Beyond Good Intentions: Identifying and Remediating Ethical Fading

Ethical fading, a concept in decision science, describes how psychologists may gradually lose awareness of the ethical implications of their actions while continuing to believe their decisions and professional conduct are virtuous (Bazerman & Tenbrunsel, 2013). This often unconscious decline in ethical awareness is difficult to detect and address without intentional self-reflection and the consistent practice of ethical vigilance. Within the Ethical Acculturation Model (Handelsman et al., 2005), ethical fading represents a shift from an integrated approach, where personal values align with professional ethics, to a separated approach, where personal values and emotional responses increasingly take precedence over ethical codes, professional duties, and sound clinical judgment. This erosion of an ethical framework weakens decision-making skills and poses significant risks to the therapeutic alliance, patient rights, and clinical outcomes.

Ethical Blind Spots: Why Good Clinicians Lose Ethical Clarity

Ethical fading can begin as an inconspicuous deviation where psychologists gradually lose awareness of the ethical dimensions of their decisions while still perceiving themselves as moral, often occurring unconsciously and shifting their focus from ethical codes to personal values (Tenbrunsel & Messick, 2004). Ethical fading occurs when a psychologist’s professional role, which is rooted in research, standards, and ethics, conflicts with self-interest driven by personal convictions, unmet needs, and cognitive biases. In practice, ethical fading often starts subtly as psychologists increasingly prioritize factors like their emotional needs, personal moral imperatives, and worldview, causing critical ethical considerations to fade from the forefront of their decision-making.  In essence, ethical fading occurs when psychologists elevate their own needs over their patients’ well-being, while rationalizing these actions as beneficial to the patient.

Ethical fading can systematically undermine respect for patient autonomy through the gradual erosion of appropriate therapeutic boundaries as clinicians increasingly substitute their own judgment for their patients’ self-determination. This process often begins subtly, with seemingly helpful statements like “If I were you, I’d choose this option.” While this approach may appear therapeutic, it actually diminishes the patient’s agency by positioning the psychologist as the expert on the patient’s life decisions. More problematically, “intrusive advocacy” can involve promoting specific ideological positions, whether political, religious, or cultural, that reflect the psychologist’s worldview rather than exploring the patient’s own values and beliefs (Sonne & Pope, 1991). Consider this vignette: Dr. Williams began offering increasingly directive advice to patients about relationship decisions, career choices, and even voting preferences, rationalizing these interventions as “cutting through resistance” and being “more efficient than endless processing.” Over time, this approach creates a subservient dynamic where patients defer to the psychologist’s opinions rather than developing their own decision-making capacities. The psychologist may defend this pattern as being “supportive” or “results-oriented,” failing to recognize how it systematically weakens patient autonomy and self-efficacy. This power dynamic represents a clear deviation from core ethical principles. Along with issues related to autonomy, it violates beneficence by potentially harming the patient’s psychological development, compromises nonmaleficence by stifling personal growth, and fundamentally undermines the therapeutic relationship’s foundation of trust and respect.

Consider this second example: Dr. Johnson, facing financial pressures, has been working to reduce his caseload of Medicaid patients to free up time for private-pay clients. He implements an intensive exposure therapy protocol with Maria, a patient presenting complex developmental trauma including childhood abuse and significant emotion dysregulation difficulties. Dr. Johnson is motivated to conclude Maria’s treatment quickly to open the session slot, rationalizing the accelerated approach as “efficient” and adhering to a “pure” exposure model, thereby ignoring the need for prior stabilization. However, current research and practice guidelines emphasize the importance of individualizing treatment for complex PTSD and assessing patient stability, with phase-based approaches prioritizing safety, symptom reduction, and enhancing emotional and social skills before intensive trauma processing (APA, 2025; Lewis et al., 2023). When Maria reports escalating panic attacks, severe sleep disruption, and new avoidance behaviors that significantly exceed the expected temporary distress during exposure therapy, Dr. Johnson minimizes these warning signs as “temporary activation” and continues the protocol unchanged. Rather than modifying his approach in response to clear indicators of treatment-induced deterioration, he rationalizes general efficacy research on exposure therapy for PTSD while ignoring its specific contraindications and the evidence for phase-based care for complex trauma. This exemplifies ethical fading because financial incentives gradually erode clinical judgment, compromising both nonmaleficence and fidelity through a series of seemingly small but ultimately significant compromises in professional standards.

Eroded Boundaries, Diminished Care: Outcomes of Ethical Fading

Multiple psychological mechanisms contribute to ethical fading in psychological practice. Psychologists may, often unintentionally, employ various cognitive strategies that allow them to compartmentalize or distance themselves from ethical considerations (Tjeltveit & Gottlieb, 2010). Below are several such distortions that can lead to ethically compromised decision-making.

Motivated moral reasoning refers to a cognitive process in which individuals’ moral judgments are shaped by their desires, preferences, or self-interests, rather than by an impartial evaluation of the situation (Ditto et al., 2009). In psychotherapy, the inherent power imbalance between psychologist and patient makes motivated moral reasoning particularly problematic. Psychologists have a fiduciary responsibility to adopt a patient-centered approach. However, when faced with a clinical dilemma, a psychologist may prematurely decide what is in the patient’s best interest without adequately understanding the patient’s value system or appreciating the importance of working through the emotional issues collaboratively. This can lead to a paternalistic misuse of motivated moral reasoning, where the psychologist imposes their own beliefs and priorities rather than respecting those of the patient.

Decision framing is a cognitive process in which individuals interpret or categorize a decision based on the context or perspective from which they view it (Tenbrunsel & Messick, 2004). Psychologists may inadvertently diminish the salience of ethical considerations by categorizing decisions as primarily clinical, administrative, or business-related, thereby activating distinct, non-ethical frameworks for decision-making (Rees, et al., 2022). This cognitive framing can effectively obscure the inherent ethical dimensions of a situation. For instance, a psychologist might frame a decision to extend a patient’s treatment solely as a clinical matter, overlooking the significant ethical implications related to the necessity of continued treatment and the patient’s right to autonomy in making such choices.

Ethical blindness, closely related to decision framing, refers to the failure to recognize that a situation carries ethical implications (Bazerman & Tenbrunsel, 2013). This process reflects a form of selective attention in which the ethical dimensions of a decision are overlooked or fail to register. For example, a newly licensed psychologist working in a system that prioritizes manualized interventions for specific diagnoses may become so focused on following prescribed steps and tracking adherence that they miss the ethical significance of disregarding a patient’s cultural background, individual needs, or emerging concerns outside the protocol. In such cases, deviating from the manual may be perceived as a failure to provide evidence-based care, rather than an ethical responsibility to adapt treatment to the patient’s circumstances. This rigid adherence can result in ineffective or even harmful outcomes.

Cognitive Dissonance Reduction is a psychological phenomenon where individuals experience discomfort (dissonance) when holding conflicting beliefs, values, or attitudes, or when their behavior is inconsistent with their self-concept (Tavris & Aronson, 2020). To reduce this discomfort, individuals often engage in rationalizations that minimize the perceived conflict. Consider a psychologist who begins to regularly extend therapy sessions beyond the agreed-upon time for a patient who is particularly engaging, rationalizing it as providing extra support and clinically necessary. Initially, the psychologist might feel some unease about the potential for boundary crossings or inequitable treatment of other patients. However, to reduce this cognitive dissonance, they might start to believe that this particular client genuinely needs the extra time, that it’s a minor exception, or that their dedication justifies the extended sessions (Tjeltveit & Gottlieb, 2010). Over time, this self-deception can lead to ethical fading, where the psychologist no longer recognizes the ethical implications of their actions regarding time boundaries, potential dependency, and fairness to other clients.