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Social Work Ethics: An Exploration of Values, Ethical Dilemmas, and Critical Practice, Lecture notes of Social Work

An in-depth analysis of social work ethics, focusing on philosophical approaches, ethical issues, and critical practice. It discusses the influence of various philosophical approaches on social work ethics, the role of values in social work identity and education, and ethical decision-making in social work. The document also explores ethical dilemmas in social work education and the promotion of social work ethics by the Hellenic Association of Social Workers.

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THE MEANING OF ETHICS AND ETHICAL DILEMMAS IN
SOCIAL WORK PRACTICE:
A QUALITATIVE STUDY OF GREEK SOCIAL WORKERS
A thesis submitted for the degree of Master of Philosophy
By
Dimitra Giannou
School of Health Sciences and Social Care
Brunel University
July 2009
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THE MEANING OF ETHICS AND ETHICAL DILEMMAS IN

SOCIAL WORK PRACTICE:

A QUALITATIVE STUDY OF GREEK SOCIAL WORKERS

A thesis submitted for the degree of Master of Philosophy

By

Dimitra Giannou

School of Health Sciences and Social Care

Brunel University

July 2009

Abstract

Social work struggles between the dichotomy of “ individual ” and “ society ” as it is characterized as enhancing both individual well-being and social justice. As these are not always easily balanced and social work has limited autonomy, social workers must develop their capacity for making moral judgments and defend these within their various roles and responsibilities. Studies which explore the role of ethics in social work practice enhance the potential for maintaining a common identity. This exploration permits a deeper understanding of social work ethics and reinforces a common framework inclusive of purpose and standards for the profession. These studies also capture the contextual factors impacting on the moral agency of social workers, and thus substantiate the role for social work in a world with structured oppression.

The purpose of this study was to obtain an in-depth understanding of social work ethics in the practice context of public hospitals in Greece. Using a case study design, data was gathered to explore and understand the role of social work ethics in daily practice and the formation of what is perceived as “good” practice. The analysis followed Yin‟s (1993) descriptive strategy. Data collection included fifteen in-depth interviews with hospital social workers, a group interview with social work academics, and a thematic analysis of the social work journal of the Hellenic Association of Social Workers (HASW). The meaning of ethical dilemmas and problems appeared to be constructed by personally held values, a lack of attention in social work education and the HASW on social work ethics, a professional emphasis on individualism rather than collectivism, and insufficient social protection in Greece. Importantly, these factors led to a fairly consistent response to ethical problems. “Having a clear conscience” , character traits such as bravery and imaginativeness, as well as the use of psychotherapy emerged as characteristics of “good” social work practice. These findings are of value to those who try to restore the values and ethics as central in social work. Values and ethics as key elements of social work expertise can lead social workers to a more competent and effective practice in terms of their ethical engagements.

Table of Contents

2.1. 6 Postmodernism, ethics and social work 2.1. 7 Summary

Conclusion

Ethics and Ethical Dilemmas and the Broader Social Work Context: Social work education and the Hellenic Association of Social Workers

Discussion and Conclusion

  • Abstract
  • Acknowledgments
  • Chapter
  • 1.0 An introduction to social work ethics Introduction
  • 1.1 Research aims
  • Chapter
  • Introduction Literature Review
  • 2.1 Philosophical approaches to ethics and their influence in social work - 2.1.1 The Greek philosophy of ethics-The genesis of virtue ethics - 2.1. 2 Christianity and ethics - 2.1. 3 The philosophical approach of Immanuel Kant - 2 .1. 4 Consequentialism, the Utilitarian approach on ethics - 2.1. 5 Feminist ethic of care
  • 2.2 Ethics and social work
    • 2.2. 1 Values and ethics and the social work identity
    • 2 .2.2 Social work education and ethics
    • 2.2. 3 Value-based evaluation of social work practice
      1. 2 4 Fundamental ethical issues and dilemmas in social work
      1. 2 5 Ethical decision-making in social work
    • 2.2.6 Ethical decision-making in health care settings
      1. 2 .7 Summary
  • 2.3 Exploring the context of social work ethics in Greece
    • 2.3.1 The history of social work in Greece
    • 2.3.2 Social work and the welfare state
    • 2.3.3 The social work profession within a globalized environment - 2.3.4 The National Health System in Greece - 2.3.4.1 Social work in Greek public hospitals.
      • 2.3.5 Summary
  • Conclusion
  • Chapter
  • Introduction Theoretical foundations: social work ethics and critical social work practice
  • 3.1 Politics and ethics - 3.1.1 Social policy and social work - 3.1.2 Politics and social work ethics
  • 3.2 Critical practice and social work - 3.2.1 Critical practice and its values
  • Conclusion
    • Chapter
  • Introduction Study Design
  • 4 1 Qualitative research methods and the case study approach - 4 1 .1 Data collection methods and a case study approach
  • 4 2 Ethical considerations
  • 4 3 The sample - 4 3 .1 Research sites - 4 3 .1.1 Athens - 4 3 .1.2 Patra - 4 3 .2 The participants
  • 4 4 Data Collection - 4 4 .1 Securing the sample - 4 4 .2 Pilot work - 4 4 .3 The interviews and reflections on them
  • 4 .5 Data analysis and management - 4 5 .1 Empirical description and thematic analysis - 4 5 .2 Analyzing interview data
    • 5 .5.5 Obstacles in the resolution of ethically difficult situations
    • 5.5.6 Summary
  • 5 6 Evaluating hospital social work practice
    • 5 .6.1 Characteristics of the “good” social worker
    • 5 .6.2 Personal values as the moral base for “good” social work
    • 5 .6.3 Psychotherapy and the “good” social worker
    • 5.6.4 Summary
  • Chapter
  • Introduction
  • 6 .1 Ethics and ethical dilemmas in social work education - 6 .1.1 Social theory versus social work practice - 6 .1.2 Social work students and practice learning - 6.1.3 Whistle blowing - 6.1.4 Accountability and social work academics - 6.1.5 Summary
  • 6 2 Hellenic Association of Social Workers and the promotion of social work ethics - 6.2.1 Roles and responsibilities for ethical social work - 6 2 .2 New knowledge and knowledge transfer for ethical social work practice - 6 .2.3 Summary
  • Chapter Conclusion
  • Introduction
  • Greece 7.1 The meaning of ethics and ethical dilemmas in hospital social work practice in
    • 7 .1.1 Social work in Greek public hospitals
    • 7 .1.2 The meaning of ethics in hospital social work practice
    • 7 .1.3 Ethical dilemmas and ethical decision-making
    • 7 .1.4 Ethics and the evaluation of “good” social work practice
  • 7.2 Implications for social work policy and practice in Greece
  • 7.3 Study limitations
  • 7.4 Recommendations for further research
  • Conclusions
    1. Letter to hospitals Appendices
    1. Participant information sheet
    1. Consent form
    1. Interview schedule for hospital social workers
  • Workers 5. Interview schedule for the representative of Hellenic Association of Social
    1. Interview schedule for social work academics
    1. Ethics approval letter, Brunel University
  • 8 Interview transcript
  • References

Chapter 1 Introduction

1.0 An introduction to social work ethics

Historically, social work is identified with the “helping” or “caring” professions as it is dedicated to help people meet their needs and advance their potential in a continuously changing society. Social work indeed began as a philanthropic helping activity, but it was developed as a special scientific field. Therefore, the identity of social work needed to be more specific and formed with specific characteristics which would enable a unique description of its practice among the other “helping” professions and the social sciences. By defining or characterizing it as both a science and a profession, we acknowledge elements in social work such as the existence of specific theories, ideologies, methods, techniques, and values and ethics. Furthermore, we recognise social work as having a social function which is provided by the state vis à vis the department of social welfare. We also acknowledge that this role is in a constant state of development, like everything else in society, by what we briefly call social dynamics.

Current ethical codes define social work as a profession which has its main purpose defined in relation to social change. Specifically, the International Federation of Social Workers (2005) and the U.S. National Association of Social Workers (1999) see social work as a profession that not only helps individuals to meet their needs, but also promotes social justice and social change. Importantly, the notion of social change can only describe an explicit change to the structure of a given society, a transformation of important aspects of human societies, changes in beliefs, values, culture, attitude, social relationships, civilization, stratification and anything else that affects human lives (Goode, 1988). What remains for social workers then, is to depict the changes that need to be done in order to ensure the personal and social well-being of all individuals. Therefore, social workers should be engaged not only for the purpose of social change, but for a common vision of what can replace an old status_._ Social workers should, therefore, define specific aims for social change in order to ensure their professional accountability and scientific identity.

Social work by its engagement with specific values and ethics determines the kind of social change that the profession wants to bring. Thus, by the use and interpretation of the profession‟s

values, the purpose of the profession is not abstract and could be identified in exploring practice. Through our common values and ethics we gain a common vision and a common identity that no one can take from us or criticize us for being unspecific. Through the profession‟s common values and ethics a vision for change and its identity emerges. Thus criticisms aimed at suggesting social work lacks specificity or remains undefined are unfounded.

Although social work is not the only profession that is dedicated to the promotion of important values, its relationship with social policy, its holistic approach to human needs and its engagement with mutually opposed values create complicated ethical dilemmas. There is an apparent agreement in the literature that social work tries to practise among conflicting interests, and therefore complicated ethical dilemmas are common in every day social work practice (IFSW, 2005; Rossiter, 2001; Briskman, 2001; Clark, 2000). For example, by approaching an individual‟s needs holistically, social workers have to deal with various needs and rights that should be addressed simultaneously. However, this is practically impossible. In light of these conflicts, social workers can only proceed by making value judgements (Clark, 2000).

As stated above, the concern of social work is not only to help individuals, but also to affect change in society to enable it to adequately correspond in its response to individual needs. Tragically, as Rossiter (2001) argues, this is something that social workers forget or ignore:

…I realized how exhausted and beleaguered I am by a lifetime of being positioned as a “professional helper” by a state that organizes the people‟s problems as individual pathologies that are best administered by professionals who are trained not to notice the state (pp.2).

If social workers are only familiar with seeing injustice as having only to do with individual relationships, then structural or social policy issues are removed from decision-making, including the value judgements they make. In this instance, they are unable to identify all of the stakeholders that are implicated within a problem(s); the identification of which is a very important part of the ethical decision-making process (Boland-Prom and Anderson, 2005). Consequently, an important condition for what is perceived as a “good” social work practitioner is introduced. In particular, and as Speicher (1998) indicates, ethical awareness is a prerequisite of ethically informed decision-making, and ethical decision-making is a significant aspect of social work practice as social workers continually mediate among conflicting interests or competing values (Clark, 2000).

qualitative orientation have also the ability to maintain closeness with practice realities. Therefore, social work research must uncover the contextual factors impacting on the moral agency of social workers, and thus substantiate the role for social work in a world with structure oppression.

However, different contexts shape the social work realities in different countries, and therefore, it is not possible to assume that social workers in Greece face the same challenges as in other countries. Likewise, it is difficult to identify a cross-national social work identity without recognising how a local context (e.g. local needs, national laws, employment opportunities and status) affects the profession. On the other hand, globalisation and closer ties with Europe have cross-national effects, and then the social work realities in one country could be seen in light of the political and economic changes that dominate on the global stage (Lyons, 2006).

Greece is a member state of European Union, however, the fundamental structure of the welfare state remains considerably stable. Currently, the social policy literature in Greece indicates that poverty, unemployment and social exclusion are pressing realities for the population while the Greek state spends considerably less than the average of the Member States of EU countries on social protection. Furthermore, the Greek welfare system is traditionally characterized by fragmentation and preferential treatment in the funding and delivery of social protection leading to large-scale inequities (Yfantopoulos, 2004; Sotiropoulos, 2003). Mass immigration and expansion of privatization due to globalization are also part of the economic and social reality of Greece (Petronoti and Triandafyllidou, 2003; Zambeta, 2000).

Not surprisingly, social work in Greece appears to reflect the insufficient social protection in Greece. The welfare state and social work education in Greece have not developed educational opportunities for social workers and therefore, social work‟s status is likely to remain low. Social work activities are characterized by a “first-aid” pattern and the individualization of problematic situations in contrast to collective intervention. Social work in Greece has not benefited by the international exchange of knowledge and professional experience, although the EU has instituted policies that promote student and professional mobility. In addition, the curricula of social work schools in Greece have no reference to international or European social work, and their focus is on the local and national level (Pediadikaki, 2003). Similarly, social work research is underdeveloped and there is only a scant body of work exploring social work practice in Greece (Dedoussi et al ., 2004; Pediadikaki, 2003).

To summarise, social work is a value laden profession and it is ethics that permits us to manage this balance. With this study I would like to contribute in such way that social work will understand its values and ethics at the front line of its practice as social workers are professionally employed to accomplish the balance between societal and personal well-being. In addition, with the establishment or re-establishment of values and ethics at the core of evaluative practices as well as in the formation of what is perceived professional expertise, we challenge the prevalence of evidence-based practice and we develop the potential of value-based social work practice. Only then can social work play a role in the development of a genuine moral discourse on the values that underpin social policy within the political arena of societies. If social workers are incapable of criticizing social policy in reference to its underpinning values, then social workers will become technical agents and their practice will be driven by the prevailing values of a given society.

1.1 Research aims

Since social work is a value-ladened profession social workers are obligated to make decisions on ethical grounds and their decisions should not be based solely on bureaucratic procedures and technical rules (O‟Sullivan, 1999). Ethical dilemmas are common in social work practice and they often reflect the ambiguities of the social work identity or its ethical engagement with mutually opposed values. However, not all factors that create ethical dilemmas are relevant in all social work contexts. Differentiations in social work education and tradition, social policy and the prevailing social values are only a few of the factors that structure variations in the ways that social workers perceive ethics and their ethical dilemmas.

This study was an exploration of the complex reasoning of ethical dilemmas and problems that hospital social workers face in their daily practice. In fact, social work ethics in Greece has not been researched before. By adopting a qualitative approach which is sensitive to cultural issues, and political and organizational context, I intend to outline the nature of social work ethics and the consequent ethical problematic situations that social workers face in their practice. My aim was to explore the role of social work ethics in Greece by looking through the case of social work practice in the Social Services Departments (SSD) of the public hospitals. In particular, the focus of this study was to outline the role of the ethics in the formation of what social workers perceived as ethically difficult situations and the consequent decisions they make. Additionally, the role of ethics in the formation of social work identity and the ideal of the “good” social worker was also of interest particularly in relation to how ethics affect the evaluative process of practice. Hence, the

the ethic of care, this narrow view appeared to reinforce paternalism and parochialism rather than a more cognitive appreciation of rights and justice as necessary aspects of a caring behavior (Meagher and Parton, 2004). Interestingly, all the participants appeared to determine that it was their personal values that provided important guidance for ethical decisions. Any consideration of professional knowledge and training or the professional association‟s code of ethics was not apparent.

It is anticipated that the dissemination of this study to Greek social workers is an initial effort to enable social workers to develop their ability to be ethically aware and learn to reflect on the ethical dilemmas of their practice. Moreover, this study encourages the efforts of those who try to establish a common framework inclusive of purpose and standards for the social work profession. In addition, the qualitative orientation of this study highlights the contextual factors that determine the ethical obstacles of social workers who daily try to respond to their clients‟ needs. Therefore, this study empowers social workers as they were able to identify and describe with their own words the realities of their practice.

Chapter 2 Literature Review

Introduction

Ethical dilemmas are considered as an inherent characteristic of the social work identity and reflect the involvement of social workers in multiple obligations often framed by conflicting values (IFSW, 2005; Banks, 2001; Rossiter, 2001; Clark, 2000). In fact, ethical awareness has currently emerged as a primary social work skill enabling social workers to respond effectively to their professional responsibilities and make ethically informed interventions (Banks, 2001; Rossiter, 2001; Clark, 2000).

Theoretical and empirical investigations into the meaning of ethics and ethical dilemmas in social work practice respond to theories that perceive social work as a value-laden profession and used to accomplish the balance between societal and personal well-being. In addition, as social work is defined in relation to social change, it is important for social work research to determine the contextual factors that constrain the ability of the social workers to promote their professional values and ethics.

The purpose of this chapter is to present the literature review of this thesis. It is grouped into three main sections. The chapter begins with a review of the philosophical and theoretical approaches to ethics as these are the origins of the substantial concepts used within the ethical code. The focus here is to understand the influences of these approaches in the formation of social work identity and practice.

In the second section the social work identity is discussed through the elaboration of its values and ethics. Following is the presentation of fundamental ethical dilemmas as consequences of the inherent ambiguities of social work identity. The emerging skill of ethical awareness as a prerequisite of ethically informed decisions and value-based evaluation are also illustrated through the existing theoretical social work literature. In addition, through a review of the existing empirical studies, the place of social work ethics and ethical dilemmas in daily practice is identified.

believed that only a virtuous person could be really happy because only a virtuous person had his/her soul in such a condition so as to be happy. Justice, courage, moderation and wisdom were the central aspects of a virtuous person according to Socrates and Plato (Huby, 1974).

Similarly, Aristotle believed that to lack virtues was to lack happiness which was the absolute evil. However, Aristotle developed a completely different approach on ethics and challenged the ideas of Plato and Socrates. Particularly, he argued that nothing is good in its own right and everything is good in relation to something else. He also argued that wisdom or the knowledge of something could be used both for good and for bad purposes; therefore, he was the first who separated the notions of means and ends. For Aristotle, virtues could be reached only if we choose the right means, and the choice of means was within our power.

The virtue theory of Aristotle rejects any notion of principles or moral rules. Right ethical decisions are dependent only on perception of individual circumstances. However, humans learn to make right decisions only if they gain certain virtues by cultivating certain dispositions, and in particular by educating their desires. Moreover, Aristotle made a distinction between acting virtuously and acting in conformity with virtues. This distinction was made in order to reflect the belief that virtue was fundamentally a matter of having the right desires, towards the right objects and in the right degree (Benn, 1998; Huby, 1974).

The theory of virtue ethics provides us with a different meaning of effectiveness in professional practice. Therefore, social work and its effectiveness take on a special meaning as virtue theorists place a special emphasis on virtues and vices and give relatively little explicit attention to moral rules and principles. Virtues are not just statements of principles. Rather they are dispositions to choose well; they are states of character. According to Banks (1995), “a virtue is a character trait which contributes toward some ideal of the good life, both for individuals and the society they belong” ( pp.35). The majority of character traits that are currently considered as virtues originate from the ancient Greek philosophy of the virtuous human being. For example, current virtue ethics theorists have embraced some of the virtues of Aristotle‟s and Socrate‟s ethical theories, including justice, courage and temperance.

Concerning the social work profession, virtue theorists argue that virtues have an important role in the formation of the social workers‟ professional identity. In particular, McBeath and Webb (2002) argue that ambiguity in the social work profession due to our complex socio-political world

could be resolved by placing virtues in what we perceive as the social worker‟s identity. Moreover, they believe that doing a task well is not merely a matter of following rules, rather it involves the skills and virtues of a person. Corresponding to this idea, the question of “what is good social work practice” is replaced by the question of “what is a good social worker”.

Virtue ethics give a moral meaning to the social work profession because social workers‟ actions are not driven by abstract obligations based on deontological rule books. Contrarily, social workers‟ actions take on a real moral worth as they reflect the importance of the values that the social work profession is supposed to promote. Nevertheless, there is one problematic area based on how social work virtues are established and defined in the first place (Houston, 2003). This idea becomes more complicated when we consider Aristotle‟s doctrine on means, whereby a good life is the means between vice and virtue and that too much virtue could be a bad thing (Benn, 1998). In response to this challenge, McBeath and Webb (2002) propose that virtues must be developed from a conscious analytical process rooted in dialogical exchanges between committed inquirers. They also explicitly suggest several virtues for social workers based on the Aristotle‟s ethical theory: justice, reflection, perception, judgement, courage, prudence, liberality and temperance.

Nevertheless, by accepting traits of character uncritically as virtues is opposite to the core theory of virtues and perhaps oversimplifies Aristotle‟s theory about virtues. Even if Aristotle himself explicitly defined some core character virtues, his theory implied a more complicated formation of virtues. Still, his theory gave some guidance on what could be defined as virtue. First of all, his doctrine of means, as previously mentioned, proposed that virtue must depend on the circumstances and must be discerned by careful judgement. To reach an absolute trait of character cannot be seen as an end in itself. In addition, a state of character is seen as virtue only if it operates as virtue. For example, courage is not a virtue in the case of a courageous murderer, because murder is not seen as enhancing “good life” or human happiness. In this case, therefore, courage is not a virtue because it does not serve its main purpose (Benn, 1998).

The discourse on virtue ethics does not solve all moral problems or dilemmas. However, it enables a revelation of moral and ethical concerns that enhance the action-based account of Kantian and utilitarian approaches on ethics. In particular, it emphasizes our priority on the individual, the social worker as a moral agent who plays a role in the production and reproduction of the public sphere and has powers to affect the structure of social relations contained therein