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date: 24 July 2019

Taking Stock and Looking Forward

Abstract and Keywords

In this chapter we offer a summary and synthesis based on the sections of the Handbook, present topics and issues related to psychological ethics that have recently received and will likely continue to receive significant attention worldwide, and address emerging challenges, such as the feasibility of a universal code of ethics, given global events and forces. We describe and evaluate the progress that psychology and psychologists have made in developing an ethical scientific and applied practice, and provide several recommendations on how best to ensure the international adherence to the ethical principles and standards of conduct in the various activities in which psychologists around the world are engaged.

Keywords: historical perspective, critical issues, future challenges

Taking Stock: Psychological Ethics in Historical Perspective

Psychology has come a long way over the past century or so, and this is also true of ethics. This trajectory is not, of course, limited to our own discipline, as others have had much longer to develop an ethical basis for practice. As Sinclair shows in the first chapter of this handbook, we can trace the history of professional ethics to the 18th century bce, but until recently professional ethics primarily provided a foundation for progress in medicine. The growth in psychology and of psychologists in the 1940s to 1950s stimulated the American Psychological Association (APA) to design its first ethics code. Nevertheless, it is instructive to note Sinclair's analysis, which shows that the four basic ethical principles that form the heart of the Universal Declaration of Ethical Principles for Psychologists (Ad Hoc Joint Committee, 2008) can be identified in these early writings: Respect for the dignity of persons and peoples, Competent caring for the well-being of persons and peoples, Integrity, and Professional and scientific responsibilities to society.

There are now over 50 countries whose national psychological associations have a code of ethics (see http://www.iupsys.net/index.php/resources/ethics). Furthermore, specialist organizations such as the International Test Commission (ITC; 2000) have developed their own codes (see Chapter 2 in this volume by Oakland, Leach, Bartram, Lindsay, Smedler, & Zhang). Such codes, however, are not specific to psychologists as they address activities rather than members of a specific profession. For example, testing and assessment of human clients are practiced by many other groups whose constituents may include, but not be exclusive to, psychologists. These may be practitioners, such as speech pathologists and audiologists, psychotherapists, and human resources specialists or researchers. Researchers have developed more specific codes, such as codes published to guide qualitative research (Qualitative Research Consultants Association; see http://www.qrca.org/displaycommon.cfm?an=1&subarticlenbr=26). (p. 452) We have witnessed the forging of both profession-specific and interdisciplinary pathways; that is, ethics codes for distinct professional groups as well as codes based on common activities that are practiced by diverse professions.

With respect to psychology, the role of the APA was fundamental to the development of ethics codes, beginning in the 1940s and continuing into the early 1950s to produce the inaugural edition of the APA's code of ethics in 1953 (Joyce & Rankin, 2010; see Chapter 1 in this volume by Sinclair). This code was built upon and reflected the evolution of professional psychology up to that time. Psychology's scientific research base provided the foundations for the application of disciplinary knowledge to various aspects of society, including education, health, and work. Joyce and Rankin argue that a key factor in psychology's rapid professional growth was the perceived success of “mental tests” in World War I, leading to significant advancements in assessments in different settings, such as business and schools.

It is clear from accounts of the development of the first APA code, Ethical Standards for Psychologists (American Psychological Association, 1953) that there was debate about whether a code was appropriate (e.g., Hall, 1952) as well as its form. Nevertheless, this pioneering work led to the foundation not only of the APA code of ethics, but also to inroads in psychological ethics in other countries.

Developing Model Codes of Ethics

The early work by the APA can be fast-forwarded to the current ethics code. Examination of the content and language of the ethics codes of other national psychology associations indicates a positive influence in some cases, but also certain opposing reactions motivated by a sense of not wanting to follow the APA's model, but rather to formulate a national code that provides a better fit with national circumstances and culture. The development of the European Federation of Psychologists’ Associations’ (EFPA) Meta-Code of Ethics (http://www.efpa.eu/ethics) is an interesting case in point. During the initial period of its construction, there was a proposal to adopt the APA code, but this was resisted by the European Federation of Professional Psychologists’ Associations’ (EFPPA)1 Task Force on Ethics (Lindsay, 2011). Instead, the Task Force examined other codes including that of the Canadian Psychological Association (CPA; Canadian Psychological Association, 2000) and the Nordic code (Nordic Committee of Psychological Associations, 1998). There also was a strong view that simply to borrow the code of another country's national organization, however well-regarded, was fundamentally inappropriate. The Task Force therefore decided to use the framework of ethical principles found in the CPA code, which also had an admired companion manual (Sinclair & Pettifor, 1992), as well as that of the APA. South European national psychological organizations had developed the Carta Etica, which the Task Force also considered, later becoming an appendix to the first edition of the Meta-Code (European Federation of Professional Psychologists’ Associations, 1995).

The development of both the APA code and the EFPA Meta-Code are well documented and informative. First, there is the requirement for a perceived need. This may now seem obvious, but it seems generally the case that ethical codes come later in the maturation of a psychological association than a focus on disciplinary-based science and practice. At some point the need to offer guidance on ethical behavior becomes a priority.

Second, there are differences in the ways in which ethics codes are constructed. The original APA ethics code used ethical dilemmas and issues identified by its members (Bersoff, 2008; Nagy, 2011), whereas later editions have relied upon the expert committee informed by consultation with association members. Third, the structure of a code must be decided. The three common structural models have been areas of practice (e.g., ethical issues concerned with testing and therapy), ethical domains (e.g., confidentiality, informed consent), and ethical principles, each with specifications of associated mandatory behaviors (often called standards). The fourth variable concerns the scope of an ethics code. National associations adopt codes for all of their members and these codes reflect the prevalence and range of member activity (e.g., clinical psychology in its various forms is often the most common professional activity). The development of the Nordic code and Universal Declaration of Ethical Principles for Psychologists2 demonstrate the more recent phenomenon of transnational codes.

The issue of process noted in the second point above is arguably even more critical in the development of transnational ethics codes. At a practical level, the task is to ensure adequate evidence of practice in the constituent countries, as well as specialized domains of practice. More than this, however, is the importance of capturing the particulars of the cultural, historical, and indeed political characteristics of each country. This is also true within (p. 453) countries which are often, and increasingly, heterogeneous in their populations.

As we take stock now, we see both the development of ethics codes for specific national organizations and also the establishment of transnational or supranational codes, both of which provide guidance to psychologists, albeit more detailed in the case of national codes. Data from the International Union of Psychological Science (IUPsS) indicate that increasing numbers of national associations have adopted an ethics code; data from the EFPA reveal the impact of the Meta-Code not only in supporting this trend, but also in substantively refining national codes, as each EFPA member must have an ethics code that is compliant with the Meta-Code. This has allowed a fruitful evolution of ethics codes across Europe that address common principles and specified behavioral domains, while at the same time permitting national variation to meet local circumstances. In addition, we see ethics codes and ethical guidance that support more specific practices, such as testing: here, too, transnational, and in some cases such as testing, trans-professional codes have contributed greatly to ethical practice (e.g., International Test Commission, 2000; see http://www.intestcom.org/guidelines/index.php).

The events just summarized are quite positive. The interest in ethical matters is now stronger and becoming more common across the world. As psychology develops as a discipline and its presence grows in different countries, the need for guidance to support an ethical science and practice behavior will likewise grow. As a discipline and profession we can be proud of our progress thus far, but what lies ahead? In the remainder of this chapter we consider some of the key issues that may influence the further international development of psychological ethics.

Specificity Versus Universality in Psychological Ethics

The development of transnational codes and guidance brings to the fore the need to consider diversity. Put simply, to what extent are ethical principles common across the world? Alternatively, to what extent are there specific ethical issues that vary between countries and cultures? Indeed, this task is also applicable to the development and review of national codes, given the demographic heterogeneity of many countries. Whereas some countries have traditionally been relatively homogenous on key dimensions such as ethnicity (e.g., Ireland), others have a history of substantial diversity (e.g., the United States, United Kingdom) or a smaller number of distinct groups, each of which represent a sizeable proportion of the population. The latter case is often found with respect to groups that identify with a certain religion or communicate in a particular language. Furthermore, diversity can be represented by the distinction between indigenous people(s) and later immigrants (e.g., Australia, New Zealand). Hence, diversity may reflect any one or combination of dimensions that include ethnicity, language, religion, and indigenous status. Added to these are the dimensions of history (when peoples become part of a society) and both the current movements and trajectory of acquiring political and socioeconomic status. These situated factors lead to a necessity of ensuring that due consideration is given to the generic and specific aspects of ethics codes and associated systems, including regulation and credentialing, whether they be national or transnational.

The implications of the development of ethics codes lie both in their content and language. For example, the Universal Declaration of Ethical Principles for Psychologists (Ad Hoc Joint Committee, 2008) refers to “peoples” in order to inspire psychologists to respect the diversity found within countries, especially those with indigenous populations. Interpretation of practice must also take account of cultural norms and practices. As Pettifor and Ferrero (see Chapter 3 in this volume) argue, the realities imposed by demographic diversity may lead to competing hierarchies of ethical principles. Pettifor and Ferrero argue that respect and caring should take precedence over compliance with rules when there is an ethical conflict between cultural beliefs and standards of conduct. Such value priorities have implications for the interpretation of ethics codes and judgments of psychologists’ behavior vis-à-vis such codes; more importantly, perhaps, there are implications for the relevance of ethics codes in guiding decisions in such situations.

Pettifor and Ferrero argue for the importance of resolving questions concerned with evidentiary support for indigenous psychology, specifically the place of indigenous healing within the science-informed professional practice. Again, this is not only a matter of globalization, but also a dilemma for ethically appropriate choices and actions when working with different groups within one nation. A key factor in working with indigenous groups is the ethnocentrism of the dominant culture (Tassell, Herbert, Evans, & Young; see Chapter 13 in this volume). This may be exemplified by interventions designed and administered by the dominant culture (p. 454) that clash with an indigenous culture's perspectives and needs. However, the situation is even more complex. As Tassell et al. show, we cannot assume that external definitions and labels of “indigenous” are appropriate: indigenous peoples in different countries express preferences for different terms, and, no doubt, there are multiple worldviews within each group.

An important distinction that applies to indigenous peoples is the existence of a formal treaty between indigenous people(s) and the government which, in Aotearoa / New Zealand, for example, institutes a statutory bicultural heritage. Such conditions create a different context for framing an understanding of diverse groups within one nation than, alternatively, a country with minority groups all of which are composed of immigrants (see New Zealand Psychological Society, 2002).

Developing a Universal Ethical Practice

Several national associations have elected to collaborate in producing a common ethics code and/or format for considering ethical issues. The Nordic countries developed a common code in 1988, the EFPA created its Meta-Code 1991–1995. These codes differed in purpose, as the Nordic code was a finished product from the constituent member associations of that region whereas the Meta-Code was a model to be used by all member associations in Europe in order to create or modify their national codes. By 2009 one-third of European national ethics codes were known to be compliant, with others in the process of becoming so (Lindsay, 2011). The nature of the relationship between the EFPA and its member associations allowed an expectation of convergence and compliance, but it is interesting to note the willingness of national associations to engage. The Nordic code was revised to be compliant with the Meta-Code (Nordic Committee of Psychological Associations, 1998) and even the British Psychological Society (BPS, 2009), one of the oldest associations, completely changed from a code of conduct with a very different structure to an ethics code firmly based on the Meta-Code. Furthermore, the 2005 revision of the Meta-Code resulted in few, relatively minor changes, reinforcing the fitness in purpose of the original (Lindsay, Koene, øvreeide, & Lang, 2008). It has been argued that this success was in large part the result of a careful process of constituting the international group of experts which formed the EFPA Standing Committee on Ethics, which drafted the Meta-Code, coupled with the participation of member associations and formal approval by the EFPA General Assembly (Lindsay, 2011).

The task facing the development of the Universal Declaration of Ethical Principles for Psychologists was even more daunting. Although this was not intended to be an ethical code, it has a similar aim to the EFPA Meta-Code but without formal expectation of compliance. Its development also required the formation of a committee drawn from experts across the world, along with sensitive and transparent engagement with the psychological community through the three international organizations that sponsored its development, the International Union of Psychological Science (IUPsyS), International Association of Applied Psychology (IAAP), and International Association of Cross-Cultural Psychology (IACCP). Gauthier, Pettifor, and Ferrero (2010) and Gauthier and Pettifor (see Chapter 9 in this volume) have described the development of the Universal Declaration, stressing that it is not a “worldwide code,” but rather a statement of aspirational principles that reflect moral values that would be expected of a code of ethics. The development of the Universal Declaration took as a central tenet the need to set forth principles empirically grounded in values that could be considered universal, but equally to avoid the specification of conduct standards, as these are culturally situated. In short, the Universal Declaration of Ethical Principles for Psychologists was intentionally designed to be culturally sensitive.

The success of the Universal Declaration of Ethical Principles for Psychologists, and of previously mentioned transnational codes, suggests that it is indeed possible to create culturally sensitive ethical guidelines that have broad applicability at the level of values and principles. Evidence following the introduction of the Meta-Code suggests that the model of specifying how general ethical principles may be used at the national level to formulate standards of conduct is also sound.

New and Emerging Challenges

Psychology is a rapidly evolving science and profession, and ethical thinking must be reviewed and often refined as new developments emerge. Furthermore, because psychologists operate in a sociopolitical context, we also need to take account of events and forces external to psychology and our interaction with macro-level factors. In this section we consider some of these issues.

(p. 455) Testing and Assessment

Psychology has a long history in testing and the broader domain of assessment. This history has not always been a comfortable fit from the perspective of ethics. Assessment may be biased and unfair, even if unintended, and well-constructed measures may be abused in practice. The history of the cognitive ability testing is an obvious example of both exemplary and poor quality approaches and of both the well-meaning and not so benign motivations of users or commissioners of assessments. For example, see Neisser (1998) for a critique of The Bell Curve (Herrnstein & Murray, 1994), which argued for limits on the intelligence of most of the population: Neisser's edited book argued that, in fact, intelligence scores were rising across the world and examined the complex set of factors involved. Looking to the future, the main challenges in psychological testing and assessment may lie in a continuation of efforts to ensure fairness and in tackling the growing problem of attempts to subvert assessment systems. The former is linked to the increasing diversity and mobility of societies, whether voluntary or as a result of flight from adverse conditions such as war and persecution, scarce resources, and natural disasters. Although long-standing phenomena, the scale of both has increased markedly. As a result, the challenge to create fair methods of assessment has become urgent. Oakland (see Chapter 15 in this volume) argues that national ethics codes tend not to say much about testing and assessment, but that international organizations, such as the ITC (http://www.intestcom.org/itc_projects.htm) have addressed this task; the ITC has posted guidelines on adapting tests and on computer-based and Internet-delivered testing in addition to its more general guidelines on test use. The work of international organizations is clearly positive and complementary to that of national psychology associations. Ethics codes set the main implications of ethical principles and values, but additional guidance can be quite helpful in specific domains of research and practice. The leadership of transnational organizations such as the ITC is crucial, not least because this underscores the need to address cultural diversity and facilitates developments that address issues of cultural diversity in testing and assessment.

The second challenge reflects growth of the Internet. There have always been those prepared to cheat, both assessors and assessed, but the availability of Internet-delivered administration and scoring has vastly increased the use of psychological assessment. Employment selection and educational assessments, for example, are often “high stakes” processes as the outcomes have potential major life implications on test takers. Foster and Miller (see Chapter 16 in this volume) have graphically set out five challenges posed by those seeking to cheat the system. Their specification of these challenges makes clear the responsibilities of psychologists, as researchers developing measures, users of measures in research and practice, and as consultants to others who plan to administer or adapt measures. These include the psychometric quality of assessment approaches, the fairness or nonbiased nature of assessment, and the security of the assessment process.

Telepsychology: Intervention at a Distance

The Internet is a powerful medium for practicing psychology at a distance. There have been earlier versions of telepsychology, as in the case of telephone help lines, which may provide relatively simple information or a vehicle for substantive therapeutic interventions. The Internet, as with testing, raises the potential for ethical concerns and infractions many times. Consequently, a key question is whether these ethical challenges are fundamentally new to the medium or essentially identical to ethical issues that occur in conventional face-to-face methods in a professional workplace.

Hilgart, Thorndike, Pardo, and Ritterband (see Chapter 12 in this volume) have set out the range of ethical challenges that must be addressed as well as the benefits of using the Internet for psychotherapeutic or behavioral interventions. There is evidence for therapeutic effectiveness and cost effectiveness, although research is at a relatively early stage (see also Richardson, Frueh, Grubaugh, Egede, & Elhai, 2009). Using a different medium, Sanders, Montgomery and Brechman-Toussaint (2000) showed positive effects from a randomized control trial of a 12-episode television series designed to reduce children's conduct problems, a Level 1 intervention of the 5-level Triple P parenting program delivered at a distance. More research is needed to examine the comparability of outcomes of face-to-face interventions and delivery of interventions at a distance, of which the Internet is likely to be the main area of growth. Notwithstanding clear practical benefits (e.g., convenience for clients, accessibility for rural residents), Internet-based technology poses risks, including the security (i.e., confidentiality) of digitally transmitted data, difficulties for (p. 456) accurate communication, especially with culturally diverse clientele, and limited access by the poor.

In addition, use of Internet-based therapy is not yet the subject of specific regulation. Koocher (2009) notes that the APA “has not chosen to address tele-therapy directly in its ethics code and by this intentional omission (emphasis added) has created no rules prohibiting such services” (p. 342). The same action was taken by the EFPA Standing Committee on Ethics, which took the view that telepsychology did not introduce any fundamentally new ethical issues. Rather, the difference between face-to-face and Internet-delivered approaches was seen in the practical implications and relative impact of various challenges, not least articulating an extension of traditional competencies necessitated by use of the medium. There are numerous unresolved ethical challenges to use of the Internet in psychological research and practice, some of which reflect the lack of guidance for psychologists whose activities fall beyond the purview of national ethics codes and laws, and even beyond geographic regions that are regulated by transnational ethics. Moreover, which standards of conduct should be invoked in the adjudication of alleged unethical conduct when such conduct occurs in cyberspace?

Clearly, there are multiple challenges to professional associations and regulators to resolve. With respect to ethical guidance, however, it appears the main approach should be the development of specific guidelines, rather than amending the ethics code. National and transnational bodies have produced such support (e.g. European Federation of Psychologists’ Associations, 2006, see http://www.efpa.eu/ethics/efpa-guidelines). Fitzgerald, Hunter, Hadjistavropoulos, and Koocher (2010) have advocated for the application the Universal Declaration of Ethical Principles for Psychologists as a means of framing and resolving ethical issues that arise from psychologists’ use of the Internet. In addition, both training and continuing education of psychologists must inform scholars and practitioners alike of the ethical issues that arise given the growth of both psychology and the Internet.

Ethical Implementation of Innovative Psychological Approaches

There is increasing recognition by government of the value of science-based practice. In the United Kingdom, for example, the previous New Labour administration funded studies of a large number of new educational initiatives. In one instance, a study was commissioned of parenting programs, three of which were selected as they had evidence of efficacy from research trials. A second study examined the effectiveness of implementing a funded program in 18 local authorities. The success shown led to the funding of a national program in which all local authorities received money to implement programs with demonstrable efficacy; the implementation of these programs was later shown to be effective (Lindsay et al., 2011, Lindsay, Strand, & Davis, 2011). The U.K. government's Allen Review (Allen, 2011) surveyed evidence on the success of early intervention more widely and set forth proposals for evaluating the efficacy of such interventions. Psychologists had been instrumental in devising a number of these interventions and both school and clinical psychologists were engaged in implementing recommended interventions in community settings. On the other hand, a recent study has indicated that the most common intervention programs used by speech pathologists and audiologists in United Kingdom had at best a limited empirical support (Lindsay, Wren, Bakopoulou, & Roulstone, 2011).

Introducing new methods requires careful consideration if psychological practice is to be deemed ethical. Unless the method is effective, fair, and appropriate it could be unhelpful at best or dangerous at worst. The media latch on to many new methods often with little if any firm evidence for their reliability, validity, and usefulness. Ethics codes increasingly recognize the dilemma of when to adopt a new method. A range of evidence may be minimally needed to justify experimental implementation, beyond research trials, in real-world community settings (see Allen, 2011 for a useful framework). Nevertheless, ethical practice requires recognition of a method's scientific status. Responsibility is placed on the psychologist to monitor the administration of innovative interventions and report findings based on measureable outcome. Sadly, such efforts are often poorly designed or variable in quality, as the above examples demonstrate3. Section 2.01e of the APA ethics code states that psychologists should take “reasonable steps to ensure the competence of their work and to protect patients, clients, students, research participants, and others from harm” (American Psychological Association, 2002). The EFPA Meta-Code of Ethics (European Federation of Psychologists’ Associations, 1995) has a similar clause but recognizes the importance of new methods:

3.2.3 (iii) Obligation to balance the need for caution when using new methods with a recognition that (p. 457) new areas of practice and methods will continue to emerge and that this is a positive development.

Looking ahead, the ethical challenge is relatively simple to identify. It is to have a receptive stance toward to new developments, but also a healthy critical perspective. The use of methods that have accumulated evidence of technical quality, usefulness, and cultural sensitivity requires an analysis of risk. Careful preparation, monitoring, review, and reporting can optimize the likelihood of positive growth in applied psychology and limit the possibility of unethical practice and harm.

Psychological Ethics as Situated in Politics

In this section we consider the potential future impact of political events and forces. We are all citizens of one (or more) country, and as such are subject to the laws and political systems of the society in which we live or work, as mobility increases. Sociopolitical policies have an impact on us as psychologists as well, and some policies raise ethical challenges.

In this regard, a recent controversial topic has been the role of psychologists in times of “war.”4 The events of Abu Ghraib and Guantanamo Bay have shocked the world. There also are specific concerns about the roles of U.S. psychologists5 and the APA in matters related to national security; the 2002 edition of the APA's Ethical Principles for Psychologists and Code and Conduct was criticized as not adequately guiding psychologists engaged in national security operations. The report of the Presidential Task Force on Psychological Ethics and National Security (PENS, 2005; see Abeles Chapter 17) led to much debate within and beyond the association. We will not examine the issues raised by the PENS Report, but note in particular the revision to the ethical code (American Psychological Association, 2010). These amendments were relatively minor in scale, but nonetheless important. They made reference to human rights and may be interpreted to clarify the primacy of the ethics code in matters related to national security. There is recognition of potential conflict between the ethics code and the demands of the organization for or within which a psychologist works or is affiliated. Yet, a psychologist is required to “take reasonable steps to resolve the conflict committed within the General Principles and Ethical Standards of the Ethics Code” (American Psychological Association, 2010, Section 1.02). The amendment further states that, “Under no circumstances may this standard be used to justify or defend violating human rights” (American Psychological Association, 2010, Section 1.03). These changes unambiguously link the ethical practice of psychology to human rights, as has been done even more strongly in the ethics codes and laws of other countries whose histories reveal fundamental violations in human rights through the misuse of psychological science and practice (Colegio de Psicologos de Chile, 1999; Health Professions Council of South Africa, 2004; see Chapter 27 by Stevens in this volume).

The broader point is that in any political system, psychologists may be expected to engage in behavior which appears at odds with ethical practice. Some regimes have severely limited human rights and have had laws (or deliberately misinterpreted or acted beyond de facto laws) that have limited the degree to which psychologists were able to adhere to their ethical principles and standards. The lack of ethics codes in some dictatorships or countries of the former Soviet bloc was recognized by the EFPA Standing Committee on Ethics in its construction of the Meta-Code; that is, the creation of an ethics code was highly sought by psychologists with the newly acquired freedom to practice their profession. However, political constraints may be more subtle. One outcome of the global financial crisis in many countries has been a cutback in support for vulnerable members of society. In the United Kingdom, the provision of most educational and health-related services, including the majority of psychological services in these domains, is funded through taxes and, therefore, free. Current government policy is to reduce substantially public services. There are, of course, arguments for and against this and other political decisions, but political decisions clearly can have major impacts on the practice of psychology, including government-funded research.

The implications for psychologists are first to recognize the potential effect of political decisions on the breadth and depth of psychological research and practice, and second to examine the ethical issues and dilemmas that may arise. The growing interest in ethics, the development of national ethics codes, and the support for transnational ethical initiatives have been salutary in this regard. We cannot, however, assume that the benign ambient circumstances that have allowed, and even supported, these developments will necessarily continue; there may be more rocky paths ahead.

Regulating the Discipline of Psychology

The applications of psychology rest upon their scientific foundations. The development of ethical (p. 458) codes has arguably been driven by applied psychology. The role of regulation and enforcement has been and continues to be more controversial. Revelation of the horrors of medical experimentation during the World War II was a major factor in the development of ethical standards for research with human beings. The 1947 Nuremburg Code of Ethics in Medical Research was an important achievement in safeguarding the rights of research participants (see Chapter 1 by Sinclair and Chapter 9 by Gauthier and Pettifor in this volume), and later the Declaration of Helsinki by the World Medical Association in 1964 (World Medical Association, 2008; http://www.wma.net/en/30publications/10policies/b3/). Although formulated by medical institutions, their basic principles have been found useful in guiding others engaged in human-participants research, including psychologists.

Before considering regulation, it may be helpful to consider whether there is a case for ethical guidance. The extreme case (and not just for research) was put by Hall (1952) in his contribution to articles published in the American Psychologist when the first edition of the APA ethics code was being developed. He argued that a code was a retrograde step, as “decent mature people do not need to be told how to conduct themselves” (p. 430). In other words, psychologists should be considered to be right-thinking and inherently ethical in their behavior. He went further to argue that “I think it (a formal code of ethics) plays into the hands of crooks on the one hand and because it makes those who are covered by the code feel smug and sanctimonious on the other hand” (p. 430).

However, there is evidence from two main sources that Hall's 1952 assertion does not always apply: studies of psychologists’ responses to ethical dilemmas and the data reporting allegations made against psychologists for unethical behavior. For example, data from the American Psychological Association (2009) and the British Psychological Society (2006) indicated 288 and 109 complaints, respectively, against members for alleged unethical conduct, although it should be noted that these represent a very small percentage of the membership of the two organizations, about 91,000 and 45,000 respectively. Investigations of ethical dilemmas have also shown that psychologists in different types of practice, both research and applied settings, sometimes struggle with situations that pose ethical dilemmas (Pope & Vetter, 1992; Lindsay & Colley, 1995). A further source of evidence comprises surveys that provide evidence that respondents have behaved in a manner that could be judged unethical (Lindsay, 1996). This phenomenon is not exclusive to psychologists. Martinson, Anderson, and deVries (2005) conducted a survey of early and mid-career scientists that found nontrivial percentages who admitted to unethical behavior. For example, 20.6% of mid-career respondents admitted to changing the design, methodology, or results of a study in response to pressure from a funding source; small, but still worrisome percentages of 0.5% early-career and 0.2% mid-career scientists reported falsifying or “cooking” their data. Koocher and Keith-Spiegel (2010) conducted a survey of psychologists engaged in research who had suspicions of scientific wrongdoing. Although the survey focused on the actions of these psychologists, it also revealed substantial numbers suspected wrongdoing; over 600 of the 2599 respondents suspected fabrication or falsification of data (the largest category) and over 400 suspected plagiarism.

In summary, there is clear evidence of unethical behavior in both psychological research and applied practice. It is also important to note that the percentage of psychologists who are the target of an ethical complaint is very small, and of those only a small percentage result in an investigation and adjudication (see the APA and BPS reports cited above), although the Koocher and Keith-Spiegel (2010) research suggests that, in the specific domain which they examined, the problem may be much larger. What to do?

Developments up to this point in time have been of two types: self-regulation and institutional regulation. The former stresses the important role of each psychologist in assuming responsibility for his or her behavior. This practice can be informed, maintained, and enhanced by a number of actions. Fundamental is appropriate initial training in ethics, followed by continuing professional education and development. Ethics codes support both professional training and lifelong professional growth by providing a structure with which to gain a formative appreciation of the ethical dimension of professional conduct and guide subsequent decisions when confronted with ethical ambiguities and challenges, respectively. The latter requires the establishment of formal systems of regulatory procedures, which involves financial support and, more importantly, colleagues willing to serve as experts on investigatory panels with the authority to adjudicate allegations of ethical infractions. A related issue concerns whether such a regulatory system should be statutory (i.e., governed by law), (p. 459) operated by the psychological organization, and, if both, how their respective roles and activities are to be coordinated.

There are two approaches that are not mutually exclusive, but which represent different ways of addressing the task of professional regulation. The first may be described as an example of quality assurance, getting it “right” the first time, whereas the latter is quality control—monitoring practice and correcting errors.

If they do so at all, psychological organizations tend to institute regulatory systems as they begin to mature. This is understandable given the need for an ethics code to signal a professional organization's authoritative status. The EFPA Standing Committee on Ethics provided guidance for its member associations to establish systems of evaluation of complaints and determination of corrective actions. These are along the lines of the Meta-Code, namely a general framework and set of principles to inform ethical decision making with latitude for national associations to introduce locally pertinent detail (see http://www.efpa.eu/ethics/efpa-guidelines; Lindsay, Koene, øvreeide, & Lang, 2008).

An important limitation of an organization's regulatory system is that it can only regulate the organization's members; regulation per se cannot prevent poor practice. Sanctions are limited to reprimands and restrictions on practice if membership is to survive, with expulsion as the ultimate sanction. Statutory regulation, therefore, must be sought in order to secure the power of the law. Such legal regulatory authority may take various forms depending on a country's legal system and conventions. For example, in the United Kingdom regulation of most professionals is indicative rather than functional. That is, the law regulates who may use a protected title. In the United Kingdom only practitioner psychologists are regulated (i.e., not academics unless they also practice) and protected titles refer to specialist expertise (e.g., clinical psychologist, educational psychologist) rather than the title “psychologist.” This is because to regulate this generic title would necessitate bringing nonpractitioner academics into a regulatory system, which is inappropriate. Functional regulation defines who may engage in specified professional activities, such as psychological assessment and psychotherapy. Indicative regulation has the limitation that nonregulated persons may establish themselves by adopting a nonregulated title, whereas functional regulation is exceedingly difficult to implement unless the activity can be clearly operationalized. To add to the confusion, psychological activities may be appropriately and effectively undertaken by professionals other than psychologists (e.g., social workers).

Both self-regulation and regulatory bodies have a vital place in the future. The former is fundamental, and we suggest that this ought to be the primary focus. Self-regulation requires the institutional involvement of psychological organizations at training and post-licensure stages to ensure the acquisition of a positive orientation to professional ethics and an ongoing commitment to further awareness, knowledge, and competencies in professional ethics, respectively. This may well necessitate the articulation of additional guidelines given current gaps. Support for continuing education is another important function of psychological organizations if they are to maintain and enhance the ethical conduct of their members.

Developing regulatory bodies raises separate challenges depending on whether these are statutory or operated within a psychological association. In the latter case, the actions necessary for a psychological association to regulate the ethical conduct of its members are well within its authority. The EFPA guidelines and experience of other psychological organizations can inform national associations that seek to construct a regulatory framework, although the parameters of any regulatory system must fit the legal and cultural characteristics of each country if it is to be meaningful and effective. Where there is a statutory basis for professional regulation, a psychological association's capacity to influence legislative and judicial structures of government is key. In some cases this capacity is well developed and strong. For example, in Canada and the United States, it is the state or provincial psychology licensing board that has responsibility for regulating psychologists, but the APA code of ethics has been used by many states in the United States as the legal basis for a regulating authority's procedures and determinations. In other countries, however, there may not be a direct relationship between a psychological association and statutory regulatory entity. In the United Kingdom, the BPS no longer regulates practitioner psychologists who are members, a task now carried out by a state regulator, the Health Professions Council, whose code is entirely different in conceptualization and structure. It was developed before the Health Professions Council was given responsibility in 2009 for the regulation of psychologists, and was designed to be generically applicable to the 12 professions within its purview at that time. Variants exist in other countries, such as Australia (p. 460) and New Zealand (e.g., Allan & Love, 2010; Garton & Allan, see Chapter 26 in this volume).

Where psychologists seek a statutory regulation system, such a system is more likely to be instituted once a national association becomes well established, respected, and has both an ethics code and in-house regulatory system. Political action then becomes necessary to influence government to implement statutory regulation and to do so in a manner appropriate to the discipline of psychology. Since 1955 the APA has made available a Model Act of State Licensure of Psychologists to guide this legislative process (see American Psychological Association, 2011, for the most recent version). The BPS commissioned the drafting of a psychologist act for the U.K. government when legislation specific to the regulation of psychologists was expected to be the method favored by the government6. When government policy changed, the BPS remained engaged in the legislative process by working with the Department of Health officials articulating the details of the professional regulatory law that would be implemented by the Health Professions Council.

Finally, the role of mediation should be considered an integral component of any regulatory system, whether statutory or nonstatutory (for EFPA guidelines on mediation see http://www.efpa.eu/ethics/efpa-guidelines). As Koene (see Chapter 7 in this volume) argues, mediation can be very useful in many cases in reducing the need for formal evaluative and disciplinary action. Moreover, mediation may offer a more satisfactory option for an aggrieved client, provide a path for rehabilitation of a psychologist found to have behaved unethically, and cost less.

The Case of Research

The need for ethics codes to regulate research activities has been more controversial. For example, Dingwall (2008) has argued forcibly that there is an ethical case against the ethical regulation of research in the humanities and social sciences. He suggests that the need for such regulation in biomedical science has been overgeneralized to other disciplines, including psychology. He argues that “ethical regulation is fundamentally (original emphasis) wrong because the damage that it inflicts on a democratic society far exceeds any harm that HSS (Humanities and Social Science) research is capable of causing to individuals” (p. 1). Dingwall's case is primarily about the negative impact of regulatory procedures; however, he explores a number of ethical dilemmas that can arise in the research in which psychologists (and others) may engage, albeit of minimal risk.

Generally speaking, there has been resistance by academics in the social sciences in response to efforts to oversee their research. Nevertheless, in many countries research in the social sciences has been brought under a regulatory system when it involves human or nonhuman participants. Guidance at regional, national, and local (e.g., university) levels have been instituted to varying degrees. For example, the European Commission specifies its research ethics requirements for its 7th Framework Programme (2007–2013) (see Fitzgerald, 2007, and Pauwels, 2007). National criteria for the ethical conduct of research have also been formulated (e.g., UK Research Integrity Office, 2009; see http://www.ukrio.org/ukR10htre/UKRIO-Code-of-Practice-for-Research1.pdf). Guidance on specific research-related topics has been produced that covers copyright issues (British Academy and the Publishers Association, 2008) and retractions in academic journals (UK Research Integrity Office, 2010; see http://www.ukrio.org/ukR10htre/UKRIO-Code-of-Practice-for-Research1.pdf). The main research funding council in the United Kingdom has published its Research Ethics Framework (Economic and Social Research Council, 2006; http://www.esrc.ac.uk/_images/Framework_for_Research_Ethics_tcm8-4586.pdf). Many of the initiatives noted above are in the form of guidance, but other stipulations are clearly regulatory, such as the requirement that research cannot be conducted without ethical approval from an authorized body. It is these regulatory restrictions that have raised concerns (e.g., Dingwall, 2008.

First, there are practical issues related to the time required to approve the ethical foundation of research proposals. This has been a major problem in the United Kingdom and especially in the National Health Service. The bureaucracy that was established contributed to delays, a problem that has been addressed to some extent, but the National Health Service also has research governance procedures which themselves impede the start of research projects. Ironically, therefore, the regulatory system is producing what might be construed as an unethical impact due to increased public cost, delays in much-needed research, and in some cases compromises in the quality of the research (e.g., by reducing the period in which a study may be conducted because of inordinate delays). Second, there have been concerns about the operation of research regulatory committees. Angell and Dixon-Woods (2008) report poor communication by National (p. 461) Health Service research-ethics committees with researchers in regard to their decisions and the basis on which they were reached. Third, there are concerns about the legitimacy of some research-ethics committees in judging social science (including psychology) research per se, or suitability of certain investigative methodologies (e.g., Jacobson, Gewurtz, & Haydon, 2007). The separation of biomedical from social science research can be helpful in this respect, with disciplinary peers appointed to evaluate research proposals that are fundamentally psychological. Fourth, the need to determine what research should be subject to ethical review creates significant tensions. The American Anthropological Association (2004), for example, produced a statement on whether ethnographic methods or ethnography as a whole should be excluded from the domain of research requiring regulatory oversight, after the Office of Human Research Protection ruled that research methods involved in taking oral histories were to be exempted.

These above concerns include fundamental issues, such as the nature of research and its practical implementation. The former has been addressed in a meaningful way by guidelines, such as the Economic and Social Research Council's (2006) Research Ethics Framework (revised 2010), which begins with the premise that all research has ethical components but that there are different levels of risk to participants. Hence, all research should be conducted with the utmost integrity, but the specific actions necessary to administer a research project ethically, and the involvement of an institution's research-ethics committee, should mirror the risk posed to participants. A useful contrast would be statistical analysis of large anonymous datasets versus the qualitative analysis of interviews on highly personal matters with individuals, the protection of whose identity may be difficult if not impossible to guarantee.

In the future, there is likely to be a furtherance of regulatory systems for psychologists in countries that do not yet have them. The lessons learned so far suggest that the primary task is to institute effective training and continuing education for psychologists to anticipate and thereby avoid engaging in unethical behavior. Because some psychologists may still engage in inappropriate behavior, some regulatory framework is necessary to protect the general public. Our recommendation is to base regulation on tried and tested procedures, to modify these as needed to meet local circumstances (e.g., cultural and legal factors), and to limit institutional bureaucracy to a minimum. Furthermore, mediation may prove helpful in satisfying harmed clients and research participants where appropriate, enabling psychologists to correct faulty ethical reasoning and harmful actions, and, hopefully, reducing the likelihood of a recurrence.

Conclusion

This is the first international handbook of psychological ethics. It marks an important development of the standing of ethics in the science and applied practice of psychology. There is now international recognition of the importance of ethical behavior by psychologists in all aspects of their professional work. There also is international agreement of the legitimacy of a core set of ethical principles derived from basic human values. These values reflect fundamental human rights that are enshrined in law.

The future is likely to see an increase in the number of countries that have a national ethical code. This process will be greatly assisted by the Universal Declaration of Ethical Principles for Psychologists and, particularly but not exclusively within Europe, by the EFPA Meta-Code. The juxtaposition of the Universal Declaration with a perspectival framework for understanding psychology as a situated discipline raises at least two important issues regarding national ethics codes in psychology and the professional conduct of psychologists in their local milieu (Stevens, 2010):

  1. 1. Is it possible for a country's psychological ethics code to mirror universal principles while at the same time embracing local norms; conversely, to what extent are universal principles and local norms irreconcilable?

  2. 2. What variables predict whether psychologists from culturally diverse countries accept, reject, or respond ambivalently to universal ethical principles as they engage in professional activities locally?

Fundamental to the task of crafting national ethics codes will be to test the above propositions concerning the interface of universal ethical principles with local specifications.

Psychology finds itself in an ideal position to grow and prosper worldwide. International collaboration is essential to ensure collective understanding and the development of collective wisdom, especially in a world where globalization and diversity at local and national levels are common. The regulation of psychologists is likely to expand as more countries initiate procedures to address public concerns about alleged unethical practice. However, (p. 462) it is of greater importance to ensure that we train ethical psychologists and that high levels of ethical conduct are maintained and strengthened over the course of their careers. Both national and international psychological organizations have a major role to play in supporting the continued development of ethical practice. As a community of psychologists, we owe this to our fellow citizens and to the societies in which we live. Each of us must contribute to the development of ethical principles, standards of conduct, and methods for their application that better serve diverse persons and communities, with diverse problems, in diverse ways and settings, both at home and across national borders.

References

Ad Hoc Joint Committee. (2008). Universal declaration of ethical principles for psychologists. Retrieved from http://www.am.org/iupsys/resources/ethics/2008-universal-decl-report.pdfFind this resource:

Allan, A., & Love, A. W. (Eds.). (2010). Ethical practice in psychology: Reflections from the creators of the APS code of ethics. Chichester, UK: Wiley.Find this resource:

Allen, G. (2011). Early intervention: The next steps: An independent report to Her Majesty's government. London: Cabinet OfficeFind this resource:

American Anthropological Association. (2004). Statement on Ethnography, and Institutional Review Boards. Retrieved June 17, 2011 from http://www.aaanet.org/stmts/irb.htm.Find this resource:

American Psychological Association. (1953). Ethical standards of psychologists. Washington, DC: Author.Find this resource:

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Washington, DC: Author.Find this resource:

American Psychological Association (2009). Report of the Ethics Committee, 2008. American Psychologist, 64(5), 464–473.Find this resource:

American Psychological Association. (2010). 2010 amendments to the 2002 “Ethical principles of psychologists and code of conduct.” American Psychologist, 65, 493.Find this resource:

American Psychological Association. (2011). Model act for state licensure of psychologists. American Psychologist, 66, 214–226.Find this resource:

Angell., & Dixon-Woods. (2008). Style matters: An analysis of 100 research ethics committee decision letters. Research Ethics Review, 4, 101–105.Find this resource:

Bersoff, D.N (2008). A short history of the development of APA's ethics codes. In: D. Bersoff (Ed.), Ethical conflicts in psychology (4th ed.) (pp. 10–13). Washington, DC: American Psychological Association.Find this resource:

British Academy and the Publishers Association. (2008). Joint guidelines on copyright and academic research. London: AuthorFind this resource:

British Psychological Society (2006). The 2006 Annual Report. Leicester: AuthorFind this resource:

British Psychological Society. (2009). Code of ethics and conduct. Leicester, England: BPS. Retrieved 20 June, 2011 from http://www.bps.org.uk/the-society/code-of-conduct/.Find this resource:

Canadian Psychological Association. (2000). Canadian code of ethics for psychologists. Ottawa: Author.Find this resource:

Colegio de Psicologos de Chile. (1999). Codigo de etica profesional [Code of professional ethics]. Retrieved from http://www.colegiopsicologos.cl/el-colegio/comisiones/comision-de-etica/estatutos/.Find this resource:

Dingwall, R. (2008). The ethical case against ethical regulation in humanities and social science research. 21st Century Society, 3, 1–12.Find this resource:

Economic and Social Research Council. (2006). Framework for research ethics. Swindon, UK: Author.Find this resource:

European Federation of Psychologists’ Associations. (1995). Meta-code of ethics (revised). Retrieved 20 June, 2011 from http://www.efpa.eu/.Find this resource:

Fitzgerald, M. (2007). The EU gets tough on ethics. Technology Ireland, 38, 27–30.Find this resource:

Fitzgerald, T. D., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010). Ethical and legal considerations for internet-based psychotherapy. Cognitive Behaviour Therapy, 39, 173–187.Find this resource:

Gauthier, J., Pettifor, J., & Ferrero, A. (2010). The universal declaration of ethical principles for psychologists: A culture-sensitive model for creating and reviewing a code of ethics. Ethics and Behavior, 20(3&4), 1–18.Find this resource:

Hall, C. S. (1952). Crroks, codes and cant. American Psychologist, 7, 430–431.Find this resource:

Health Professions Council of South Africa. (2004). Rules of conduct pertaining specifically to psychology. Retrieved from http://www.psyssa.com/aboutus/codeofconduct.asp.Find this resource:

Herrnstein, R. J. & Murray, C. (1994). The bell curve: Intelligence and class structure in American life. New York: Free Press.Find this resource:

International Test Commission. (2000). International guidelines for test use. Retrieved 20 June, 2011 from http://www.intestcom.org/itc_projects.htm.Find this resource:

Jacobson, N., Gewurtz, R., & Haydon, E. (2007). Ethical review of interpretive research: Problems and solutions. Ethics and Human Research, 29, 1–8.Find this resource:

Joyce, N. R., & Rankin, T. J. (2010). The lessons of the development of the first APA ethics code: Blending science, practice, and politics. Ethics & Behavior, 20, 466–481.Find this resource:

Koocher, G. P. (2009). Any minute now but far far away: Electronically mediated mental health. Clinical Psychology: Science and Practice, 16, 339–342.Find this resource:

Koocher, G., & Keith-Spiegel, P. (2010). Peers nip misconduct in the bud. Nature, 466, 438–440.Find this resource:

(p. 463) Lindsay, G. (1996). Psychology as an ethical discipline and profession. European Psychologist, 1, 79–88.Find this resource:

Lindsay, G. (2011). Transnational ethical guidance and the development of the EFPA meta-code of ethics. European Psychologist, 16, 121–131.Find this resource:

Lindsay, G., & Colley, A. (1995). Ethical dilemmas of members of the Society. The Psychologist: Bulletin of the British Psychological Society, 8, 214–217.Find this resource:

Lindsay, G., Koene, C., øvreeide, H., & Lang, F. (2008). Ethics for European psychologists. Ashland, OH: Hogrefe & Huber.Find this resource:

Lindsay, G. Strand, S., Cullen, M. A., Cullen, S., Band, S., Davis, H., et al. (2011). Parenting Early Intervention Programme evaluation: DFE-R121A. London: DfE. Retrieved from https://www.education.gov.uk/publications/eOrderingDownload/DFE-RR121A.pdf.Find this resource:

Lindsay, G., Strand, S., & Davis, H. (2011). A comparison of the effectiveness of three parenting programmes in improving parenting skills, parent mental well being and children's behaviour when implemented on a large scale in community settings in 18 English local authorities: The Parenting Early Intervention Pathfinder (PEIP), BMC Public Health 2011, 11:962 doi:10.1186/1471-2458-11-962Find this resource:

Lindsay, G., Wren, Y., Bakopoulou, I., & Roulstone, S. (2011). Interventions for children with speech, language and communication needs in England: Lacking an evidence base? 32nd Annual Conference of the Symposium on Research in Child Language Disorders (SRCLD), June 9–11. Madison, Wisconsin.Find this resource:

Martinson, B. C., Anderson, M. S., & deVries, R. (2005). Scientists behaving badly. Nature, 435, 737–738.Find this resource:

Nagy, T. F. (2011). Essential ethics for psychologists: A primer for understanding and mastering core issues. Washington, DC: American Psychological Association,Find this resource:

Neisser, U. (Ed.). (1998). The rising curve: Long-term gains in IQ and related measures. Washington, DC: American Psychological Association.Find this resource:

New Zealand Psychological Society. (2002). Code of ethics for psychologists working in Aotearoa / New Zealand. Wellington: Author.Find this resource:

Nordic Committee of Psychological Associations. (1998). Ethical principles for Nordic psychologists. Retrieved from http://www.psykologforbundet.se.Find this resource:

Pauwels, E. (2007). Ethics for researchers: Facilitating research excellence in FP7. Luxembourg: Office for Official Publications of the European Communities.Find this resource:

Pope, K. S., & Vetter, V. A. (1992). Ethical dilemmas encountered by members of the American Psychological Association. American Psychologist, 57, 397–411.Find this resource:

Richardson, L. K., Frueh, B. C., Grubaugh, A. L., Egede, L., & Elhai, J. D. (2009). Current directions in videoconferencing tele-mental health research. Clinical Psychology: Science and Practice, 16, 323–338.Find this resource:

Sanders, M., Montgomery, D. T., & Brechman-Toussaint, M. L. (2000). The mass media and the prevention of child behavior problems: The evaluation of a television series to promote positive outcomes for parents and their children. Journal of Child Psychology and Psychiatry, 41, 939–948.Find this resource:

Sinclair, C., & Pettifor, J. (1992). Companion manual to the Canadian code of ethics for psychologists, 1991. Ottawa: Canadian Psychological Association.Find this resource:

Stevens, M. J. (2010). Etic and emic in contemporary psychological ethics. Europe's Journal of Psychology, 6(4), 1–7.Find this resource:

Task Force on Psychological Ethics and National Security. (2005). Report of the American Psychological Association presidential task force on psychological ethics and national security. Washington, DC: American Psychological Association.Find this resource:

UK Research Integrity Office. (2009). Code of practice for research: Promoting good practice and preventing misconduct. London: Author. Retrieved from: http://www.ukrio.orgFind this resource:

UK Research Integrity Office. (2010). Guidance for researchers on retractions in academic journals. London: Author. Retrieved from: http://www.ukrio.orgFind this resource:

World Medical Association. (2008). Declaration of Helsinki: Ethical principles for medical research involving human subjects. Retrieved from http://www.wma.net/en/30publications/10policies/b3/.Find this resource:

Notes:

(1.) Now the European Federation of Psychologists’ Associations (EFPA), the title to be used for the rest of this chapter.

(2.) The Universal Declaration of Ethical Principles for Psychologists is not an ethics code as such. Indeed, neither is the EFPA Meta-Code, which provides guidance not to individuals but to national associations.

(2.) The introduction of parenting programs was an example of positive practice, but it should be noted that many other such programs have been developed and are in use with little if any evidence of their efficacy or effectiveness.

(2.) The quotation marks are used here as recent events have occurred in some instances where there has been no formal declaration of war; this includes the rhetorical “war on terror.”

(2.) Similar concerns apply to and have been raised by members of other professions, in particular physicians and psychiatrists.

(2.) Previous acts had also been designed to regulate individual professions. As this is very costly in parliamentary time, the 1999 Health Act set up the Health Professions Council for 12 existing health professions (see above) with powers to add to those professions by statutory instrument; psychologists were regulated by this process.