Ethics: Making Critical Decisions in TreatmentPatricia Sherman, Ph.D., LCSW
An 18-year old adolescent who is 4 months pregnant has contacted you several times in regard to planning for her child. In her last visit, she confided to you that she is habituated to heroin. You have expressed your concern that the drug may damage her unborn child, but she does not seem worried nor does she want to give up use of the drug. You also know that she obtains money for heroin through prostitution and is not attending school.
You are an agency social worker whose Cuban client has just told you she is HIV positive. She is in a monogamous relationship and has two young children. She does not plan to tell her partner about her HIV status, fearing that this knowledge would cause the relationship to break up. She says she and her partner do not utilize safer sex practices and that she could never ask him to use a condom, as that would hurt his pride and cause him to become suspicious.
Purposes of the NASW Code of Ethics(Stone, 2004) • Identifies core values on which social work’s mission is based • Summarizes broad ethical principles that reflect the profession’s core values and establishes ethical standards to guide social work practice
Is designed to help social workers identify relevant considerations when professional obligations conflict or ethical uncertainties arise • Provides ethical standards to which the general public can hold the social work profession accountable
Socializes practitioners new to the field to social work’s mission, values, ethical principles, and ethical standards • Articulates standards that the social work profession itself can use to assess whether social workers have engaged in unethical conduct
Provides practitioners with guidance when faced by practice dilemmas that include ethical issues • Protects the public from charlatans and incompetent practitioners • Protects the profession from governmental control; self-regulation is preferable to state regulation
Enables professional colleagues to live in harmony with each other by preventing the self-destruction that results from internal bickering • Protects professionals from litigation; practitioners who follow the Code are offered some protection in suits for malpractice
Social work Ethical Principles • Primary goal is to help people in need and to address social problems • Challenge social injustice • Respect the inherent dignity and worth of the person
Recognize the central importance of human relationships • Behave in a trustworthy manner • Practice within areas of competence and develop and enhance professional expertise
Acceptance • Individualization • Purposeful expression of feelings • Nonjudgmental attitudes
Objectivity • Controlled emotional involvement • Self-determination • Access to resources • Confidentiality and accountability
Begin With Values Societal Values – Professional Values – Client Values – Personal Values –
Values VALUEis the reality in the inner core of a person which: • shapes one’s ideas • conditions one’s feelings • affects one’s behavior (Simon, Values Clarification, 1970, p. 25) Whether recognized or unrecognized, values are essential to professional action and to any conception of practice theory
Are implicit and explicit about what we cherish as ideal and preferable • Determine which goals and actions we evaluate as “good” • Shape our beliefs and our attitudes and, in turn, our beliefs and attitudes shape our values
Define norms or guidelines for behavior • Laden with emotions • Influence our evaluations of situations and motivate the actions we take
Social Justice Values(Catechism of the catholic church, 1994, catholic conference of the united states bishops, 1995, himchak, 2007) Life and dignity of the human person Call to family Community and participation
Rights and responsibilities Option for the poor, the vulnerable, and people at risk Dignity of work and the rights of workers Solidarity and care for God’s creation
Values shared by all helping professions • Autonomy • Nonmaleficence – do no harm • Beneficence – promote good • Justice • Fidelity – create trusting relationship • Veracity – be truthful
Common Social Work Values • Promotion of the client ‘s well-being and individual dignity • Self-determination • The right to have basic needs met
The right to actualize one’s full potential • Client empowerment • Human diversity • Social and economic justice
Values specific to work area • Child welfare • Protection of children • Preservation of families • Respect for families • Diligence – “hanging in there” with difficult situations
culture • When do cultural/religious values of clients create ethical concerns? • When do cultural/religious values of social workers create ethical concerns?
Scale of social distance • What’s your first response? • On what are you basing your response? • What values does your response reflect? • What feelings do you have about your response?
Cognitive dissonance(Taylor, 2007) • Feeling of discomfort arising from the conflict between professional and/or personal values and job tasks • Social workers have to make decisions that both protect society and maximize the rights of the individual • Strongest when a cognition related to self-concept conflicts with a cognition about behavior
Potential problem areas (IFSW, IASSW) • Social worker’s loyalty often in the middle of conflicting interests • Social workers function as both helpers and controllers • Conflicts between duty to protect clients’ interests and societal demands for efficiency and utility • Limited resources
SOCIAL WORKER’S ETHICAL RESPONSIBILITY TO SOCIETY • The social worker should promote the general welfare of society • The social worker should act to ensure that all person have access to the resources, services, and opportunities which they require • The social worker should advocate changes in policy and legislation to improve social conditions and to promote social justice
Moral questions for the Profession • What are the clients’ rights as individuals? • What are their obligations to their families? • Under what circumstances is it permissible to support the breaking up of a family?
Under what circumstances is it legitimate to override client self-determination (e.g., clients with mental illness who will not take medication)? • Is coercion justified in any given case? How far and when is individual dependency a public responsibility; how far and when a private responsibility?
In what circumstances, if any, should the client’s confidence be violated by the social worker? • Should the social worker ever be responsible for law enforcement?
ETHICS The study of rightness and wrongness of human conduct (Varga, 1980, p. ix). It is that part of a moral philosophy that concerns relationships between people, and a set of values, assumptions, beliefs, and normative rules that identify, support, and explain the duties and obligations for good, right conduct (Siporin, 1982. p. 523).
Relates to what people consider correct or right • Generates standards that direct conduct • Represents “values in action” • Social work ethics represents behavioral expectations or preferences that are associated with social work responsibility
Ethics and values • Ethics are deduced from values and must be in consonance with them • The difference between them is that values are concerned with what is good and desirable while ethics deal with what is right and correct. (Loewenberg et al, 2000)
Values deal with what beliefs are appropriate • Ethics address what to do with or how to apply those beliefs
Ethical Standards • Ethical Responsibilities to Clients • Ethical Responsibilities to Colleagues • Ethical Responsibilities in Practice Settings • Ethical Responsibilities as Professionals • Ethical Responsibilities to the Profession • Ethical Responsibilities to Society at Large
PROFESSIONAL ETHICS Refers to the moral philosophy that is the set of values, beliefs, and normative rules that prescribes and explains the obligations for good, right conduct on the part of a profession’s members
Ethical Theory • Deontological theories – certain actions are inherently right or wrong, or good and bad, without regard for their consequences. Rules, rights, and principles are sacred and inviolable. The ends do not necessarily justify the means
Teleological Theories – the rightness of any action is determined by the goodness of its consequences • Egoism – people should maximize their own good and enhance their self-interest • Utilitarianism– an action is right if it promotes the maximum good
Act utilitarianism – the rightness of an action is determined by the goodness of the consequences produced in that individual case or by that particular act • Rule utilitarianism – takes into account the long-term consequences likely to result if one generalizes from the case at hand or treats it as a precedent
KANTproposed that an action is good in itself not because of the results it produced, but if it is the product of good will. Kant’s theory is what is sometimes called a universalistic or conservative theory in that there are general rules that are not to be broken in any situation
MORAL POSITIVISMstates that morality is not determined by the nature of an act but by extrinsic factors. Morality is made and not discovered. The fact that something is prescribed or forbidden makes it good or bad (Hammurabi Code, Ten Commandments)
THOMISMis an ethical theory that is very influential in current thinking about ethics in medicine. According to Aquinas, ”The perfecting of creatures through the development of their natures constitutes the highest good for them” • The first natural law is that all actions that conserve life or avoid death are included in moral law
Since all living creatures share a natural inclination to propagate the species, a natural law for mankind is that the species should be propagated and children educated • Human beings are rational beings and should therefore seek truth and avoid ignorance
Aquinas did not believe that actions contrary to moral law are wrong simply because they are prohibited by God; rather, he believed that they are prohibited by God because they are wrong • God-given law - Life is sacred
Confidentiality and Privileged Communication • Confidential information includes personal details about the client’s identity, records of verbal statements made by the client, professional reports or professed opinions concerning the client, and content from other records (Reamer, 1995)
Relative Confidentiality is a broad term that exists for the protection of the individual client but may allow a limited amount of disclosure, especially to those co-workers, superiors, and subordinates whose knowledge of certain communications is required to aid in the therapy or planned change process of the client
Privilege refers to legal rights transpired between the worker and client and is protected by law and cannot be revealed without that client’s expressed permission (Barker 1999) • Relative confidentiality is much more common than privilege