Volume LIV, No. 4
December, 2000
Promoting Justice in the Curriculum:
Integrating Service-Learning and Ethical Decision Making
Thomas G. Plante
In this issue Psychology professor Thomas Plante outlines a strategy for psychology and related fields to incorporate social responsibility ideals and values into the undergraduate curriculum. Efforts by the author at Santa Clara University are detailed. Hopefully, other professors might use the Santa Clara example as a potential model for incorporating social responsibility and justice values into their undergraduate curricula.
While psychology has been a leading discipline in the area of professional ethics as exemplified by the Ethics Code for psychologists (American Psychological Association, 1992), in reality, social responsibility and justice values appear to be neglected by the undergraduate psychology curriculum at many colleges. The purpose of this paper is to outline a strategy for psychology and related social science fields to incorporate social responsibility and justice ideals and values into the undergraduate curriculum. Efforts by the author at Santa Clara University will be detailed. Hopefully, other professors might use the Santa Clara example as a potential model for incorporating these values into their undergraduate curricula.
Ethics and service-learning appear to be two natural areas where social responsibility and justice ideals can be appropriately integrated into the curriculum. Of course, matters of faith, justice, and ethics would become more acceptable to psychology if they are based on solid research findings. The next section reviews ethics in psychology and outlines how ethics can be integrated into the undergraduate psychology curriculum.
Photo by Charles Barry, Santa Clara University
Ethics in Psychology: A Place Where Psychology Has Shined
Whether a psychologist is a researcher, teacher, therapist, or administrator, he or she is expected to maintain the highest professional ethics in all professional activities at all times. In fact, psychology is one of the few fields that have adopted ethical guidelines which hold members to a much higher standard than the law.
The American Psychological Association formed an ethics committee in the 1930s, and later developed its first set of ethical principles in 1953. The most current version of the Ethics Code, published by the American Psychological Association, was released in 1992. It is especially important for the field of psychology to focus on professional ethics since psychologists generally have a high degree of responsibility that often significantly impacts the lives of others. For example, psychologists who conduct psychotherapy are entrusted with the emotional and often physical vulnerabilities, confidences and well-being of the people who seek their guidance. Psychologists must closely and carefully follow ethical principles to ensure that they behave in an appropriate, responsible, and professional manner protecting the public as well as the profession.
The American Psychological Association reports that between 1985 and 1994 an average of 337 ethical complaints were received per year (American Psychological Association, 1995) with over 400 received every year since 1992 (American Psychological Association, 1996). Many other ethical violations may not have been reported to the American Psychological Association or to state ethics and licensing boards. Most of the complaints that result in action against psychologists by the American Psychological Association or local authorities involve breaking confidentiality, sexual misconduct (e.g., sexual relationship with a patient), nonsexual dual relationships (e.g., friendships or business partnerships with patients), and insurance/fee misbehavior (e.g., over billing insurance, billing for services not rendered). Several authors have reported that the most common ethical violation involves patient confidentiality (e.g., Pope & Vetter, 1992). While many of these violations involve breaking confidentiality without patient permission, a sizable number of cases involve psychologists refusing to break confidentiality when they are ethically and legally required, as in the case of reporting child abuse to the police or state child protective services. Fortunately, however, the vast majority of psychologists do behave in an ethical and professional manner (Koocher & Keith-Spiegal, 1998; Layman & McNamara, 1997).
Many of the principles outlined in the Ethics Code were originally highlighted many centuries ago in the Hippocratic Oath. These include competence, respect, confidentiality, informed consent, social justice, and avoiding both harm and exploitation. Thus, many of the fundamental principles outlined several thousand years ago are still in use today. Koocher and Keith-Speigal (1998) outlined eight general principles for psychologists distilled from the Ethics Code and additional sources. These include doing no harm, benefiting others, being just and faithful, according dignity, treating others with caring and compassion, pursuing excellence, respecting autonomy, and accepting accountability. In addition to the Ethics Code, more specific speciality guidelines have also been developed by the American Psychological Association to provide further instructions and expectations for professional conduct. For example, the American Psychological Association has published the following speciality guidelines: Specialty Guidelines for the Delivery of Services by Clinical Psychologists (American Psychological Association, 1981), Guidelines for Computer Based Tests and Interpretations (American Psychological Association, 1987), Standards for Educational and Psychological Testing (American Psychological Association, 1985), and Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (American Psychological Association, 1990).
Declining moral and ethical behavior in American society has resulted in increased interest in developing educational programs in ethical decision-making (Allegretti & Frederick; Coles, 1997; Pellegrino & Thomasma, 1993; Rachels, 1993). Some authors have argued that training in ethics as well as sensitivity to ethical issues should begin during childhood (e.g., Coles, 1997). Although many undergraduate psychology courses such as research methods and abnormal psychology include sections on ethical issues (e.g., Wilson, O’Leary, Nathan, & Clark, 1996), Brewer, Hopkins, Kimble, and Matlin (1993), reflecting the suggestions from the 1991 American Psychological Association (APA) National Conference on Enhancing Undergraduate Education in Psychology, has called for more organized and structured training in ethics for psychology undergraduates. While professional psychology has focused on ethics at the postgraduate level, the undergraduate ethics curriculum has been neglected.
The Santa Clara Model
The use of service learning placements, the development of undergraduate ethics in psychology courses, and the application of ethical and justice issues incorporated into all classes are three ways the author integrates these Jesuit ideals into the psychology curriculum at Santa Clara University. These three approaches will be detailed below.
Service Learning
Service learning provides students with an opportunity to examine matters of faith, justice, and ethics in the community. In the words of James Fleming, S.J., "... service learning offers a potent and engaged pedagogy consonant with the long and successful history of Jesuit education, consistent with central tenets of Ignatian spirituality, and compatible with the Jesuit focus on educating students for a just society" (p. 7). Working in homeless shelters, battered women’s shelters, low fee community clinics and hospitals, day care centers for children or elderly adults, and other placements provide students with an experiential opportunity to examine matters of faith, justice, and ethics in the lives of many who depend on these values for survival. At Santa Clara University, a campus organization called the Eastside Project provides students with these unique learning opportunities by placing them in a wide variety of community agencies that focus on serving the poor. Students participate in a comprehensive orientation and the directors of the SCU program work closely and collaboratively with the directors of these community agencies. During the course of an academic term, students spend 2 hours per week at their community placements. Students discuss their experiences in classes that sponsor these placements and students are provided with ample opportunities to give feedback to the instructors and program directors about their experiences.
The Eastside Project is used in many psychology classes such as General Psychology, Abnormal Psychology, Health Psychology, Psychosomatic Medicine, Clinical Psychology and other courses. For example, students enrolled in Abnormal Psychology are placed in one of several homeless shelters that are designed for mentally ill patients. Homeless adults experiencing schizophrenia, bipolar illness, substance abuse, and/or personality disorders receive services at one agency while homeless adolescents experiencing substance abuse, conduct, attention deficit, and/or learning disorders obtain services from another agency. Students might be involved with serving meals, tutoring clients, or recreational activities during their visits. There is also ample opportunity for students to observe client meetings and engage in conversations with both staff and clients. Students discuss their experiences in class during lectures and discussion regarding psychiatric disorders. For example, during a lecture on schizophrenia, students are encouraged to discuss the symptoms of the disorder in light of the clients they work with at the shelter. Students are requested to write brief reflection papers on their experiences at the end of the term. Inevitably, students discuss ethical and justice issues in these papers as well. Themes such as the injustices of poverty, discrimination, and lack of both financial and community support are common topics of focus. Ethical issues regarding staff burnout and turnover or incompetence as well as disability monies used for cigarettes and other substances are also often considered.
Ethics in Psychology: Expanding the Undergraduate Curriculum
Another attempt to incorporate Jesuit values into the psychology curriculum involves the development of an undergraduate course on the topic of psychology ethics. Most campuses offer psychology ethics courses at the graduate but not undergraduate level. At Santa Clara, the course is offered for undergraduates and blends moral philosophy as well as specific ethical issues relevant to psychology. The course is an upper division elective with enrollment limited to 35 students. The class serves as a university core curriculum distribution requirement in ethics.
During the first two weeks of the course, students learn the principles involved in moral philosophy and ethical decision making. They read a standard text on moral philosophy (Rachels, 1998) that addresses cultural relativism, psychological and ethical egoism, the utilitarian approach, social contract approach, virtue approach, and the notion of absolute moral rules. They also learn a model of ethical decision making and approaches to ethics developed by the university’s ethics center. This model includes various stages of decision making, including the recognition of an ethical issue, making decisions that are both fair and just that result in consequences emphasizing the common good, and evaluating alternatives. Class discussions highlight the use of this ethical decision making model as well as different philosophical approaches to ethical decision making. Students learn and discuss the strengths and weaknesses of the model as well as each approach to ethics.
Students watch brief video presentations from the series Ethics in America (Miller & Elliott, 1989) to make the material come alive. This series presents ethical dilemmas such as doctor-patient confidentiality, medical research on vulnerable human research participants, and ethical obligations to members of society in need such as homeless persons. Four teaching assistants or "student reflectors" who are advanced philosophy majors specifically trained by the university’s Center for Student Leadership assist the class by facilitating small group discussions. The goal at the end of the first two weeks of the course is for students to have a solid understanding of the major philosophical approaches and context generally used to make ethical decisions. They are then able to identify different strategies for ethical decisions and articulate the advantages and limitations of each approach.
Following this introduction, students apply moral philosophy and ethical decision making to issues in psychology and related fields. Students read the Hippocratic Oath (from Arras & Steinbock, 1995) and the psychologists' ethical principles and code of conduct (APA, 1992). Students read chapters from Ethics in Psychology (Koocher & Keith-Spiegel, 1998) during the remainder of the academic term. One of the 6 aspirational ethical principles from the APA Ethics Code acts as a theme for each week. These principles include issues related to competence, integrity, professional and scientific responsibility, respect for people’s rights and dignity, concern for others’ welfare, and social responsibility. Students discuss common ethical and legal dilemmas experienced by psychologists and other professionals in light of these readings and experiences. For example, topics include issues related to limits on confidentiality, duty to warn potential victims, treatment of minors without parental consent, dealing with managed health care conflict of interests, professional boundary violations such as sexual indiscretions, and the use of deception in research experiments.
Students also participate in the Eastside Project. Their activities working in these community programs provide useful experiences for discussion and reflection concerning ethics. For example, in one school placement, confidentiality of children who have tested positive for HIV is protected; yet other children, parents, and teachers interact with infected children without knowledge of the potential threat. In another placement, the shelter discharges homeless persons if they violate the shelter’s rules concerning curfew, drug use, fighting, the use of foul language, and other infractions. Class discussions focus on the experiences generated from these placements as well as clinical case vignettes obtained from the American Psychologist, the APA Monitor, and other sources.
At the end of the term students write a 5-page reflection paper concerning their service-learning placements in light of the ethical principles learned in class. Students also complete two in-class essay examinations as well as a final essay examination. Parts of the examination use clinical case vignettes modeled after the oral licensing examination offered for state licensure of psychologists.
In summary, the course represents an undergraduate class experience dedicated to teaching psychology ethics to college students. It incorporates information and discussion of moral philosophy and the APA Ethics Code along with service-learning and peer-led small group discussion experiences.
Incorporating Ethics in all Psychology Courses
During the last week of all psychology classes taught by the author, at least one class session (and often two) are dedicated to applying ethical and justice principles to the course topic. A review of the APA Ethics Code as well as strategies for ethical decision making and social justice are introduced as well as applied to the various topics highlighted throughout the term. In this way, all psychology courses consider justice and ethical issues at some point during the course. For example, in a course entitled Health Psychology, ethical issues related to the inability of the poor to obtain quality health care, the rationing of health care, and the profiting of managed care insurance companies are discussed. In a Clinical Psychology course, ethical issues related to limits to confidentiality, access to mental health services by the poor, and challenges of maintaining professional competence are discussed.
Photo by Charles Barry, Santa Clara University
Conclusion
Psychology has generally avoided active engagement with Jesuit ideals of justice as well as respect for religious faith and ethics broadly defined. By integrating ethics into all psychology courses, offering ethics in psychology courses, and liberal use of service learning opportunities, the psychology curriculum can begin to incorporate Jesuit ideals. Fortunately, recent interest in religious values has created an opportunity for psychology to incorporate Jesuit ideals into the undergraduate curriculum. Successful integration may increase the chances that psychology students in general may become more knowledgeable and comfortable with these Jesuit ideals and hopefully maintain them throughout their lives.
Although this paper has focused on the discipline of psychology, many of the principles discussed here can also be applied to other fields as well such as sociology, health sciences, political science, business, and so forth. Attention to ethics and service learning can be successfully used in many classes and departments across campus. For example, business students might offer money management and accounting services to non-profit organizations or families with few financial resources. Health science students might offer health education and preventative services to low income families, school groups, and homeless shelters. Modern language students might offer tutoring services to recent immigrants. Ethical issues can be highlighted in all of these types of classes. For example, ethical issues in environmental science, chemistry, biology, and so forth might allow students to examine issues through the lens of justice.
Santa Clara University has provided a great deal of attention and financial support to ethics and service learning in recent years and thus the infrastructure and support is in place for faculty who wish to incorporate social justice into their course work. Staff have been hired, relationships have been developed with community agencies, and the university has allocated a large amount of money to fund centers of distinction that highlight these issues (e.g., the Bannan Center for Jesuit Education and Christian Values, the Markula Center for Applied Ethics). It is important that there is a great deal of interest and support from the president’s office on down in order for these programs and efforts to be successful.
Recently, representatives from all of the 28 U.S. Jesuit universities met at Santa Clara for a 3-day conference on justice in higher education. These representatives included university presidents, provosts, deans, and faculty. These joint efforts will hopefully result in a wide variety of creative ideas for the promotion of Jesuit values among all of the American Jesuit universities in the future. Sharing of ideas and programs between the 28 schools might hopefully result in numerous efforts to promote Jesuit ideals into the curriculum.
Endnotes
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American Psychological Association (1995). Report of the ethics committee, 1994. American Psychologist, 50, 706-713.
American Psychological Association (1993). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. American Psychologist, 48, 45-48.
American Psychological Association (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597-1611.
American Psychological Association (1990). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. Washington, DC: Author.
American Psychological Association (1987). Guidelines for computer based tests and interpretations. Washington, DC: Author.
American Psychological Association (1985). Standards for educational and psychological testing. Washington, DC: Author.
American Psychological Association (1981). Specialty guidelines for the delivery of services by clinical psychologists. American Psychologist, 36, 640-651.
Arras, J. D., & Steinbock, B. (1995). Ethical issues in modern medicine (4th ed.). Mountain View, CA: Mayfield.
Brewer, C. L., Hopkins, J. R., Kimble, G. A., & Matlin, M. W. (1993). Curriculum. In T. V. McGovern (Ed.), Handbook for enhancing undergraduate education in psychology. Washington, DC: American Psychological Association.
Coles, R. (1997). Moral intelligence of children. New York, NY: Random House.
Fleming, J.J. (1999). The emerging role of service learning at Jesuit universities. Explore: A Quarterly Examination of Catholic Identity and Ignatian Character in Jesuit Higher Education. Santa Clara University, CA: Bannan Institute for Jesuit Education and Christian Values.
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About the Author
Thomas G. Plante, Ph.D., chairs Santa Clara University's Psychology Department He is also Clinical Associate Professor ,Psychiatry and Behavioral Sciences at Stanford University's School of Medicine and Consulting Associate Professor, School of Education, Stanford University
He is the author of Contemporary Clinical Psychology (1999, Wiley), editor of Bless Me Father For I Have Sinned: Perspectives on Sexual Abuse Committed by Roman Catholic Priests (1999, Greenwood), co-author of Getting Together, Staying Together: The Stanford University Course on Intimacy (FirstBooks, 2000), and co-editor of the forthcoming Faith and Health: Perspectives on the Relationships Between Religious Faith and Health Outcomes (2001, Guilford).
His research experieinc includes faith and health relationships among addicts, bone marrow transplant patients, cervical cancer patients, and other populations as well as the psychological effects of exercise. He has published over 75 professional journal articles.
He lives in Menlo Park, CA with wife, Lori (also a psychologist), and son, Zachary (age 4). He can be contacted by e-mail at tplante@scu.edu. His webpage is www.drplante.ohgolly.com
