Legal and Ethical Issues

What are the purpose of the rules and guidelines in psychology?

To protect vulnerable persons.

What are some risks of the law in psychology?

You can have un- or -under qualified clinicians, clinicians treating outside their areas of expertise, or clinicians using treatments without empirical support.

Why does the interpretation of the law keep changing?

As a result of lawsuits.

How does the Canadian Charter or Rights and Freedoms relate to pscyhology?

It has three clauses that are important in psychology. First, one must guarantee the rights and freedoms of the client. Second, there can be no arbitrary detainment or imprisonment without good reason. Third, equality comes before the law, meaning no discrimination of any kind is acceptable.

What are ethics?

The accepted values that guide ecisions.

What are the two primary ethical bodies for psychologists in BC?

The Canadian Psychological Association, which has a code of ethics, and College of Health and Care Professionals of BC, which has a code of conduct.

What are the four main principles of the CPA code of ethics?

Respect for the dignity of persons, responsible caring, integrity in relationships, and responsibility to society.

What are examples of responsible caring?

Clinical competence and treatments maximizing benefits and minimizing risk/harm.

What are examples of respect for the dignity of persons?

Confidentiality and informed consent.

What are examples of integrity in relations?

Only treating people who you have unbiased affiliations with.

What are examples of responsibility to society?

Recognizing how your actions affects society (in addition to the clients rights)

What are the primary ethical issues in psychology?

Confidentiality, involuntary confinement, and deinstitutionalization.

What are the differences between Privilege and Privacy confidentiality?

Lawyers follow privilege laws meaning that they have the right to refuse to disclose information to the legal system in all circumstances. Psychologists follow privacy laws meaning they have the right to choose what information is being shared in most circumstances.

When are psychologists allows to breach confidentiality?

When the client is an imminent risk to themselves of others, when a suspected harm to a child or dependent adult (that a guardian will not protect) is occuring, when the client may drive while intoxicated, and then they are under a court subpoena.

When does the CPA say that aclinician must breach confidentiality?

When a 3rd party (identifiable victim or class of victims) is believed to be at risk.

Are clinicians allows to break confidentiality in non risky situations?

No, there are laws prohibiting them from doing so.

What was the Tarasoff v. Regents of the University of California case and what came from it?

It was a case where the defendant was not warned of a threat and ended up being killed because of a lack of warning and protecting. This case established the duty of a clinician to both warn and protect.

What was Ewing v. Goldstein and what did it establish?

It was a case that established the importance of trusting information from a close family member or other third party.

What was Smith v. Jones and what did it establish?

It was a key case in determining when its acceptable to breach client confidentiality for public safety, and really differentiated between privilege and privacy laws.

What are the two ethical issues that frequently come up when discussing client condifentiality?

First, clinicians often make efforts to reduce their liability by asking fewer important questions and using vague language in their notes. Second, it is important to differentiate who the eact client is and who the duty of confidentiality pertains to.

What is criminal commitment?

Criminal commitment is the confinement to a psychiatric institution of a person who commited a crime due to mental illness. These individuals are deemed to not be criminally responsible on account of mental disorders, this is also known as an insanity defence.

What was M’Naghten Rule and what did it establish?

M’Naghten Rule was a situation where a person murdered the English prime minister’s secretary. It was the first case of an insanity defense being used.

When can an individual be criminally convicted and not use an insanity defense?

When they have the ability to know an act is wrong, are legally responsible, have committed a morally wrong act, have the intellectual ability to know right from wrong, and the ability to apply that knowledge rationally in the situation.

Why is an insanity defense rarely used?

Because it often results in a longer sentence for the same crime and is only successful for severe disorders.

Is an insanity defense equal to acquittal?

No

What is the irresistible impulse rule?

The irresistible impulse rule consists of three premises: the impulse to act, the irresistibility of the impulse, and the knowledge of right vs. wrong.

What debate about sentencing is currently occuring in neurolaw?

It is currently being debated whether evidence of a disordered neural structure and function is sufficient to alter an individual’s sentence. These differences are often looked for by using fMRI’s o see the activation in areas condidtent with impulsive urges and the inability to control irresistible urges.

What is volitional control vs. irresistible urges?

The neural system makes constant checks and balances between the self-reflective PFC and the impulsive amygdala.

What are the differences in PFC and subcortical activation in impulsive vs. premeditated murderers?

Murderers who are impulsive have higher subcortical activation and lower PFC activation. Murderers who kill with a plan have higher subcortical activation but normal PFC activation.

What is civil commitment?

Civil commitment is the confinement of a person to a psychiatric institution if: they are a danger to themself or others and/or if they are incapable of providing for their basic physical needs and/or they are unable to make responsible decisions about hospitalization and they are in ned of treatment or care in a hospital.

What are the differences between informal, formal, and community civil commitment?

Informal commitment is where there is no court order. Formal commitment is commitment with a court order. Community commitment is a conditional treatment order where an individual must show up for treatment, but does not have to live at the facility.

Why is dangerousness such a touchy topic?

Because it is very hard for psychologists to predict and if they make the wrong decision it would threaten the autonomy of the individual or public safety.

What is the Violence Risk Appraisal Guide?

A commonly used guide to see who will commit a violent crome after release from prison?

What is the Violence Risk Appraisal Guide really good at predicting?

It strongly predicts psychopathy scores and elementary maladjustment scores.

What is the Violence Risk Appraisal Guide good at predicting?

General recidivism, sexual and violent recidivism, and extreme violent recidivism. However, the correlation with violent recidivism is only .44!

What are the differences between the dangerousness model and treatment model when it comes to standards for commitment?

The dangerousness model is only used to present physical harm, but denies personal freedom. Softer standards also tend to discriminate against people with mental illness and it is often very paternalistic. It is important to remember that clinicians are terrible at predicting dangerousness. The treatment model is used to prevent physical harm or serious deterioration because dangerousness is very difficult to predict and there is a need to protect vulnerable persons.

What was deinstitutionalization?

Pre 1960s, people with mental disorders were often placed in psychological institutions indefinitely. In the 1960’s, deinstitutionalization was popularized with the belief being that other mental health support resources would be available, meaning many psychological institutions closed their doors.

What were the results of deinstitutionalization?

This resulted in a massive release of patients to the streets with no alternative care provided; resulting in homelessness, substance addiction, and jail for many affected individuals. 

What are the controversies that surround deinstitutionalization (what principles are in conflict)?

The controversies surrounding deinstitutionalization revolve around people’s rights. Individuals have the right to treatment, the right to refuse treatment, the right to a less restrictive environment, and the right to live in a community.

What was the Starson v. Swayze case and what was the outcome?

In 2003, the Starson v. Swayze case Starson, who is schizophrenic, was civilly committed but refused treatment. The supreme court ruled that the “best treatment” was not relevant to his legal rights and that his autonomy was more important.

What solutions for deinstitutionalization did Scott Simmie propose?

Home care for people with serious mental illness, community mental health centers as access points, increase forensic beds, increase number of mental health workers in jails, prescribe most effective medicals first even if they are more expensive, increase early detection and defragment intervention in children, 24-hr information/crisis lines for appropriate referrals, and improve police training in response to psychosis.

What solutions for deinstitutionalization did André Picard propose?

public education campaigns to reduce stigma, 10$ billion national health fund, build tens of thousands of supporting housing units, 2x amount spent on mental health research, advisory groups to represent families, early interventions in all schools, and reduce wait times.