught on health care ethics.

Thomas R. Kerkhoff, PhD, ABPP (Rp), completed his undergraduate education at Xavier University in Cincinnati and was granted both a master's degree and doctorate in clinical psychology from Virginia Commonwealth University.

He has served on the APA Division 22 (Rehabilitation Psychology) Social and Ethical Responsibility Committee since 1996, and has presented numerous workshops and lectures focused on the clinical case study approach to applied ethics.

Dr. Kerkhoff is currently a clinical associate professor in the Department of Clinical and Health Psychology, University of Florida. He teaches undergraduate health science applied ethics and graduate rehabilitation psychology, and he provides clinical rehabilitation psychology services to the Shands Health Care system.

Shane Bush, PhD, ABPP, ABPN, is in independent practice in Smithtown, New York, and is director of neuropsychological services at the St. Johnland Head Injury Rehabilitation Center in Kings Park, New York. He is board certified in rehabilitation psychology by the American Board of Professional Psychology and board certified in neuropsychology by the American Board of Professional Neuropsychology.

He is chair of the Social and Ethical Responsibility Committee of Division 22 (Rehabilitation Psychology) and a member of the Ethics Committee of Division 22 (Clinical Neuropsychology) of the APA. He is a member of New York State Psychological Association's Committee on Ethical Practice.

He is coeditor of the textbook Ethical Issues in Clinical Neuropsychology. He is an editorial board member of The Clinical Neuropsychologist, coediting the Ethical and Professional Issues section. He is the coordinator of the Grand Rounds section of the National Academy of Neuropsychology Bulletin.

He has presented on ethical issues in rehabilitation psychology and neuropsychology at national conferences and has authored or coauthored chapters and articles related to health care ethics. He is a veteran of both the U.S. Marine Corps and the Navy.