Presentation on theme: "Ethics: Making Critical Decisions in Treatment Patricia Sherman, Ph. D"— Presentation transcript:
1 Ethics: Making Critical Decisions in Treatment Patricia Sherman, Ph. D Ethics: Making Critical Decisions in Treatment Patricia Sherman, Ph.D., LCSW
2 An 18-year old adolescent who is 4 months pregnant has contacted you several times in regard to planning for her child. In her last visit, she confided to you that she is habituated to heroin. You have expressed your concern that the drug may damage her unborn child, but she does not seem worried nor does she want to give up use of the drug. You also know that she obtains money for heroin through prostitution and is not attending school.
3 You are an agency social worker whose Cuban client has just told you she is HIV positive. She is in a monogamous relationship and has two young children. She does not plan to tell her partner about her HIV status, fearing that this knowledge would cause the relationship to break up. She says she and her partner do not utilize safer sex practices and that she could never ask him to use a condom, as that would hurt his pride and cause him to become suspicious.
4 Purposes of the NASW Code of Ethics (Stone, 2004) Identifies core values on which social work’s mission is basedSummarizes broad ethical principles that reflect the profession’s core values and establishes ethical standards to guide social work practice
5 Is designed to help social workers identify relevant considerations when professional obligations conflict or ethical uncertainties ariseProvides ethical standards to which the general public can hold the social work profession accountable
6 Socializes practitioners new to the field to social work’s mission, values, ethical principles, and ethical standardsArticulates standards that the social work profession itself can use to assess whether social workers have engaged in unethical conduct
7 Provides practitioners with guidance when faced by practice dilemmas that include ethical issues Protects the public from charlatans and incompetent practitionersProtects the profession from governmental control; self-regulation is preferable to state regulation
8 Enables professional colleagues to live in harmony with each other by preventing the self-destruction that results from internal bickeringProtects professionals from litigation; practitioners who follow the Code are offered some protection in suits for malpractice
9 Social work Ethical Principles Primary goal is to help people in need and to address social problemsChallenge social injusticeRespect the inherent dignity and worth of the person
10 Recognize the central importance of human relationships Behave in a trustworthy mannerPractice within areas of competence and develop and enhance professional expertise
11 AcceptanceIndividualizationPurposeful expression of feelingsNonjudgmental attitudes
12 ObjectivityControlled emotional involvementSelf-determinationAccess to resourcesConfidentiality and accountability
13 Begin With Values Societal Values – Professional Values – Client Values –Personal Values –
14 Values VALUE is the reality in the inner core of a person which: shapes one’s ideasconditions one’s feelingsaffects one’s behavior (Simon, Values Clarification, 1970, p. 25)Whether recognized or unrecognized, values are essential to professional action and to any conception of practice theory
15 Are implicit and explicit about what we cherish as ideal and preferable Determine which goals and actions we evaluate as “good”Shape our beliefs and our attitudes and, in turn, our beliefs and attitudes shape our values
16 Define norms or guidelines for behavior Laden with emotionsInfluence our evaluations of situations and motivate the actions we take
18 Social Justice Values (Catechism of the catholic church, 1994, catholic conference of the united states bishops, 1995, himchak, 2007)Life and dignity of the human personCall to familyCommunity and participation
19 Rights and responsibilities Option for the poor, the vulnerable, and people at riskDignity of work and the rights of workersSolidarity and care for God’s creation
20 Values shared by all helping professions AutonomyNonmaleficence – do no harmBeneficence – promote goodJusticeFidelity – create trusting relationshipVeracity – be truthful
21 Common Social Work Values Promotion of the client ‘s well-being and individual dignitySelf-determinationThe right to have basic needs met
22 The right to actualize one’s full potential Client empowermentHuman diversitySocial and economic justice
23 Values specific to work area Child welfareProtection of childrenPreservation of familiesRespect for familiesDiligence – “hanging in there” with difficult situations
24 cultureWhen do cultural/religious values of clients create ethical concerns?When do cultural/religious values of social workers create ethical concerns?
26 Scale of social distance What’s your first response?On what are you basing your response?What values does your response reflect?What feelings do you have about your response?
27 Cognitive dissonance (Taylor, 2007) Feeling of discomfort arising from the conflict between professional and/or personal values and job tasksSocial workers have to make decisions that both protect society and maximize the rights of the individualStrongest when a cognition related to self-concept conflicts with a cognition about behavior
28 Potential problem areas (IFSW, IASSW) Social worker’s loyalty often in the middle of conflicting interestsSocial workers function as both helpers and controllersConflicts between duty to protect clients’ interests and societal demands for efficiency and utilityLimited resources
29 SOCIAL WORKER’S ETHICAL RESPONSIBILITY TO SOCIETY The social worker should promote the general welfare of societyThe social worker should act to ensure that all person have access to the resources, services, and opportunities which they requireThe social worker should advocate changes in policy and legislation to improve social conditions and to promote social justice
30 Moral questions for the Profession What are the clients’ rights as individuals?What are their obligations to their families?Under what circumstances is it permissible to support the breaking up of a family?
31 Under what circumstances is it legitimate to override client self-determination (e.g., clients with mental illness who will not take medication)?Is coercion justified in any given case? How far and when is individual dependency a public responsibility; how far and when a private responsibility?
32 In what circumstances, if any, should the client’s confidence be violated by the social worker? Should the social worker ever be responsible for law enforcement?
33 ETHICS The study of rightness and wrongness of human conduct (Varga, 1980, p. ix).It is that part of a moral philosophy thatconcerns relationships between people, anda set of values, assumptions, beliefs, andnormative rules that identify, support, andexplain the duties and obligations for good,right conduct (Siporin, p. 523).
34 Relates to what people consider correct or right Generates standards that direct conductRepresents “values in action”Social work ethics represents behavioral expectations or preferences that are associated with social work responsibility
35 Ethics and valuesEthics are deduced from values and must be in consonance with themThe difference between them is that values are concerned with what is good and desirable while ethics deal with what is right and correct. (Loewenberg et al, 2000)
36 Values deal with what beliefs are appropriate Ethics address what to do with or how to apply those beliefs
37 Ethical Standards Ethical Responsibilities to Clients Ethical Responsibilities to ColleaguesEthical Responsibilities in Practice SettingsEthical Responsibilities as ProfessionalsEthical Responsibilities to the ProfessionEthical Responsibilities to Society at Large
38 PROFESSIONAL ETHICS Refers to the moral philosophy that is the set of values, beliefs, and normative rulesthat prescribes and explains theobligations for good, right conduct on thepart of a profession’s members
39 Ethical TheoryDeontological theories – certain actions are inherently right or wrong, or good and bad, without regard for their consequences. Rules, rights, and principles are sacred and inviolable. The ends do not necessarily justify the means
40 Teleological Theories – the rightness of any action is determined by the goodness of its consequencesEgoism – people should maximize their own good and enhance their self-interestUtilitarianism – an action is right if it promotes the maximum good
41 Act utilitarianism – the rightness of an action is determined by the goodness of the consequences produced in that individual case or by that particular actRule utilitarianism – takes into account the long-term consequences likely to result if one generalizes from the case at hand or treats it as a precedent
43 KANT proposed that an action is good in itself not because of the results it produced, but if it is the product of good will. Kant’s theory is what is sometimes called a universalistic or conservative theory in that there are general rules that are not to be broken in any situation
44 MORAL POSITIVISM states that morality is not determined by the nature of an act but by extrinsic factors. Morality is made and not discovered. The fact that something is prescribed or forbidden makes it good or bad (Hammurabi Code, Ten Commandments)
45 THOMISM is an ethical theory that is very influential in current thinking about ethics in medicine. According to Aquinas, ”The perfecting of creatures through the development of their natures constitutes the highest good for them”The first natural law is that all actions that conserve life or avoid death are included in moral law
46 Since all living creatures share a natural inclination to propagate the species, a natural law for mankind is that the species should be propagated and children educatedHuman beings are rational beings and should therefore seek truth and avoid ignorance
47 Aquinas did not believe that actions contrary to moral law are wrong simply because they are prohibited by God; rather, he believed that they are prohibited by God because they are wrongGod-given law - Life is sacred
48 Confidentiality and Privileged Communication Confidential information includes personal details about the client’s identity, records of verbal statements made by the client, professional reports or professed opinions concerning the client, and content from other records (Reamer, 1995)
49 Relative Confidentiality is a broad term that exists for the protection of the individual client but may allow a limited amount of disclosure, especially to those co-workers, superiors, and subordinates whose knowledge of certain communications is required to aid in the therapy or planned change process of the client
50 Privilege refers to legal rights transpired between the worker and client and is protected by law and cannot be revealed without that client’s expressed permission (Barker 1999)Relative confidentiality is much more common than privilege
51 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 or when needed to defend self (NASW 1996)Should inform the client to extent possible about the disclosure of confidential information and the potential consequences when feasible before the disclosure is made
52 Self-Determination and Paternalism Self-determination is an ethical principle that acknowledges people’s right to make their own decisions and choices (Barker 1999)Paternalism is action that interferes with a client’s wishes or freedom for his own good (Reamer 1995)
53 Evaluate client’s decision-making capacity Evaluate client’s decision-making capacity. In the social worker’s professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or othersIt also urges action on behalf of clients and pursuit of courses of action that safeguard such clients
54 Dual RelationshipsDual Relationships are those where social workers engage in more than one relationship with a client, becoming social worker and friend, employer, teacher, business associate, or sex partner (Kagle 1994)Social worker assumes more than one role concurrently or consecutively
55 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 (NASW CODE)
56 Involves boundary issues Boundaries are invisible barriers that separate various roles and limit the types of interaction expected and considered ethically appropriate for each roleExample: Social worker and client attend the same AA meeting
57 Think about boundary issues and establish professional boundaries from the beginning, taking cultural issues into considerationConsult your supervisor and professional colleaguesScrutinize your own motivations
58 Discuss with the clients Sexual attraction – refer client to another professional if this cannot be resolved through supervision; never act on itDistribute fliers on client rights and professional ethics
59 Whistle-BlowingAct of informing on another or making public an individual’s, group’s or organization’s corrupt, wrong, illegal, wasteful, or dangerous behaviorHow great is the threat to the potential victims?
60 What type and quality of proof are available that the wrongdoing has occurred or is going on? Are there less severe alternative measures you might take to remedy the problem?Can you assume the burden of risk? How much do you have to lose?
61 Guidelines for Ethical Decision Making (Reamer, 1999) Rules against basic harms to the necessary preconditions of human action (such as life itself, health, food, shelter, mental equilibrium) take precedence over rules against harms such as lying or revealing confidential information or threats to additive goods such as recreation, education, and wealth
62 An individual’s right to basic well-being (including goods that are essential for human action) takes precedence over another individual’s right to self-determinationAn individual’s right to self-determination takes precedence over his or her right to basic well-being
63 The obligation to obey laws, rules, and regulations to which one has voluntarily and freely consented ordinarily overrides one’s right to engage voluntarily and freely in a manner that conflicts with these laws, rules, and regulationsIndividuals’ rights to well-being may override laws, rules, regulations, and arrangements of voluntary associations in cases of conflict
64 The obligation to prevent basic harms such as starvation and to promote public goods such as housing, education, and public assistance overrides the right to complete control over one’s property
65 Process of Ethical Decision Making Identify the ethical issues, including the social work values and duties that conflictIdentify the individuals, groups, and organizations likely to be affected by the ethical decision
66 Determine what additional information you need and how that information might affect your decision Tentatively identify all viable courses of action and the participants involved in each, along with the potential benefits and risks for each
67 Thoroughly examine the reasons in favor of and opposed to each course of action, considering relevantEthical theories, principles, and guidelinesCodes of ethics and legal principlesSocial work practice theory and principlesClient’s values (including religious, cultural and ethnic values, and political ideology), particularly those that conflict with one’s ownPersonal values
68 Consult with colleagues and appropriate experts (such as agency staff, supervisors, agency administrators, attorneys, ethics scholars)Make the decision and document the decision-making processMonitor, evaluate, and document the decision’s outcome
69 Ethics Audit (Reamer, 2000) Client rights Confidentiality and privacy Informed consentService delivery – competenceBoundary issues and conflicts of interestDocumentationDefamation of character
70 An ethics audit should assess social workers’ familiarity with the variety of ethical dilemmas germane to their practice setting and the procedures they use to make ethical decisions
71 Supervision and training ConsultationReferralFraudTermination of servicesPractitioner impairment