Thursday, November 18, 2010

The Worst Clinical Ethics Textbook Ever?

This post is going to be a great deal more vulgar than my usual fare. I apologize, but I've been having a great deal of difficulty in restraining myself over this matter, and I really need to vent.

Moreover, I literally lack the words to adequately express my revulsion. Sometimes, "Ugh" doesn't cut it.

You see, I'm taking my program's clinical ethics class this semester. Our textbook is Corey, Corey, & Callanan's Issues and Ethics in the Helping Professions, eighth edition. In other words, this book.

As the title of this blog entry suggests, I don't like it very much. It's just... incredibly bad. To be honest, "bad" doesn't really cut it here. I mean, the book even says that I'm not human.

No, I'm not joking. The relevant quote is at the bottom of Page 93:

Spirituality is an essential quality of being human, and Allen Weber believes it must be addressed in whatever form is appropriate in counseling [Emphasis added].

An "essential quality" is a defining quality. Something without an essential quality of X isn't X -- and something which has all of the essential qualities of X is X. To say that spirituality is an essential quality of being human is to say that anyone or anything lacking spirituality is not human.

It would be far less offensive if the authors had written that spirituality is an essentially human quality (i.e. that only humans are spiritual), but the context makes it abundantly clear that this is not what they mean: in Corey et al.'s view, apparently, atheists aren't human.

No, I'm not an atheist (at least by the most common definitions), but I share an atheistic lack of spirituality (and, in fact, go a great deal further than many, as an upcoming Symphony of Science video helps illustrate). As such, I'm apparently not human.

I regard this sort of statement as blatantly unethical conduct in the writing of a clinical ethics textbook. How the hell did this get past the editors?

Of course, this is just one line in a 587-page book. If this was just an isolated problem, I wouldn't be nearly so frustrated. Unfortunately, however, it's not. The problems start far earlier... with the book's very definition of ethics.

"Ethics" is defined on Page 14. There are three statements which can be considered defining:

... ethics pertains to the beliefs we hold about what constitutes right

Ethics are moral principles adopted by an individual or group to provide rules
for right conduct.

And, finally:

Ethics represents aspirational goals, or the maximum or ideal standards set by the profession, and they are enforced by professional associations, national certification boards, and government board that regulate professions. Codes of ethics are conceptually broad in nature and generally subject to interpretation by practitioners. Although these minimum and maximum standards may differ, they are not necessarily in conflict.

I've shown these quotes to several actual ethics professors. "What the fuck?" was the most common response.

You see, that's not what ethics is. Ethics is the branch of philosophy concerned with the evaluation of human conduct. Ethics is the study of what is right and wrong, the study of how we should act and how we should treat our fellow human beings.

By contrast, this book defines "ethics" as "following the rules set by your profession". What the Hell?

I could go on and on about the flaws in this book. These include its "discussion" of the issues surrounding proxy consent (it doesn't exist), its discussion of the issues surrounding involuntary committment (which boils down to, "consult with your colleagues and follow the law"), and many, many others. I just wouldn't be able to post this review in a reasonable timeframe if I did.

All of this raises a very important overarching issue, however: this book is being used to educate clinical professionals (who often likely never get much education beyond what's in the book). A substandard clinical ethics textbook promotes substandard and unethical treatment of clients -- meaning that it hurts and even kills people. As such, I have to conclude that both the publication and use of this textbook (qua textbook) is highly unethical.

In conclusion, however, I suppose I should revisit the headline of this post and ask the inevitable question: is this the worst clinical ethics textbook ever?

I don't know. I sincerely hope I am never in a position to test that hypothesis.

Edit: Corrected a couple of typos.


  1. Hope to see the Symphony of Science film pretty soon.

    Spirituality is an essential (=defining) quality of being human?

    Ethics are aspirational goals? If the profession isn't there, is there still a need for the rules? Do the rules live past the profession?

    (cf: "Rules must be good enough to live past their makers". Poulter [1993] The beginning of the law).

    "Beliefs" and "evaulation" are lightly and vaguely connected (in this book's epistemic universe).

    "A substandard clinical ethics textbook promotes substandard and unethical treatment of clients -- meaning that it hurts and even kills people."

    Yes. Books hurt and kill people. At least a how to make a bomb book is honest in its intentions.

  2. Adelaide,

    Are you referring to the Symphony of Science videos? If you are, they're pretty easy to get online (and are really, really cool).

    As for the rules... rules pertaining to a role exist only as long as the role does -- they're rendered obsolete when the role no longer exists. On the other hand, the considerations underlying them are another matter... and THOSE are what the book skimps on.

  3. Alexander:

    Yes, was referring to the Symphony videos.

    So far I have seen Poetry of Reality and We are all connected.

    I think I will ask now: "What are the considerations?"

  4. Generally speaking, each line of the ethics codes is a result of careful reasoning (and, usually, vigorous debate) from certain basic principles (look up "bioethics" for an explanation; they'll be listed and explained almost anywhere).

    Note the parenthetical "usually vigorous debate". A good ethics text will give you the tools you need to understand these debates; Corey et al. doesn't even try. I'm not quite sure how to briefly elaborate beyond this (lengthy elaboration would take too long and I need to go to sleep), so I'll stop here.

    Also -- regarding Symphony of Science, I've met the guy who made them. He's pretty interesting, and the videos are... really, really cool (as I said above). Actually, Poetry of Reality is my favorite... although another one (which should hopefully be coming out relatively soon) comes close. Sorry that I can't remember its title...

  5. OK, I went and looked at the book. While it certainly is far from a definitive book on ethics, I'm not sure that it qualifies as the worst example of ethics writing, either.

    In terms of "spirituality", I think if one accepts a broader definition, such as this one from a free online dictionary

    internality, inwardness - preoccupation with what concerns human inner nature (especially ethical or ideological values); "Socrates' inwardness, integrity, and inquisitiveness"- H.R.Finch

    that you might even feel that you do, indeed, possess "spirituality".

    In terms of their definitions of ethics, I think the problem lies with them conflating ethics as a philosophical pursuit, and ethical codes of conduct. What they are mainly talking about are ethical codes of conduct, and not philosophy. When taken in that light, their statements make a bit more sense.

    In looking at some of the other sections in the book, they give at least some space to considering diversity, and how it needs to be considered more. So I'm not prepared to write off the entire book.

    But yes, this is hardly a groundbreaking or seminal text on ethics.


  6. Joe,

    The comment about spirituality is in the context of a discussion about the importance of involving the client's religious beliefs in therapy. A "broader definition" is not applicable -- the context makes the meaning readily apparent.

    As for the rest of the book -- as I note above, the book skimps (EXTENSIVELY) in understanding WHY the ethics codes are the way they are. A person who learned solely from the book would have no understanding whatsoever of the various controversies and disputes in modern clinical ethics. They would have no understanding whatsoever of the ethical considerations that went into writing the ethics codes (and why various people DISAGREE with them). Etc., etc., etc.

  7. When people are sick, or stressed, I find that it's important for them to put decisions into the context of their lives. This context may include religious beliefs, a general belief in a higher power not grounded in a particular religion, other beliefs on what it means to be a member of the human race, or even a belief in The Flying Spaghetti Monster.

    I consider all of the above as subsumed under the greater heading of "spirituality", and still don't see the book's statement as being particularly egregious. Teachings like this are fairly common in clinical ethics classes. The point is to a) not impose your own world belief on the patient, b) realize that whatever is happening with the patient takes place in a much greater context, which involves whatever their world view is, as well as the relationships they have with family and friends, and c) assist the patient in putting whatever the current problem/situation is into whatever core values they hold, so they can make a decision that is good for them.

    The book appears to be a brief "how to" book, and the authors (as I noted) seem to be light in terms of their ethics credentials. We agree that these are no Socrates, Locke, or Childress here. Still, I still think the "spirituality" objection is perhaps not so bad, afterall


  8. Joe,

    If they were just arguing that you shouldn't impose your beliefs on clients, arguing for the importance of broader context, etc., I'd agree with you. As I've observed, however, they were not.

    Besides which, that one quote wasn't anywhere near central to my objections to the book. it's phenomenally *bad* on so many levels that it's not even funny. That quote was just one example of *many*, and selected mostly because of how easy it is to quote (and explain).

  9. Hi, Alex.

    I certainly haven't read the book, and don't plan to. I'll take your word on the rest of it.

    Take care.