Legal & Ethical Issues Flashcards
Law in Psychology
Rules governing clinicians’ actions to protect vulnerable persons
Risks:
* Un- or under-qualified clinicians
* Clinicians treating outside their areas of expertise
* Treatments without empirical support
-e.g., rebirthing therapy
Ethics
Accepted values that guide decisions
Canadian Psychological Association (CPA)
-Code of Ethics
Code of Ethics: Principles
-
Respect for the dignity of persons
* Confidentiality, informed consent -
Responsible caring
* Clinical competence, treatment must maximize
benefit and minimize harm -
Integrity in relationships
* Unbiased by affiliations (guided solely by clinical judgment) -
Responsibility to society
* Recognize how actions affect society (in addition to clients’ rights)
Legal & Ethical Issues
Confidentiality
Involuntary Confinement
Deinstitutionalization
The Law
Canadian Charter of Rights and Freedoms (1982)
Select relevant items:
* Guarantee of rights and freedoms
* No arbitrary detainment or imprisonment
-Equality before the law
-No discrimination (race, national/ ethnic origin, color, religion, sex, age, mental/ physical ability) - how interpret the law might change over time
Confidentiality: Privacy vs. Privilege
Privacy
* Right to choose information being shared
Privilege
* Right to refuse to disclose information to legal
system
Communication between clinician and client is private
Confidentiality
Confidential communication
* Communication is private
* Client chooses whether & to whom information can be disclosed
* Law against breaching confidentiality
Exceptions
* Imminent risk to self or others
* Suspected harm to a child or dependent adult (and guardian will not protect)
* Court subpoena
Imminent Risk to Others
Tarasoff v. Regents of the University of California (1974)
stocking that endedd with tarasoff killed
* Duty to warn (Tarasoff I) - someone who might be in danger should know about this
* Duty to protect (Tarasoff II)
Ewing v. Goldstein (2004)
* Information from a close family member
Smith v. Jones (1999)
* Privilege of legal counsel
CPA Code!!!
Must breach confidentiality when
a 3rd party (identifiable victim or class of victims/group of vict ) is believed to be at risk
Ethical Issues in Confidentiality
Clinician efforts to reduce liability
* Asking fewer (important) questions
* Vague language in session notes
Who is the client?
* Organization vs. patient
* Parent vs. child
Involuntary Confinement
Criminal Commitment
Civil Commitment
Criminal Commitment
Confining person who commits crime due to mental illness to mental institution
Not criminally responsible on account of mental disorder (NCRMD)
* “Insanity defense”
NCRMD
Legal – not psychological – term
Not capable of criminal responsibility
Criminal Responsibility
M’Naghten Rule (murder of English prime minister)
Ability to know an act is wrong (“wild beast”)
Legally or Morally (standards of society) wrong
Intellectual ability to know right from wrong
Ability to apply that knowledge rationally in the situation (“policeman at the elbow”)
Insanity Defense
Rarely used
Typically successful only for severe disorders
Detention often longer than sentence for same crime if not NCRMD
≠ Acquittal
Insanity Defense
The Irresistible Impulse Rule (1887)
* Knowledge of right vs. wrong
…but…
* Impulse to act
* Irresistible Impulse
together then can be consider not criminally responseble
Neurolaw
Evidence of disordered neural function = sufficient to alter sentence?
Activation in impulsive urges vs. inability to control (“irresistible”) urges
-do they have the ability to control it based in neurocisnce and so can they be crimannaly charged
Volitional Control vs. “Irresistible” Urges
Neural systems – checks & balances
- Impulsive (including amygdala)
- Self-reflective (including vmPFC)
Volitional Control vs. “Irresistible” Urges
Neural activity
Murderers (impulsive vs. predatory) vs. controls
Controls – normal subcortical, normal PFC
Impulsive – ↓ subcortical(sensation seeking), ↓PFC(planning)
Predatory – ↓ subcortical(sensation seeking), normal PFC(planning)
Descriptive or causative?
Civil Commitment
Confining person to mental institution
1. No laws broken
-
Mental illness results:
* Dangerous to self or others
and/or
* Incapable of providing for their basic physical needs
and/or
* Unable to make responsible decisions about hospitalization
and
* In need of treatment or care in a hospital
Civil Commitment
“Dangerousness” to self or others
- Difficult to predict
- Often overpredicted by professionals
Types of Civil Commitment
- Informal commitment (no court order)
- Formal commitment (court order)
- Community commitment
- Conditional Treatment Order (CTO)
-usually drugs
Standards for Commitment
Dangerousness Model
- Only to prevent physical harm
- Denying personal freedom is
grave - Softer standards discriminate against people with mental
illness and are paternalistic
But…clinicians terrible at
predicting dangerousness
Treatment Model(used in BC most often)
- Prevent physical harm or
serious deterioration - Dangerousness difficult to
predict - Need to protect vulnerable
persons
Predicting Dangerousness
Who will commit a violent crime after release from prison?
Violence Risk Appraisal Guide (VRAG)
Strongest predictors of crime:
* Psychopathy scores (PCL-R)
* Elementary school maladjustment score
- Good at predicting general recidivism, sexual and
violent recidivism, extreme violent recidivism - Correlation with violent recidivism r = .44 (r2 = .19) - left wanting
However, situational factors also important (e.g., substance use, environment)
