m1-psy 570

Chapter 1

Case 1-28 Skid Greenspace, MSW-Page 15

Case 1–28: Skid Greenspace, L.M.F.T., prided himself on recycling anything before disposing of it. Mr. Greenspace was chagrined when a client showed him the scratch paper he left in the waiting room for children to draw on. It had confidential client treatment notes on the back.

Chapter 2

Case 2-2 Carl Klutzkind, PhD-Page 22

Case 2–2: Carl Klutzkind, Ph.D., treated a woman with many adjustment problems in the wake of a separation and impending divorce. After Dr. Klutzkind had worked with the client for 6 months, her attorney asked whether he would testify in support of her having custody of her 7-year-old child. Despite having no forensic train-ing or experience, Dr. Klutzkind agreed and from the witness stand offered many opinions about the adjustment of the woman and her child. The client’s husband filed an ethical complaint against Klutzkind, noting that he lacked any training in child work, that he never actually interviewed the child, and that he was therefore negligent in offering an opinion. It seems that the child had been in treatment with another psychologist, and Klutzkind never sought information from that colleague or the child’s father.

Case 2-3 Sarah Bellum, Psy.D., completed her graduate training in the 1980s, before clinical neuropsychology evolved as a distinct specialty. She was trained to “assess organicity” using the first edition of the Wechsler Adult Intelligence Scale (WAIS), House-Tree-Person drawings, and the Bender Motor Gestalt Test. She has never studied neuroanatomy and has no knowledge of newer assessment tools designed for use in neuropsychological assessment. Her current practice focuses chiefly on psychotherapy. An attorney contacted Dr. Bellum about assessing a client who had suffered a closed head injury and was experiencing language, memory, and perceptual sequella. She accepted the referral and tested the client using the “tried-and-true” techniques she learned decades earlier.

Chapter 9

Case 9-3 A Young Asian-Page 278

Case 9–3: A young Asian client saw herself as homely and unlikable. Letme Fixit, Ph.D., explained how he was only trying to boost her self-esteem when he told her she had beautiful eyes and how he could imagine her having a close relationship with a “white man” like him, even though it could not be him as much as he would like that. His attempts to exonerate himself on the grounds that he went overboard trying to con-vince the client that she was attractive were not persuasive to a licensing board. Dr. Fixit may have meant well in his own mind; however, his actions illustrate insensitiv-ities and cultural bias. He focused on physical attributes of the client and clearly asserted white privilege with an implication that attraction to people of Asian ancestry holds less value. Most therapists would not attempt to alter a client’s self-perceptions without first attempting to understand the basis for the feelings.

Case 9-50 After an affair-Page 302

Case 9–50: After an affair between Gary Goferit, Ph.D., and Paula Jettison had ended, Jettison filed charges against Goferit for sexual harassment and exploitation. She also contacted the local newspapers. She was joined by several other students, who claimed they, also, had experienced the same abuse by Goferit. Dr. Goferit lost his job and his wife. The contemporary popular press relishes stories like this, and even sophisticated academic publications, such as the Chronicle of Higher Education, feature them. We collected dozens of articles from the media, several involving mental health and social science educators, from which to adapt our cases. Students also take far greater risks than they may appreciate. At the time, some may see their relationship with professors as exciting, possibly even as putting them on the fast rungs up the career ladder, only to later find themselves dis-carded and frozen out.

Chapter 10

Case 10-53 Zena Freeman-Page 341

Case 10–53: When Zena Freeman asked Macho Mann, Ph.D., for assistance with problems she was having understanding certain concepts in her organizational psychology class, he commented that women did not belong in the course because they were not suited to the field. Mann refused to respond to her specific questions. Instead, he continued to refer to the general unsuitability of women for work in the business world and cited her difficulties in comprehension as evidence. This case does not involve direct sexual references or touching, but the effect was to keep the woman in a subordinate position through exclusion or ridicule. This also seems to be an example of how faculty members and super-visors can exploit their power over students (Carr, 1991). The next two cases illustrate the need for ethical sensitivity to professional interactions in the workplace regardless of how one defines and interprets sexual or gender harassment. The first incident came to our attention from a middle-aged supervisor, who concluded ultimately that her trainee must be gay, never recognizing that her own behavior might well be unwelcome to any young man.

Chapter 13

Case 13-4 Dahlia Discord, MSW-Page 434

Case 13–4: Dahlia Discord, M.S.W., has been treating Melissa Malfunction for anxiety and mild depression in the aftermath of an automobile accident. Ms. Malfunction has been out of work for 3 months and receives disability insurance payments. The insurer has scheduled her for a disability case review, and Ms. Malfunction has asked Ms. Discord to complete a disability evaluation form and possibly testify as an expert in support of her claim before an administrative law judge. Ms. Discord would like to support her psychotherapy client but is not certain that she can objectively support Ms. Malfunction’s claim that she is totally unable to work at any job for emotional reasons. Psychotherapists are often asked to write letters of various sorts in support of their clients but must take care not to compromise their professional integrity. Ms. Discord should not allow herself to be manipulated into making a recommendation or evaluative statement that she cannot, in good conscience, support. At the same time, she does not want to disrupt the rapport with her client. One possible solution would involve advising Ms. Malfunction that, although she cares deeply about her welfare, Ms. Discord cannot take on the role of an independent evaluator to determine disability. Ms. Discord could also agree to write a letter, with the client’s consent, documenting her work with Ms. Malfunction, the symptoms reported by the client, her diagnostic impressions, an estimate of the level of symptom severity, and other treatment information. However, the letter should include only accurate information and should avoid commenting specifically on Ms. Malfunction’s ability to work or qualification for disability. Those recommendations should be left to other mental health experts who do not have preexisting or ongoing therapeutic relationships with her.

Case 13-7 Billy Berzerk-Page 436

Case 13–7: Billy Bezerk was to stand trial for the axe murder of his family of four. His attorney was planning to use an insanity defense and hired Cruddy D. Cider, Psy.D., to conduct an expert psy-chological evaluation of criminal responsibility.

Case 13-9 Helena Scruples-Page 438

Case 13–9: Helena Scruples, Ph.D., has considerable knowledge regarding eyewitness identification. Her own research shows the frequent unreliability of such identifications. When asked to serve as an expert witness by the defense in a rape case, Dr. Scruples feels sympathetic to the female victim and knows that prosecution of alleged perpetrators is difficult. If she agrees to help the defense, she ma

Case 13-10 Herman Beastly Page 438

Case 13–10: Herman Beastly is accused of raping and murdering an adolescent babysitter. Evidence strongly indicates that he is guilty and may meet criteria for a death sentence based on a state law that permits capital punishment for criminals likely to commit repeated violent crimes of this sort. John Qualm, M.D., considered an expert on the prediction of dangerousness, has published reports that highlight the difficulty in making such predictions reliably. He is asked to testify by the defense in the hope that his opinions may save Beastly from execution

Case 13-13 Jack Balance, M.D. Page 441

Case 13–13: Jack Balance, M.D., undertook a child custody evaluation at the request of the attorney representing the child’s father. The attorney advised Dr. Balance that both parents were interested in cooperating with the evaluation. Balance met with the father and the child for assessment purposes, but the mother subsequently declined to participate. At the trial, Dr. Balance testified only with respect to the child–father relationship, but the mother’s attorney attempted to discredit him as an expert because he had not interviewed the child’s mother. Dr. Balance would have been better advised to confirm in advance the willingness of all parties to cooperate. He might have accomplished this through personal contact or by court order, if necessary. He certainly behaved ethically in commenting only on his actual contacts (i.e., the adequacy of the child–father relationship), while refraining from any comments about the parent who declined to participate. In addition, Dr. Balance had to pay special attention to note the limitations, based on incomplete data, of any recommendations he might make. The attempt to discredit his testimony is unfortunate, but he did not commit an ethical violation.

Case 13-19 Windy Fluffball, JD, PhD Page 445

Case 13–19: Windy Fluffball, J.D., Ph.D., agreed to serve as an expert witness in a civil lawsuit that involved alleged wrongful termination of a clinical psychology graduate student from a doctoral program. Dr. Fluffball expounded on his years of teaching and membership on the National Psychological Society’s Education and Training Oversight Committee. On cross-examination, Fluffball was forced to admit that his doctorate was in physiological psychology, that he never had clinical training, that he never worked or taught in a clinical psychology program, that he was not licensed as a psychologist, and although he had recently won appointment to the Education and Training Oversight Committee of his professional association, he had yet to attend a single meeting. After the jury returned a verdict favoring the other side, the lawyers were allowed to poll the jurors and discovered that Dr. Fluffball’s testimony was given very little weight. One must wonder whether the side for which he testified would have fared better using a witness who did less to inflate his qualifications. MENTAL HEALTH PROFESSIONALS AS DEFENDANTS Rather than simply focus on mental health malpractice, it seems more reasonable to think of the broader concept of professional liability as applying to all of one’s professional service delivery activities. In a legal sense, there are four elements that must be present before a successful civil liability lawsuit is possible. Think of them as the four Ds: duty, dereliction, direct causation, and damages. First, the clinician must have a professional relationship with the party in question. That is, a practitioner–client relationship must have existed with a resulting duty to the client. Second, there must be some negligence or dereliction of that duty on the part of the therapist. Third, some harm must have accrued to the client as a direct result of the negligence or dereliction of the duty. Finally, a causal relationship between the negligence and the resulting damages must be shown (Bennett et al., 2007; Bucky et al., 2005; Caudill, Sparta, & Koocher, 2006; Falender & Shafranske, 2004; Knapp et al., 2013). Needless to say, by this definition a successful prosecution for malpractice would necessarily mean that the clinician had behaved unethically by virtue of negligence. Read the next three cases with these standards in mind and see whether you can hazard a guess about the outcomes.

Chapter 14

Case 14-4 Two students-Page 462

Case 14–4: Two students sought monetary damages because a course proved too difficult. The judge in small claims court ruled that the professor was guilty of educational malpractice for making an entry-level course too demanding (Shea, 1994).

Case 14-13 Professor Daze Fluster Page 466

Case 14–13: Students complained to the department chair about Professor Daze Fluster regard-ing the quality of Fluster’s classes. The students claimed that he often arrived late, spent time flipping through a tangled mass of papers in his briefcase, had no readily apparent agenda for each class session, and spoke in an unconnected fashion. The students asserted that their time and tuition were not being well spent.

Case 14-23 Professor Ablation Page 470

Case 14–23: Professor Ablation showed a video in his undergraduate neuropsychology class demonstrating vivid depictions of brain surgery techniques on a puppy and a cat. Two students fled the room in tears, and many others became visibly distressed. When one student asked Professor Ablation why he had not given them some warning, he replied, “You’re supposed to attend every class. This is a course about the brain, after all.” Images evoke powerful emotions. Having sat through multiple previous showings, instrutors may lose touch with the reactions some students will have to seeing visual depictions for the first time. Students seem to be more squeamish or more open than students from much earlier decades in expressing distress when shown videos or demonstrations that involve animal experimentation (Herzog, 1990). We recommend remaining alert to what kinds of film experiences may prove too intense for some students and excuse them or provide alter-native assignments if at all possible. In areas that predictably upset many or most undergraduate students, such as invasive research procedures using primates or companion animals, the instructor might consider available alternatives. Unusual classroom demonstrations can range from exciting and memorable to the questionable or inappropriate. The next case is illustrative.

Case 14-37 Bonnie Bruised Page 477

Case 14–37: Bonnie Bruised told her instructor, Professor Disclose, that she feared for her life. Her boyfriend had threatened and beaten her badly, breaking her wrist, and is currently stalking her. Professor Disclose advised the student to contact campus security and the counseling center immediately. The student adamantly refused to interact with either resource. Professor Disclose contacted them herself to warn of the potential danger to her student. Professor Disclose has been put in a difficult position because there is no mandated duty to impose herself into her student’s life. However, she feels morally obligated to take protective action despite possibly alienating her student by divulging information presumably shared in confidence. Depending on the circumstances (e.g., if the alleged offender is another student), Professor Disclose might have a reporting obligation under Title IX. It may be difficult to rebuild the student–instructor relationship with Ms. Bruised after she learns of the inter-vention. Under emergency conditions, ethical guidelines are not always helpful. Instructors (and therapists) can minimize greatly the risk of future censure, however, as long as their actions will be viewed as attempts to protect others rather than to exploit or harm them. (See Chapter 17 for more on decision making in emergency circumstances.) Futzing With FERPA The Family Educational Rights and Privacy Act, a federal law (i.e., 20 U.S.C. § 1232g; 34 CFR Part 99, 1974), applies to all schools that receive federal funds from programs administered by the U.S. Department of Education. FERPA imposes firm limits on disclosing students’ educational records. Specific rights are assigned to parents by FERPA, but it transfers these to the designation of “eligible students” on attaining the age of 18 or when attending a school beyond the high school level. These rights include the ability to inspect and review any of the student’s education records maintained by the school. Redress procedures exist when parents or eligible students believe the records contain errors. Generally, schools must have written per-mission from the parent or eligible student to release any information from a student’s education record. Schools may disclose, with-out consent, directory information such as a student’s name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. FERPA does allow schools to disclose records, without consent, under certain circumstances (see 34 CFR § 99.31). Examples of such releases might include those to school officials with legitimate educational interests; other schools to which a student seeks to transfer; appropriate parties in connection with accreditation, audits, or financial aid; responses to a judicial order or lawful subpoena; appropriate officials in cases of health and safety emergencies; and state and local authorities, pursuant to specific state law.

Case 14-42 After Pam Sincere Page 480

Case 14–42: After Pam Sincere completed a semester of her master’s-level counseling program at Minus College, she learned that the degree would not qualify her to sit for a licensing exam. When she confronted her advisor, he pointed out that the program did offer a legitimate academic degree with the title “counseling,” but made no promises about qualifications to enter into a licensed profession. He advised her to complete the program and later try to transfer into a doc-toral-level program. Sincere had not planned on committing to advanced study. Had Ms. Sincere actively sought information on licensing requirements she might have saved herself time, grief, and money. Students may readily assume, as did Ms. Sincere, that an advanced degree in counseling would lead to the opportunity to practice as a counselor without having to take additional course work. Minus College is, however, ultimately to blame The degree description should have conspicuously issued an appropriate caveat. Program representatives have the responsibility to take whatever extra steps are necessary to ensure that applicants are informed of changes or circum-stances that may affect their legitimate educational needs. Helping professionals who become involved with continuing education programs and workshops must realize that today’s busy consumers on a budget (and that includes other helping professionals) expect to get value for their time and treasure. Promotional materials should offer current and complete information, including realistic descriptions of what to expect. We have heard complaints from workshop attendees that the participants added nothing new beyond presenting material from their previously published books, which the attendees had already read. Many students base their course selections on catalog descriptions, especially when signing up for an unfamiliar course or one outside their major field of study. When a significant course component is added, shifted, or eliminated, a correction should be made in the next catalog printing. In the meantime, any discrepancies should be communicated in other forums (e.g., e-mail and websites, bulletin boards, department newsletters) and, most certainly, specifically addressed on the first day of class.

Case 14-49 Clinton Clever Page 483

Case 14–49: Clinton Clever’s term paper con-tained a literature background and a detailed design for an ingenious experiment. Professor Purloin fleshed it out a little more, collected data, and published it without any reference to Clever. Mr. Clever complained to his advisor, who in turn confronted Purloin. Purloin’s response was, “Clever expressed no intention of ever running the study. He is just an undergraduate student. If he had asked to be involved, I would have let him help with it. He could never have executed it on his own. Besides, I gave him a perfect score on this paper.” Professor Purloin’s attitude reflects a lack of respect. That Clever is “just an undergraduate” is not relevant in and of itself. Further, it was not Clever’s responsibility to initiate an intention to execute the study to maintain proprietary rights of the design. It may well be true that Clever did not intend to run the study on his own and would have faced difficulties had he tried; how-ever, Professor Purloin should have consulted with the student. At that point, Clever could have declined the invitation to collaborate and given Purloin permission to go ahead inde-pendently. Even then, it would have been very appropriate for Purloin to credit Clever’s contri-bution to the design in a footnote (APA: 8.12a, 8.12b; AAMFT: 5.6; ACA: G.5). What if Clever’s work had been less detailed, maybe in the form of a few sentences that sug-gested an idea for a study? We acknowledge that there comes a point at which a student paper or a casual discussion provides a glimmer of an idea that stimulates the development of an executable project. In such instances, involv-ing the others who may have jump-started an independent creation is not morally mandated, although we maintain that acknowledging the contributions of others never hurts anyone and can even enhance a positive reputation for mentoring. Research collaboration with students (including undergraduate students) is popu-lar because of the benefits that can accrue to everyone involved. Scholarly output remains a primary consideration in faculty promotion and retention decisions. Research experience is one of the primary determinants of gradu-ate school admission for many academic pro-grams (Keith-Spiegel, 1991; Keith-Spiegel, Tabachnick, & Spiegel, 1994). Instructors must be careful, however, to prepare their students with a realistic picture of expectations.

Chapter 15

Case 15-14 At the Farnsworth-Page 505

Case 15–14: At the Farnsworth Elementary School, teachers have full access to a child’s cumulative school record. Material of a personal nature entered in these records occasionally became a topic of conversation in the teach-er’s lounge. When school social worker Sylvia Caution, M.S.W., learned of this, she decided that she would no longer document any of her clinical observations in the record. The case of the school record system high-lights a variety of issues covered in Chapter 6 and well described specifically in the school confidentiality context by others (Bor, Ebner-Landy, Gill, & Brace, 2002; Glosoff & Pate, 2002; Jacob & Hartshorne, 2003; McNamara, 2013; Moriya, 2006; Reamer, 2005). Sadly, Ms. Caution’s response seems a bit overreactive. As discussed in Chapter 6, record entries must be considered with a balance of utility and the need to know. The teachers may not need to know that Johnny Smith was born prior to his parents’ marriage, but it would clearly help Johnny if his teachers understood his tendency to withdraw socially when stressed. The circumstances of Johnny’s birth add nothing to assist in the promotion of his educational progress, but information regarding a tendency toward social withdrawal might help a teacher reach out to him more effectively in the classroom. In any case, his par-ents have a right to know who within the school will have access to what information and have the option to give or withhold their consent. Ms. Caution should take some professional initiative in educating her colleagues about more appropriate treatment of confidential information, or she could take steps to limit access to records if necessary

Chapter 16

Case 16-16 Nancy Icarus-Page 535

Case 16–16: Nancy Icarus, Ph.D., had always prided herself on a commitment to conducting ethical research. However, the IRB at her university was unreasonable in its demands in a way that unduly restricted her ability to do work in her specialty area. Several members obviously had no understanding of her field. Furthermore, the memos the IRBs issued were arrogant and rude. In frustration, she went ahead and conducted her research while misleading the IRB about what she was actually doing. Ethical standards demand that when research requires approval by an institution, the information in the protocol must be accurate. Paradoxically, however, IRBs charged with upholding the responsible conduct of science may actually encourage deceit. We may have some sympathy for Dr. Icarus, who ran up against a wall and broke the rules to get around it. In the meantime, however, such research is not being properly monitored as required by federal policy. Participants’ rights could be slighted, but the institution may never know of it. Unfortunately, charges that IRBs are unreasonable, unresponsive, and incompetent are not uncommon (Giles, 2005; Keith-Spiegel & Koocher, 2005).

Chapter 18

Case 18-5 Mary Tripped-Up, PhD Page 615

Case 18–5: Mary Tripped-Up, Ph.D., was asked to undertake a child sexual abuse evaluation by a woman who was seeking a divorce because of domestic violence. Dr. Tripped-Up evaluated the child and found no signs of abuse. Nonetheless, she was subpoenaed to court by both parties in the divorce. In an informal meeting with both parties and their lawyers outside court, she was asked for “informal advice” on a child custody settlement. She made a variety of properly qualified recommendations, which were readily accepted by all concerned, and a court hearing was avoided. Months later, however, the settlement agreement broke down, and the father filed a licensing board complaint. The board, in a hurry to resolve cases, did not do a careful investigation and offered Dr. Tripped-Up a consent decree by which, if she admitted giving improper advice, they would simply issue a reprimand. Tripped-Up’s lawyer, who was unfamiliar with the issues and potential consequences, urged her to take the offer without seeking any expert advice. She accepted and was promptly sued by the father, who cited the consent agreement as evidence. embarrassment for the licensing board when it realized that it had unintentionally led Dr. Sucker to breach the man’s confidence. Dr. Tripped-Up was dropped from two man-aged care panels because of disciplinary sanctions by the board. Ironically, she had done nothing wrong except to obtain and accept poor legal advice. The quality of licensing exams and statutes have also been called into question (e.g., Herbsled, Sales, & Overcast, 1985; Koocher, 1979, 1989). It is unreasonable to expect that licensing boards will credential only those who are competent and morally fit. The boards are established primarily to vet candidates against the minimum acceptable threshold of competence and to address complaints. The rules for minimum qualifications are often defined in legislation that boards must follow, and not every incompetent or unsavory practitioner is reported or is the subject of complaints. Because state licensing credentials vary in educational and experiential requirements across profession and state lines, mobility across state lines for psychologists, social workers, and counselors can prove difficult or unrealistic. Herman and Sharer (2013) provided a history of attempts to create national standards for psychologists, but attempts to date have not proven successful. Medicine and nursing have fared better as professions in promoting interstate mobility, and federal policy makers have stated that enhancing practice mobility is a priority. As was discussed in Chapter 4, this will become increasingly important as access to mental health services via telemetry becomes more prevalent. Unlike ethics committees, licensing boards can prevent an unscrupulous and harmful individual from operating with a protected title in the state in which the individual is are licensed. Some also levy fines. This is tremendous power when one realizes that even successful criminal or civil litigation may not prevent a mental health professional from continuing to practice. In balance, the public is well served when a licensing body functions effectively and focuses on its primary role of protecting the public from unqualified and unethical practitioners. For U.S. and Canadian psychologists, the most frequent causes among the 4,397 disciplinary actions during 1983–2009 were (in descending order of frequency) sexual mis-conduct, unprofessional conduct, nonsexual dual relationships, negligence, conviction of a crime, failure to maintain adequate or accurate records, and inadequate or improper super-vision or delegation (Pope & Vasquez, 2011). It has been estimated that as many as 11% of psychologists will have to respond to a licensing board complaint during the course of their careers (Schoenfeld, Hatch, & Gonzales, 2001), and licensing board complaints have become far more frequent than civil lawsuits. However, a good number of complaints, perhaps as high as 50%, are found to be groundless (Van Horn, 2004). Ethics Committees Ethics committees consist primarily of members of the profession—typically experienced and well regarded for their sensitivity to ethical matters—elected or appointed by the governing body of the professional association. Some committees include public members. Committee members serve without pay and, at the state and local levels, often without reimbursement for expenses. Serving on an ethics committee is not an easy duty. The dilemmas commit-tee members face are often extremely difficult because the issues are intricate, the parties to the action are distressed, and the facts of the case are not always clear. The time commitment can be extensive, and the experience itself is often both intense and exhausting. Ethics committees are able to investigate violations at all levels of seriousness, whereas state regulatory boards rarely have sufficient resources or even the inclination to investigate behaviors that may be offensive to professional sensibilities and clearly cross the line but are not likely harmful to the public. For example, a dispute over a publication credit will not likely trigger the interest of an overburdened licensing board staff. It is in such contexts that the ethics committees of professional associations can play a critical role in filling that gap. Many organizations subscribing to an eth-ics code—especially smaller organizations and state-level chapters —no longer adjudicate com-plaints. Instead, these organizations perform primarily educative and consulting functions and refer aggrieved consumers to the national associations or state licensing boards. Some may view ethics codes with no mechanism to back them up as mere window dressing, tooth-less, or possibly even misleading. However, they do set aspirations and expectations for mem-bers, establishing a standard of care for proper conduct. Some state and smaller associations offer consultation and hotlines when a member is facing a dilemma. Some screen applicants for evidence of unethical behavior prior to acceptance. There are understandable reasons why most state professional associations no longer inves-tigate and adjudicate complaints. Objectivity requires and complainants; this was difficult to ensure at the state level, requiring committee mem-bers to often recuse themselves lack of familiarity with respondents (Grenier & Golub, 2009). As complaints became more diverse and complex and as the potential for easy public access to guilty findings increased dramatically, the conclusions reached by ethics committees were more frequently appealed or challenged. Whereas ethics committees were originally intended to serve as the hallmark of a profession—namely, fulfilling an autonomous, monitoring function—accused mental health professionals today more often view the process as adversarial rather than collegial. Legal assistance, outside consultants, liability risk, and associated clerical and duplicating services quickly drain the already-modest budgets of most state and smaller organizations. Some professional associations drop members who have been adjudicated for serious infractions by another legitimate authority. For example, the APA notifies other professional associations, licensing boards, and its members when it expels a member or when one resigns while under ethical scrutiny. If a complaint is received about a member who has been convicted of a felony (or equivalent criminal act) or found by a court of competent authority to have committed mal-practice, has lost a license, and a few other findings of ethical failings as adjudicated by another body, committees may accept such information as prima facie evidence and take action. Thus, the burden of ethics monitoring currently falls largely on national professional organizations, licensing boards, and the courts.

Although ethics committees of professional associations seem uniquely able to pick up some of the slack that other levels of control may be unwilling or unable to handle, whether they always exert a constructive and efficient means of peer control and public protection has also been called into question. Specific criticisms include bias among committee members; lack of training and experience of members to function adequately in a quasi-judicial capacity; conflicts of interest; excessive time taken to adjudicate cases, resulting in possible harm to the public in the interim; insufficient investigatory and other resources to do the job properly; failure to follow due process; timid procedures from fear of lawsuits; reactive rather than proactive procedures; and a bias favoring guild interests and due process rights of respondents over the welfare of the complainants or (conversely) the tendency to take the complainants’ sides while depriving the respondents of due process and an unbiased tribunal. Frustrated complainants can always con-tact lawyers or the media when sources of redress are inefficient or reach unwelcome conclusions