《社会工作伦理》课程重要文献（英文）：Integrating Contextual Issues in Ethical Decision Making

This article was downloaded by: Shanghai Jiaotong University On:23May2012,At:07:04 Publisher: Routledge Informa Ltd Registered in England and Wales registered Number: 1072954 Registered office Mortimer house 37-41 Mortimer street London wit 3JH, UK Ethics t behavior EIHICS& BEHAVIOR Publication details, including instructions for authors and ubscription information http://www.tandfonline.com/loi/hebh20 Integrating Contextual Issues in Ethical Decision Making Alvaro Verges Department of Psychological Sciences, University of missouri Columbia Available online: 13 Dec 2010 To cite this article: Alvaro Verges(2010): Integrating Contextual lssues in Ethical Decision Making Ethics a behavior. 20: 6, 497-507 Tolinktothisarticlehttp://dx.doi.org/10.1080/10508422.2010.521451 PLEASE SCROLL DOWN FOR ARTICLE Fulltermsandconditionsofusehttp://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing systematic supply, or distribution in any form to anyone is expressly forbidden The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary indirectly in connection with or arising out of the use of this material,0% sources. The publisher shall not be liable for any loss, actions, claims, proceedings demand or costs or damages whatsoever or howsoever caused arising directly or

This article was downloaded by: [Shanghai Jiaotong University] On: 23 May 2012, At: 07:04 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Ethics & Behavior Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hebh20 Integrating Contextual Issues in Ethical Decision Making Alvaro Vergés a a Department of Psychological Sciences, University of Missouri￾Columbia Available online: 13 Dec 2010 To cite this article: Alvaro Vergés (2010): Integrating Contextual Issues in Ethical Decision Making, Ethics & Behavior, 20:6, 497-507 To link to this article: http://dx.doi.org/10.1080/10508422.2010.521451 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material

ETHICS BEHA VIOR. 20(6). 497-507 Copyright O 2010 Taylor Francis Group, LLC Routledge ISSN: 1050-8422 print/1532-7019 online DOI:10.1080/10508422.2010.521451 Taylor & Francis Group Integrating contextual Issues in Ethical decision making Alvaro Verges Department of Psychological Science University of Missouri-Columbia Many issues in ethics arise in relation to the contexts in which psychologists work. However, most ethical decision-making models reproduce the way in which psychologists tend to approach ethics by m寸○ focusing on ethical dilemmas and proposing a step-by-step response to deal with them. Although these models might be useful, their emphasis on reactive approaches and their lack of contextualize- tion constitute significant limitations on their applicability. In this article, an approach to ethical deci- sion making that highlights the importance of the context in developing proactive strategies to solve thical issues is proposed. This approach is further explained through its application to medical and rural settings. The implications of these suggestions to the training in ethics are finally discussed. Keywords: ethics, ethical decision making, ethical dilemmas, training Many conflicts in ethics arise in direct relation to the contexts in which psychologists work. For example, problems with boundaries in rural settings where overlapping relations are common or with confidentiality in medical settings where records of patients are shared by different profes- sionals, emerge before the psychologist has even started to work. Clinical psychologists, as well as other mental health professionals, tend to think about ethics as a circumscribed problem related to their specific work in the treatment room. However, their responsibility goes beyond the time and space of the therapeutic process, and their ethical concerns should begin in the moment they start to know the contexts in which they will work Most ethical decision-making models reproduce the way in which psychologists tend to ap- proach ethics. The major concerns of these models are the ethical dilemmas and the sequence of steps necessary to deal with them. Although these models are useful, they emphasize reactive ap- proaches to ethical issues and overlook preventive measures that might help solving ethical prob- lems before they arise. Moreover, ethical decision-making models tend to be abstract statements about how psychologist should behave and do not take into account the different contexts in which they might be applied Attempts have been made to modify existing ethical decision-making models in a way that in- orporates these issues. For example, ethical decision-making models to be used in contexts as di- erse as military operations (Stephenson Staal, 2007) or the work with AIDs patients (Erickson, 1990) have been proposed. In this article, the limitations of these kinds of models are Correspondence should be addressed to Alvaro Verges, 200 South Seventh Street, Department of Psychological Sci- ences. University of Missouri-Columbia, Columbia, MO 65211. E-mail: awhz6@ mail. mizzou. edu

VERGÉS CONTEXT IN ETHICAL DECISION MAKING Integrating Contextual Issues in Ethical Decision Making Alvaro Vergés Department of Psychological Sciences University of Missouri-Columbia Many issues in ethics arise in relation to the contexts in which psychologists work. However, most ethical decision-making models reproduce the way in which psychologists tend to approach ethics by focusing on ethical dilemmas and proposing a step-by-step response to deal with them. Although these models might be useful, their emphasis on reactive approaches and their lack of contextualiza￾tion constitute significant limitations on their applicability. In this article, an approach to ethical deci￾sion making that highlights the importance of the context in developing proactive strategies to solve ethical issues is proposed. This approach is further explained through its application to medical and rural settings. The implications of these suggestions to the training in ethics are finally discussed. Keywords: ethics, ethical decision making, ethical dilemmas, training Many conflicts in ethics arise in direct relation to the contexts in which psychologists work. For example, problems with boundaries in rural settings where overlapping relations are common or with confidentiality in medical settings where records of patients are shared by different profes￾sionals, emerge before the psychologist has even started to work. Clinical psychologists, as well as other mental health professionals, tend to think about ethics as a circumscribed problem related to their specific work in the treatment room. However, their responsibility goes beyond the time and space of the therapeutic process, and their ethical concerns should begin in the moment they start to know the contexts in which they will work. Most ethical decision-making models reproduce the way in which psychologists tend to ap￾proach ethics. The major concerns of these models are the ethical dilemmas and the sequence of steps necessary to deal with them. Although these models are useful, they emphasize reactive ap￾proaches to ethical issues and overlook preventive measures that might help solving ethical prob￾lems before they arise. Moreover, ethical decision-making models tend to be abstract statements about how psychologist should behave and do not take into account the different contexts in which they might be applied. Attempts have been made to modify existing ethical decision-making models in a way that in￾corporates these issues. For example, ethical decision-making models to be used in contexts as di￾verse as military operations (Stephenson & Staal, 2007) or the work with AIDS patients (Erickson, 1990) have been proposed. In this article, the limitations of these kinds of models are ETHICS & BEHAVIOR, 20(6), 497–507 Copyright © 2010 Taylor & Francis Group, LLC ISSN: 1050-8422 print / 1532-7019 online DOI: 10.1080/10508422.2010.521451 Correspondence should be addressed to Alvaro Vergés, 200 South Seventh Street, Department of Psychological Sci￾ences, University of Missouri-Columbia, Columbia, MO 65211. E-mail: avhz6@mail.mizzou.edu Downloaded by [Shanghai Jiaotong University] at 07:04 23 May 2012

498 VERGES addressed, together with the suggestion that a different approach should be implemented to inte- grate the context into ethical decision making. Examples of the application of this approach to nedical and rural settings are provided. Finally, the implications of these suggestions to training ETHICAL DECISION-MAKING MODELS Ethical decision-making models originally emerged as a response to the limitations of mandatory ethics, centered in the creation of universal principles and standards that guide the ethical behav ior of psychologists in the most diverse situations(Tymchuk, 1982). As stated by Stephen Behnke (Barnett, Behnke, Rosenthal, Koocher, 2007), the idea that the correct answer to an ethical di- lemma comes from external prescriptions was considered both impossible and undesirable. It was impossible because the complexity of situations in which psychologists are involved make it im- practicable to create a standard for every single ethical problem. It was also undesirable because it implied the idea of psychologists as passive appliers of ethical prescriptions. In contrast, ethical lecision-making models promoted an active processing of ethical principles and standards in or der to generate a creative response to a particular ethical problem( Seitz o Neill, 1996).More- over, ethical decision-making models analyze ethical behavior in the light of the process through which a course of action is selected, instead of just considering the final action. This implies that a right action"is discerned not only by its consequences but also by reviewing the steps that led to it( Garfat ricks, 1995) In a review of the ethical decision-making models proposed between 1984 and 1998, Cottone and Claus(2000) analyzed theoretically and empirically based models. Among the models cluded in their review, there are some that consider contextual issues in the process. For example, the feminist model of Hill, Glaser, and Harden(1998) considers the social context in which the ethical dilemma arises. Similarly, Betan(1997) developed a model based on hermeneutics, incor- porating the context in which the therapeutic relationship occurs into the narrating process that characterizes ethical decision making according this author. Furthermore, Cottone's (2001) social constructivist approach states that the process of solving an ethical dilemma takes place in the in- teraction among people and not in the individual mind of the psychotherapist. However, none of these models provide explicit guidelines on how the context should be incorporated in the process Moreover, with the exception of Welfel's(2006)model, which includes a first step of developing ethical sensitivity, most models reviewed by Cottone and Claus start with the identification of rel- evant aspects of the problem, that is, they consider the ethical dilemma as the starting point for ethical deliberation and do not mention preventive steps to impede the occurrence of the ethical dilemma One of the models reviewed by Cottone and Claus is the one proposed by garfat and Ricks (1995) for clinical work in child and youth care, which deserves special attention here. In this model, the activity of the self is the core of ethical behavior. The self processes the influences of contextual values, codes of ethics, and standards through a critical and reflective analysis that gen erates a decision given a context of ethical practice. Once the action is taken, its consequences are evaluated and integrated as feedback to the process and the self. Thus, the whole process is said to be driven by the self, implying a more personalized interpretation and application of general stan- dards that takes into account the context in which the decision must be made. However in this

addressed, together with the suggestion that a different approach should be implemented to inte￾grate the context into ethical decision making. Examples of the application of this approach to medical and rural settings are provided. Finally, the implications of these suggestions to training in ethics are discussed. ETHICAL DECISION-MAKING MODELS Ethical decision-making models originally emerged as a response to the limitations of mandatory ethics, centered in the creation of universal principles and standards that guide the ethical behav￾ior of psychologists in the most diverse situations (Tymchuk, 1982). As stated by Stephen Behnke (Barnett, Behnke, Rosenthal, & Koocher, 2007), the idea that the correct answer to an ethical di￾lemma comes from external prescriptions was considered both impossible and undesirable. It was impossible because the complexity of situations in which psychologists are involved make it im￾practicable to create a standard for every single ethical problem. It was also undesirable because it implied the idea of psychologists as passive appliers of ethical prescriptions. In contrast, ethical decision-making models promoted an active processing of ethical principles and standards in or￾der to generate a creative response to a particular ethical problem (Seitz & O’Neill, 1996). More￾over, ethical decision-making models analyze ethical behavior in the light of the process through which a course of action is selected, instead of just considering the final action. This implies that a “right action” is discerned not only by its consequences but also by reviewing the steps that led to it (Garfat & Ricks, 1995). In a review of the ethical decision-making models proposed between 1984 and 1998, Cottone and Claus (2000) analyzed theoretically and empirically based models. Among the models in￾cluded in their review, there are some that consider contextual issues in the process. For example, the feminist model of Hill, Glaser, and Harden (1998) considers the social context in which the ethical dilemma arises. Similarly, Betan (1997) developed a model based on hermeneutics, incor￾porating the context in which the therapeutic relationship occurs into the narrating process that characterizes ethical decision making according this author. Furthermore, Cottone’s (2001) social constructivist approach states that the process of solving an ethical dilemma takes place in the in￾teraction among people and not in the individual mind of the psychotherapist. However, none of these models provide explicit guidelines on how the context should be incorporated in the process. Moreover, with the exception of Welfel’s (2006) model, which includes a first step of developing ethical sensitivity, most models reviewed by Cottone and Claus start with the identification of rel￾evant aspects of the problem, that is, they consider the ethical dilemma as the starting point for ethical deliberation and do not mention preventive steps to impede the occurrence of the ethical dilemma. One of the models reviewed by Cottone and Claus is the one proposed by Garfat and Ricks (1995) for clinical work in child and youth care, which deserves special attention here. In this model, the activity of the self is the core of ethical behavior. The self processes the influences of contextual values, codes of ethics, and standards through a critical and reflective analysis that gen￾erates a decision given a context of ethical practice. Once the action is taken, its consequences are evaluated and integrated as feedback to the process and the self. Thus, the whole process is said to be driven by the self, implying a more personalized interpretation and application of general stan￾dards that takes into account the context in which the decision must be made. However, in this 498 VERGÉS Downloaded by [Shanghai Jiaotong University] at 07:04 23 May 2012

CONTEXT IN ETHICAL DECISION MAKING 499 model the context is still considered after the dilemma has arisen so that contextual issues are not incorporated in a proactive analysis. Like other models of ethical decision making, Garfat and Ricks's model seems to describe the self as being activated by the ethical problem, rather than be- ing active before the problem In recent years, new models of ethical decision making have emerged, most of them focusing in one area, setting, or ethical dilemma, so that the new tendency seems to be the development of an ethical decision model for every specialty in clinical psychology(e.g, Gottlieb, 1993; Knapp vande Creek, 2007: Stephenson Staal, 2007). However, this line of work, although useful in guiding the application of general principles to specific contexts, does not teach how to do the ap- plication by oneself. Do we have to wait until a new ethical decision-making model for a specific setting is published before we start to work in that setting? with the rapid changes that we witness every day in psychology and the reasonable expectation for the emergence of new areas of devel- pment in the near future, it seems more wise to develop skills in the thoughtful examination of new settings to identify as soon as possible the ethical challenges and dilemmas that we are lik ely m寸○ to encounter. To identify those skills, it might be useful to consider the influences that affect ethi cal decision makin INFLUENCES IN ETHICAL DECISION-MAKING PROCESSES One of the first studies that highlighted the role of contextual factors in ethical decision makin was conducted by Kurtines(1986). Sixty-four undergraduate students were asked to report their course of action in six different scenarios, categorized as behavioral (involve the analysis of possi ble consequences)and distributive(don' t involve analysis of consequences)decision-making sit- uations. Individual differences in the use of justice, benevolence, and pragmatism as moral princi- ples and situational factors were included as predictors in regression equations in which the ethical decision was the dependent variable. The results indicate that, although both individual and situational factors significantly predicted ethical decision making, the situational factors tended to be better predictors (i.e, accounted for more variance). In a study involving 258 students of 59 clinical psychology programs, Betan and Stanton (1999)examined the discrepancy between the ability to identify a proper response to an ethical di- lemma and the willingness to act in accordance to that identification Their results show that onl 37%o of participants who identified the appropriate response according to the American Psycho logical Association(APA) Ethics Code(APA, 2002), said that they would actually do what they believed they should do. Furthermore, Betan and Stanton identified emotional and contextual pre- dictors of this discrepancy. They found that participants who stated their willingness to act as they should reported less anxiety and more compassion in relation to the ethical dilemma. Also, these participants reported that their decision was more influenced by ethical and professional concerns ethics code and education, and clinic-related concerns and less influenced by personal and friend-related concerns. The authors concluded that"psychologists are making inadequate deci- sions about ethical dilemmas in part because they are not well attuned to the influential role of emotions, values, and contextual concerns in ethical discourse"(p. 299). That is, although psy- chologists may know the principles and standards that regulate the profession, their implementa tion of those principles and standards can be interfered by emotional and contextual issues, espe- ially when they are not aware of those factors. For this reason, any ethical model used in training

model the context is still considered after the dilemma has arisen, so that contextual issues are not incorporated in a proactive analysis. Like other models of ethical decision making, Garfat and Ricks’s model seems to describe the self as being activated by the ethical problem, rather than be￾ing active before the problem. In recent years, new models of ethical decision making have emerged, most of them focusing in one area, setting, or ethical dilemma, so that the new tendency seems to be the development of an ethical decision model for every specialty in clinical psychology (e.g., Gottlieb, 1993; Knapp & VandeCreek, 2007; Stephenson & Staal, 2007). However, this line of work, although useful in guiding the application of general principles to specific contexts, does not teach how to do the ap￾plication by oneself. Do we have to wait until a new ethical decision-making model for a specific setting is published before we start to work in that setting? With the rapid changes that we witness every day in psychology and the reasonable expectation for the emergence of new areas of devel￾opment in the near future, it seems more wise to develop skills in the thoughtful examination of new settings to identify as soon as possible the ethical challenges and dilemmas that we are likely to encounter. To identify those skills, it might be useful to consider the influences that affect ethi￾cal decision making. INFLUENCES IN ETHICAL DECISION-MAKING PROCESSES One of the first studies that highlighted the role of contextual factors in ethical decision making was conducted by Kurtines (1986). Sixty-four undergraduate students were asked to report their course of action in six different scenarios, categorized as behavioral (involve the analysis of possi￾ble consequences) and distributive (don’t involve analysis of consequences) decision-making sit￾uations. Individual differences in the use of justice, benevolence, and pragmatism as moral princi￾ples and situational factors were included as predictors in regression equations in which the ethical decision was the dependent variable. The results indicate that, although both individual and situational factors significantly predicted ethical decision making, the situational factors tended to be better predictors (i.e., accounted for more variance). In a study involving 258 students of 59 clinical psychology programs, Betan and Stanton (1999) examined the discrepancy between the ability to identify a proper response to an ethical di￾lemma and the willingness to act in accordance to that identification. Their results show that only 37% of participants who identified the appropriate response according to the American Psycho￾logical Association (APA) Ethics Code (APA, 2002), said that they would actually do what they believed they should do. Furthermore, Betan and Stanton identified emotional and contextual pre￾dictors of this discrepancy. They found that participants who stated their willingness to act as they should reported less anxiety and more compassion in relation to the ethical dilemma. Also, these participants reported that their decision was more influenced by ethical and professional concerns, ethics code and education, and clinic-related concerns and less influenced by personal and friend-related concerns. The authors concluded that “psychologists are making inadequate deci￾sions about ethical dilemmas in part because they are not well attuned to the influential role of emotions, values, and contextual concerns in ethical discourse” (p. 299). That is, although psy￾chologists may know the principles and standards that regulate the profession, their implementa￾tion of those principles and standards can be interfered by emotional and contextual issues, espe￾cially when they are not aware of those factors. For this reason, “any ethical model used in training CONTEXT IN ETHICAL DECISION MAKING 499 Downloaded by [Shanghai Jiaotong University] at 07:04 23 May 2012

500 VERGES must incorporate these contextual factors in order to awaken therapists' sensibilities""(p. 299) However, Betan and Stantons proposal focuses mainly in the interpersonal context and doesnt take into account the specific features of the setting in which the ethical problem arises In a review of the literature on ethical decision making in business environments, O Fallon and utterfield(2005)found good empirical support for individual and contextual factors affecting the process of ethical decision making. Among the contextual factors, OFallon and Butterfield reported that the existence of a code of ethics tends to be associated with positive measures of ethi cal decision making. Also, the creation of an ethical climate or culture in an organization fosters the ethical decisions of individuals. Finally, the existence of rewards and sanctions that are consis- tent with ethical behaviors is positively related to ethical decision making. Another contextual factor that according to O Fallon and Butterfield requires more investigation is the influence of Although these findings apply to the field of business, there is some research suggesting their generalizability to other situations. For example, Mumford et al. (2007)examined the responses m寸○ of 102 graduate students in programs in biological, health, and social sciences to different scenar- ios reflecting conflictive ethical situations in research. Their results show that some dimensions of both environmental experiences and perceptions of climate in the workplace are associated with ethical decision making In summary, the accumulated evidence shows that there are contextual factors that systemati- cally influence the processes and results of ethical decision making. If we take these results seri- ously, we should consider taking these factors into account whenever we are confronted by ethical dilemmas and engage in a deliberative decision making process. That implies the use of an ethical decision-making model in combination with an awareness of all the factors that might influence the steps prescribed by the model. However, if this is the case, ethical decision-making models be- gin to appear more overwhelming than useful. a different approach might involve trying to iden- tify and, if possible, modify the contextual factors that influence ethical decisions before the model is applied, that is, applying the model when there is no ethical dilemma to focus on. The next section provides some ideas on how contextual issues might be incorporated into formal ethi cal decision making INTEGRATING CONTEXT TO ETHICAL DECISION-MAKING MODELS Traditional ethical decision-making models are useful to avoid impulsive responses to an ethical dilemma. However, this statement can be slightly reframed saying that these models are useful only if they avoid impulsive responses, because once an impulsive response has occurred, there is little more to take from the model. This problem is solved in part if psychologists take a time prior to any ethical conflict to apply a model to their distinctive context and think of alternative solu tions to problems that have not yet occurred. Thus, if the worse scenario happened and the psy- chologist could not avoid an impulsive response, at least that response would more likely be one that has been considered before. in a better state of mind. I IA reasonable reader could think at this point that this is what most(or at least some)people already do. That is true. decision-making model is to systematize the ical decision-making models. One of the most important goals of an ethical However the same can be said about m best practices in dealing with ethical issues

must incorporate these contextual factors in order to awaken therapists’ sensibilities” (p. 299). However, Betan and Stanton’s proposal focuses mainly in the interpersonal context and doesn’t take into account the specific features of the setting in which the ethical problem arises. In a review of the literature on ethical decision making in business environments, O’Fallon and Butterfield (2005) found good empirical support for individual and contextual factors affecting the process of ethical decision making. Among the contextual factors, O’Fallon and Butterfield reported that the existence of a code of ethics tends to be associated with positive measures of ethi￾cal decision making. Also, the creation of an ethical climate or culture in an organization fosters the ethical decisions of individuals. Finally, the existence of rewards and sanctions that are consis￾tent with ethical behaviors is positively related to ethical decision making. Another contextual factor that according to O’Fallon and Butterfield requires more investigation is the influence of peers. Although these findings apply to the field of business, there is some research suggesting their generalizability to other situations. For example, Mumford et al. (2007) examined the responses of 102 graduate students in programs in biological, health, and social sciences to different scenar￾ios reflecting conflictive ethical situations in research. Their results show that some dimensions of both environmental experiences and perceptions of climate in the workplace are associated with ethical decision making. In summary, the accumulated evidence shows that there are contextual factors that systemati￾cally influence the processes and results of ethical decision making. If we take these results seri￾ously, we should consider taking these factors into account whenever we are confronted by ethical dilemmas and engage in a deliberative decision making process. That implies the use of an ethical decision-making model in combination with an awareness of all the factors that might influence the steps prescribed by the model. However, if this is the case, ethical decision-making models be￾gin to appear more overwhelming than useful. A different approach might involve trying to iden￾tify and, if possible, modify the contextual factors that influence ethical decisions before the model is applied, that is, applying the model when there is no ethical dilemma to focus on. The next section provides some ideas on how contextual issues might be incorporated into formal ethi￾cal decision making. INTEGRATING CONTEXT TO ETHICAL DECISION-MAKING MODELS Traditional ethical decision-making models are useful to avoid impulsive responses to an ethical dilemma. However, this statement can be slightly reframed saying that these models are useful only if they avoid impulsive responses, because once an impulsive response has occurred, there is little more to take from the model. This problem is solved in part if psychologists take a time prior to any ethical conflict to apply a model to their distinctive context and think of alternative solu￾tions to problems that have not yet occurred. Thus, if the worse scenario happened and the psy￾chologist could not avoid an impulsive response, at least that response would more likely be one that has been considered before, in a better state of mind.1 500 VERGÉS 1A reasonable reader could think at this point that this is what most (or at least some) people already do. That is true. However, the same can be said about most ethical decision-making models. One of the most important goals of an ethical decision-making model is to systematize the best practices in dealing with ethical issues. Downloaded by [Shanghai Jiaotong University] at 07:04 23 May 2012