Ethical, Legal, and Professional Issues
Ethics stems are applied: a realistic dilemma with two defensible answers, one of which respects the proper hierarchy of obligations. Know the structure of the APA Ethics Code, the difference between ethics and law, and the recurring rules on consent, multiple relationships, records, and disclosure.
Structure of the Ethics Code
- Five aspirational general principles: beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, and respect for people's rights and dignity.
- Ten enforceable standards, opening with resolving ethical issues (1) and competence (2) and closing with therapy (10).
- The code sets a floor, not a ceiling. When law and code conflict, psychologists make known their commitment to the code and take steps to resolve the conflict responsibly.
Confidentiality, privilege, and disclosure
- Confidentiality is the clinician's ethical duty; privilege is the client's legal protection against disclosure in proceedings, and the client holds it.
- Limits include danger to self or others, child, elder, or dependent adult abuse, court order, and client consent.
- Tarasoff duty to protect is state-specific: assess the threat, warn the identifiable victim, notify law enforcement, arrange hospitalization, or intensify treatment as the jurisdiction requires.
- HIPAA's minimum necessary standard governs disclosures; 42 CFR Part 2 imposes stricter protections on substance use disorder records.
Multiple relationships and forensic roles
- Not all multiple relationships are unethical; they become problematic when they could impair objectivity or risk exploitation. Sexual intimacies with former clients are prohibited for at least two years and rarely permissible afterward.
- Never serve as both treating psychologist and custody evaluator; the roles conflict and the evaluator must remain impartial.
Worked example
A subpoena arrives requesting a client's full record in a divorce case. The correct sequence: do not release records, because a subpoena is a demand from a party rather than judicial authorization. Verify the document, contact the client or counsel to discuss privilege and objections, and assert privilege on the client's behalf unless the client waives it or a court orders disclosure. Document each step. Releasing the chart immediately would breach privilege even though it feels compliant.
Traps
- Treating confidentiality as absolute.
- Believing a subpoena alone compels disclosure.
- Assuming all dual relationships are prohibited, or that none are.
- Equating an ethics violation with illegality, or legality with ethical adequacy.
- Offering a custody opinion while serving in a treating role.