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Ethics: Rules of Engagement. How We Do What We Do.

2/8/2018

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Fred Schade, ACSW, LMSW, CAADC. Past Chair, NASW-Michigan Chapter Ethics Committee
 
As soon as two or more people engage in an activity, there are rules governing the relationships and responsibilities. These rules form a structure and a framework by which responsibilities, actions, and expectations are defined. The more complex the activity, and the more people (or agencies) involved, the greater the need for rules. (I am of the opinion that the paperwork, for example, increases exponentially with the number of people/agencies involved).
 
Furthermore, as new situations and considerations come into play, more regulation and procedure is needed. The original NASW Code of Ethics fit on one page; the current booklet is 27 pages, and recently new rules were added addressing the ethical use of technology.

As stated in the Preamble to the NASW Code of Ethics, the primary mission of social work is to enhance human well-being and help to meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.
 
Social work ethics are a set of rules for conducting the mission of social work. These ethics spring from the social work values of service, social justice, dignity and worth of the person, the importance of human relationships, integrity, and competence.

Social work's clients are in trouble, in need, in distress and seeking assistance. The social worker, having subscribed to the mission as noted above, is ready to help. How is the help to be rendered? The help is to be provided without causing further damage, with respect for the client. This is to be done while advocating for the client, strengthening them, and with the competence needed to provide appropriate services. This entire process must take place with the client's consent, without exploitation.
 
In short, assistance must be rendered ethically.
 
The social work relationship usually involves someone in need seeking the services of someone who can assist with meeting that need. There is a need help/provide help dynamic. Within this dynamic is the tendency for the seeker of help to not antagonize the provider of help. There is a possibility for the provider to become paternalistic and manifest a "I know what is best for you" attitude. The seeker of help, the client, must never be exploited or dealt with in a condescending manner. The client's point of view must be understood and respected.

It is further possible that the social worker's understanding of the Code of Ethics is incomplete and/or that the social worker has made assumptions about ethics (in general or the NASW code) that are inaccurate or incomplete.  Social workers must have an understanding of ethics beyond their own experience and formulation. This is why ethical training is necessary. Ignorance begets mistakes. The better prepared that the social worker is, the less likely they are to make mistakes that could harm someone.
 
The entire purpose of training is to know what to do before you need to do it, and to be aware of pitfalls. Some common pitfalls are: 

  1. It cannot be unethical because there was no harm done.

    All danger is potential.  What may appear harmless or to not have an immediate detrimental impact can be, nevertheless, dangerous.  When the potential danger is realized, then harm is done.   Clients cannot be put at risk.  Recall that it is considered abuse to put a vulnerable person at risk.
  2. It cannot be unethical because the boss told me to do it.

    As social workers, we advocate and promote for the best outcomes in the interests of our clients.  Bosses often advocate and promote the best outcomes for the agency. I once had a boss who told me to do something that was a bit dicey.  Not wanting to be insubordinate, I requested that he put the order in writing. He never did. I have been known to say that if a social worker does not get the boss annoyed at least once a year, they are not doing a thorough job.
  3. It cannot be unethical because the client suggested it.

    Do not enter into any arrangement where it even looks like the client is your agent or employee.   Graciously decline the client's offer to get it for you wholesale or that they know a guy who knows a guy who can do a service or task for you for a great deal.  Do not go outside of the treatment agreement that was made at the onset.  (Side note: Barter for goods as payment agreements may be reached.  But who decides the worth of the chicken?) The potential for conflict of interest and boundary issues is fabulous.
  4. It cannot be unethical because a different professional organization says it's OK.

    Social workers abide by the NASW Code of Ethics.  For example, social work ethics advise that it is never permissible to have sexual relationships with clients/ex-clients; while psychology ethics indicate that such relationships are permitted three years after closing the case. Neither is more or less ethical. I would hazard that psychological services may tend to be more evaluative and short term and social work services tend to be more long term; this may have a bearing on the ethic. In areas where the two services overlap, such as clinical psychotherapy, I favor the social work ethic. (I also think that good ethical practice supports and enhances good clinical practice.)
  5. It cannot be unethical because it is legal.

    The question is not of legality, but of ethics.  It is pretty much legal for consenting adults to have a sexual relationship.  As noted above, there are times when it is unethical. And for some, it is considered immoral to have a sexual relationship outside of marriage. Do not ask if an activity is illegal, immoral, or fattening; ask if it is ethical.
  6. It cannot be unethical because this is how it has always been done, it is standard procedure.

    All agencies have their procedures.  For example, some agencies and facilities have security guards.  Having clients sign in with the guards may make a certain amount of administrative sense.  However, it could be a violation of client confidentiality.   At a facility one of my colleague’s once worked at, the clients who sought services through the health clinic were required to sign in and to list the presenting problem. The client's well-being is primary, not the agency's procedure.
  7. It cannot be unethical because everyone knows it. It just stands to reason.

    When I hear this I am pretty sure that I am hearing something that is an unquestioned assumption. It has been my experience that when I am told "it stands to reason" that the real statement is "this is what I think and don't argue."   Statements such as these, no matter where they originate, deserve exploration.
So, continue to do good; and continuing doing it in a good way.
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