Chapter 15 Ethical and Legal Issues in Psychological Disorders

Chapter 15 Ethical and Legal Issues in Psychological Disorders: Clinical Perspectives

Introduction

• Psychologists are guided in both their clinical and research work by the professional guidelines established by the American Psychological Association (APA).

• Key points:

  • Guidelines do not hold legal power, meaning they serve as a professional standard rather than legal mandates.

  • Strict codes are required for psychologists and other mental health professionals to obtain and retain their licenses.

Ethical Standards

Overview of Licensure Requirements

1. All states in the United States have a board of psychologists which implements the legal requirements for obtaining and maintaining a psychology license.

2. Typical requirements include:

   • Passing an examination.

   • Completing a specified number of hours of supervised training.

   • Receiving recommendations from other licensed psychologists.

   • Participating in a predetermined number of hours of continuing education.

APA Ethical Principles of Psychologists and Code of Conduct

• The code comprises:

  • General principles: These are intended for consideration when determining ethical courses of action but are not enforceable.

  • Ethical standards: Enforceable rules that outline psychologists' responsibilities and conduct.

Emerging Ethical Concerns

• Concerns related to the use of artificial intelligence (AI) and machine learning in psychological work are expected to arise. Specifics include:

  • Chatbots can produce responses based on psychologist input.

  • AI may aid in diagnosis.

  • Lack of human involvement may introduce ethical dilemmas.

  • Clients may not fully grasp the extent of computer involvement in their care.

  • Issues arise concerning the management of client data and the role of technology in professional training, with potential for misuse.

  • There is a risk of exacerbating existing health inequities.

Summary of APA Ethics Code

Competence in Psychological Practice

• The competence standard (Standard 2) articulates that psychologists are expected to:

  • Carry out therapy.

  • Engage in consulting.

  • Teach.

  • Conduct research.

• Emotional competence: Clinicians should not have diagnosable psychological disorders.

• Guardian ad litem: A court-appointed individual representing or making decisions for someone unable to do so themselves.

  • Clinicians must ensure assessments for children are pertinent to their care, nonharmful, and should involve parents where applicable, especially with adolescents.

Informed Consent in Clinical Practice

• Clinical psychologists are required to furnish clients with a clear understanding of what to expect from treatment, encapsulated in a written document that covers:

  • Goals and nature of treatment methods.

  • Client rights and clinician responsibilities.

  • Risks and techniques to be utilized.

  • Financial obligations and confidentiality limits.

Confidentiality and Duty to Warn

• Privileged communication: Clinicians cannot disclose client information without express permission in court.

• Limits to confidentiality include:

  • Mandated reporting: Obligated to inform authorities to protect those at risk of abuse or neglect.

  • Duty to warn: Clinicians must notify potential victims of threats from clients, though complexities exist if threats are vague or targets unspecified.

• Ethical dilemmas may arise if broad warnings could discourage treatment-seeking behavior in potentially violent individuals.

Relationships in Professional Practice

• Sexual intimacy: Prohibited between psychologists and their clients.

• Multiple relationships: Such relationships become unethical when compromising the psychologist’s objectivity or effectiveness. Acceptable scenario: Serving as both an individual and group therapist for the same client.

Record Keeping Practices

• The rise of electronic health records necessitates increased protections for client data.

• Health Insurance Portability and Accountability Act (HIPAA) of 1996: U.S. legislation ensuring coverage and protecting healthcare consumers:

  • Title I safeguards against loss of insurance during job changes.

  • Title II regulates medical records management.

• The Ethics Code regulates fee structures for services rendered by psychologists.

Commitment of Clients and Emergency Procedures

1. Commitment: Refers to emergency procedures for involuntary psychiatric hospitalizations under the doctrine of parens patriae, allowing the state to intervene for those unable to protect themselves.

2. Kendra's Law: Establishes court-ordered involuntary outpatient commitment programs.

3. Schools have legal obligations to intervene when aware of a student’s suicidal activities.

Right to Treatment and Refusal

• The Right to treatment: Legal entitlement of individuals admitted to psychiatric facilities to receive proper treatment:

  • Courts mandate that mental health stakeholders provide assurance that commitment will aid the individual, akin to preventing wrongful imprisonment.

  • Individuals with psychiatric conditions have a right to community treatment instead of institutionalization.

Treating Refusal and Alternatives

• Substituted judgment: Decision-making framework for those unable to express their wishes, allowing health professionals and family to make decisions acting in the best interest of the patient.

• Least restrictive alternative: Treatment methods that impose the fewest limitations on a client's autonomy.

Forensic Issues in Psychological Treatment

Role of Forensic Psychologists

d- Forensic psychologists interface between psychology and the legal system in various capacities:

• Serving as expert witnesses during trials.

• Assessing whether individuals who commit crimes should face incarceration or be treated in mental health facilities.

• Weighing the ethical implications of long-term detention for offenders.

Insanity Defense Concepts

1. Insanity: Legal term signifying a lack of moral responsibility due to mental disorder.

2. Insanity defense: Legal argument that individuals should not be held accountable for crimes due to mental illness.

3. M’Naghten Rule: A standard determining legal responsibility based on knowledge of right and wrong at the time of the offense.

4. Irresistible impulse: The argument that individuals understood the wrongness of their actions but could not control their impulses.

Advanced Insanity Defense Justifications

• Durham Rule: Extends insanity defense criteria to those without criminal responsibility when their unlawful behavior results from a psychological disorder.

• American Law Institute (ALI) guidelines: Proposed criteria state that responsibility is diminished due to a mental disorder affecting behavior regulation or understanding wrongfulness.

• Insanity Defense Reform Act: Introduces requirements placing the burden of proof on the defense to demonstrate reasonable doubt regarding the sanity of the defendant, excluding those with personality disorders from pleading insanity.

Competency to Stand Trial

• Competency to stand trial: Assessment by mental health experts regarding a defendant's cognitive and emotional capacity during trial proceedings:

  • Evaluations consider cognitive abilities, emotional stability, and persistent symptoms.

  • Juridical procedures can delay trial processes if the accused is found unwell.

Understanding Punishment

• Significant questions arise regarding whether a person with mental illness comprehends the implications of a death sentence:

  • Organizations like the American Psychological Association emphasize that psychosis may hinder understanding of reality, cause-and-effect relations, or the criminality of actions leading to punishment.

Concluding Perspectives

• The intersection of psychology and law is expanding with mental health professionals integral to the legal system:

  • Practitioners must remain informed about a wide range of forensic issues as expectations rise.

  • Future interventions should prioritize humane, ethical, and effective approaches.