The nature of the social work taskSocial work is a responsible and demanding job. Practitioners work in social settings characterised by enormous diversity, and they perform a range of roles, requiring different skills. Public expectations, agency requirements and resources and the needs of service users all create pressures for social workers. The public receives only a snapshot of a social worker's responsibilities and, against a background of media concentration on the sensational, the thousands of successful outcomes and years of hard work in child care and with vulnerable adults are never considered (Hardy and Hannibal, 1997). In intervening in people's lives, social workers face practice dilemmas arising from the relationship between social work values and the law (for example, working to promote the rights and self-determination of service users and having to balance this with the need to protect them and to protect the rights of others).The relationship between social work and the law is part of an ongoing debate. There are those who adopt a legalistic model and argue that the law, reflected through court orders, is central to social work practice (for example, Blom-Cooper, 1985). Others have argued that over-reliance on the law fails to address the problems people face and may even exacerbate them (Stevenson, 1988; King and Trowell, 1992; Braye and Preston-Shoot, 1997). This seems to present a dilemma for practice. The growing importance of the law in social work practice and decision making is reflected in the training requirements for professionals working in the field of social work (Department of Health, 2002). Yet it is essential that alongside this there is a value base with an emphasis on principles, such as partnership, equality and empowerment, which must inform good practice.Over the past two decades there have been a number of events that raised serious questions regarding social work practice. There has been fierce debate in relation to child protection issues, the changes within the criminal justice system (for example the introduction, by the Crime and Disorder Act 1998, of anti-social behaviour orders) and the effectiveness of community care. There have been well-documented tragedies and errors of judgement (Blom-Cooper, 1985), apparent over-zealousness such as in the Cleveland affair (Butler-Sloss, 1988) and the misuse of power in residential care in the pindown affair (Levy and Kahan, 1991).For many professionals in the field of social work, the publicity surrounding these and other events has led to a feeling of crisis. Social work as a profession has frequently been under attack since the mid-1980s, and this has undermined the public's awareness of social work's successes. For example, one of the observations about the Children Act 1989 was that it was based on current best practice within social work at the time, though such practice was not sufficiently widespread. The Act represented a new start for children and families and other professionals working with children by radically changing the legal framework regulating the care and upbringing of children (Hardy and Hannibal, 1997). No legislation or legal framework can remain static, however, and as a result of reviews and enquiries such as the Victoria Climbie Inquiry Report (Department of Health and Home Office, 2003), the Children Act 1989 has been significantly updated, and the way in which it is interpreted, resourced and implemented has been strengthened.

Eye on EthicsMaking Difficult DecisionsBy Frederic G. Reamer, PhDSocial Work TodayOctober 14, 2002Recently, I received a phone call from a seasoned social worker seeking consultation. The social worker is employed by a community mental health center where she provides clinical services to people with chronic mental illness. Two days earlier, one of her clients, Alice M., committed suicide. According to the social worker, Alice struggled for many years with depression and cocaine addiction.Immediately following the suicide, Alices parentswho had participated in her treatment at various times in the context of family counselingcontacted the social worker to discuss this tragic turn of events. The social worker met with her parents, with whom she had considerable rapport, and they talked about Alices lifelong triumphs and challenges. Alices parents spoke at length about how much they appreciated the social workers earnest efforts to help their daughter. The parents also talked about how difficult it would be for them to bury their daughter the following day.Toward the end of the conversation, Alices parents told the social worker that they wanted to ask a special favor. They explained that the social worker was an important person in their familys life and that it would mean a lot to them if the social worker would deliver a eulogy at their daughters funeral.The social worker was touched by the parents sentiments and their poignant request. She felt close to the family and wanted to be supportive. At the same time, however, the social worker quickly recognized the ethical dilemma facing her. She was especially concerned about violating Alices privacy and confidentiality. The social worker was also concerned about managing the boundaries in her relationship with the family; she wanted to avoid entering into an inappropriate dual relationship. The social worker was deeply ambivalent and unsure about how to resolve this ethical dilemmaa situation in which professional values, duties, and obligations clash.In recent years, social workers have refined their approach to ethical decision making. Although many practitioners completed their formal education at a time when content on ethical dilemmas and ethical decision making was not a prominent component in the social work education curriculum, continuing education on the subject is now common. Todays social workers and social work students are being introduced to state-of-the-art frameworks to help them identify ethical dilemmas and make difficult decisions.Ethical dilemmas come in all shapes and sizes. Many involve social workers delivery of services to individuals, families, couples, and small groups. Typical examples involve disclosing confidential information without a clients consent (for example, when a client threatens to harm himself, herself, or someone else); limiting a clients right to self-determination against his or her wishes (for example, when a social worker pursues involuntary psychiatric hospitalization of a troubled client); or social contact with a former client.Other ethical dilemmas pertain to agency administration, community work, social policy, and research. Examples include administrators decisions about the allocation of scarce or limited agency resources (what moral philosophers refer to as distributive justice issues), conflicts of interest among staff, and the use of ethically questionable marketing strategies to solicit clients. Still other ethical dilemmas involve relationships among professional colleagues. Common examples involve a social workers response to a colleague who has behaved unethically or who is impaired or incompetent (the ethics of whistle-blowing).The literature in most professions now contains thoughtful discussions of conceptually based frameworks designed to guide practitioners ethical decisions. These frameworks do not guarantee easy solutions to hard ethical choices, of course; rather, they provide useful guideposts to help professionals who face daunting ethical circumstances. Although the frameworks vary, they tend to contain common elements.1. Identify the ethical issues, including the social work values and ethics that conflict.In the case involving the social worker who faced a decision about delivering a eulogy at the funeral of her client who committed suicide, the practitioner would focus primarily on conflicting values and duties related to the deceased clients privacy and dignity, the parents right to self-determination, the social workers commitment to client well-being, and ethical standards related to informed consent and dual relationships.2. Identify the individuals, groups, and organizations that are likely to be affected by the ethical decision.In this case, those most likely to be immediately affected include the deceased client (with respect to her dignity and right to privacy and confidentiality), the deceased clients parents, and the social worker. In addition, the social workers colleagues at the community mental health center where she is employed and the social work profession itself could be affected. That is, the social workers actions might be viewed by the public as an extension of the agency or the social work profession and their respective policies and standards.3. Tentatively identify all possible courses of action and the participants involved in each, along with possible benefits and risks for each.Put simply, the social worker can agree to deliver the eulogy or reject the parents request. Between these stark options are more subtle possibilities that include attending but not speaking at the funeral and speaking at the funeral without disclosing to attendees any information concerning the nature of the social workers relationship with the deceased client.If the social worker delivers the eulogy, she may provide comfort to the deceased clients parents and others who attend the funeral. The social worker, too, may gain some solace in the process.On the other hand, delivering the eulogy may compromise the deceased clients privacy and confidentiality. Further, those who attend the funeral may feel uncomfortable hearing the social workers comments, particularly if the social worker discloses the nature of her relationship with the deceased. Also, the social workers reputation may be harmedalong with that of her agency and the social work professionif those in attendance are critical of the social workers decision to deliver the eulogy.If the social worker declines, the deceased clients parents may be angry and hurt and may suffer emotionally. Also, the social worker may feel some misgivings as a result, especially if the social workers relationship with the parents becomes strained.4. Thoroughly examine the reasons in favor of and opposed to each possible course of action, considering relevant (a) ethical theories, principles, and guidelines; (b) codes of ethics and legal principles; (c) social work practice theory and principles; and (d) personal values (including religious, cultural, and ethnic values and political ideology).In recent years, social work students and practitioners have been introduced to the rudiments of ethical theorygrounded in moral philosophyas a tool in the analysis of ethical dilemmas. Briefly, classic ethical theory involves various schools of thought concerning what constitutes morally right and wrong action in the face of ethical dilemmas.For example, according to the deontological perspectiveoften associated with 18th-century German philosopher Immanuel Kantcertain actions are inherently right or wrong, or good or bad. Deontological statements include the following: Always tell the truth, always obey the law, and never kill an innocent person. Thus, a deontologist might argue that the deceased client has a fundamental right to privacy and that it would be unethical for the social worker to speak at the funeral about any aspect of the clients life or the parties therapeutic relationship.In contrast, a teleological perspective in moral philosophy asserts that ones ethical obligation is determined by the goodness of the consequences that are likely to result. That is, the decision makers emphasis should be on likely outcomes rather than on conclusions about what is the morally right or wrong action.From this vantage point, the social worker should conduct a utilitarian calculus (a phenomenon introduced more than a century ago by philosophers Jeremy Bentham and John Stuart Mill), weighing the potential benefits and costs of each possible course of action. Although there are several versions of utilitarianismalso known as consequentialismthe most common states that when faced with an ethical dilemma, one should act in a manner that produces the greatest balance of good over bad consequences. Thus, if the social worker concludes that more harm than good would result if she delivers the eulogy, she would not honor the parents request.In addition to considering pertinent ethical theories and their respective strengths and limitations, the social worker should also consult relevant codes of ethics and legal principles. The National Association of Social Workers (NASW)Code of Ethics, for example, contains a number of explicit standards related to client self-determination (standard 1.02), informed consent (standards 1.03 [a][c]), conflict of interest (standards 1.06 [a][c]), and privacy and confidentiality, including the rights of deceased clients (standards 1.07 [a][b][g][r]). In addition, the code makes specific reference to a social workers obligation to consult with colleagues when necessary to make sound decisions in complex circumstances (standards 2.05 [a-c]).The social worker in this case must also be cognizant of legal issues. State laws and licensure regulations often address clients privacy and confidentiality rights, informed consent requirements, and dual relationship issues. In addition, the social worker should be aware of the possibility, albeit perhaps a remote one, that disgruntled parties who are upset with the social workers handling of this circumstance could file an ethics complaint (for example, with the state licensing board or NASW) or lawsuit alleging unethical conduct or malpractice.Of course, the social worker should also draw on his or her knowledge of pertinent ethical theory and principles, especially concerning key ethics concepts and clinical phenomena related to grief and loss. Also relevant are the social workers own values, in this case related perhaps to personal loyalty and respecting individuals dignity.5. Consult with colleagues and appropriate experts (such as agency staff, supervisors, agency administrators, attorneys, ethics scholars, and ethics committees).Any social worker who faces difficult, complex ethical decisions should make a concerted effort to consult with knowledgeable colleagues and ethics experts. Some human services agencies now sponsor ethics committeesformally known as institutional ethics committeeswhose members have training in ethics-related matters and provide collegial consultation. In addition to offering consultation, many ethics committees sponsor in-service training and facilitate the development of agencies ethics-related guidelines and policies. In some settingsusually healthcare agencies such as teaching hospitals and rehabilitation facilitiesprofessional ethicists may be available for consultation. Typically, ethics consultants are human services professionals who have received advanced training in ethics or moral philosophers who have become knowledgeable about professional practice. Finally, when ethical dilemmas pose legal questionsfor example, related to interpretation of state laws or regulations, or potential lawsuitssocial workers would be wise to consult with an attorney who specializes in professional malpractice and risk management.6. Make the decision and document the decision-making process.Once the decision is made, social workers should document the process carefully. Not only is this act consistent with sound social work practice and documentation standards, but also careful documentation can protect social workers in the unlikely event that ethics complaints or lawsuits are filed against them. Thorough notes describing the social workers decision-making steps and rationale provide compelling evidence of the practitioners prudence and professionalism.7. Monitor, evaluate, and document the decision.What may appear to be a final decision is not the end of the ethical decision-making process. Once the decision is made, the social worker should keep track of both immediate and more distant consequences and respond to them conscientiously. For example, if the social worker in this case decides to attend but not speak at the clients funeral, the social worker should monitor the parents reactions to ensure that there are no untoward or harmful clinical repercussions.Ethical decision making is a complex process. Todays social workers are learning much about the nature of ethical dilemmas and sound decision-making procedures. There is no guarantee, of course, that even the clearest set of decision-making guidelines will yield simple solutions to complex ethical problems. No set of guidelines can produce such outcomes. In the final analysis, even the most thoughtful and reasonable practitioners may disagree about the most ethical course of action. In this respect, ethical decisions are no different from complex clinical or other social work decisions. Conceptual frameworks are useful and help to guide practitioners decisions; however, they do not guarantee clearcut solutions or collegial consensus. What they do ensure is systematic, thorough analysis and reflectionessential elements of competent practice.

September/October 2008 IssueWhen Ethics and the Law CollideBy Frederic G. Reamer, PhDSocial Work TodayVol. 8 No. 5Albert G. is a social worker at a state-funded community mental health center. Albert provides services to a 32-year-old woman who struggles with clinical depression. The woman is an undocumented immigrant who had been physically abused by her former partner. Shortly after the relationship ended, the woman attempted suicide by swallowing a large dose of prescription drugs.The states governor recently issued an executive order prohibiting state-funded agencies from providing health and social services to undocumented immigrants. According to the governor, the state faces a severe budget crisis and cannot afford to provide services to noncitizens.Albert is so concerned about his clients well-being that he is considering counseling her off the books, even though it would violate the governors executive order.Many ethical issues faced by social workers involve legal issues. When a police detective asks a social worker for confidential information about a client, the social worker must consider legal guidelines pertaining to the disclosure of confidential information to a law enforcement official without a clients consent. When parents of a minor client ask a social worker for details about their childs counseling sessions, social workers must consider legal guidelines concerning minors right to privacy and parents right to know about confidential healthcare services provided to their child.In many instances, ethical standards in social work are consistent with legal standards and requirements. For example, state laws generally require social workers to disclose confidential information without a clients consent when they have reason to believe that a client poses a serious, imminent, and foreseeable threat to an identifiable third party. However, social workers sometimes encounter circumstances in which legal standards clash with the professions ethical standards and their beliefs about their moral duty.The Nature of Legal StandardsLegal standards relevant to social work take various forms, including the following:Statutory law:Many federal laws enacted by Congress and state laws enacted by legislatures affect social workers. Examples include statutes governing social workers obligation to report suspected abuse and neglect of children, elders, and other vulnerable people; statutes governing minors right to consent to mental health counseling and drug and alcohol abuse treatment; and the federal HIPAA laws.Case law:Many laws relevant to social work are created by the courts in the context of litigation and judicial rulings. For example, a judge may need to interpret the meaning or application of existing law, resolve conflicts between laws, or fill gaps in existing laws. Such rulings by the court become legal precedent or case law. For example, current guidelines concerning social workers duty to disclose confidential information without client consent to protect third parties were initially established in the 1970s by a major California court case.Regulatory law:Social work practice is also governed by many regulations promulgated by federal and state government agencies, such as the U.S. Department of Health and Human Services and state human service, child welfare, and mental health agencies. Under our system of law, federal and state agencies have the authority to establish enforceable regulations. Public agencies must follow strict procedures when they create regulations (e.g., providing public notice and opportunity for public comment about drafts of regulations).Constitutional law:The U.S. Constitution and state constitutions include numerous provisions that pertain to social work practice. Examples concern citizens right to privacy and protections against improper search and seizure (which are important in residential treatment programs) and protections against cruel and unusual punishment (which are important in juvenile and adult correctional facilities).Executive orders:Chief executives in federal, state, and local governments (e.g., a president, governor, mayor, or county executive) may issue orders that resemble regulations. This authority is usually based in federal and state statute. Examples include a governors executive order requiring state-funded agencies to withhold health and human services from undocumented immigrants.Conflicts Between Ethics and the LawSocial workers generally agree that they should obey laws that clearly are essential for an orderly society. However, some practitioners argue that in some instances, blind obedience to the law can be shortsighted and harm clients, particularly when laws seem to be unjust.Ethical decisions in social work that involve legal issues do not always involve ethical dilemmas, particularly situations where social workers decisions are compatible with both legal and ethical standards. However, other situations produce difficult ethical dilemmas, particularly when social workers decisions are compatible with legal standards but not consistent with prevailing ethical standards in social work, and practitioners decisions are consistent with prevailing ethical standards in social work but not with legal standards. In some instances, social workers believe that actions the law permits or requires would violate ethical standards in social work or actions that would violate the law are necessary to comply with ethical standards in the profession.These conflicts are among the most daunting circumstances social workers face. Compliance with legal expectations and requirements may conflict with social workers understanding of ethical standards in social work, and compliance with ethical standards may lead to violation of the law.There are no simple solutions to these ethical dilemmas. Thoughtful, principled, and reasonable social workers may disagree in these situations. Some social workers embrace the view that all laws should be obeyed, regardless of a social workers personal opinion about their reasonableness. From this perspective, an orderly society requires strict obedience to laws; otherwise, we risk social chaos. Social workers have a right to seek changes in the law, but they do not have a right to violate the law. In contrast, other social workers resist blind obedience to the law because of their belief that some laws are unjust and harmful. These social workers argue that professionals must use their professional judgment and, if necessary, engage in civil disobedience.Social work history is filled with instances where social workers have had to make decisions of conscience about whether to obey the law, particularly when doing so seems to conflict with social work values. In the end, such decisions constitute some of the most difficult ethical dilemmas in the profession. These are the dilemmas that generate intense disagreement among practitioners, dilemmas that require earnest collegial consultation and supervision, and rResponse to Member re Recovery Group ActivityNASW member requested OEPR comment on the following situation:I run a recovery group for teenagers who have had problems in the past with drugs and/or alcohol. We normally meet in the group meeting room at my agency. As a treat for the members who have remained sober/drug free for the last six months, I would like to take the group out for pizza at the local pizzeria. We would go during the regular meeting time. Is there a problem with this plan ethically? My supervisor at the agency seems to think there may be.Response:There are no hard and fast ethical "rules" governing a professional social workers conduct in a professional setting. There are only guidelines. An excerpt from the Purpose section of theNASW Code of Ethicsstates:"TheCodeoffers a set of values, principles, and standards to guide decision making and conduct when ethical issues arise. It does not provide a set of rules that prescribe how social workers should act in all situations.Specific applications of theCodemust take into account the context in which it is being considered and the possibility of conflicts among theCode's values, principles, and standards. Ethical responsibilities flow from all human relationships, from the personal and familial to the social and professional."Nevertheless, there are specific sections of the code that seem related to the situation as posed, that might inform the decision-making process in this instance. In addition, there are certain questions that might be asked to help determine what seems to be the wisest course of action. Please note that the questions included here are not exhaustive in nature. The may well be others that could and should be considered.The most obvious section of the code pertains to dual relationships (see excerpt 1.06 c).1.06 Conflicts of Interest(c) Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)Relevant questions:1. Is this situation avoidable?2. What would this activity accomplish that cannot be accomplished in the normal setting?3. Does the situation place the client at risk of harm (no matter how slight)?4. Can clear appropriate boundaries be set and enforced not only with the client but also with others who might be present?The last question brings up the issue of privacy and confidentiality. An excerpt from section 1.07 of theCode:1.07 Privacy and Confidentiality(a) Social workers should respect clients' right to privacy. Social workers should not solicit private information from clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply.(b) Social workers may disclose confidential information when appropriate with valid consent from a client or a person legally authorized to consent on behalf of a client.(e) Social workers should discuss with clients and other interested parties the nature of confidentiality and limitations of clients' right to confidentiality. Social workers should review with clients circumstances where confidential information may be requested and where disclosure of confidential information may be legally required. This discussion should occur as soon as possible in the social worker-client relationship and as needed throughout the course of the relationship.Relevant Questions:1. Should the fact that the client is in a school support group be treated as confidential? If not, why not (specifically refer to section 1.07 e, excerpted above)?2. Is appearing in public with a client in and of itself a breach of confidentiality, even if it could be reasonably argued that appearing in public with the client does not constitute a dual relationship?3. If the answer to #2 is yes, would this required a signed consent by the student or the legal guardian? (SeeCodesection 1.03 Informed Consent, excerpted below)4. How would the professional respond to questions such as, "I saw you and a group of kids at the pizzeria yesterday. How do you know Mary (one of the kids)?"Question #3 raises the issue of informed consent, seeCodesection 1.03 Informed Consent, excerpted below:1.03 Informed Consent(a) Social workers should provide services to clients only in the context of a professional relationship based, when appropriate, on valid informed consent. Social workers should use clear and understandable language to inform clients of the purpose of the services, risks related to the services, limits to services because of the requirements of a third-party payer, relevant costs, reasonable alternatives, clients' right to refuse or withdraw consent, and the time frame covered by the consent. Social workers should provide clients with an opportunity to ask questions.(c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients' interests by seeking permission from an appropriate third party, informing clients consistent with the clients' level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients' wishes and interests. Social workers should take reasonable steps to enhance such clients' ability to give informed consent.(d) In instances when clients are receiving services involuntarily, social workers should provide information about the nature and extent of services and about the extent of clients' right to refuse service.Relevant Questions:1. Does state law allow these students to give their own consent for services? [The letter states that parents have signed permission slips]2. If the answer to #1 is no, or if some or all of the students are under the legal age of consent in that state, have the legal guardians consented to the planned activity?3. Is taking clients to a different and public location within the scope of providing services to clients only in the context of a professional relationship?4. Is the planned activity mandatory? If yes, was this covered in the initial intake process for the group? If not, what will the clients, who do not wish to participate in the activity, do during the time they would normally meet with the rest of the group?There are many other questions and considerations which might apply to this situation, depending on other factors that may or may not be operative. Some of the questions included here may not apply in this instance or may have already been answered in the description of the problem. A useful format for problem-solving an ethical dilemma isEssential Steps in Ethical Problem-Solving.