How are conference presentations professionally relevant?
Effective clinical innovations and the dissemination of research findings are key elements in the growth and development of the psychology profession. There are numerous avenues that enable authors to publish and present their work. Poster presentations at conferences are effective methods for communicating research findings and providing opportunities to meet with other researchers and clinicians to discuss the research being presented. Thus, these types of conference presentations play a key role in the proliferation of research.
In this week’s discussion, you will be submitting your proposal for the Week Five Virtual Conference. You may utilize relevant assignments from previous courses in this program or suitable projects from your professional life. See the PSY699 Call for Student Poster (Links to an external site.)Links to an external site. Presentations document for specific parameters and instructions on how to create your proposal. Following the guidelines presented in the document, create your proposal and attach it to your initial post in the discussion forum. Evaluate the impact participating in conference presentations may have on potential work settings and/or doctoral programs and comment on the following questions in your initial post.
- How are conference presentations professionally relevant?
- What elements of the proposal process were most difficult for you, and why?
- What positive outcomes do you anticipate will come from this process, which may be applied to potential work settings and/or doctoral programs?Required Resources
Articles
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Order Paper Now1 .American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments. (Links to an external site.)Links to an external site. Retrieved from http://www.apa.org/ethics/code/index.aspx
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2 .Caplan A. C. (2008). Denying autonomy in order to create it: The paradox of forcing treatment upon addicts . Addiction, 103(12), 1919–21. Retrieved from https://library.ashford.edu/ezproxy.aspx?url=http%3A//search.ebscohost.com/login.aspx?direct=true%2526AuthType=ip,cpid%2526custid=s8856897%2526db=a9h%2526AN=35118770%2526site=ehost-live
· The author of this article makes an argument that client autonomy can still be maintained when treatment is mandated.
3. Manchak, S. M., Skeem, J. L., & Rook, K. S. (2014). Care, control, or both? Characterizing major dimensions of the mandated treatment relationship . Law and Human Behavior, 38(1), 47–57. Retrieved from https://library.ashford.edu/ezproxy.aspx?url=http%3A//search.ebscohost.com/login.aspx?direct=true%2526AuthType=ip,cpid%2526custid=s8856897%2526db=pdh%2526AN=2013-24290-001%2526site=ehost-live
· The study described in this article examines whether mandated treatment relationships involve greater control than traditional treatment relationships. The principles of healthy adult attachment are also explored.
4. Snyder, C. M. J., & Anderson, S. A. (2009). An examination of mandated versus voluntary referral as a determinant of clinical outcome . Journal of Marital and Family Therapy, 35(3), 278–292. doi:10.1111/j.175-0606.2009.00118.x
· The full-text version of this article can be accessed through the ProQuest database in the Ashford University Library. In this article, the authors examine the evidence related to the effectiveness of psychotherapy with mandated clients.
5. Sullivan, M. A., Birkmayer, F., Boyarsky, B. K., Frances, R. J., Fromson, J. A., Galanter, M., . . . Westermeyer, J. (2008). Uses of coercion in addiction treatment: Clinical aspects . American Journal on Addictions, 17(1), 36–47. doi:10.1080/10550490701756369
· The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. While involuntary treatment in health care raises many clinical, cultural ethical, legal, philosophical, and political concerns, evidence exists that it can be an integral component of effective mental health treatment. Various dimensions of mandated treatment are explored in this article.
6.Walker, R., Cole, J., & Logan, T. K. (2008). Identifying client-level indicators of recovery among DUI, criminal justice, and non-criminal justice treatment referrals . Substance Use & Misuse, 43(12/13), 1785–1801. doi: 10.1080/10826080802297484
· The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. This study examined differences in treatment outcomes between mandated and non-mandated clients referred for substance misuse with a focus on client-level factors.
All of the requirement has been download except number 1. Number 1 you can go straight to the internet address.
1.American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments. (Links to an external site.)Links to an external site. Retrieved from http://www.apa.org/ethics/code/index.aspx
2. Addicition
Denying autonomy in order to create it: the paradox
of forcing treatment upon addicts
THE PRIMACY OF AUTONOMY IN
PROVIDER–PATIENT RELATIONSHIPS
American bioethics affords extraordinary respect to
the values of personal autonomy and patient selfdetermination
[1]. Many would argue that the most significant
achievement deriving from bioethics in the past
40 years has been to replace a paternalistic model of
health provider–patient relationships with one that sees
patient self-determination as the normative foundation
for practice. This shift away from paternalism towards
respect for self-determination has been ongoing in behavioral
and mental health as well, especially as it is reflected
in the ‘recovery movement’ [2–4].
As a result of the emphasis placed on patient
autonomy, arguments in favor of mandatory treatment
are rare and often half-hearted. Restrictions on
autonomy are usually grounded in the benefits that will
accrue to others from reining in dangerous behavior [5].
However, anyone who wishes to argue for forced or mandated
treatment on the grounds that society will greatly
benefit is working up a very steep ethical hill.
A person has the fundamental right, well established
in medical ethics and in Anglo-American law, to refuse
care even if such a refusal shortens their own life or has
detrimental consequences for others. Therefore,while the
few proponents of mandatory treatment for those
afflicted with mental disorders or addictions are inclined
to point to the benefit such treatment could have for
society, it is exceedingly unlikely that any form of treatment
that is forced or mandated is going to find any
traction in American public policy on the basis of a consequentialist
argument, great as those benefits might be.
However, is benefit for the greater good the only basis
for arguing for mandatory treatment? Can a case be made
which acknowledges the centrality and importance of
autonomy but which would still deem ethical mandatory
treatment for addicts? I think it can.
INFRINGING AUTONOMY TO
CREATE AUTONOMY
People who are truly addicted to alcohol or drugs really
do not have the full capacity to be self-determining or
autonomous. Standard definitions of addiction cite loss
of control, powerlessness and unmanageability [6]. An
addiction literally coerces behavior.An addict cannot be a
fully free, autonomous agent precisely because they are
caught up in the behavioral compulsion that is addiction.
If this is so, at least for some addicts, then it may be
possible to justify compulsory treatment involving medication
or other forms of therapy, if only for finite periods
of time, on the grounds that treatment may remove the
coercion causing the powerlessness and loss of control.
Addicts, just as many others with mental illnesses and
disabilities, are not incompetent. Indeed, to function as
an alcoholic or cocaine addict onemust be able to reason,
remember complex information, set goals and be orientated
to time, place and personal identity; but competency
by itself is not sufficient for autonomy. Being
competent is a part of autonomy, but autonomy also
requires freedom from coercion [7]. Those who criticize
mandatory treatment on the grounds that an addict is
not incompetent and thus ought not be forced to endure
treatment are ignoring this crucial fact. Addiction, bringing
in its wake as it does loss of will and control, does not
permit the freedom requisite for autonomy or selfdetermination.
If a drug can break the power of addiction sufficiently
to restore or re-establish personal autonomy then mandating
its use might be ethically justifiable. Government,
families or health providers might force treatment in the
name of autonomy. If a drug such as naltrexone is
capable of blocking the ability to become high from
alcohol, heroin or cocaine [8,9], then it may release the
addict from the compulsive and coercive dimensions of
addiction, thereby enhancing the individual’s ability to be
autonomous. If a drug or therapy can remove powerlessness
and loss of control from the addict’s life, then that
fact can serve as an ethical argument allowing the mandating
of treatment. If naltrexone or any other drug can
permit people to make choices freed from the compulsions
or cravings that would otherwise control their behavior
completely, then it would seem morally sound to permit
someone who is in the throes of addiction to regain the
ability to choose, to be self-governing, even if the only
way to accomplish this restoration is through a course of
mandated treatment.
Of course, it would not be ethical to force treatment
upon anyone if there were significant risks involved with
the treatment but new drugs, such as naltrexone, appear
safe and effective for those addicted to heroin and perhaps
cocaine, and should also prove so for alcoholics. The
mechanisms behind the drug are well understood [8,9],
and in some populations this drug has been used for a
long time to reduce the cravings of addiction safely and
EDITORIAL doi:10.1111/j.1360-0443.2008.02369.x
© 2008 The Author. Journal compilation © 2008 Society for the Study of Addiction Addiction, 103, 1919–1921
effectively. Mandating treatment requires that the intervention
carry minimal risk as the patient cannot consent,
but some interventions may be able to meet this admittedly
difficult standard.
Nor would it make moral sense to force treatment
upon someone, restore their autonomy successfully and
then continue to force treatment upon them in their fully
autonomous state. The restoration of autonomy is the
end of any moral argument for mandatory treatment.
Similarly, efforts to restore autonomywould not justify
continuous, open-ended use of drugs or therapy in
addicts. There must be some agreed-upon interval, after
which treatment must be acknowledged to have failed
and other avenues of coping with addiction to alcohol or
drugs pursued.
PRECEDENTS FOR MANDATING
TREATMENT IN THE NAME
OF AUTONOMY
Interestingly enough, despite the emphasis on autonomy
in law and ethics in American health care there are situations
where the ethical acceptability of the rationale of
autonomy restoration in permitting mandatory treatment
is already accepted. Consider what occurs in rehabilitation
medicine. The short-term infringement of
autonomy is tolerated in the name of long-term creation
or restoration of autonomy.
Patients, after devastating injuries or severely disfiguring
burns, often demand that they be allowed to die. They
say: ‘Don’t treat me’, or they may insist that: ‘I can’t live
like this’. In evaluating their requests, no one would be
able to question seriously their competency. They know
where they are. They know what is going on. However,
staff in rehabilitation and burn units almost always
ignore these initial demands. Patient autonomy is not
respected. Why?
What rehabilitation experts say is that they want to
allow an adaptation to the new state of affairs: to the loss
of speech, amputation, facial disfigurement or paralysis.
They know from experience that if they do certain things
with people—train them, counsel them, teach them
adaptive skills—they can encourage them to start to
‘adjust’ [10].
There are, admittedly, still peoplewho say at the end of
a run of rehabilitation: ‘I don’t want to live like this’. The
suicide rate is higher in these populations. Nevertheless,
at least initially, rehabilitation specialists will say that
they have to force treatment on patients because they
know from experience that they can often encourage
them to accept their new state of affairs. The normal
practice of rehabilitation immediately after a severe
injury is to mandate treatment, ignore what patients
have to say, and then seewhat happens. If they still do not
want treatment after a course of rehabilitation then their
wishes will be respected [10].
The rehabilitation model is precisely the model to
follow in thinking about the mandatory use of a drug
such as naltrexone for the treatment of addiction. The
moral basis for mandating treatment is for the good of the
patient by rebirthing their autonomy. How long and
whether someone ought to be able at some point say: ‘I’ve
done this for 6 months, I’m finished, I want to get high
again’ is a challenging problem, but it is not the key one.
The keymoral challenge is to open the door to temporary
mandatory treatment. That can be achieved, ironically,
on the grounds of autonomy. It may press current ethical
thinking to the limit, but mandating treatment in the
name of autonomy is not as immoral as many might
otherwise deem forced treatment to be [7]. Once competency
and coercion are distinguished, it is clear that both
are requisite for autonomy. Mandatory treatment which
relieves the coercive effects of addiction and permits the
recreation or re-emergence of true autonomy in the
patient can be the right thing to do.
Acknowledgement
The author is grateful for the support of the Scattergood
Foundation in writing this essay.
Declaration of interest
None.
Keywords Addiction, autonomy, mandatory treatment,
naltrexone, paternalism, right-to-refuse treatment.
ARTHUR CAPLAN
