Introduction

Ethics is not just an abstract intellectual discipline. It is about the conflicts that arise in trying to meet real human needs and values.

John Ziman, 1971

This book had its beginnings in the imagination and aspirations of Dr. Jean Pettifor. Integrally involved in the original development (1986) and subsequent revisions (1991, 2000, 2017) of the Canadian Psychological Association’s Canadian Code of Ethics for Psychologists (variably called the Code or the Canadian Code in this book),¹Jean was a champion of its ethical principles, values, and emphasis on decision making. However, she thought that the ethics literature tended to be overly “academic” and impersonal, and thereby less impactful than it could/should be. She believed there was much to be learned from psychologists’ lived experiences of dealing with the ethical issues and dilemmas they faced. She also believed that adding their stories to the literature could enhance our understanding of ethics and the significance of the Code’s principles and values. In her interactions with students and colleagues, she frequently engaged in conversations about their experiences, listening to their stories of success and struggle in trying to honour the Code’s principles and values, and with making ethical decisions in the context of internal, external, and cultural needs and pressures—all this set within the context of their own emotions and of living in an imperfect world.

Jean occasionally succeeded in convincing someone to present such an experience at a psychology conference. However, she found it difficult to find individuals to do so. Although willing to speak with her or in a small group in private “off the record,” they often expressed fears of being misunderstood and criticized to the point of losing confidence in their ability to think through and respond to the ethical challenges they faced in their work. In addition, she thought that presentations at conferences were perhaps too sporadic and did not reach enough listeners to be of significant benefit. About five years before her death in 2015, she began to think seriously about putting together a book of lived experiences that could stimulate thinking about ethics in psychology on a more personal and engaging level. She thought that such a format would provide a bit more distance for those willing to share their experiences and points of view, and more opportunity to explain their thinking and choices—in other words, to feel less vulnerable. To this end, she invited two of the co-editors of this book, Suzie Bisson and Ivana Djuraskovic, to meet with her to discuss the feasibility of producing such a book. The group met several times to identify and speak with several potential authors. However, due to Jean’s failing health, the meetings became more infrequent over time. Nevertheless, true to her nature and aware that she would not be able to complete the book in her lifetime, Jean encouraged members of the group to continue with the project after her passing, building on the ideas that had been generated thus far. This book is the outcome of that continued effort.

Invitations to contribute a chapter to this book were sent to Canadian psychologists known to be involved in the teaching of ethics, contributions to the ethics literature, or in areas of psychology with much-discussed ethical challenges. They were asked to pass the invitation on to colleagues they thought might be interested. The nature and intent of the book were discussed at various convention presentations, and participants interested in contributing were invited to contact the editors. In addition to this introduction and the appendixes, which include a dedication to Jean, the book was structured to consist of six “Parts.” For four of the Parts (A, B, C, and D), contributors were invited to focus their chapter on one of the four ethical principles of the Code, with the understanding that there often is overlap between the principles. For the other two Parts (E and F), contributors were asked to focus their chapters on either ethical decision making (Part E) or international ethics (Part F). Regardless of whether they focused on a particular ethical principle or were writing for one of the other two Parts of the book, contributors were asked to introduce themselves in their chapters and to explain why they chose to focus on their topic. They were encouraged to write in the first person as much as possible, and to provide questions for reflection at the end of their chapter that could be used in graduate or continuing education training or as personal reflections.

The resulting book has 21 chapters. To protect privacy, all use pseudonyms or otherwise disguise identity when describing the persons and circumstances involved, some are written by a single author, some by two or more authors. The authorship of a few chapters is interprofessional. Some of the chapters are highly personal; others are a little more academic or traditional in tone and writing style. However, all provide details and reflections on the lived experiences portrayed. A summary of the content of each Part of the book can be found below.

Part A: Principle I (Respect for the Dignity of Persons and Peoples)

Part A contains four chapters. The first chapter addresses the vulnerability of immigrant families and how a more intentional and conscientious approach to conveying respect for dignity is needed when working with them. The author demonstrates how she does this within the counselling framework, and the ways in which this conveys respect for their perspectives and worldviews, including the message that they have choices and that all human beings are connected and of value. The second chapter explores the importance of hospitality and faith in the worldview of many Muslim clients, and how considering each client as a “guest” and integrating faith-based concepts into practice can help to convey respect for dignity. These ideas are discussed in the contexts of cultural competence, the existence of Islamophobia, and taking care not to assume that hospitality and faith have the same meaning to all Muslims. The third chapter explores the dignity of work for persons living with developmental disabilities, and the culture of exclusion, discrimination, and lack of opportunity that exists in much of our society. It outlines ways in which psychologists can support such clients in their families, communities, and workplaces, and draws on Principle I to explain why and how attention to self-determination, self-expression, identity, and each person’s social context is important. The fourth chapter in Part A is devoted to a discussion of psychological services for transgender youth and the push for better language and understanding of transgender issues. There is a focus on handling the issues of confidentiality, privacy, and informed consent with transgender youth; the need for gender nonconforming language that conveys general respect; and the need for promotion of trans-equality and non-discrimination.

Part B: Principle II (Responsible Caring)

Part B has four chapters. The first chapter focuses on the challenges in caring responsibly for persons in long-term care. The authors focus on the complexity of relationships (especially in rural and small communities), the scarcity of resources, the high vulnerability of the residents, and the need for advocacy. They reflect on how attention to many of the values of Principle II has helped them to keep residents’ well-being in focus. The second chapter looks at the role of what the authors call “inner work” in caring responsibly, particularly with respect to self-care. The authors outline many of the ways inner work can be undertaken, whether as students or seasoned practitioners; how to maintain a safe environment for students when such work is integrated into the curriculum; and the impact of inner work on engaging with clients. The third chapter links responsible caring to several aspects of supervision, including the role of deliberative and reflective practice and the concept of professionalism. The authors propose that supervisors must be role models for responsible caring, and that it will be only through increased emphasis on supervision as a professional practice that responsible caring will be actualized for supervisors, supervisees, and clients. In the fourth chapter in Part B, the authors outline steps for honouring the principle of responsible caring in couple and family therapy, particularly with respect to achieving the competence needed to engage in such work. They reflect on the impact of the lack of opportunities for formal training and encourage practitioners and students to engage concerted searches for such opportunities, and also to advocate with universities and training sites for the provision of such training.

Part C: Principle III (Integrity in Relationships)

Part C has four chapters. The first chapter explores ethical challenges in maintaining integrity with third parties, particularly those seeking therapy information about clients. The authors encourage being proactive and straightforward with both third parties and clients about sharing information, and to respectfully challenge the power of third parties when needed. They make several recommendations, some of which they acknowledge are likely to challenge the business practices of third parties. The second chapter recounts the professional journey of the author after being hired by a university to provide clinical services in a student counselling centre as well as to be a member of faculty. The author focuses on challenges related to maintaining integrity, particularly with respect to managing multiple relationships and avoiding bias with supervisees and colleagues. He also touches on challenges in identifying priorities when ethical principles conflict. The third chapter describes the experience of an Indigenous psychologist learning to work with Indigenous clients, and the importance of professional boundaries being appropriate to the cultural context of clients. The author focuses on what it means to be a healer in an Indigenous community, and how she believes her relationships with clients relates to the physical, emotional, and spiritual dimensions of Indigenous life. The fourth chapter in Part C focuses on integrity issues in interprofessional collaborative practice, particularly in a rural environment. The authors share some of the ethical challenges they face, including how their daily interactions are linked, both personally and professionally, and how they manage these overlaps. They also discuss the importance of integrity in establishing collaborative relationships with local schools, hospitals, communities, and skilled individuals of all disciplines.

Part D: Principle IV (Responsibility to Society)

Part D has three chapters. The first chapter explores the impact an inherently adversarial legal system has on children and parents of separation and divorce who are embedded in such a system, as well as the impact this has on the psychological services provided in high-conflict divorce situations. The authors reflect on some of the barriers to the delivery of services in the family justice system and explore important societal-level ethical responsibilities for psychologists, including renewal of the court system. The second chapter outlines the psychological injuries frequently experienced by first responders and the need for safe work environments to prevent and deal with such injuries. The authors address the influence of organizational culture and the stigma attached to mental health problems, particularly on the ability and willingness to speak out, as well as the role that psychologists could be and have been playing in making the situation better. The third chapter addresses the importance of establishing and maintaining professionalism in new areas of practice. Using the example of equine-facilitated therapy, the authors explore the potential benefits of innovation, but also the importance of balancing such benefits with the potential for public harm while the new practice is being established. They propose concrete activities that psychologists can engage in to help establish professionalism in a new practice area.

Part E: Ethical Decision-Making

Part E is comprised of three chapters. The first chapter provides the back story to why and how an emphasis on ethical decision-making and the inclusion of an ethical decision making model in the Canadian Code of Ethics for Psychologists came about, and how it changed over the three revisions of the Code. The author focuses on the role of serendipity and how the contributions and wisdom of many Canadian psychologists played a major role. The second chapter outlines the thinking through process of a real-life ethical dilemma related to psychological assessment of school children in a First Nation community, using the steps of the ethical decision-making model in the Code. The authors explore the impact of English-language proficiency, historical trauma, and different understandings of the education system and psychology on such assessments, and the importance of establishing relationships and trust with communities over time. The third chapter also addresses a real-life ethical dilemma in which a provisional psychologist under supervision is asked by a client to be his primary support person when he undergoes Medical Assistance in Dying (MAiD). The provisional psychologist and the supervisor outline the ethical struggles they experienced in trying to decide whether to agree to this request; in particular, the difficulty in balancing competing values, the importance of support and consultation, and what they learned from the experience.

Part F: International Ethics

Part F is comprised of three chapters. The first chapter explores the experience of two psychologists, originally trained in their country of origin, and who subsequently received further training in Canada and then returned to their country of origin. They describe how what they learned in Canada was very transferable to a non-Canadian setting because it was attuned to interactional patterns and the preferences and goals of parents in the context of their culture. The second chapter focuses on the many ethical challenges faced by Canadian psychologists doing humanitarian work in international settings. The author reflects on how the Code was developed within and for a democratic society with basic equality, resources, and professional standards in place, and how it is not always applicable in the same way in societies torn by wars, fewer resources, and longstanding inequalities. The third chapter describes how the development of the Universal Declaration of Ethical Principles for Psychologists (2008) came about. It provides details about the backstory; the care with which the Declaration needed to be developed to reflect ethical principles and values that are held in common across the cultures of the world; how it has influenced global ethical thinking; and how it has contributed to the international advancement of psychological ethics, including in Canada.

note

1. 1 A reprint of the 2017 version of this document can be found in Appendix A.

References

Canadian Psychological Association. (1986). A Canadian code of ethics for psychologists. Canadian Psychological Association.

Canadian Psychological Association. (1991/2000/2017). Canadian code of ethics for psychologists. Canadian Psychological Association.

Universal declaration of ethical principles for psychologists. (2008). http://www.iupsys.net/about/governance/universal-declaration-of-ethical-principles-for-psychologists.html (Reprint of this document can be found in Appendix B.)

Ziman, J. (1971). Getting scientists to think about what they are doing. Science and Engineering Ethics, 7(2), 165–176.