By: Allan Barsky, JD, MSW, Ph.D.
Gretchen is a social worker who discovers during counseling that her client, Carly, was sexually abused by her father. Now if Carly was a minor, Gretchen would know that she would have a legal obligation to report this abuse to child protective services. Carly, however, is 24 years old, and the laws of her state do not specifically require social workers to report past abuse if the survivor is now an adult. In this case, Gretchen wishes she could report the abuse, as she personally believes that Carly’s father should be held to account for his heinous actions. Gretchen faces an ethical dilemma, however, because Carly disclosed in strict confidence that she was abused and does not want Gretchen to tell anyone else, least of all the police or child protection authorities.
If you were Gretchen’s supervisor, what guidance would you give her? What considerations should she take into account when deciding what to do?
Since the laws in Gretchen’s state do not require her to report the abuse, Gretchen looks to the NASW Code of Ethics for guidance. Standard 1.07 says Gretchen should respect the privacy of her client and not disclose information to outsiders unless there is a particular exception. These exceptions include consent of the client, clear and immediate danger, and otherwise required by law.
Although Carly initially states she doesn’t want the abuse reported, her stated wishes are not necessarily fully informed. Gretchen may, therefore, provide Carly with information and other support, so Carly can consider her options more fully. For instance, she may not be familiar with what happens during an abuse investigation, fearing that a report to the police will lead to immediate and broad publication of her case. She may not know of legal and procedural protections afforded to survivors of sex-related crimes. Assume, however, that even with such information and support, Carly still resists reporting her father. As Standard 1.02 suggests, social workers should respect a client’s right to self-determination and should avoid imposing their own beliefs on clients.
As noted above, the Code of Ethics does not authorize Gretchen to release confidential information for safety concerns unless there is a risk of serious, imminent harm. Carly says that her father does not live with or have immediate access to other minors, so Gretchen cannot say there is risk of serious, imminent harm. Because the Code of Ethics does not explicitly cover Gretchen’s concerns in this case, Gretchen considers the following ethical principles: beneficence (doing good), nonmaleficence (avoiding doing harm), justice, and respect. In terms of beneficence, Gretchen thinks that reporting the abuse will be for the greater good of society because it will help protect other minors from being abused by Carly’s father. From Carly’s perspective, however, reporting the abuse may be experienced as harm: she is not emotionally ready to confront her father about the abuse, she fears his reactions, and she does not believe the state will adequately protect her from harm. Also, in terms of nonmaleficence, Gretchen realizes that reporting the abuse may have a negative impact on her social work relationship with Carly. Carly may feel betrayed by Gretchen and therefore terminate services. From a justice perspective, Gretchen might argue that reporting the abuse is a method of bringing Carly’s father to justice, and that silence or inaction is tantamount to condoning his abuse. Alternatively, Gretchen might consider justice as prioritizing Carly’s emotional and physical safety. Even if reporting the abuse may help protect other children, should Gretchen have the right to impose certain risks on Carly? Finally, respect comes back to the notions of honoring Carly’s rights to privacy and self-determination.
On balance, given the facts of the case as interpreted by Gretchen, she decides to permit Carly to decide whether or not to report the abuse. This course of action not only respects Carly’s rights to self-determination and privacy, but also affords Gretchen with the opportunity of continuing to work with Carly. Perhaps with ongoing information and support, but not pressure or manipulation, Carly may eventually decide to report her father’s abuse to appropriate authorities. In the meantime, Gretchen is supporting a decision that her client believes is best.
Gretchen notes further that had the situation varied in certain aspects, her decisions might be different. If Carly had younger siblings living with her father, for instance, she might need to report the abuse in order to protect the children. If Carly lived in a state that legally required social workers to report past abuse even though the survivor is no longer a minor, she would have more impetus to make the report. And if Gretchen worked in an agency that informed clients that workers had a positive duty to report abuse, regardless of the client’s current age, she would also be more inclined to report the abuse.
Gretchen documents her decision, including her rationale and those she consulted to assist with her decision—her clinical supervisor and the agency’s attorney. She still feels anxiety about her decision, but recognizes that feeling some anxiety is actually a good sign when faced with an ethical dilemma that has no clear-cut, perfect solution for all the stakeholders.
Allan Barsky, JD, MSW, Ph.D., is a professor of social work and member of the NASW National Ethics Committee. His book credits include Ethics and Values in Social Work and Conflict Resolution for the Helping Professions (see http://www.barsky.org).