Social Work Values and Ethics
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Social Work Values and Ethics

Frederic Reamer

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eBook - ePub

Social Work Values and Ethics

Frederic Reamer

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About This Book

For more than a decade, teachers and practitioners have turned to Frederic G. Reamer's Social Work Values and Ethics for its comprehensive introduction to ethical decision making and practical guidance regarding professional misconduct. This new edition incorporates the legal and technological realities now facing individuals in the field, featuring a discussion of the ethical issues that arise from practitioner use of online services and social networking sites, as well as an overview of ethical standards that protect confidential information transmitted electronically.

Reamer also adds a discussion on potential conflicts between ethical standards and legal guidelines and a section defining statutory law, regulatory law, case law, and constitutional law. He expands his coverage of boundary issues and dual relationships and includes new material exploring the complexities of practitioner self-disclosure and the challenges of living and working within small and rural communities. Revised content and case materials include an investigation into the ethics of practitioner engagement with social justice and advocacy, as well as updates to the National Association of Social Workers (NASW) Code of Ethics. Reamer compares NASW's ethics to those of other human service professions, and he pursues an in-depth analysis of the relevance of cultural difference to ethical dilemmas and decision making.

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An Overview
IMAGINE THAT you are a social worker at a local community mental health center. You spend most of your time providing supportive and casework services to individuals and families experiencing some sort of difficulty. You have worked at the agency for about three years.
During the past two months you have provided counseling to Sarah Koufax and her two children, Brooks, seven, and Frank, four. Sarah Koufax originally sought help at the agency because of difficulty she was having managing Brooks’s behavior. According to Sarah Koufax, Brooks “frequently throws temper tantrums when he’s upset—he can really kick and scream.” Sarah Koufax also reported that Brooks’s teacher said she was having a great deal of difficulty controlling the boy and wanted to discuss whether he should be transferred to a different classroom, one for difficult students.
You have spent considerable time teaching Sarah Koufax various ways to handle Brooks’s behavior, particularly the use of positive reinforcers. During the past few weeks Sarah Koufax has reported that his tantrums have been less frequent and that he has responded well to the positive reinforcers. Brooks’s teacher has also reported that the child’s behavior has “improved somewhat.”
Throughout your relationship with Sarah Koufax she has talked at length about some of her own difficulties—single parenthood, financial problems, and her struggle with alcoholism. In recent weeks she has been especially eager to discuss these problems. In your judgment you and she have developed a constructive, trust-filled relationship.
Yesterday morning you received a telephone call from Sarah Koufax. She was clearly distraught and said she needed to see you as soon as possible, that she could not wait for her regularly scheduled appointment later in the week. She reported over the telephone that “something awful has happened and it’s really bothering me. I need to talk to you fast. I know you’ll understand.”
You were able to see Sarah Koufax today because another client had canceled his appointment. Sarah Koufax came in alone and immediately started to cry. She said that two days earlier Brooks was throwing a terrible tantrum, one of his worst: “I had just had it. I was feeling sick, and Frank was screaming for me to feed him. Brooks just wouldn’t let up. I got so frustrated I grabbed him and pushed him. He tripped and fell into the radiator in the kitchen, breaking a tooth. I got him to a dentist right away. I told the dentist that Brooks was horsing around with his brother and bumped into the radiator. I just couldn’t tell her the truth. I’m so ashamed. Things were getting so much better. I don’t know what happened. I just lost it.”
During this session you spent most of the time encouraging Sarah Koufax to express her feelings. You also talked with her about how most children who are receiving help for behavior-management problems will regress sometimes, even though they are making considerable progress overall. The two of you talked about how Sarah Koufax might respond to any future tantrums.
Toward the end of the session you told Sarah Koufax that you were “in a real pickle. I know that what happened with Brooks was an accident, that you didn’t mean to hurt him. But here’s the problem. The law requires me to report what happened. I know you don’t think you deliberately abused Brooks, but, according to state law, I have to report to the child welfare agency the fact that Brooks was injured. I’d like you to help me report this, so we can show the state social worker how hard you’ve been working on your problems. Frankly, I don’t think they’ll do much. This is just something I’m supposed to do.” Sarah Koufax immediately started to cry and became agitated. “I can’t believe you would do this to me,” she said. “I thought I could trust you. If you call the state, I’m never coming back here. I can’t believe this.”
In fact, you do not really want to report the case to state child welfare authorities. You firmly believe that Sarah Koufax did not mean to harm Brooks and that this was an isolated instance in which she lost control. You have been impressed with Sarah Koufax’s earnest attempt to address her problems and with her progress in recent months. You sense that reporting the incident to the child welfare authorities will do more harm than good; reporting is likely to alienate Sarah Koufax and undermine your therapeutic relationship with her. Moreover, Sarah Koufax is already receiving competent help from you; in your judgment services from a state worker are not needed and would be counterproductive.
The bottom line, however, is that you feel compelled to obey the state law. You did your best to explain to Sarah Koufax why you felt the need to report the case. You told her you understood why she was so angry. But despite your best effort, Sarah Koufax walked out quite distressed and agitated, saying: “Do what you have to do. Just let me know what you end up doing so I can figure out what I need to do.”
Seasoned social workers can certainly identify with this predicament. Helping the client deal with her anger and to sustain the therapeutic relationship demands sophisticated clinical skills. Sometimes the clinical intervention is effective, and sometimes it is not.
At the center of the example that opens this chapter is a complex set of issues involving values and ethics. In fact, the values and ethical issues in this case represent the four core issues in social work—and those on which I shall focus throughout this book:
The value base of the social work profession
Ethical dilemmas in social work
Ethical decision making in social work
Ethics risk management
At the heart of this case is a difficult decision about core social work values. Social work is among the most value based of all professions. As I shall explore more fully, social work is deeply rooted in a fundamental set of values that ultimately shapes the profession’s mission and its practitioners’ priorities. As the social worker in this example, you would be concerned about several key values, including Sarah Koufax’s right to self-determination, confidentiality, and privacy (her wish for you to continue working with her without notifying state child welfare officials about the incident involving Brooks); the obligation to protect your clients from harm (Brooks from harm in the form of parental abuse, his mother from being deprived of meaningful help from you, and both from harm that might result from investigation by state child welfare officials); the obligation to obey the law (the law that requires social workers to report all instances of suspected child abuse and neglect); and the right to self-protection (that is, social workers’ right to avoid sanctions and penalties that might result from their failure to comply with the law).
Ideally, of course, the social worker would act in accord with all these values simultaneously. What social worker would not want to respect clients’ right to self-determination, confidentiality, and privacy; protect clients from harm; obey the law; and protect herself or himself? The problem is that situations sometimes arise in social work in which core values in the profession conflict, and this leads to ethical dilemmas. An ethical dilemma is a situation in which professional duties and obligations, rooted in core values, clash. This is when social workers must decide which values—as expressed in various duties and obligations—take precedence.
To make these difficult choices social workers need to be familiar with contemporary thinking about ethical decision making. In the Sarah Koufax case the social worker must decide whether to comply with the state’s mandatory reporting law—and risk jeopardizing the therapeutic alliance that has been formed with Sarah Koufax—or deliberately violate state law in an effort to sustain the meaningful, and apparently helpful, therapeutic relationship.
As I shall explore shortly, the phenomenon of ethical decision making in the professions has matured considerably in recent years. Professionals trained today have far more access to helpful literature and concepts related to ethical decision making than did their predecessors. This is particularly true in social work, which has experienced a noticeable burgeoning of interest in ethical decision making.
Finally, social workers must be concerned about the risk-management ramifications of their ethical decisions and actions, particularly the possibility of professional malpractice and misconduct. Is it acceptable for a social worker to knowingly and willingly violate a law, even if she has only noble motives involving service to clients? What consequences should there be for a social worker who does not act in a client’s best interests? What legal risks—in the form of criminal penalties, ethics complaints, formal adjudication by ethics disciplinary committees or state licensing boards, and lawsuits—do social workers face as a result of their actions?
To explore fully the nature of contemporary values and ethics in social work, it is important to understand the historical evolution of thinking in the field with respect to its value base, ethical dilemmas in practice, ethical decision making in social work, and practitioner malpractice and misconduct. The social work profession’s grasp of key values and ethical issues has matured considerably in recent years.
The general topics of values and ethics have been central to social work since its formal inception. Historical accounts of the profession’s development routinely focus on the compelling importance of social work’s value base and ethical principles. Over the years beliefs about social work’s values and ethics have served as the foundation for the profession’s mission. Social work is, after all, a normative profession, perhaps the most normative of the so-called helping professions. In contrast to such professions as psychiatry, psychology, and counseling, social work’s historical roots are firmly grounded in such concepts as social justice and fairness. Throughout the history of social work, its mission has been anchored primarily, although not exclusively, by conceptions of what is just and unjust and by a collective belief about what individuals in a society have a right to and owe one another.
Although the theme of values and ethics has endured in the profession, social workers’ conceptions of what these terms mean and of their influence on practice have changed over time. The evolution of social work values and ethics has had several key stages: the morality period, values period, ethical theory and decision-making period, and ethical standards and risk management period (Reamer 1998a).
Social work was formally inaugurated as a profession in the late nineteenth century and was much more concerned about the morality of the client than about the morality or ethics of the profession or its practitioners. Organizing relief and responding to the “curse of pauperism” (Paine 1880) were the profession’s principal missions. This preoccupation often took the form of paternalistic attempts to strengthen the morality or rectitude of the poor who led wayward lives.
The rise of the settlement house movement and Progressive era in the early twentieth century marked a time when the value orientations and goals of many social workers shifted from concern about the morality, or immorality, of the poor to the need for dramatic social reform designed to ameliorate a wide range of social problems, for example, those related to housing, health care, sanitation, employment, poverty, and education (Reamer 1992b). Especially during the Great Depression, social workers promoted social reforms to address structural problems. Many social policies and programs created during the New Deal years in the United States (1933–41) were shaped or influenced by social workers (McNutt 2008).
Concern about the morality of the client continued to recede somewhat during the next several decades of the profession’s life, as practitioners engaged in earnest attempts to establish and polish their intervention strategies and techniques, training programs, and schools of thought. Over time, concern about clients’ morality was overshadowed by debate about the profession’s future, that is, the extent to which social work would stress the cultivation of expertise in psychosocial and psychiatric casework, psychotherapy, social welfare policy and administration, community organization, or social reform. After a half-century of development the social work profession was moving into a phase characterized by several attempts to develop consensus about the profession’s core values. Several prominent commentaries appeared during this period in which authors defined, explored, and critiqued the profession’s core values and mission (Bartlett 1970; Emmet 1962; Gordon 1962, 1965; Keith-Lucas 1963; Levy 1972, 1973, 1976; H. Lewis 1972; Perlman 1965; Pumphrey 1959; Teicher 1967; Towle 1965; Varley 1968; Vigilante 1974; Younghusband 1967).
In addition to exploring the profession’s core values, some literature during this period (the 1960s and 1970s) reflected social workers’ efforts to examine and clarify the relationship between their own personal values and professional practice (see, for example, Hardman 1975; Varley 1968). In the context of this so-called values clarification movement, many social workers developed a keen understanding of the relationship between their personal views and their professional practice, especially when controversial and divisive issues such as poverty, abortion, homosexuality, alcohol and drug use, and race relations were involved.
Nearly half a century after its inauguration, the profession began to develop formal ethical guidelines, based on its core values, to enhance proper conduct among practitioners. In 1947, after several years of debate and discussion, the Delegate Conference of the American Association of Social Workers adopted a code of ethics. The profession’s journals also began to publish articles on the subject with greater frequency (Hall 1952; Pumphrey 1959; Roy 1954).
This is not to say that social workers neglected the subject until this period. Social workers have always espoused concern about a core group of central values that have served as the profession’s ballast, such as the dignity, uniqueness, and worth of the person, self-determination, autonomy, respect, justice, equality, and individuation (Biestek 1957; Cabot 1973; Hamilton 1951; Joseph 1989; National Association of Social Workers 1974; Richmond 1917). And earlier in the twentieth century there were several modest efforts to place ethics on social workers’ agenda. As early as 1919 there were attempts to draft professional codes of ethics (Elliott 1931). In 1922 the Family Welfare Association of America appointed an ethics committee in response to questions about ethical chal...

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