Strom-Gottfried, K. (2008).  The ethics of practice with minors:  High stakes, hard choices.  Chicago, IL:  Lyceum Books.

http://lyceumbooks.com/EthicsofPracticeswMinors.htm

Suzanne Y. Bushfield, Ph.D., MSW, LCSW

Kim Strom-Gottfried, PhD, LISW, is the Smith P. Theimann Distinguished Professor of Ethics and Professional Practice at the School of Social Work at the University of North Carolina at Chapel Hill.  Professor Strom-Gottfried has authored numerous articles, monographs, and chapters on ethics in practice.    

This new text is intended to “make ethics accessible to students and experienced practitioners by providing an easy-to-use framework to resolve complex ethical dilemmas with children and adolescents” (p. xi).  Dr. Strom-Gottfried’s approach to ethical decision making recognizes the often confusing and conflicting imperatives from legal, ethical, clinical, organizational, and developmental perspectives, and offers a straightforward decision-making model designed to encourage critical thinking about ethical dilemmas.  Dr. Strom-Gottfried has not only synthesized a variety of decision-making frameworks into a memorable process, but she has also led the reader through the decision-making when applied to perplexing dilemmas with children and adolescents.  The numerous common examples of dilemmas that occur in practice with children and adolescents that are included are a welcome addition to the literature, since the rights and choices of children are often constrained by their age, maturity, and parental prerogatives.  Most ethical texts stress the principles of autonomy, beneficence, nonmaleficence, justice, and the NASW Code of Ethics (1999).  As the author points out, “Codes are not typically written with minor clients in mind” (p. 14).  This text attempts to provide some clarity when translating values and principles into action with respect to children and adolescents.

Dr. Strom-Gottfried has provided a careful and balanced discussion of some of the more difficult dilemmas that arise when working with minor clients.  Her decision-making process is deceptively simple:  “A-Assess options; B-Be mindful of process; C-Consult; D-Document; and E-Evaluate” (p. 17).  However, this five-part “ABC” process, when applied, is by no means simplistic.  When all steps are taken, the student or the practitioner gains valuable practice in the high-stakes field of ethical decision-making—an important improvement to the often “reflexive” or “liability-averse” approaches that many report using.

The author walks us through a variety of types of dilemmas, organized around Kidder’s (1995) polarities:  justice versus mercy, short term versus long term, individual versus community, and truth versus loyalty.  She offers insight into each step of her process, when applied to realistic dilemmas.  The first step, “Assess options,” can be further addressed by using the mnemonic rubric offered by the author:  “ELVIS” (p. 18).  Readers will recognize the key elements that influence our options, and assist us in thinking critically about the situation.  These elements include:  “E-Ethical theories and principles, L-Laws and politics, V-Values and ethics, I-Information, and S-Standards” (p. 18).  Strom-Gottfried effectively elaborates the key perspectives from each of these elements.  Both students and skilled practitioners will appreciate the tensions embedded in Kidder’s polarities, as well as the author’s straightforward and balanced discussion of options.  The thorough discussion of alternatives and their implications assists the reader in critical thinking, rather than expecting an instant solution to the dilemma. The author recognizes that some dilemmas require compromise between competing values, principles, and standards, but that ethical dilemmas require choices that are well grounded, even when the solution is not wholly satisfactory.  Dr. Strom-Gottfried elaborates on the implications of these choices, encouraging the reader to participate.

A particular contribution of this text is in regard to clarifying developmental issues and their role in the proxy decision making for dependent and vulnerable children.  The author states, “In work with minors, a full appreciation of the principle of client autonomy is strongly connected with an accurate understanding of a child’s abilities, particularly the status of his or her evolving capacities” (p. 61).  A strong developmental focus may assist social workers in this process.

The author’s conclusions that “solutions are imperfect; systems are imperfect; resources are imperfect; and parents are imperfect” (p. 190-193) may be disquieting.  Nevertheless, while recognizing that many things are outside of our control, Dr. Strom-Gottfried provides support for key strategies that may improve our ethical practice.  These include:  self awareness, to counteract our own prejudices that may undermine balanced decision making; forging alliances with trusted colleagues with whom we may consult and collaborate; vigilant attention to opportunities for exercising our skills in practiced ethics; and a willingness to take action (p. 195). The moral courage that is required in pursuit of ethical practice may be bolstered by regularly engaging in the process of ethical decision-making.  Dr. Strom-Gottfried’s text is a useful tool in this pursuit.   

References

Kidder, R. M. (1995).  How good people make tough choices:  Resolving the dilemmas of ethical living.  New York, NY:  Simon and Schuster.

NASW (1999).  Code of ethics of the National Association of Social Workers. Washington, DC:  NASW Press.