Ethics and Boundaries Jeff Wright, MSW, LCSW

agenda Introductions Bioethics video End of Life Small group discussion Review Code of Ethics/MPSW 20 Break… Boundaries discussion (small group exercise) Models for framing ethical dilemmas Sharing and resolving your ethical dilemmas Wrap-up

Introductions Name and where you work How many years have you been a Social Worker?

Why are these trainings relevant? We’re all practicing Social Workers, do we really need help with this stuff? Does resolving ethical dilemmas get easier? What gets in our way of really being able to think about, and resolve issues that happen everyday? What do you hope you get out of this presentation today?

End of life ethics(bioethics)

Small groups What issues do you encounter around end of life decisions? How do you feel your employer addresses end of life issues with families and residents? What could be done better? What types of ethical dilemmas do you encounter, from the standpoint of our Code of Ethics?

NASW standards for palliative & end of life care Ethics and values Encompasses both profession and contemporary bioethics standards Knowledge Particularly around family systems Assessment Foundation of practice. May need to reassess and revise treatment plans frequently. Intervention/treatment planning Utilizes assessment strategies

Standards cont’d Attitude/self-awareness Empowerment and advocacy Compassion, sensitivity, and belief in the client’s rights to self-determination and dignity. What else here? Empowerment and advocacy Sometimes we are the only voice for our clients Documentation Guessing you all could teach this part! Interdisciplinary Teamwork Essential in end of life care

Standards cont’d Cultural competence Continuing education What are challenges for us here? Continuing education This is a changing field, we need to stay ahead of the curve Supervision, Leadership, and Training Share your expertise when you can

Lunchtime?

What are Ethics? Ethics: the “rightness” or “wrongness” of an action. The Code of Ethics does not require a particular theory as a base Many ethical theories, positing a base on which ethics may be constructed: Absolutist Something is intrinsically right or wrong Relativist All ethical situations are different Teleological/Consequentialism “The ends justify the means”

Core Beliefs and values Most likely drives you to do what you do. What are your inherited values? How have these changed through the years? How do you navigate the challenge of having your personal and professional values conflict? Managing value conflicts can be just as challenging as ethical dilemmas. The key is self-awareness.

Law and ethics are not the same. Law – legal justice; following the norms established by society through the political process (legislature): Chapter 457, MPSW 20 Ethics – focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws: NASW Code of Ethics Examples of this in your settings? Examples from the political world?

Let’s Review MPSW 20 Note: MPSW 20 addresses principally the obligations to clients. MPSW 20 is phrased in negative terms, I.e., what you should not do. Almost all of what is contained in MPSW 20 appears also in the NASW Code.

MPSW 20 Conduct 20.01 Gross negligence: “…the performance of professional services that does not comply with an accepted standard of practice that has a significant relationship to the protection of the health, safety or welfare of a patient, client, or the public and that is performed in a manner indicating that the person performing the service knew or should have known, but acted with indifference to or disregard of, the accepted standard of practice.”

MPSW 20 Conduct 20.02 Unprofessional conduct…includes, but is not limited to, engaging in, attempting to engage in, or aiding and abetting the following conduct….. Comparison sheet.

Applicability of Codes of Ethics Rule of the court: In legal matters regarding ethical practice, the code of ethics of the largest professional organization in the field shall apply.

Structure of the NASW Code Preamble(includes Core Values) Purpose Ethical Principles Ethical Standards: Ethical responsibilities To clients To colleagues In practice settings As Professionals To the social work profession To the broader society

Core Values Service Social Justice Dignity and worth of the person Importance of Human relationships Integrity Competence

Service “Social workers’ primary goal is to help people in need and address social problems.” [NASW Code] Service to others, above self-interest Encouraged to engage in pro bono service [volunteer skills with no expectation of significant financial return.

Social Justice “Social workers challenge social injustice.” [NASW Code]. Social workers pursue social change, esp. on behalf of vulnerable and oppressed groups. Focus on poverty, unemployment, discrimination, and other forms of social injustice. Promote sensitivity to and knowledge about oppression. Strive to ensure access to needed information, services, and resources. Equality of opportunity and meaningful participation in decision making.

Dignity and Worth of the Person “Social workers respect the inherent dignity and worth of the person.” [NASW Code] Mindful of individual differences and cultural, social diversity. Promote socially responsible self-determination. Enhance self-determination. Cognizant of responsibilities to both client and society.

Importance of Human Relationships “Social workers recognize the central importance of human relationships.” [NASW Code] Recognize that relationships are the vehicle for change. Engage people as partners. Strengthen relationships among people in order to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities.

Integrity “Social workers behave in a trustworthy manner.” [NASW Code of Ethics] Continually aware of social work’s mission, values, ethical principles, and ethical standards. Act in accord with them. Act honestly and responsibly. Promote ethical practices in organizations with whom they are affiliated.

Competence “Social workers practice within their areas of competence and develop and enhance professional expertise.” [NASW Code] Strive to increase professional knowledge and skills. Apply the knowledge and skills in practice. Aspire to contribute to the knowledge base of the profession.

Ethical Responsibilities: 1. To Client Primary commitment to clients Self-determination Informed consent Competence of social work skills Cultural & social diversity competence Avoidance of conflict of interests Proper boundary setting Privacy and confidentiality Client access to records

Ethical Responsibilities: To Client (continued) No sexual relationships or harassment Proper physical contact Accurate & respectful language Fair & reasonable fees Clients who lack decision-making capacity Proper termination

Ethical Responsibilities: 2. To Colleagues Respect Confidentiality Interdisciplinary collaboration Consultation Proper referrals Proper boundary setting Resolution of unethical conduct of colleagues Action to resolve incompetence of colleagues

Ethical Responsibilities: 3. In Practice Settings Supervision & consultation Education & training Performance evaluation Proper record keeping Proper billing practices Proper transfer of clients Administration Staff development Commitment to employer Resolution of labor disputes

Ethical Responsibilities: 4. As Professionals Competency Non-discrimination Non-interference of private conduct No use of dishonesty, fraud or deception Treatment for impairments Accurate representations No solicitation of clients Proper acknowledgment of credit

Ethical Responsibilities: 5. To the Profession Integrity High standards of practice Advancement of ethics, values, knowledge & mission Evaluation & research Prevent unqualified practice of social work Monitor policies & programs Keep current with knowledge Informed consent for research Protection of research subjects Confidentiality in research & evaluation

Ethical Responsibilities: 6. To the Broader Society Promotion of general welfare Facilitation of informed participation in public policies & institutions Assistance in public emergencies Engagement in social & political action to ensure equal access Action to expand choice & opportunity Promotion of respect for cultural & social diversity Prevention of discrimination & exploitation

Confidentiality Essential to the full and satisfactory completion of the work Basis of the fiduciary relationship Shared: With informed consent Compliance with law Prevent serious, foreseeable, and imminent harm

Federal Laws regarding Privacy HIPAA – The Health Insurance Portability and Accountability Act of 1996 Food, Drug, and Cosmetic Act (21 USC 301 seq.) ERISA of 1974 (PL 93-06) Gramm-Leach-Bliley Act (GLBA - PL 106-102) - privacy regulations for financial institutions and health care companies FERPA provisions regarding school health records and educational records (20 USC 1232 g) FIA (5 USC 552a) and the Privacy Act of 1974 (5 USC 552) regarding records maintained by federal agencies Clinical Laboratory Improvement Amendments (42 USC 263 a, and 42 CFR, Part 493)

common ethical situations Client asking for advice Therapist or life coach? Taking a public stance on a controversial subject. Client gifts. Client invitations to events. Cultural differences. Other common ones…?

Break time…

Boundaries A systems concept: social boundaries Within personal boundaries, we enact our roles. Dual relationships: entering into a relationship in addition to worker- client

Distinguish: Boundary Violations/Boundary Crossings Deliberate, constructed Providing benefits for the professional Crosses the line of ethical practice Ethical obligation: avoid the violation to begin with Inadvertent, unintended Neutral in regard to any benefits Creates ethical quandaries which can be resolved. Ethical obligation: attend to the ethical issue.

Boundary Crossings and Violations Intimate relationships Personal benefit Emotional and dependency needs Altruism Unavoidable circumstances [Frederic Reamer]

Note: Boundary violations and crossings can occur at the Micro level – in our work with individuals Mezzo level – in our work with families and groups, and Macro level – in our administration, management, supervision, organizational change efforts, community development, and social action efforts

Boundary Violations Are potentially exploitative Produce a service or benefit outside of the worker-client relationship Cross the boundaries of ethical practice May impair the judgment of the professional May produce negative consequences in the client: anger, low self-esteem, inability to use professional services

Attend to: The Before: clients you have reason to believe will make their way to you. The During: Attend to the lines which are not to be crossed The After: Basic consideration: potential of harm to the client

Small groups What are recurring boundary issues that happen in working with the population that you work with? How do you avoid them, or resolve them when they do occur?

Ethical Decision Making Determine: an ethical issue or an ethical dilemma? [conflicts of values, rights, responsibilities]. Identify key values and principles; rank them. [Go deep into the Code] Identify key persons, groups, organizations with a stake in the issue/dilemma Identify all possible courses of action Examine reasons for & against each action Consult with colleagues, supervisor, ethics board; do not do this alone. Select the strategy, implement it, document it. Reflect on outcomes: Monitor, evaluate, document [From: Reamer, Frederic G. (2001). Ethics education in social work. Alexandria, VA: Council on Social Work Education, pp. 106-112].

Let’s take a shot at resolving your ethical dilemmas We will use Reamer’s framework on the previous slide

Wrap-up Questions, random thoughts, etc… If you have suggestions or feedback for me, feel free to stop and chat after we end, or send me an email at: wrightjd@uwec.edu