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CHAPTER 1
ETHICAL STANDARDS IN SOCIAL WORK:
AN INTRODUCTION
One hallmark of a profession is its willingness to establish ethical standards to guide practitioners’ conduct (D. Callahan & Bok, 1980; Congress, 2013; Greenwood, 1957; Hall, 1968; Lindeman, 1947). Ethical standards are created to help professionals identify ethical issues in practice and provide guidelines to determine what is ethically acceptable or unacceptable behavior. Professions typically organize their ethical standards in the form of published codes of ethics (Bayles, 1986; Brandl & Maguire, 2002; Congress, 2013; S. J. Freeman, Engels, & Altekruse, 2004; Kultgen, 1982; Montgomery, 2003). According to Jamal and Bowie (1995), codes of ethics are designed to address three major issues. First, codes address “problems of moral hazard,” or instances in which a profession’s self-interest may conflict with the public’s interest. Such conflicts can arise in a variety of ways. Examples include whether accountants should be obligated to disclose confidential information concerning financial fraud that their clients have committed, whether dentists should be permitted to refuse to treat people who have an infectious disease such as HIV/AIDS, whether physicians should be allowed to invest personally in laboratories or rehabilitation facilities to which they refer patients, and whether social workers should be expected to disclose to law enforcement officials confidential infor- mation about crimes their clients have admitted committing. Second, codes address issues of professional courtesy, that is, rules that govern how pro- fessionals should behave to enhance and maintain a profession’s integrity. Examples include whether lawyers should be permitted to advertise and solicit clients, whether psychiatrists should accept gifts and favors from pharmaceutical companies, whether psychologists should be prohibited from soliciting colleagues’ clients, and whether social workers should report colleagues who are impaired or who engage in unethical conduct. Finally, codes address issues that concern professionals’ duty to serve the public interest. For example, to what extent should physicians and nurses be expected to assist people who do not have health insurance or to help in a public emergency? Should dentists donate a portion of their professional time to provide services to low-income people who do not have dental insurance? Should social workers provide services without remuneration to clients whose insurance coverage has been exhausted? As in other professions—such as medicine, nursing, law, psychology, journalism, and engi- neering—social work has developed a comprehensive set of ethical standards. These standards 1
2 Ethical Standards in Social Work have evolved over time, reflecting important changes in the broader culture and in social work’s mission, methods, and priorities. They address a wide range of issues, including, for example, social workers’ handling of confidential information, sexual contact between social workers and their clients, conflicts of interest, use of technology, documentation, supervision, education and training, research and evaluation, and social and political action. Ethical standards for the social work profession appear in various forms. The NASW Code of Ethics (NASW, 2017; included in this book as Appendix A) is the most visible compilation of the profession’s ethical standards. Ethical standards can also be found in codes of ethics developed by other social work organizations (for example, the National Association of Black Social Workers, the Clinical Social Work Association [CSWA], and the Canadian Associa- tion of Social Workers), regulations governing state licensing boards, and codes of conduct promulgated by social services agencies. In addition, the social work literature contains many discussions of ethical norms in the profession (Banks, 2012; Barsky, 2009; Congress, 1999, 2013; Dolgoff, Loewenberg, & Harrington, 2004; Hugman & Carter, 2016; Reamer, 1990, 1995a, 1995b, 2013; Rhodes, 1986). The Evolution of Social Work Ethics The current NASW Code of Ethics reflects major changes in social work’s approach to ethical issues throughout its history and the profession’s increasingly mature grasp of ethical issues. During the earliest years of social work’s history, few formal ethical standards existed. The earliest known attempt to formulate a code was an experimental draft published in the 1920s and attributed to social work pioneer Mary Richmond (Pumphrey, 1959). Although several social work organizations formulated draft codes during the profession’s early years—includ- ing the American Association for Organizing Family Social Work and several chapters of the American Association of Social Workers—not until 1947 did the latter group, the largest organization of social workers of that era, adopt a formal code (A. Johnson, 1955). In 1960, NASW adopted its first code of ethics, five years after the association was formed. Over time, the NASW Code of Ethics has come to be recognized in the United States as the most visible and influential code of ethics in social work. The 1960 NASW Code of Ethics consisted of 14 proclamations concerning, for example, every social worker’s duty to give precedence to professional responsibility over personal inter- ests; to respect clients’ privacy; to give appropriate professional service in public emergencies; and to contribute knowledge, skills, and support to human welfare programs. First-person statements (that is, “I give precedence to my professional responsibility over my personal interests” and “I respect the privacy of the people I serve”) were preceded by a preamble that set forth social workers’ responsibility to uphold humanitarian ideals, maintain and improve social work service, and develop the philosophy and skills of the profession. In 1967, a 15th proclamation pledging nondiscrimination was added. Soon after the adoption of the code, however, NASW members began to express concern about its level of abstraction, its scope and usefulness for resolving ethical conflicts, and its provisions for handling ethics complaints about practitioners and agencies. As McCann and Cutler (1979) noted, The sources of dissatisfaction are widespread and have involved practitioners, clients, chap- ter committees, and, in particular, those persons directly engaged in the adjudication of
4 Ethical Standards in Social Work In 1993, a task force chaired by this author recommended to the NASW Delegate Assembly that it further amend the code of ethics to include five new principles—three related to the problem of social worker impairment and two related to the problem of dual or mul- tiple relationships (boundary issues). This recommendation reflected social workers’ growing understanding of the need to address impairment among some social workers and the ways in which blurred or confused boundaries between social workers and clients can compromise the quality of services delivered. The first three of these new principles addressed instances in which social workers’ own problems and impairment interfere with their professional function- ing, and the latter two addressed the need to avoid social, business, and other nonprofessional relationships with clients because of possible conflicts of interest. The 1993 Delegate Assembly voted to incorporate the five new principles and passed a resolution to establish a task force to draft an entirely new code of ethics for submission to the 1996 Delegate Assembly that would be far more comprehensive and relevant to contemporary practice. An entirely new code was needed because, since the 1979 code had been drafted, a new scholarly field—applied and professional ethics—had emerged. Much of what contemporary professionals in general and social workers in particular have learned about professional ethics occurred after the ratification of the 1979 code. Social workers developed a firmer grasp of the wide range of ethical issues facing practitioners, many of which were not addressed in the 1979 code. The broader field of applied and professional ethics, which had begun in the early 1970s, had matured considerably, resulting in the identification and greater understanding of novel ethical issues not covered by the 1979 code. The revised code was adopted in August 1996 and serves as the foundation of the current code. The NASW Code of Ethics Revision Committee was appointed in 1994 and spent two years drafting a new code. This committee, which was chaired by this author and included a professional ethicist and social workers from a variety of practice and educational settings, carried out its work in three phases (Reamer, 1997b). Each phase was designed to provide the committee with the most comprehensive information available on social work ethics and, more broadly, professional ethics so that the new code would reflect prevailing opinion in the profession. The committee first reviewed the literature on social work ethics, and applied and profes- sional ethics generally, to identify key concepts and issues that might be addressed in the new code. This was particularly important because so much of the literature on professional and social work ethics had been published after the development of the 1979 code. The commit- tee also reviewed the 1979 code to identify content that should be retained or deleted and to identify areas in which content might be added. The committee then discussed possible ways of organizing the new code to enhance its relevance and use in practice. During the second phase, and while the first-phase activities were occurring, the com- mittee also issued formal invitations to all NASW members and to members of various social work organizations (such as the National Association of Black Social Workers, Council on Social Work Education [CSWE], National Federation of Societies for Clinical Social Work, and Association of Social Work Boards [ASWB]) to suggest issues to be addressed in the new code. The NASW Code of Ethics Revision Committee reviewed its list of relevant content areas drawn from the professional literature and from public comment and developed numerous drafts, the last of which was shared with ethics experts in social work or another profession for their review and comment.
ETHICAL STANDARDS IN SOCIAL WORK: AN INTRODUCTION 5 In the third phase, the committee made several revisions on the basis of the feedback it received from the experts who reviewed the document, published a copy of the draft code in the January 1996 issue of the NASW News, and invited all NASW members to send comments for consideration by the committee as it prepared the final draft for submission to the 1996 NASW Delegate Assembly. In addition, during this last phase various committee members met with each of the six NASW Delegate Assembly regional coalitions to discuss the code’s development and receive delegates’ comments and feedback. The code was then presented to and ratified overwhelmingly by the Delegate Assembly in August 1996 and implemented in January 1997 (NASW, 1996). In 1999, NASW approved deleting a phrase from one standard (1.07[c]) to clarify the circumstances in which social workers may need to disclose confidential information without a client’s consent. The deleted phrase required social workers to disclose confidential information “when laws or regulations require disclosure without a client’s consent.” After the code was ratified in 1996 with this language, some social workers became concerned that this phrase could be interpreted to mean that social workers would be required to comply with new laws requiring disclosure of the identity of undocumented immigrants who were receiving social services, which would compromise practitioners’ integrity and erode clients’ willingness to trust social workers. In 2008, the code was revised to incorporate sexual orientation, gender identity, and immigration status into the existing nondiscrimination standards. August 2017 marked another significant date in social work history. The NASW Del- egate Assembly formally approved significant updates to the Code of Ethics. The revisions focused explicitly on ethical challenges pertaining to social workers’ and clients’ increased use of technology. They reflect a broader shift in social work practice related to technology that has led to very recent and noteworthy changes in regulatory (licensing board) standards, practice standards, and ethical standards. It is significant that the updated code retained the content of the 1996 code, a clear acknowledgment of that code’s continuing relevance and usefulness; nearly all of the 2017 revisions were technology related. The process leading to these significant updates began when NASW appointed a task force to determine whether changes to the Code of Ethics were needed to address concerns related to social workers’ and clients’ increased use of technology. Since 1 996, when the code was revised significantly, the use of computers, smartphones, tablets, e-mail, texting, online social networking, monitoring devices, video technology, and other electronic technology in various aspects of social work practice has significantly increased. In fact, many of the tech- nologies currently used by social workers and clients did not exist in 1996. The 2017 code now includes extensive technology-related additions pertaining to informed consent, competent practice, conflicts of interest, privacy and confidentiality, sexual relationships, sexual harass- ment, interruption of services, unethical conduct of colleagues, supervision and consultation, education and training, client records, and evaluation and research. The most significant revisions to the code Encourage social workers to discuss with clients policies concerning use of technology in the provision of professional services. Clients should have a clear understanding of the ways in which social workers use technology to deliver services, communicate with clients, search for information about clients online, and store sensitive informa- tion about clients.
ETHICAL STANDARDS IN SOCIAL WORK: AN INTRODUCTION 7 Advise social workers to inform clients of unauthorized access to the social worker’s electronic communication or storage systems (for example, cloud storage). Advise social workers to develop and inform clients about their policies on the use of electronic technology to gather information about clients. Advise social workers to avoid posting any identifying or confidential information about clients on professional Web sites or other forms of social media. Advise social workers using technology to facilitate evaluation or research to obtain clients’ informed consent for the use of such technology. The code also encourages social workers to assess clients’ ability to use technology and, when appropriate, offer reasonable alternatives. For a variety of reasons, especially during the 1980s and early 1990s, scholarly analyses of ethical issues in all professions burgeoned. First, and perhaps most important, was the emer- gence in the 1970s of complicated ethical issues in health care (for example, public debate about the ethics of allocating scarce organs, genetic engineering, abortion, and euthanasia). These developments led to the establishment of the bioethics field (Beauchamp & Childress, 2013). Without question, debate and scholarship in bioethics paved the way for other professions’ exploration of ethical issues. Professionals in all fields began for the first time to appreciate the useful and complex connections between ethical theory and principles and real-life ethical problems faced by practitioners (Reamer, 1985, 1986, 1991a, 1993b, 1997c, 2013). Second, at about the same time (the late 1960s and early 1970s), many social work and health professionals were embroiled in sustained debate concerning patients’ rights, welfare rights, prisoners’ rights, and civil rights. Relevant issues included a patient’s right to refuse treatment, the role of informed consent in research, the humane treatment of prisoners, and affirmative action and civil rights protections in the workplace. These concepts, which many professionals now take for granted, were new at the time, and discussion of them helped shape the emerging field of applied and professional ethics. Third, professionals began paying more attention to ethical issues because of increased litigation concerning alleged ethical misconduct involving practitioners in all fields (Reamer, 2001b, 2015). Lawsuits alleging, for example, breaches of privacy and confidentiality, sexual misconduct, defamation of character, fraudulent billing, and inappropriate termination of ser- vices alerted many people in the helping professions to possible ethical problems in their ranks. If for no other reason, practitioners needed to learn more about ethics to prevent malpractice claims and avoid lawsuits (Reamer, 2003b, 2015). Fourth, increasingly widespread publicity in all media about professional misconduct did much to convince practitioners that they needed to pay more attention to ethics. For example, there were reports of physicians who committed Medicaid fraud, clergy who were sexually involved with minors, lawyers who raided clients’ escrow accounts, police officers who accepted bribes or abused suspects, and psychotherapists who developed sexual relationships with cli- ents. Of course, in the midst of this period (the early 1970s), the nation was wrestling with the ethical implications of the Watergate political scandal, an ethical lapse with far-reaching consequences. Watergate and myriad other national and local political scandals since have done much to inspire interest in ethical issues. Finally, interest in professional ethics grew because the professions themselves matured. Like people, professions experience stages of development. It took decades for nearly all the
8 Ethical Standards in Social Work professions to pay serious attention to ethical issues, in part because, during the earlier phases of their development, they tended to be preoccupied with cultivating their technical expertise and proficiency. This is understandable, given these professions’ need to establish their cred- ibility with the public. A clear by-product of this general trend is that social workers as a group have begun to pay much more attention to ethical issues in the profession. Many state licensing boards now require ethics education during each licensing cycle. Also, presentations on social work eth- ics at professional conferences sponsored by NASW, CSWE, CSWA, and other social work organizations have increased substantially. In addition, CSWE has strengthened its require- ments concerning instruction in undergraduate and graduate social work education programs on ethical issues and ethical decision making. Moreover, many social services agencies now provide ethics in-service training. Current NASW Code of Ethics The current code includes four major sections. The first section,“Preamble,” summarizes social work’s mission and core values. For the first time in NASW’s history, the association has adopted and published a formally sanctioned mission statement and an explicit summary of the profession’s core values. The committee members who wrote the 1996 code believed strongly that it was time for the profession to codify a widely endorsed mission statement, particularly as social work approached the 100th anniversary of its formal inauguration. The mission statement sets forth several themes key to social work practice.
Key Themes
Commitment to Enhancing Human Well-Being and Helping Meet Basic Human Needs of All People. Social work historically has paid particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. The concept of this enduring dedication to basic human needs was included to remind social workers of the profession’s fundamental preoccupation with people’s most essential needs, such as food, clothing, health care, and shelter. (See Towle’s [1965] seminal work, Common Human Needs , for a discussion of this concept.) Client Empowerment. Especially during the era of charity organization societies in the late 19th and early 20th centuries, many social workers tended to behave paternalistically toward clients. Social workers of that time were inclined to focus on issues of moral rectitude and character in an effort to address people’s problems. Over the years, however, as social workers have developed a richer understanding of the ways in which structural problems—such as a weak economy, racial discrimination, poverty, and deindustrialization—can create problems in people’s lives, they have promoted client empowerment as a goal (Gutierrez, 1990). Empower- ment is “the process of helping individuals, families, groups, and communities increase their personal, interpersonal, socioeconomic, and political strength and to develop influence toward improving their circumstances” (Barker, 2003, p. 142). As Black (1994) has suggested,
10 Ethical Standards in Social Work to understand a problem in social functioning, you cannot achieve understanding by adding together, as separate entities, the assessment of the individual and the assessment of the environment. Rather you must strive for a full understanding of the complex interactions between client and all levels of social systems as well as the meaning the client assigns to these interactions. (p. 118) Promotion of Social Justice and Social Change. One of social work’s hallmarks is its endur- ing and deep-seated commitment to social justice with and on behalf of clients, “an ideal con- dition in which all members of a society have the same basic rights, protection, opportunities, obligations, and social benefits” (Barker, 2003, p. 404). Throughout the profession’s history, social workers have been actively involved in social efforts to address basic human needs and enhance people’s access to important social services. Such social action has taken various forms, such as lobbying public officials, undertaking community organizing, changing organizations to be more responsive, and campaigning for political candidates (Gamble & Weil, 2013; Hardina, 2013; Schneider, Lester, & Ochieng, 2013). Although social workers’ social change efforts have ebbed and flowed over time (Gil, 1994, 1998) at both the national and the local levels, they have at least in principle understood the importance of social justice and social action. This, too, is one of the features that distinguishes social work from other helping professions. Sensitivity to Cultural and Ethnic Diversity. Unlike the earlier NASW codes of ethics, the current code emphasizes the need for social workers to understand the role of cultural and ethnic diversity in practice; it also exhorts social workers to strive to end all forms of dis- crimination, whether related to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical ability. Particularly since the 1970s, social workers have enhanced their understanding of the ways in which cultural and ethnic norms and history can affect clients’ experiences, perceptions, and life circumstances. In addition, social workers have developed a sound understanding of the ways in which social work interventions and social policies must take into consideration cultural and ethnic diversity (Chau, 1991; Devore & Schlesinger, 1998; Green, 1982; Ho, 1987; Hooyman, 1994; Lister, 1987; Lum, 1992, 2007, 2013; Pinderhughes, 1994; Pitner & Sakamoto, 2016). The preamble to the current code also sets forth the core values in which social work’s mission is rooted.
Purpose of the Code
The second section of the code, “Purpose of the NASW Code of Ethics ,” provides an overview of its main functions and a brief guide for dealing with ethical issues or dilemmas in social work practice. This section alerts social workers to the code’s various purposes. The code identifies core values on which social work’s mission is based. The preamble identifies six core values: service, social justice, dignity and worth of the person, the impor- tance of human relationships, integrity, and competence. The NASW Code of Ethics Revision Committee settled on these core values after a systematic review of literature on the subject. The committee’s final list represented a distillation of the numerous lists of social work values proposed by various authors.
ETHICAL STANDARDS IN SOCIAL WORK: AN INTRODUCTION 11 The code summarizes broad ethical principles that reflect the profession’s core values and establishes a set of specific ethical standards that should be used to guide social work practice. As discussed in more detail later, the code distinguishes between broad ethical principles based on social work’s core values and more specific ethical standards designed to guide practice. The code is designed to help social workers identify relevant considerations when profes- sional obligations conflict or ethical uncertainties arise. The Code of Ethics is one of many tools social workers can use to address ethical issues that emerge in practice. This section’s guide for dealing with ethical issues emphasizes various resources social workers should con- sider when faced with difficult ethical decisions, such as ethical theory and decision making, social work practice theory and research, laws, regulations, agency policies, and other relevant codes of ethics. Social workers are encouraged to obtain ethics consultation when appropriate, whether from an agency-based or social work organization ethics committee, regulatory body (for example, a state licensing board), knowledgeable colleagues, supervisors, or legal counsel. Ethical theory and decision making are now widely understood to be critically important components of practice. Some ethical issues faced by social workers are clear and straightfor- ward. It is easy for practitioners to agree, for example, that clinical social workers should not have sexual contact with clients, social work administrators should not embezzle agency funds, and social work researchers should not fabricate program evaluation results. Other issues, however, are ethically complex. They arise in situations in which social work- ers face conflicting professional duties, such that fulfilling one violates another (Reamer, 1990, 1998a, 2013). Examples include social workers who struggle to decide whether to intervene with a client who is engaging in self-destructive behavior; to have online social networking contact with a former client; to use technology to provide remote services to a client; to with- hold troubling information contained in a case record from a particularly vulnerable client; to disclose confidential information against a client’s wishes to protect a third party from harm; to report to authorities that a professional colleague is impaired or has engaged in unethical behavior; to exaggerate a clinical diagnosis to help a vulnerable client qualify for service; to participate in a labor strike at a work site, which could have detrimental consequences for clients; or to violate a mandatory reporting law to maintain a therapeutic relationship with a client who has made meaningful progress. In such cases, social workers often struggle to reconcile competing and conflicting professional obligations (Reamer, 2005b, 2013). Particularly since the early 1970s, when the field of applied and professional ethics emerged, professionals in all fields have developed a better understanding of the role of ethical theory and ethical decision making in circumstances in which practitioners face conflicting ethical duties (Reamer, 1984, 1987c, 1989b, 1997a, 1998a, 2013). During this period, social workers began to analyze systematically how practitioners make ethical decisions and resolve ethical dilemmas. Although there have been discussions of ethics and values since the profes- sion’s formal beginning in the late 19th century, the deliberate, systematic study of ethical dilemmas in the profession is more recent ( Joseph, 1989; Keith-Lucas, 1977; Levy, 1972, 1973, 1976; Reamer, 1995a, 1995b, 2013). Especially since the 1980s, practitioners and scholars in many fields have become inter- ested in examining the ways in which principles of ethics and ethical theory—drawn largely from the discipline of moral philosophy and, at times, theology—can be applied to ethical dilemmas in the professions. Much of the inquiry has focused on two key questions: (1) What
ETHICAL STANDARDS IN SOCIAL WORK: AN INTRODUCTION 13 (Beauchamp & Childress, 2013). The ethics of care, in contrast, reflects a collection of moral perspectives more than a single moral principle (Gilligan, 1982). This view emphasizes the importance in ethics and moral decision making of the need to care for, and act on behalf of, persons with whom one has a significant relationship (Beauchamp & Childress, 2013). For social workers, this perspective emphasizes the critical importance of their commitment to their clients. Ethicists and professionals continue to disagree about the merits and demerits of these points of view. The debate has been healthy in that it has alerted professionals to competing perspectives that need to be considered when they are faced with an ethical dilemma, especially when professional duties conflict and choices must be made. To enhance the quality of their decision making, social workers need to critically examine the strengths and limitations of various schools of thought that can be brought to bear on the diverse challenges that profes- sional practice produces. This is analogous to the need for clinical social workers to understand the strengths and limitations of the diverse conceptual models used to understand individuals’ mental health problems and design interventions to assist them. The code also highlights the role of ethics consultation. In many cases, practitioners should consult with others when they are faced with challenging ethical dilemmas. Social workers well understand the importance of consultation in other practice domains—for exam- ple, when they are unsure where to head clinically in a difficult case, how to handle a compli- cated administrative matter, or how best to promote a legislative proposal to address a critical issue. Two (or more) heads are often better than one, and this holds for those situations in which ethical dilemmas arise. Ethics consultation can take various forms. First, social workers should always consider examining the professional literature on ethical issues. Scholarship on social work ethics, and on applied and professional ethics generally, has burgeoned in recent years, and practition- ers should do their best to keep up with it. Some of the literature addresses broader, and at times more abstract, issues related to ethical theory and decision-making strategies. Much of it, however, concentrates more narrowly on specific ethical issues, such as the limits of confi- dentiality when third parties are at risk, informed consent challenges, professional boundaries, practitioner impairment, and social workers’ use of technology to deliver services and com- municate with clients. Second, many agencies have developed their own ethics committees designed to help staff and clients think through the best way to handle an ethical dilemma. The concept of eth- ics committees (often called “institutional ethics committees” [IECs]) first emerged in 1976, when the New Jersey Supreme Court ruled that Karen Ann Quinlan’s family and physicians should consult an ethics committee in deciding whether to remove her from life support sys- tems. (However, many hospitals have had something resembling ethics committees since at least the 1920s.) The New Jersey court based its ruling on an important article by Teel (1975) that appeared in the Baylor Law Review in which a pediatrician advocated the use of ethics committees in cases in which health care professionals face difficult ethical choices. Ethics committees typically include representatives from various disciplines and posi- tions, such as nursing, medicine, social work, the clergy, and agency administration. Ethics committees in large agencies often include a professional ethicist, typically someone with formal education in moral philosophy and professional ethics (Post & Blustein, 2015). This expert may be a trained philosopher or theologian or a member of one of the professions (for
14 Ethical Standards in Social Work example, a nurse, physician, or social worker) who has supplemental education related to ethics. Sometimes ethics committees also include an agency’s attorney. This is especially controversial because an attorney’s obligation is to offer advice intended to protect his or her client (in this case, the agency); some critics believe that all members of an ethics committee should be in a position to think freely without constraint. An alternative is to include on the committee an attorney who is not employed by the agency and who, therefore, is free to express more independent opinions based on her or his legal expertise. Most ethics committees devote the bulk of their time to case consultation (C. B. Cohen, 1988; Conrad, 1989; Cranford & Doudera, 1984; Kennedy Institute of Ethics, 1993; Post & Blustein, 2015; Reamer, 1987a). The committee is available to agency staff and perhaps to clients to think through how an ethical dilemma might be handled and to offer nonbinding advice. In health care settings, in which ethics committees are particularly prominent, such case consultation might concern a patient’s eligibility for organ transplantation, a patient’s right to refuse treatment, and end-of-life decisions. In other settings, such as a community mental health center or family services agency, case consultation might focus on questions concerning the disclosure of confidential information against a client’s wishes, staffers’ use of technology to deliver services, whether certain sensitive information should be shared with a particularly fragile client, management of complex boundary and dual relationship issues, and how to handle the discovery of some fraudulent activity within the agency. Although ethics committees are not always able to provide clear-cut advice about the complicated issues that come to their attention (nor should they be expected to), they can provide a valuable forum for thoughtful and critical exploration of complex ethical issues. Many ethics committees also serve other functions, including drafting, reviewing, and revising agency policies that pertain to ethical issues, such as confidentiality guidelines or informed consent procedures, and sponsoring staff training on ethics-related matters. Training may include traditional didactic instruction and what has become known in many health care settings as “ethics grand rounds,” which are educational sessions offered to staff on various ethics-related topics. Third, on occasion social workers may want to draw on the expertise of individuals who serve as ethics consultants. These formally educated ethicists can provide useful advice on a case-by-case basis as well as serve as advocates or mediators should the need arise. As with ethics committees, ethics consultants are in a position to help practitioners think through difficult ethical choices, acquaint social workers with relevant conceptual tools and practical resources, and offer nonbinding advice (Aulisio, 2001; Aulisio, Arnold, & Youngner, 2003; Fletcher, 1986; Fletcher, Quist, & Jonsen, 1989; La Puma & Schiedermayer, 1991; Reamer, 1995c; Skeel & Self, 1989; Taylor, 2005). Of course, consultation can also be obtained from knowledgeable and thoughtful col- leagues and supervisors who do not have formal ethics education. In some instances, social workers might find it useful to consult with members of their state licensing or regulatory board or members of their NASW chapter’s Ethics Committee. Some NASW chapters also provide more formal ethics consultation services, such as an ethics hotline. Finally, social workers should keep in mind that some ethical issues broach legal ques- tions that should be brought to the attention of an attorney. For example, social workers may want to seek legal advice when they need to decide whether to disclose confidential informa- tion to a third party against a client’s wishes, comply with a subpoena that requests privileged information, terminate services to a client who has threatened to file a lawsuit against the
16 Ethical Standards in Social Work The code socializes practitioners new to the field to social work’s mission, values, ethical principles, and ethical standards. The code provides social work educators, including both classroom faculty and field instructors, with an efficient tool that can be used to acquaint stu- dents with the profession’s mission, core values, broad ethical principles, and specific ethical standards. It is clearly the most visible and widely recognized statement of social work’s aims, values, and ethical principles and standards. The code articulates standards that the social work profession itself can use to assess whether social workers have engaged in unethical conduct. The code provides NASW with specific standards to determine whether social workers have engaged in unethical conduct. The association is required to use the code as its principal source when complaints are filed against members. As mentioned before, many social work licensing and regulatory boards also use the code or portions of it to adjudicate complaints filed against practitioners who fall under their jurisdiction. The updated code highlights ethical issues that arise related to social workers’ use of technology. The code defines technology as any social work services that involve the use of computers, mobile or landline telephones, tablets, video technology, or other electronic or digital technologies; this includes the use of various electronic or digital platforms, such as the Internet, online social media, chat rooms, text messaging, e-mail, and emerging digital applications.
Ethical Principles
The code’s third section, “Ethical Principles,” presents six broad ethical principles that inform social work practice, one for each of the six core values cited in the preamble. To provide a conceptual base for the profession’s ethical standards, the principles are presented at a fairly high level of abstraction. The code also provides brief annotation for each of the principles. It is important to note that the core values on which the ethical principles are based are not listed in rank order: “This constellation of core values reflects what is unique to the social work profession. Core values, and the principles that flow from them, must be balanced within the context and complexity of the human experience” (NASW, 2017, p. 1). The first value, service, and the accompanying ethical principle emphasize social workers’ commitment to helping people in need. The annotation promotes the concept of altruism, encouraging social workers to “elevate service to others above self-interest” (NASW, 2017, p. 5). Of special note, social workers are urged but not required to volunteer a portion of their professional skills with no expectation of significant financial return, that is, pro bono service (from the Latin, pro bono publico, meaning “for the public good or welfare”). The NASW Code of Ethics Revision Committee concluded that it would be inappropriate to require social workers to volunteer a portion of their professional skills because there are pressing professional and personal demands on many practitioners and their often modest salaries. However, the committee did believe that it was important to encourage social workers to provide some pro bono service. The second value, social justice, and the accompanying ethical principle reiterate key points made in the code’s mission statement. The annotation emphasizes social workers’ obliga- tion to pursue social change with, as well as on behalf of, vulnerable and oppressed individuals and groups of people. That is, social workers should not always act for others; when possible,
ETHICAL STANDARDS IN SOCIAL WORK: AN INTRODUCTION 17 social workers should engage clients and others as partners in efforts to promote social justice and challenge social injustice. The third value, dignity and worth of the person, and the accompanying ethical principle emphasize the need for social workers to respect people and “treat each person in a caring and respectful fashion, mindful of individual differences and cultural and ethnic diversity” (NASW, 2017, p. 5). Key elements include promoting clients’ “socially responsible self-determination” and enhancing “clients’ capacity and opportunity to change and to address their own needs” (pp. 5–6). Thus, although social workers are sensitive to and seek to address structural and environmental determinants of individuals’ and social problems, they also understand the important role of individual responsibility. The annotation also acknowledges social work- ers’ dual responsibility to clients and to the broader society and the need for social workers “to resolve conflicts between clients’ interests and the broader society’s interests in a socially responsible manner” (p. 6). The fourth value, importance of human relationships, and the accompanying ethical principle stress what social workers have long known, that “relationships between and among people are an important vehicle for change” and that social workers need to “engage people as partners in the helping process” (NASW, 2017, p. 6). This principle is consistent with and reinforces the discussion of empowerment in the code’s mission statement. The fifth value, integrity, and the accompanying ethical principle emphasize the role of trust in the helping relationship and the need for social workers to “act honestly and responsibly and promote ethical practices on the part of the organizations with which they are affiliated” (NASW, 2017, p. 6). That is, social workers are not only responsible for their own professional ethics and integrity, they must also seek to ensure that the agencies and organizations with which they are affiliated act ethically and responsibly. The sixth value, competence, and the accompanying ethical principle assert that social workers should achieve reasonable levels of skill before offering their services to others. This principle exhorts social workers to practice only within their areas of expertise and continually seek to enhance their professional knowledge and skills. The principle also encourages social workers to contribute to the profession’s knowledge base.
Ethical Standards
The code’s last section, “Ethical Standards,” is the most detailed and includes specific ethi- cal standards to guide social workers’ conduct and provide a basis for adjudication of ethics complaints filed against NASW members. The standards fall into six categories concerning social workers’ ethical responsibilities (1) to clients, (2) to colleagues, (3) in practice settings, (4) as professionals, (5) to the profession, and (6) to the broader society. The introduction to this section of the code states that some of the standards are enforceable guidelines for profes- sional conduct, and some are standards to which social workers should aspire. This is a very important distinction. Moreover, “the extent to which each standard is enforceable is a matter of professional judgment to be exercised by those responsible for reviewing alleged violations of ethical standards” (NASW, 2017, p. 7). In general, the code’s standards concern three kinds of issues (Reamer, 2003b, 2013, 2015). The first includes what can be described as mistakes social workers might make that have ethical implications. Examples include leaving confidential information displayed on one’s desk or computer screen in such a way that it can be read by unauthorized people or
ETHICAL STANDARDS IN SOCIAL WORK: AN INTRODUCTION 19 ethnicity, national origin, color, gender, sex, sexual orientation, gender identity or expression, age, marital status, political beliefs, religion, immigration status, or mental or physical ability. The code’s standards concerning conflicts of interest alert social workers to their obliga- tion to avoid circumstances that might interfere with the exercise of professional discretion and impartial judgment. This includes avoiding any dual or multiple relationships with clients or former clients in which there is a risk of exploitation of or other potential harm to the cli- ent, including in-person contacts and contact via digital and other technology. Social workers are also urged to take special precautions when they provide services to two or more people who have a relationship with each other. Practitioners who anticipate having to perform in potentially conflicting roles are advised to clarify their obligations with the parties involved and take appropriate action to minimize any conflict of interest (for example, when a social worker is asked to testify in a child custody dispute or divorce proceedings involving clients). The current code includes extensive standards on privacy and confidentiality. Notewor- thy details concern social workers’ obligation to disclose confidential information to protect third parties from serious harm; confidentiality guidelines for working with families, couples, or groups; disclosure of confidential information to third-party payers; discussion of confidential information in public and semipublic areas (such as hallways, waiting rooms, elevators, and res- taurants); disclosure of confidential information during legal proceedings; protection of client confidentiality when responding to requests from the media; protection of the confidentiality of clients’ written and electronic records, as well as the confidentiality of information transmitted by use of computers, mobile telephones, electronic tablets, and other forms of technology; use of Internet-based search engines to gather information about clients; posting confidential informa- tion about clients on Web sites or other forms of social media; use of case material in teaching or training; client access to records; and protection of the confidentiality of deceased clients. Social workers are advised to discuss confidentiality policies and guidelines as soon as possible in the social worker–client relationship and then as needed throughout the course of the relationship. The current code also includes considerable detail on social workers’ sexual relationships with clients, including in-person contact and sexual communications using technology. In addition to prohibiting sexual relationships with current clients, which was addressed in the 1979 code, the current code also generally prohibits sexual contact with former clients. This is a particularly important development because there is intense concern among social work- ers about practitioners’ possible exploitation of former clients. The code also prohibits sexual contact with clients’ relatives or other individuals with whom clients maintain a close personal relationship when there is a risk of exploitation of or potential harm to the client. Moreover, social workers are advised not to provide clinical services to individuals with whom they have had a prior sexual relationship because of the likelihood that such a relationship would make it difficult for the social worker and client to maintain appropriate professional boundaries. In addition to its extensive detail on sexual relationships and sexual harassment, the 2017 NASW Code of Ethics also comments on other physical contact between social workers and clients. The code acknowledges the possibility of appropriate physical contact (for example, physically comforting a distraught child who has been removed from his or her home because of parental neglect or holding the hand of a nursing home resident whose spouse has died), but social workers are cautioned not to engage in physical contact with clients, such as cradling or caressing, when there is the possibility that psychological harm to the client could result. Social workers also are admonished not to sexually harass clients.
20 Ethical Standards in Social Work The current code includes a specific provision concerning the use of barter (accepting goods or services from clients as payment for professional service). The code stops short of banning bartering outright, recognizing that in some communities it is a widely accepted form of payment. However, social workers are advised to avoid the use of barter because of the potential for conflict of interest, exploitation, and inappropriate boundaries in their relationships with clients. For example, if a client “pays” a social worker for counseling by performing some service, such as painting the social worker’s house or repairing his or her car, and the service is somehow unsatisfactory, attempts to resolve the problem could interfere with the therapeutic relationship and seriously undermine the social worker’s effective delivery of counseling services. The code advises social workers about proper referral of clients to other providers; practi- tioners are expected to refer clients to other professionals when colleagues’ specialized knowl- edge or expertise is needed to serve clients fully, or when they believe they are not being effective or making reasonable progress with clients. In addition to addressing interruption of in-person and technology-based services, the code advises social workers to terminate properly with clients when services are no longer required or no longer meet clients’ needs or interests. The code permits social workers in fee- for-service settings to terminate services to clients who have not paid an overdue balance. However, services may be terminated in these circumstances only when the financial arrange- ments have been made clear to the client, the client does not pose an imminent danger to self or others, and the clinical and other consequences of the client’s nonpayment have been discussed with the client. The code advises social workers who are leaving an employment setting to inform clients of all available options for the continuation of services and their benefits and risks. This is an important standard because it permits a social worker to discuss the advantages and disadvan- tages associated with a client’s decision to continue receiving services from that practitioner in her or his new setting, to obtain services from another practitioner in the setting the social worker is leaving, or to seek services from a practitioner at some other agency. In addition, the code prohibits social workers from terminating services to pursue a social, financial, or sexual relationship with a client. Ethical Responsibilities to Colleagues This section of the code addresses issues concerning social workers’ relationships with pro- fessional colleagues. These issues include respect for colleagues; proper handling of shared confidential information; interdisciplinary collaboration and disputes; consultation; sexual relationships and sexual harassment; and impaired, incompetent, and unethical colleagues. The code encourages social workers who are members of an interdisciplinary team, such as in a health care or a school setting, to draw explicitly on the perspectives, values, and experiences of the social work profession. If disagreements among team members cannot be resolved, social workers are advised to pursue other ways to address their concerns (for example, approaching agency administrators or the board of directors). Social workers are also advised not to exploit disputes between a colleague and an employer to advance their own interests or to exploit clients in a dispute with a colleague. The current code added several standards on professional consultation. Social workers are obligated to seek colleagues’ advice and counsel whenever such consultation is in the client’s
