Winter 2001, Vol. 8, No. 1

Ethics: To Tell or Not to Tell—A Case Study

by Lee J. Zook, Ph.D.

INTERACTIVE ARTICLE

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Some years ago, prior to teaching in undergraduate social work, I was working with families and children in an outpatient psychiatric setting, Children’s Agency. In the previous year, I had completed my MSW, having practiced social work several years with an undergraduate degree. The Director of Social Services at the Children’s Agency was my supervisor. We used a team model in our work, with any particular team consisting of at least a social worker, a psychologist, and a psychiatrist. Sometimes other professionals, such as educational specialists, early childhood development specialists, and social group workers were also on the teams. I had first-rate colleagues in whom I could confide about clinical and ethical issues. Continuous learning was valued, especially as it related to clinical practice.

While I was at Children’s Agency, Mary Jones (a fictitious name) applied for a job as a social worker. Four years earlier, I had seen Mary as a client while working for an emergency service at Adult Hospital, a psychiatric facility for adults.

My contact with Mary had been rather brief at Adult Hospital. She came to be admitted to the hospital as her psychiatric condition was deteriorating. Mary told me she was a social worker with an MSW and had been in and out of psychiatric hospitals for many years. I located her chart, noted that she was previously diagnosed with schizophrenia, undifferentiated type, did the basic paperwork that social workers did on admission, consulted with the admitting psychiatrist, and took her to the hospital ward. It was a rather simple, routine admission; there were no police or court documents, and she was a voluntary client. However, the situation was a bit unsettling. My feelings had to do with the fact that I was leaving my position in the near future to pursue an MSW, and here I was, a young, rather inexperienced, “untrained” social worker, admitting an older, more experienced social worker with an MSW to a psychiatric hospital. However, I went on with my business and put the event in perspective. After all, academic degrees do not preclude a person from having a mental illness.

So now, three years later, I had my MSW, and Mary came for a job interview at Children’s Agency where I was employed. I had no responsibility for employment decisions. My supervisor, who was the Director of Social Services, and the psychiatrist, who was also the Executive Director, made these decisions. But I was faced with an uncomfortable dilemma—an ethical dilemma for which I did not see any clear answer.

On one hand, I was concerned about whether Mary would function as a competent professional colleague. Was her illness in remission? If so, would it remain in remission? If not, what would the impact be on clients? Would she be able to function adequately to work with clients who came to the agency? If she would not, would harm come to clients?

On the other hand, my knowledge of her illness was unquestionably confidential. Further, what right or responsibility did I have to suggest that a person who had a mental illness should not be hired? What right or responsibility did I have to divulge information about her (past) condition to anyone?

There was also the possibility that I could speak to Mary and verbalize my concerns to her. Would this be appropriate? Would Mary remember who I was? After three years, did the brief encounter we had give me the prerogative to confront her about her past or ask about her present condition?

The following discussion focuses on the NASW Code of Ethics and how it may be useful in this situation. At the time, I was not this thorough and did not think much about the Code of Ethics. I struggled in my own mind about what to do. If this were occurring now, I would first of all confer with the Code of Ethics. The first sentence of the preamble of the Code states:

The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.

In this situation, one could contend that clients coming to Children’s Agency were the vulnerable people referred to in the Preamble. On the other hand, one could also make a case that Mary, a person who is living with a persistent and long-term mental illness, is a vulnerable person.

As a social worker, I am particularly concerned about creating opportunity for persons with disability. And in this instance, vulnerability of a specific person could be viewed as more important than vulnerability of a general client population.