There is more to Ethics than Codes of Professional Ethics

Abstract

Alert ethical vision is needed as counseling psychologists and other mental health professionals practice in the context of managed care. New issues and myriad variations of old issues face practitioners. Cooper and Gottlieb (2000 [this issue]) go far in preparing psychologists to apply psychology's code of ethics (American Psychological Association [APA], 1992) when facing the current challenges of managed care.Several years ago, in the early stages of managed care's penetration of health care, my supervisor argued-correctly, I think-that "the crisis is permanent" (M. J. Guerrero, personal communication, 1987). That is, the ways in which health care is organized, managed, and reimbursed will keep changing. (Indeed, Cooper and Gottlieb, 2000, understate some of managed care's current diversity and complexities.) Students and practitioners will therefore need to think through-with regularity and care-the ethical implications of the most recent changes and formulate ethical responses. They also need flexibility, the ability to think critically and broadly, and a deeply rooted ethical sense, one closely connected to, but not limited to, codes of ethics.Cooper and Gottlieb (2000) strike the right balance, I think, between uncritically accepting managed care and demonizing it. As an example of the latter, Shore (1998) argues that managed care is, in its essence, "insane" (p.67) and "immoral" (p. 68). Although Shore points to managed care abuses, she does not acknowledge its advantages or the ethical dimensions of its rise. Whatever the intrinsic merits of managed care, Cooper and Gottlieb's discussion is helpful on purely pragmatic grounds, because many Americans receive psychological services through managed care, and psychologists serving those clients need to do so in optimally ethical ways.Although applying the current code of ethics to managed care is very important, and done well by Cooper and Gottlieb (2000), other, broader ethical dimensions of managed care also merit careful attention. Cooper and Gott-242