Résumés
Résumé
Bien que l’étude du jugement moral ait gagné en popularité ces dernières années dans le domaine de la psychologie, peu de recherches se sont intéressées aux dilemmes de confidentialité en contexte de jugement moral. Or, les personnes cliniciennes font régulièrement face à de tels dilemmes qui surviennent souvent dans des contextes chargés émotionnellement. Cette étude évalue le rôle des émotions dans les réponses à ces dilemmes de confidentialité. En tout, 186 participants étudiant en psychologie dans différentes universités du Québec ont été assignés aléatoirement à l’un des trois groupes d’un devis expérimental (modalité audio dramatique, modalité audio neutre, modalité texte) et ont répondu à des dilemmes de confidentialité en choisissant entre la protection ou la levée de la confidentialité. Le positionnement des participants sur un continuum allant du déontologisme à l’utilitarisme, grâce à la réponse à des dilemmes sacrificiels, a également été pris en considération. Le modèle de régression linéaire multiple hiérarchique utilisé indique un apport significatif provenant des réponses aux dilemmes sacrificiels, de l’intensité émotionnelle perçue des dilemmes de confidentialité et de la formation obtenue dans le domaine de l’éthique et de la déontologie. L’analyse révèle en outre l’effet modérateur de l’exposition à la condition expérimentale sur la relation entre la tendance à l’utilitarisme et la propension à la levée de la confidentialité dans une relation psychothérapeutique. Ces résultats ont des implications pratiques concernant le cursus en psychologie, où des mises en situation avec une validité écologique pourraient bonifier la formation en éthique.
Mots-clés :
- jugement moral,
- confidentialité,
- dilemmes moraux,
- tonalité émotionnelle,
- levée de la confidentialité
Abstract
Although the study of moral judgment has gained in popularity in the field of psychology in recent years, little research has focused on confidentiality dilemmas in the context of moral judgment. Yet clinicians regularly face such dilemmas, which often arise in emotionally charged contexts. This study assesses the role of emotions in responses to these confidentiality dilemmas. A total of 186 participants studying psychology at different universities in Quebec were randomly assigned to one of three groups in an experimental design (dramatic audio modality, neutral audio modality, text modality) and responded to confidentiality dilemmas by choosing between protecting or lifting confidentiality. Also taken into consideration were participants’ positioning on a continuum ranging from deontology to utilitarianism, based on their response to sacrificial dilemmas. The hierarchical multiple linear regression model used indicates a significant contribution from responses to sacrificial dilemmas, perceived emotional intensity of confidentiality dilemmas and training obtained in the field of ethics and deontology. The analysis further reveals the moderating effect of exposure to the experimental condition on the relationship between the tendency towards utilitarianism and the propensity to waive confidentiality in a psychotherapeutic relationship. These results have practical implications for psychology curricula, where situation scenarios with ecological validity could enhance ethics training.
Keywords:
- moral judgment,
- confidentiality,
- moral dilemmas,
- emotional tone,
- lifting confidentiality
Parties annexes
Bibliographie
- 1. Haidt, J. The emotional dog and its rational tail: a social intuitionist approach to moral judgment. Psychological Review. 2001;108(4):814-34.
- 2. Kohlberg, L. Moral stages and moralization. Dans: Lickona T, éditeur. Moral development and behavior: Theory, research and social issues. Hot, Rinehart and Winston; 1976. p. 170-205.
- 3. Greene JD, Sommerville RB, Nystrom LE, Darley JM, Cohen, JD. An fMRI investigation of emotional engagement in moral judgment. Science. 2001;293(5537):2105-8.
- 4. Trémolière B, Bonnefon JF. Efficient kill-save ratios ease up the cognitive demands on counterintuitive moral utilitarianism. Personality and Social Psychology Bulletin. 2014;40(7):923-30.
- 5. Greene JD, Nystrom LE, Engell AD, Darley JM, Cohen JD. The neural bases of cognitive conflict and control in moral judgment. Neuron. 2004;44(2):389-400.
- 6. Greene JD. Why are VMPFC patients more utilitarian? A dual-process theory of moral judgment explains. Trends in Cognitive Sciences. 2007;11(8):322-23.
- 7. Greene JD, Morelli SA, Lowenberg K, Nystrom LE, Cohen JD. Cognitive load selectively interferes with utilitarian moral judgment. Cognition. 2008;107(3):1144-54.
- 8. Koenigs M, Young L, Adolphs R, et al. Damage to the prefrontal cortex increases utilitarian moral judgements. Nature. 2007;446(7138):908-11.
- 9. Bartels DM, Pizarro DA. The mismeasure of morals: Antisocial personality traits predict utilitarian responses to moral dilemmas. Cognition. 2011;121(1):154-61.
- 10. Djeriouat H, Trémolière B. The Dark Triad of personality and utilitarian moral judgment: The mediating role of honesty/humility and harm/care. Personality and Individual Differences. 2004;67(1):11-16.
- 11. Valdesolo P, DeSteno D. Manipulations of emotional context shape moral judgment. Psychological Science. 2006;17(6):476-77.
- 12. Strohminger N, Lewis RL, Meyer DE. Divergent effects of different positive emotions on moral judgment. Cognition. 2011;119(2):295-300.
- 13. Greene JD, Cushman FA, Stewart LE, Lowenberg K, Nystrom LE, Cohen JD. Pushing moral buttons: The interaction between personal force and intention in moral judgment. Cognition. 2009;111(3):364-71.
- 14. Kant I. Foundation of the metaphysics of morals (traduit par L. W. Beck). Bobbs-Merrill; 1959. (Ouvrage original publié en 1785).
- 15. Mill JS. Utilitarianism. Andrews UK; 2011. (Ouvrage original publié en 1863).
- 16. Bartels DM. Principled moral sentiment and the flexibility of moral judgment and decision making. Cognition. 2008;108(2):381-417.
- 17. Moore AB, Clark BA, Kane MJ. Who shalt not kill? Individual differences in working memory capacity, executive control, and moral judgment. Psychological Science. 2008;19(6):549-57.
- 18. Côté S, Piff PK, Willer R. For whom do the ends justify the means? Social class and utilitarian moral judgment. Journal of Personality and Social Psychology. 2013;104(3):490-503.
- 19. Piff PK, Kraus MW, Côté S, Cheng BH, Keltner D. Having less, giving more: The influence of social class on prosocial behavior. Journal of Personality and Social Psychology. 2010;99(5):771-84.
- 20. Stellar JE, Manzo VM, Kraus MW, Keltner D. Class and compassion: Socioeconomic factors predict responses to suffering. Emotion. 2012;12(3):449-59.
- 21. Gleichgerrcht E, Young L. Low levels of empathic concern predict utilitarian moral judgment. PloS One. 2013;8:4.
- 22. Szekely RD, Miu AC. Incidental emotions in moral dilemmas: The influence of emotion regulation. Cognition and Emotion. 2015;29(1):64-75.
- 23. Bauman CW, McGraw AP, Bartels DM, Warren C. Revisiting external validity: Concerns about trolley problems and other sacrificial dilemmas in moral psychology. Social and Personality Psychology Compass. 2014;8(9):536-54.
- 24. Körner A, Joffe S, Deutsch R. When skeptical, stick with the norm: Low dilemma plausibility increases deontological moral judgments. Journal of Experimental Social Psychology. 2019;84:103834.
- 25. Pope KS, Vetter VA. Ethical dilemmas encountered by members of the American Psychological Association: A national survey. American Psychologist. 1992;47(3):397-411.
- 26. Barret B, Kitchener KS, Burris S. Suicide and confidentiality with the client with advanced AIDS: The case of Phil. Dans: Anderson JR, Barret B, éditeurs, Ethics in HIV-Related Psychotherapy: Clinical Decision Making in Complex Cases. American Psychological Association; 2001. p. 299-314.
- 27. Chenneville T, Gabbidon K. HIV, confidentiality, and duty to protect: Considerations for psychotherapists in the age of treatment as prevention. Psychotherapy. 2019;57(1):7-14.
- 28. Duncan RE, Hall AC, Knowles A. Ethical dilemmas of confidentiality with adolescent clients: case studies from psychologists. Ethics & Behavior. 2015;25(3):197-221.
- 29. Jain S, Roberts LW. Ethics in psychotherapy: A focus on professional boundaries and confidentiality practices. Psychiatric Clinics. 2009;32(2):299-314.
- 30. Kampf A, McSherry B, Thomas S, Abrahams H. Psychologists’ perceptions of legal and ethical requirements for breaching confidentiality. Australian Psychologist. 2008;43(3):194-204.
- 31. Ordre des psychologues du Québec. Guide explicatif concernant le code de déontologie des psychologues du Québec. Juillet 2008.
- 32. Ordre des psychologues du Québec. Code de déontologie des psychologues. Novembre 2022.
- 33. Éducaloi. La renonciation et les exceptions au secret professionnel. 2023.
- 34. Moyer M, Sullivan J. Student risk-taking behaviors: When do school counselors break confidentiality? Professional School Counseling. 2008;11(4):236-45.
- 35. Clark C. Against confidentiality? Privacy, safety and the public good in professional communications. Journal of Social Work. 2006;6(2):117-36.
- 36. Taylor L, Adelman HS. Confidentiality: Competing principles, inevitable dilemmas. Journal of Educational and Psychological Consultation. 1998;9(3):267-75.
- 37. Younggren JN, Harris EA. Can you keep a secret? Confidentiality in psychotherapy. Journal of Clinical Psychology. 2008;64(5):589-600.
- 38. Ametrano IM. Teaching ethical decision making: Helping students reconcile personal and professional values. Journal of Counseling & Development. 2014;92(2):154-61.
- 39. Guedj M, Sastre, MTM, Mullet E, Sorum PC. Is it acceptable for a psychiatrist to break confidentiality to prevent spousal violence? International Journal of Law and Psychiatry. 2009;32(2):108-14.
- 40. Matisson M. Ethical decision making: The person in the process. Social Work. 2000;45(3):201-12.
- 41. Wiener J. Confidentiality and paradox: the location of ethical space. Journal of Analytical Psychology. 2001;46(3):431-42.
- 42. Duncan RE, Williams BJ, Knowles A. Breaching confidentiality with adolescent clients: A survey of Australian psychologists about the considerations that influence their decisions. Psychiatry, Psychology and Law. 2012;19(2):209-20.
- 43. Sharp PM, Hahn BH. Origins of HIV and the AIDS pandemic. Cold Spring Harbor Perspectives in Medicine. 2011;1(1):a006841.
- 44. ONUSIDA. Fiche d’information – Dernières statistiques sur l’état de l’épidémie de sida. 2022.
- 45. Gouvernement du Canada. VIH et sida : symptômes et traitement. Janvier 2022.
- 46. Andrade-Rivas F, Romero M. Misinformation about HIV and negative attitudes toward homosexuality and same-sex couples’ rights: The case of Colombia. International Journal of Public Opinion Research. 2017;29(3):426-48.
- 47. Goossens I, Vargen LM, Wedman M, Connolly DA. Criminalization of HIV: Ethical and legal issues for the practice of psychology in Canada. Canadian Psychology/Psychologie Canadienne. 2021;62(3):304-17.
- 48. Rose ID, Friedman, DB. HIV information needs of parents of young men who have sex with men. Health Information & Libraries Journal. 2016;33(4):308-22.
- 49. American Psychological Association. Legal liability related to confidentiality and the prevention of HIV transmission. Le Conseil des représentants de l’APA. 1991.
- 50. Chenneville T. HIV, confidentiality, and duty to protect: A decision-making model. Professional Psychology: Research and Practice. 2000;31(6):661-70.
- 51. Lehman JS, Carr MH, Nichol AJ, et al. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS and Behavior. 2014;18(6):997-1006.
- 52. Maes L, Lievens J. Can the school make a difference? A multilevel analysis of adolescent risk and health behaviour. Social Science & Medicine. 2003;56(3):517-29.
- 53. Mendes SA, Nascimento IM, Abreu-Lima IM, Almeida LS. A study of the ethical dilemmas experienced by school psychologists in Portugal. Ethics & Behavior. 2016;26(5):395-414.
- 54. Lazovsky R. Maintaining confidentiality with minors: Dilemmas of school counselors. Professional School Counseling. 2008;11(5):335-46.
- 55. Rae WA, Sullivan JR, Razo NP, George CA, Ramirez E. Adolescent health risk behavior: When do pediatric psychologists break confidentiality? Journal of Pediatric Psychology. 2002;27(6):541-49.
- 56. Rae WA, Sullivan JR, Razo NP, de Alba, RG. Breaking confidentiality to report adolescent risk-taking behavior by school psychologists. Ethics & Behavior. 2009;19(6):449-60.
- 57. Moyer MS, Sullivan JR, Growcock D. When is it ethical to inform administrators about student risk-taking behaviors? Perceptions of school counselors. Professional School Counseling. 2012;15(3):98-109.
- 58. Froeschle J, Moyer M. Just cut it out: Legal and ethical challenges in counseling students who self-mutilate. Professional School Counseling. 2004;7(4):231-25.
- 59. Aulbach P. Attitudes of psychologists in regard to prevailing arguments for and against rational suicide as an option for the terminally ill. [Thèse de doctorat inédite]. Université de Spalding, Louisville, KY; 1997.
- 60. Fenn DS, Ganzini L. Attitudes of Oregon psychologists toward physician-assisted suicide and the Oregon Death with Dignity Act. Professional Psychology: Research and Practice. 1999;30(3):235-44.
- 61. Werth JL Jr. Rational Suicide? Implications for Mental Health Professionals. Taylor & Francis; 1996.
- 62. Werth JL Jr, Liddle BJ. Psychotherapists’ attitudes toward suicide. Psychotherapy: Theory, Research and Practice. 1994;31(3):440-48.
- 63. American Psychological Association. Ethical principles of psychologists and code of conduct. American Psychologist. 1992;47(1):1597-1611.
- 64. Provencher-Renaud G, Larivée S, Sénéchal C. L’accès à l’aide médicale à mourir pour les personnes souffrant de troubles mentaux. Annales médico-psychologiques. 2019;177(8):801-8.
- 65. Higgs C, McIntosh T, Connelly S, Mumford M. Self-focused emotions and ethical decison-making: Comparing the effects of regulated and unregulated guilt, shame, and embarrassment. Science and Engineering Ethics. 2020;26(1):27-63.
- 66. Johnson G. Emotions and sensemaking: How anger, guilt, and emotion regulation impact ethical decision making. [Thèse de doctorat inédite]. University of Oklahoma, OK, États-Unis; 2015.
- 67. Johnson JF, Connelly S. Moral disengagement and ethical decision-making: The moderating role of trait guilt and shame. Journal of Personnel Psychology. 2016;15(4):184-89.
- 68. Kligyte V, Connelly S, Thiel C, Devenport L. The influence of anger, fear, and emotion regulation on ethical decision making. Human Performance. 2013;26(4):297-326.
- 69. Motro D, Ordóñez LD, Pittarello A, Welsh DT. Investigating the effects of anger and guilt on unethical behavior: A dual-process approach. Journal of Business Ethics, 2018;152(1):133-48.
- 70. Thiel C, Connelly S, Griffith J. The influence of anger on ethical decision making: comparison of a primary and secondary appraisal. Ethics & Behavior. 2011;21(5):380-403.
- 71. Walton KC. An examination of the factors related to the ethical decision-making process of MH professionals. [Thèse de doctorat inédite]. Université de Capella, MN, États-Unis; 2007.
- 72. Bhola P, Sinha A, Sonkar S, Raguram A. Ethical dilemmas experienced by clinical psychology trainee therapists. Indian Journal of Medical Ethics. 2015;12(4):206-12.
- 73. Evans AM, Heller Levitt D, Henning S. The application of ethical decision-making and self-awareness in the counselor education classroom. Journal of Counselor Preparation and Supervision. 2012;4(2):41-51.
- 74. Bashe A, Anderson SK, Handelsman MM, Klevansky R. An acculturation model for ethics training: The ethics autobiography and beyond. Professional Psychology: Research and Practice. 2007;38(1):60-67.
- 75. Eells TD, Lombart KG, Kendjelic EM, Turner LC, Lucas CP. The quality of psychotherapy case formulations: A comparison of expert, experienced, and novice cognitive-behavioral and psychodynamic therapists. Journal of Consulting and Clinical Psychology. 2005;73(4):579-89.
- 76. Mayfield WA, Kardash CM, Kivlighan Jr DM. Differences in experienced and novice counselors’ knowledge structures about clients: Implications for case conceptualization. Journal of Counseling Psychology. 1999;46(4):504-14.
- 77. Ruedy NE, Schweitzer ME. In the moment: The effect of mindfulness on ethical decision making. Journal of Business Ethics. 2010;95(1):73-87.
- 78. Burwell-Pende L, Halinski, KH. Enhanced awareness of countertransference. Journal of Professional Counseling: Practice, Theory, and Research. 2008;36(1):38-59.