Ethical Decision Making in Social Work, Robinson et al. NASW approved.*

1. Cases and theories
2. How to use this book
3. Structure of the book
4. Acknowledgements

Many cases social workers face present an ethical issue. How such a case is handled will either benefit or harm the persons involved, and so, for that reason alone, what a social worker decides to do in response to a case is an ethical decision.

The question is how best to help social workers and students to wrestle with the ethical aspects of social work practice. They need to make the best ethical decisions they can. There are two ways to proceed. We can study ethical theory and apply it to practice, or we can examine the practice to tease out the ethical issues involved. Each method has its advantages and its disadvantages.

In either case, we ought to resist the temptation to light upon one ethical theory as ‘the best’ and use it to answer all ethical problems that arise in practice. Such a method prescribes a clarity where often clarity cannot be achieved. The Code of Ethics of the National Association of Social Workers says that it does not specify which values, principles, and standards are most important and ought to outweigh others in instances when they conflict. Reasonable differences of opinion can and do exist among social workers with respect to the ways in which values, ethical principles, and ethical standards should be rank ordered when they conflict (Codes of Ethics, Purpose).

Appealing to one ethical theory as ‘the best’ will guarantee a rank ordering of ethical values and principles, but in doing so, we will lose the ethical ambiguities inherent in social work practice and obtain clear answers at the cost of misunderstanding the complexities that some ethical problems present to us. The Code of Ethics is clear again when it says that There are many instances in social work where simple answers are not available to resolve complex ethical issues (Code of Ethics, Purpose).

We have chosen to examine social work practice and tease out the ethical issues involved by using a method we call ‘Tracking harms.’ Among its other virtues, this option confronts the reader with real cases, gleaned from hours of interviews with social work practitioners. In each case, we put in what information the practitioner had. So one virtue, we found, is that the cases resonate with the experiences of practitioners.

Another virtue is that when used in a group or a class, the cases engender lively discussions about what ought to be done, and participants discover that what they think obvious others think wrong and that they will need to provide reasons for their views if they are to have a hearing.

It is helpful to have someone leading such a discussion, but the role should be primarily an organizer of others’ thoughts, writing on the board or for an overhead what is being discussed — for instance, who is affected by the case. One can always intervene in the discussion when it seems to be going astray and say something like, ‘O.K. I’ve lost track of where we are here. I’m trying to write all this up on the board, but we were talking about such-and-such and now I’m not sure what we are talking about.’

Patience and a persistence in ensuring that the method is followed will almost always produce an answer from the participants — whether they are experienced practitioners or students in social work. So the most difficult part for the discussion leader is to learn the right touch of deftness in figuring out when to say anything and then what to say.

One permanent feature of discussions about ethical issues is the underlying assumption, perhaps too often voiced, that ethics is just a matter of personal belief. ‘No one has the right to tell me what to do, and I have no right to tell anyone else what to do.’ That assumption is especially likely to be voiced when disagreement arises about what ought to be done.

But living by the creed of that assumption would undermine professional ethics. In becoming professionals, we agree to abide by the code of ethics of our profession. The codes do not assume that ethics is a matter of choice. They assume that sometimes there is a right and sometimes a wrong. For instance, we start Chapter I with someone telling you about a confidential case while both of you are standing in a line at a restaurant where others can overhear. The code of ethics prohibits such discussions, and they are wrong — no ifs, ands, or buts.

Discussion of a case leads either to an answer or to the discovery of a conflict of values within the profession, a deep tension between, say, limiting a client’s confidentiality and demonstrating a commitment to the client’s well-being. We then have a case in which either of several responses is acceptable, with a recognition that we are in deep water. But even in such a case, participants come to see that ethics is not just a matter of personal belief. In such a situation, we are not free to believe what we wish. We must have reasons for our choice, reasons founded in the nature of the profession and in our commitment to its mission and goals. So if we must break confidentiality to protect a client, and we fear the loss of trust in the relationship in which we had confidentiality, we need to think through the full implications of taking the alternatives and make a decision based on our best judgment about what a social work practitioner ought to do in such a situation. That is what ethics requires — that those whom we affect by our judgment can trust that we did what we thought was best in accordance with the goals and values of the social work profession.

So the discussion of a case which is interesting enough to generate lots of discussion may not lead to any clear resolution. Just as life sometimes does not provide us with all the facts we need to make a thoroughly informed decision, social work life sometimes provides us with competing values. But the model we propose does help us come to grips with cases that can seem incredibly messy and overwhelming upon our first encountering them.

We should mention another feature of our exposition which also mirrors life. We have made use of first person, second person, and third person pronouns, carefully switching between the three as the occasion requires. We may use ‘we’ when we think a value is fully shared or are speaking for an identifiable group. We use the third person when, for instance, we are trying to remind the reader of the kind of objectivity ethical decision-making requires. We may use the second person when we are trying to cajole the reader into adopting the point of view of a participant so as to more fully understand why the participant might have done what he or she did. Ethical decision-making is a peculiarly personal process. You must decide what to do, and if you decide not to do anything, you will have to live with what happens from your not deciding. In our use of pronouns, we are trying to engage each and every reader in that peculiarly personal way ethics requires.

We lay out the method of tracking harms in Chapter 1, and Chapter 2 is devoted to detailing the crucial assumptions of our method — the need for providing reasons in making a decision about what to do, the requirement that the reasons be of a specific kind, and so on.

Chapters 3 through 5 cover the various kinds of relations social workers can be in — with clients (Chapter 3), with their peers (Chapter 4), with their employers (Chapter 5). Chapter 6 is on justice and concerns both particular issues about justice within our system and the general issue of what kind of social system we ought to have and what kinds of ethical relations social work practitioners ought to have to our current system. Chapters 3 through 5 are thus about issues internal to our ongoing social system, and Chapter 6 raises an ethical issue about the social system itself. Each chapter is case-driven, the cases being used to present the kinds of ethical issues social workers have faced and will face.

We have not aimed at completeness of coverage. We have aimed to cover the most general sorts of ethical issues that social workers face. These are the sorts of issues identified through our discussions with social workers as central to their practices. We have included extra cases in an Appendix. These are sample cases to practice on, and, in some instances, they raise issues other than the ones we examine. We have found that practitioners are a sure source of cases, and we encourage readers to develop their own cases.

We have also not aimed at thorough coverage of the issues raised in any one case. We have instead used the cases to provide material to begin the dialogue and work that needs to take place to come fully to appreciate the complexities of these issues. As we have discovered, the cases are fecund in their capacity to generate discussion on any one issue. In addition, issues cannot be readily isolated from one another, and so, though we use particular cases to raise a particular issue, discussion quickly leads into the implications for other issues in social work practice. For instance, we provide a case of a social work practitioner having sexual relations with a former client. Pursuing that issue to its fullest extent would require, among other matters, examining what agencies ought to do about setting standards for social work practitioners. It would also require determining what kinds of enforcement mechanisms would be appropriate and could be effective to ensure compliance regarding what is a private relationship, one not likely to come to the attention of other social work practitioners. Each case we examine, that is, is pregnant with implications. That is one of their virtues. Their discussion produces lines of investigation for further work.

But we have tried to stick as closely as we can to what we take to be the main issue each cases raises, without pursuing its implications and without necessarily drawing a conclusion about what ought or ought not to be done. We take seriously the admonition that regarding such issues ‘reasonable differences of opinion can and do exist among social workers’ (Codes of Ethics, Preface). We think one reason for this is that, as with other professions, the values of social work ethics can be tension in particular cases. For us to impose a solution would be for us to impose our particular choice about how to resolve these values.

Though we have not attempted to provide a thorough bibliography on all the issues in social work ethics, we do direct the reader’s attention to material that itself contains further references. By pursuing these leads, readers will quickly be able to hone in on whatever specifically interests or concerns them.

We thank the social workers who gave their time to be interviewed and were open about the ethical problems they experienced in their practice so that others could learn from them. They were open even when they were unsuccessful in resolving the ethical problems or had made mistakes. We cannot provide names for reasons of confidentiality, and we have for that reason carefully removed all identifying references in the cases.

We also thank the students and practitioners who helped with comments in the classes and workshops in which we tried out various versions of the text. We can only issue a blanket ‘Thanks!’ for the help provided by so many. We thank as well the anonymous reviewers who provided critical comments about how to improve the text.

We would appreciate any constructive comments readers may have as well as any cases they may wish to send (though with all identifying references removed). You may send those by e-mail to Linda Reeser at Linda.Reeser@wmich.edu or by mail to Professor Linda Reeser, School of Social Work, Western Michigan University, Kalamazoo, Michigan 49008 or to Wade Robison by e-mail at wlrgsh@rit.edu or by mail to Professor Wade Robison, Department of Philosophy, Rochester Institute of Technology, Rochester, NY 14623.