By: Marian Mattison, DSW, ACSW
Spring 2003, Vol. 10, No. 2
As you began your internship, you had been initially prepared through foundation courses that equipped you with the skills and knowledge necessary for successful interventions with clients. While the curriculum prepares students for entry level practice, a great deal of incidental learning takes place as students gain experience with actual clients. This holds particularly true as it relates to negotiating the ethical aspects of social work practice. While no course of study can fully prepare students to anticipate every ethical dilemma they may encounter, students are instructed to be aware of their limitations and to rely on supervision in cases where experience may help them to determine the best interests of clients.
While adequate preparation for professional practice is an obligation and a responsibility (see NASW Code of Ethics Standards 1.04 a & b), anticipating and preparing for every possible ethical conflict is an impossibility (see NASW Code of Ethics, pp. 2-3). Social workers, both inexperienced and experienced, can prepare themselves to address and resolve ethical dilemmas by sharpening their awareness of the ethical standards meant to guide practice (as detailed in the NASW Code of Ethics) and that serve as the basis against which the behavior of the social worker will be judged in cases of ethical misconduct. Developing one' ability for ethical reasoning can help prevent errors in judgment and forestall charges of ethical misconduct and will result in better service to clients.
What follows is an ethical dilemma faced by a student intern who unintentionally acquires information about her client during the course of the field seminar. Read the following case and give some thought to the dimensions of the ethical dilemma and how you, as the social worker, would decide what action to take.
Julia is a social work intern placed at a local Family Services Agency. Over the course of the last six months, she has worked with Carla Rodriguez to reunify her with her three children, ages 11, 4, and 3. Carla (age 28) is the mother of Tatiana (age 11), Derrick (age 4), and Angel (age 3). The children were removed to foster care when charges of neglect were substantiated. Derrick and Angel were placed in separate foster homes, and Tatiana stayed with Carla' sister. Carla' drug addiction limited her ability to care for her children, who were found to be living in squalid conditions. While the children were in foster care, Carla made a concerted effort to have the children returned to her care. She entered and completed a drug treatment program, and claims now to be “completely drug free.” Carla entered similar programs twice before; this is the first time she completed a program. The children were reunified with their mother two months ago. Carla has been drug free for a number of months and is meeting the minimum standards of care for her children.
In the field internship seminar, social work interns were exchanging information about their cases. An intern placed in a local junior high school asked her peers for advice about the group she is running. Taking precautions to change the names and identifying details of the group members, the intern spoke about “Mary'” fears about her family being broken up again “after they just got back together.” Her mother isn’t “doin’ the bad drugs anymore, but she smokes pot with her boyfriend in the apartment.” “Mary” tells the group that her mother told her “not to say nothing to nobody” if she doesn’t want to split up the family. “Mary” doesn’t want her mother' social worker to find out about the drug use.
Julia, the intern working at the Family Services site, realizes that the client being described is the daughter of her client, Carla. Carla has adamantly denied any drug use and always appears “straight” at the time of the agency visits. Julia has no firsthand evidence to suggest that Carla is using drugs. Julia wonders what to do with this information.
There are many questions for Julia to consider as she decides how to use the information she has just acquired. The following are questions that social workers might raise in resolving this ethical dilemma and determining what action to take. Do you believe that Julia is obligated to report Carla' drug use, and if so, to whom should this report be made? Julia must be clear about which client she owes primary responsibility to. If her obligation is to protect the children, she might feel more compelled to report Carla' drug use, as it may involve the children' safety. If, on the other hand, Julia is Carla' advocate, might she “overlook” Carla' occasional use of marijuana, perhaps believing that the risk to the children is not great? The social worker' beliefs about family unity and the local foster care system are also factors that will influence the decision to act. Is the risk to the children greater if the family unity is again disrupted? What are the harms/benefits to the children of being returned to foster care? Are the same foster homes still available? Could the disruption caused by foster care possibly be greater than the consequences of Carla' recreational drug use?
These are just some of the questions raised by this ethical dilemma; you may have identified others. Julia may worry that if she confronts Carla with the information about her drug use, Carla will deny the allegation and the relationship will be irreparably damaged. If the client demands to know the source of the information, should Julia indicate that it actually came from her daughter in the course of a group counseling session? What are the consequences and risks of this disclosure for Tatiana? Should the 11-year-old be placed in this position? Imagine the anger that Tatiana might have for a social worker who uses the information she disclosed in confidence against her family.
Finding a Solution
So, what are the “right” answers and what is the “solution” to the dilemma? By its very nature, an ethical dilemma is a situation for which no one solution is “right” or “correct.” If there is no “right” answer, how then can a social worker be expected to resolve the dilemma?
Resolving the dilemma not only requires addressing questions such as those posited, but also calls for the social worker to have a firm grip on the standards of practice that constitute sound practice behavior, have a working familiarity and understanding of the principles in the NASW Code of Ethics, make use of peer/supervisory consultation, understand applicable agency policies and legal mandates, and be open to examining the ways in which one' own values/preferences influence the ultimate choice of action. Use of a framework for analyzing ethical dilemmas is highly recommended. (Decision-making models have been presented in greater detail elsewhere and space restrictions prevent a detailed review of these here. See, for example, Mattison, M. 2000. Ethical decision making: The person in the process. Social Work, 45 (3), 201-212.)
One begins to address the ethical dilemma by identifying those professional values or obligations that conflict and explicating the conflicts of interest. One of the tensions in this case involves the protection of Tatiana' confidence (see NASW Code of Ethics, Standard 1.07 b) vs. the disclosure of confidential information contrary to Tatiana' wishes (see NASW Code of Ethics, Standard 1.07 c). Can the social worker justify setting limits on Carla' right to self-determine based on the belief that the well-being of her children is being harmed by her marijuana use? Is there an obligation to limit Carla' right to self-determine in order to protect third parties from harm (see NASW Code of Ethics, Standard 1.02)? Is the marijuana use a risk to the children' safety, health, social, and/or emotional development?
Knowing one' ethical obligations in advance of ethical conflicts may prevent ethical misconduct. For example, as interns, did the students alert their clients to the fact that they are interns-in-training and that they would be discussing case material with supervisors and peers (see NASW Code of Ethics, Standards 1.04a, 1.07p & 3.02c)? Had the instructor of the seminar cautioned students about the potential issues surrounding breaches of client confidentiality and ideas to best manage violations should they occur (see NASW Code of Ethics, Standard 3.02a)? Were the “limits of confidentiality” (see NASW Code of Ethics, Standard 1.07e) fully explained to students participating in the counseling group at the junior high school? Did “Mary” fully understand that her disclosures in the group might result in the filing of a report with the local child protective services? Would she have disclosed so openly if she had anticipated the consequences of her disclosure?
Supervision and Consultation
In confronting an ethical dilemma, social workers should always consult experienced colleagues and supervisors to flesh out the conflicts of interest and to determine the potential courses of action and cost/benefits associated with each. In fact, the NASW Code of Ethics requires not only students but all social workers to “seek the advice and counsel of colleagues whenever such consultation is in the best interests of clients” (see NASW Code of Ethics, Standard 2.05a). Competent practice dictates that social workers routinely document their efforts to use supervision and note their efforts to carefully analyze the ethical dilemma and their relationship to it.
In addressing ethical dilemmas, social workers often fail to acknowledge and accept that personal values, life experiences, and unaccounted for influences (personal, cultural, religious beliefs and preferences) do affect professional decisions. Social workers must be willing to identify these influences and the role they play in selecting a choice of action. For example, Julia' personal beliefs about marijuana use will influence her decision about reporting. Julia may equate marijuana use with alcohol consumption and may not consider there to be any special risk to the children caused by Carla' use of it.
The social worker must also take into account any agency (see NASW Code of Ethics, Standard 3.09a) or legal mandates to which he or she might be held responsible. If the agency policy requires reporting the drug use to the child welfare authorities, are there occasions in which the social worker might justify a “wait and see” approach and delay reporting? How do individual states define neglect related to drug use? Does parental use of marijuana itself constitute neglect, or are other indicators that the parent is unable to properly care for the children required? What are the social worker' legal obligations as a mandated reporter?
The social worker must consider the possible consequences of his or her actions for each person who may potentially be harmed or benefit by the action chosen. In this case, in addition to Julia' concern over client issues related to confidentiality (see NASW Code of Ethics, Standard 1.07p) and self determination (see NASW Code of Ethics, Standard 1.02), what is Julia' responsibility to her peer who unintentionally disclosed information that could possibly have long standing consequences for client/social worker relationships (see NASW Code of Ethics, Standard 2.02)? Is the intern working with Tatiana at the junior high school obligated to tell Tatiana that the information she shared in confidence in the group will be brought to the attention of her mother' social worker (see NASW Code of Ethics, Standard 1.07d)? Is she obligated to disclose the details of how this occurred? How will this affect "Mary"/Tatiana' treatment? Can Tatiana be expected to trust social workers in the future? Did the intern unwittingly encourage “Mary” to reveal more than she had intended to reveal regarding her mother' drug use?
The Right Decision?
Students struggling to reach the “right” decision are often surprised to learn that among experienced social workers, there may be no consensus on one “preferred” course of action (review the first few pages of the NASW Code of Ethics). In practice classes, students often learn that there is typically a preferred skill, practice approach, or model to apply based on case circumstances. The relative certainty of practice decisions feels safer than the uncertainty of struggling with and resolving ethical dilemmas. Becoming accustomed to the uncertainties associated with resolving ethical dilemmas is a target that many social workers fail to strike.
Keep in mind that the goal of sound ethical reasoning is not to reach the “right” solution but rather to rationally and systematically consider the ethical aspects of a case and to be clear about the basis on which the decision was made. This involves a process of deconstruction and contemplation that enables you to consciously articulate the reasoning behind your choice of action. You must be able to explain and justify that the decision you reached protected the client' rights and served the client' best interests, and that you upheld the values and standards of the profession.
This case example is presented to stimulate interest in the subject of ethical decision making and is designed to encourage students and new social workers to discuss and debate ethical dilemmas with peers and colleagues. Finding out what others think or would do in a case such as this will help you to clarify your position and will sharpen your ethical reasoning skills. Discuss this case (or another ethical dilemma you are facing in your practice) at the lunch table, bring it into the classroom for discussion, or deliberate on it in a supervisory session. Ask questions, reach to see things through the lens of others who have a stake in the outcome of the decision, and be open to the positions and value preferences of colleagues.
As social workers, we are in close agreement about upholding standards related to client confidentiality, fostering self-determination, promoting the dignity and worth of the client, and acting in a trustworthy manner with clients. There is less agreement about how to translate these into practice, particularly when one of these commitments can be served only at the expense of another. Since “the NASW Code of Ethics does not specify which values, principles, and standards are most important and ought to outweigh others in instances where they conflict” (NASW Code of Ethics, p. 2) and “does not provide a set of rules that prescribes how social workers should act in all situations” (NASW Code of Ethics, p. 2), social workers must develop skills to systematically analyze ethical dilemmas and, on a case by case basis, carefully assess which action they determine to be more incumbent over the others.
National Association of Social Workers (1999). Code of ethics. Washington, D.C.: Author.
Marian Mattison, DSW, ACSW, is an Associate Professor and Chair of the Department of Social Work at Providence College in Providence, RI. She has conducted numerous workshops on the subject of ethical decision making and has written articles on this subject.
Copyright © 2003 White Hat Communications. All rights reserved. From THE NEW SOCIAL WORKER, Spring 2003, Vol. 10, No. 2. For reprints of this or other articles from THE NEW SOCIAL WORKER (or for permission to reprint), contact Linda Grobman, publisher/editor, at P.O. Box 5390, Harrisburg, PA 17110-0390, or at email@example.com.