ETHICAL CONCERNS

Application of ethical considerations about SOCE have long included concerns about their associations with stigma and their potential to be used coercively (e.g., APA, 1998). The charge to “do no harm” has historically been a foundational principle of practice for healthcare professionals. Aspirational principles such as “Respect for People’s Rights and Dignity” (Principle E, APA Ethics Code), which includes respecting the rights of individuals to self-determination, are held in dynamic tension with other principles, including “Beneficence and Nonmaleficence” (Principle A, APA Ethics Code). Shidlo and Gonsiorek (2017) argued that self-determination is not intended to be used as the only or more important ethical principle in clinical decision-making. There are a number of patient requests a psychologist would decline (e.g., a request for a behavioral weight loss program from a patient with anorexia nervosa) in the interest of the patient’s health and well-being. Ethics Code Standard 2.04 also states “Psychologists’ work is based upon established scientific and professional knowledge of the discipline” (APA, 2017b, p. 5). Moreover, Standard 3.04(a) of the APA Ethics Code requires that “psychologists take reasonable steps to avoid harming their clients/patients and to minimize harm where it is foreseeable and unavoidable” (APA, 2017b, p. 6). Self-determination does not necessitate or justify dispensing with other ethical obligations regarding patient care.