I left that discussion with more questions than answers. To what extent have social workers thought about and analyzed the ethical dimensions of practice and policy? What guidelines has the profession cultivated to help social workers conceptualize about, and attempt to resolve, ethical issues? In what ways do social work values shape the profession’s practice principles and policies?
I recall visiting the school’s library later that week to search the literature; in those pre-Internet days I was limited to the dusty card catalogue and tomes of journal abstracts in the stacks. I assumed, naively it turns out, that I would find volumes of publications on the subject of social work values and ethics. I was surprised to discover relatively little. Most of what I came across focused on the nature of social work values and the profession’s value base. I found a handful of discussions of social work perspectives on clients’ right to confidentiality and self-determination.
It was then that I decided to broaden the contours of my doctoral education to include this broad arena related to professional ethics. It seemed clear to me that social work, as a profession, was rife with ethical challenges in direct and clinical practice, community practice, administration, supervision, policy and planning, and research and evaluation. I resolved to spend some time learning about the broad subject of ethics – as conceptualized by moral philosophers – and applying my new knowledge to the practical challenges and dilemmas in social work.
That is how my ethics journey in social work began. In the earliest years I spent considerable time learning the theories, concepts, and argot that formally trained ethicists use to understand and think about moral problems. I brought myself up to speed on the core subjects of meta-ethics and normative ethics. I started at square one with foundation literature in moral philosophy on relatively arcane meta-ethical theories of cognitivism, intuitionism, emotivism, prescriptivism, and naturalism (Rachels, 2002). I moved on to classic ethical theories related to deontology, teleology, egoism, act utilitarianism, and rule utilitarianism. My mind began to explode with ideas about how these abstruse concepts – which originated in the works of Socrates, Plato, and Aristotle and found currency in the later works of luminaries such as Immanuel Kant, Jeremy Bentham, John Stuart Mill, and John Rawls – might help social workers think more clearly about, and respond to, ethical dilemmas in the profession.
LOOKING BACK TO PLAN THE FUTURE
In retrospect, it is clear to me that my early musings about social work ethics – in the mid-to-late 1970s – occurred midstream in the profession’s complex attempts to develop a core set of values and ethical standards. Viewed broadly, social work has traveled through four major periods, and now needs to embark on a fifth.
The morality period
When social work practice and education began formally in the United States in the late 19th century, many practitioners paid more attention to the values and morality of clients than to the morality or ethics of the profession and social workers themselves. Paternalistic concern about clients’ moral virtues and rectitude (especially preventing “waywardness” and responding to “shiftless” tendencies) often dominated social workers’ efforts during the Charity Organization Society phase of the profession’s history (Brieland, 1995; Leiby, 1985; Lubove, 1965). Scholarly discussions of social work’s history typically note practitioners’ relatively patronizing and judgmental preoccupation with clients’ personal morality.
The values period
A critical mass of scholarship on social work ethics per se did not emerge in the U.S. until the 1950s, although certainly the subject was explored in several earlier publications (Elliott, 1931; Frankel, 1959; Johnson, 1955). After a half-century of development in the U.S., the social work profession began to explore in earnest the development of a core set of nationally endorsed values and ethical standards (Emmett, 1962; Pumphrey, 1959; Varley, 1968). Clearly, the social foment of the 1960s, including intense and widespread focus on social justice issues, inspired a number of social workers to highlight and analyze social work values and construct conceptually-based typologies (Gordon, 1965; Levy, 1976).
In addition to exploring the profession’s core values, some of the literature during this period reflected social workers’ attempts to examine, clarify, and critique their own personal values and professional practice (Hardman, 1975; McCleod & Meyer, 1967; Varley, 1968). Many social workers developed a rich appreciation of the relationship between their personal values and professional practice, especially with respect to controversial issues such as welfare reform, abortion, homosexuality, substance use and abuse, and race relations.
Ethical theory and decision-making period
In the late 1970s and early 1980s, social workers in the U.S. embarked on another stage in the evolution of professional values and ethics, due largely to the emergence of a new field of applied and professional (or practical) ethics. The applied and professional ethics field began primarily with the development of the bioethics field in the 1970s, when a small group of scholars and practitioners began to explore moral ethical issues in health care. This was a watershed period in the ethics field, in that it entailed, for the first time, the deliberate, systematic, and explicit application of moral philosophy, ethics concepts, and ethical theory to the practical ethical challenges in diverse professions, such as medicine, law, business, journalism, engineering, nursing, the military, psychology, and social work (Chadwick, 1998; Reich, 1995; Sloan, 1980). The emergence of the applied and professional ethics field directly influenced the development of social work ethics. Beginning in the early 1980s, a small number of U.S. social work scholars began writing about ethical issues and dilemmas, drawing in part on literature, concepts, and theories from moral philosophy in general and the newer field of applied and professional ethics (Loewenberg & Dolgoff, 1982; Reamer, 1982; Rhodes, 1986). Using somewhat different approaches, these authors explored the relevance of moral philosophy and ethical theory and concepts to the analysis of ethical dilemmas faced by social workers. Since the early 1980s several social work scholars have developed frameworks for ethical decision-making (Congress, 1998; Linzer, 1999; Reamer, 1999).
Ethical standards and risk-management period
In the early 1990s several social workers began to explore the nature of formal, codified ethical standards in social work and related risk-management issues. One key event was the ratification in 1996 of a new National Association of Social Workers Code of Ethics, only the third code in NASWs history (Reamer, 1998). The complex national process required to develop this new code stimulated widespread discussion and analysis of maturing ethical standards in the profession. Further, the ratification of new ethical standards also led many social work licensing boards to examine and refine their ethical guidelines.
One of the explicit purposes of the new NASW Code of Ethics was to prevent ethics complaints and ethics-related lawsuits, in addition to the primary purpose of protecting social workers’ clients. Since the mid-1990s social workers have paid much more attention to ethical issues broached in licensing board complaints and lawsuits filed against social workers (Houston-Vega, , Nuehring, & Daguio, 1997; Reamer, 2003). As a result of practitioners’ growing awareness of ethics-related risk management issues, many social work education programs, social service agencies, and professional organizations began to sponsor special training and education on ethical issues with an emphasis on risk management.
AN AGENDA FOR THE FUTURE
One of the outcomes of social workers’ increased focus on ethics-related risk-management issues is growing concern that ethics education is now preoccupied with “defensive ethics,” that is, teaching social workers about ethical standards primarily to prevent ethics complaints and lawsuits. Understandably, many social workers are concerned that the profession’s ethics ballast has shifted from primary concern about protecting clients to primary concern about protecting practitioners.
In my opinion, the principal challenge facing social work in the 21st century is to design and deliver ethics education in a way that retains client well-being as the centerpiece and, in addition, provides appropriate risk-management instruction as an important, but secondary, goal. Toward this end, I claim that ethics education and training – in undergraduate and graduate programs, agency settings, and continuing education curricula – needs to be strengthened considerably to include several core components (Reamer, 2001a):
Values in social work practice
Contemporary ethics education and training should focus especially on the core values and virtues that constitute the profession’s moral foundation and mission. In addition to acquainting social workers with traditional social work values (particularly as they are reflected in the profession’s literature and the current NASW Code of Ethics), educators and trainers should also encourage practitioners to constructively critique the profession’s enduring, shifting, and emerging values. Practitioners must continually examine and critique the validity of social work’s values and their relevance to contemporary life.
Further, educators and trainers should highlight values-related concepts from the broader field of applied, practical, and professional ethics. This especially includes study of virtue theory, which entails analysis of core professional virtues such as honesty, respect, trust, fairness, responsibility, autonomy, nonmaleficence, beneficence, justice, fidelity, faithfulness, forgiveness, generosity, compassion, and kindness (Beauchamp & Childress, 2001; MacIntyre, 1981).
Several issues related to social workers’ values deserve special attention. First, practitioners sometimes face tension between their own personal values and those held by clients, employers, or the social work profession itself (Goldstein, 1987; Hardman, 1975; Hodge, 2003; Siporin, 1992). Social workers may have strong reactions to the ways in which some clients parent their children, engage in self-destructive behavior, violate the law, or treat spouses or partners. Some social workers object to the profession’s official or formal positions on reproductive rights and welfare reform. How social workers respond in these situations – whether they challenge the profession’s values stance, share their views with clients, or try to influence clients’ behavior and values – depends on practitioners’ views about the role of their own personal values and opinions.
A related and critically important issue concerns social workers’ values or beliefs with respect to the determinants of clients’ problems, such as poverty, unemployment, substance abuse, domestic violence, and emotional distress. Social workers sometimes make values-based assumptions about the causes and malleability of clients’ problems and shape interventions accordingly (McDermott, 1975; Reamer, 1983). Practitioners’ values in this regard are likely to have important bearing on their response and intervention, that is, the extent to which social workers believe that clients are responsible for their difficulties in life and “deserve” help.
A particular challenge related to values involves practitioners’ and clients’ religious and spiritual beliefs. On the one hand, social workers are becoming increasingly aware of the importance of religion and spirituality in clients’ lives and the need to acknowledge and be sensitive to clients’ values and beliefs (Canda & Furman, 1999). Appropriately, spirituality and religion have become critically important issues in professional practice.
On the other hand, social workers must pay close attention to possible ethical challenges involving religion and spirituality. Specific challenges involve social workers’ decisions to share and discuss with clients the practitioners’ personal beliefs; attempt to influence clients’ religious and spiritual beliefs; and participation in religious or spiritual rituals with clients.
Ethical dilemmas
Many ethical issues in social work are not particularly complicated. However, there are many situations where social workers’ professional obligations and values are, or appear to be, in conflict, for example, when a client’s right to confidentiality or self-determination conflicts with a third party’s well being. To enhance social workers’ grasp of ethical dilemmas – those instances where professional duties and obligations clash – practitioners should be acquainted with three major themes involving: (1) the delivery of services to individuals, families, couples, and small groups (for example, ethical dilemmas related to limiting clients’ right to confidentiality and privacy, interfering with clients’ right to self-determination, conflicts of interest, and professional boundaries and dual relationships), (2) “macro” practice involving social policy and planning, administration, community practice, advocacy, supervision, and research and evaluation (for example, social workers’ use of deception or coercion for benevolent purposes, decisions about whether to violate an unjust law or regulation, and attempts to allocate scarce agency resources in a just manner); and (3) relationships between social workers and their colleagues (for example, instances when social workers must decide how to respond to impaired colleagues or colleagues’ involvement in unethical or illegal activities – the ethics of “whistle blowing”).
Ethical decision making
Since the early 1980s, all of the professions have enhanced their understanding of ethical dilemmas and ways for practitioners to address them deliberately and systematically. Consistent with this trend, practitioners have paid increased attention to decision-making steps and protocols they can use when they encounter ethical dilemmas. Typically, these frameworks include a series of conceptually-based steps social workers can follow in their efforts to address and resolve complex ethical challenges (for example, identifying the ethical issues, including the values and duties that conflict; identifying the individuals, groups, and organizations who are likely to be affected by the ethical decision; tentatively identifying the possible courses of action, along with potential benefits and risks; and examining the reasons in favor of and opposed to each course of action, considering practitioners’ values, ethical theories and principles, codes of ethics, legal guidelines and regulations, and social work practice theory.
Ethics risk management
In some instances, ethical issues present social workers with more than difficult decisions. At times these issues are accompanied by practical risks – in the form of lawsuits filed against social workers and ethics complaints filed with licensing boards and professional associations – that can threaten practitioners’ careers (in extreme cases social workers are charged with criminal offenses, such as insurance fraud, embezzlement, or sexual involvement with a client).
To minimize these risks, social workers should be acquainted with prevailing standards related to professional malpractice, liability, and negligence, particularly as they pertain to common risks involving client rights; confidentiality, privacy, and privileged communication; informed consent; delivery of services and interventions; conflicts of interest; dual relationships and boundaries; defamation of character; documentation; client records; supervision; consultation; client referral; fraud, termination of services and client abandonment; and evaluation and research (Reamer, 2001b).
Special attention should be paid to the issue of impaired social workers. Some ethics complaints and lawsuits are filed because of mistakes, judgment errors, or misconduct engaged in by social workers who are, in some way, impaired. Common forms of impairment – which occurs when social workers are unable or unwilling to adhere to professional standards or are unable to control personal stress and psychological dysfunction – include emotional disability, substance abuse, or severe burnout (Coombs, 2000; Katsavdakis, et al. 2004; Kilburg, Nathan, & Thoreson., 1986). Ideally, social workers would become familiar with the nature of professional impairment and possible causes, warning signs, and practical strategies to prevent, identify, and respond constructively to impairment.
BALANCING VIRTUE ETHICS AND RISK-MANAGEMENT
Social workers’ increasingly mature grasp of ethical issues represents one of the most impressive and important developments in the profession’s history. Over time, social workers have moved from a relatively paternalistic preoccupation with clients’ morality to concern about ethical dilemmas, ethical decision making, and ethics-related risk management.
Most recently, ethics instruction in social work education programs and, especially, continuing education offerings has emphasized ethics risk management in an effort to prevent lawsuits and ethics complaints. Focus on social work’s values, ethical dilemmas, and ethical decision making has faded some.
The current emphasis on ethics risk management is understandable, particularly in a litigious culture. However, preoccupation with ethics risk management has the potential to divert social workers from their core mission: to examine and wrestle with ethical issues that affect social workers’ ability to “enhance human well-being and help 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” (NASW, 1999). Social workers cannot afford to lose sight of the fact that, first and foremost, their duty is to understand the impact that personal and professional values, ethical dilemmas, and ethical decision making have on their ability to assist people in need. Ethics risk management – while an important and compelling issue – must always be a secondary concern.
Toward this end, I believe the social work profession must recalibrate its focus with respect to values and ethics. It is time to shift the weight of the profession’s emphasis back toward issues involving core professional and personal values, ethical dilemmas, and ethical decision making, with an eye toward what social workers need to know in order to serve people in need and carry out the profession’s noble mission. Ethics risk management is important, but it is hardly the heart of the matter. After all, social work’s raison d’etre is rooted in practitioners’ service to others, not to themselves.
References
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Author’s note:
Address correspondence to: Frederic G. Reamer, Professor, School of Social Work, Rhode Island College, Providence, RI 02908. e-mail: FReamer@ric.edu.About the Author
Frederic G. Reamer is Professor in the graduate program of the School of Social Work, Rhode Island College, where he has been on the faculty since 1983. His research and teaching have addressed a wide range of human service issues, including mental health, health care, criminal justice, public welfare, and professional ethics. Dr. Reamer received his Ph.D. from the University of Chicago (1978) and has served as a social worker in correctional and mental health settings. He has also served on the faculties of the University of Chicago, School of Social Service Administration (1978-1981), and the University of Missouri-Columbia, School of Social Work (1981-1983). Dr. Reamer has served as Director of the National Juvenile Justice Assessment Center of the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (1979-1981); as Senior Policy Advisor to the Governor of Rhode Island (1987-1990); and as a Commissioner of the Rhode Island Housing and Mortgage Finance Corporation, the state housing finance agency (1987-1995). Since 1992 Dr. Reamer has served on the State of Rhode Island Parole Board. He also served as Editor-in-Chief of the Journal of Social Work Education (1990-1994). In 1995 Dr. Reamer was appointed editor of the Columbia University Press Social Work Knowledge book series.
Dr. Reamer has conducted extensive research on professional ethics. He has been involved in several national research projects sponsored by The Hastings Center, the Carnegie Corporation, and the Haas Foundation. He is the author of many books and articles. His books include: Click the book titles to go to the purchase page on Amazon.
- Criminal Lessons: Case Studies and Commentary on Crime and Justice (Columbia University Press
- Social Work Values and Ethics (Columbia University Press)
- Tangled Relationships: Managing Boundary Issues in the Human Services (Columbia University Press)
- Ethical Standards in Social Work: A Review of the NASW Code of Ethics (NASW Press)
- The Social Work Ethics Audit: A Risk Management Tool (NASW Press)
- Ethics Education in Social Work (Council on Social Work Education)
- The Foundations of Social Work Knowledge (Columbia University Press; editor and contributor)
- Social Work Malpractice and Liability (Columbia University Press)
- Social Work Research and Evaluation Skills (Columbia University Press)
- The Philosophical Foundations of Social Work (Columbia University Press)
- AIDS and Ethics (Columbia University Press; editor and contributor)
- Ethical Dilemmas in Social Service (Columbia University Press)
- Rehabilitating Juvenile Justice (Columbia University Press; co-author, Charles H. Shireman)
- The Teaching of Social Work Ethics (The Hastings Center; co-author, Marcia Abramson).
- Pocket Guide to Essential Human Services (NASW Press)
- Heinous Crimes:Cases, Causes, and Consequences (Columbia University Press)
Dr. Reamer is also the author of chapters on professional ethics in the Encyclopedia of Social Work, the Encyclopedia of Bioethics, and the Encyclopedia of Applied Ethics. He has been a commentator on National Public Radio’s All Things Considered.
Dr. Reamer has lectured extensively nationally and internationally on the subjects of professional ethics and professional malpractice and liability. He chaired the national task force that wrote the Code of Ethics adopted by the National Association of Social Workers in 1996. Dr. Reamer received the "Distinguished Contributions to Social Work Education" award from the Council on Social Work Education (1995) and the Presidential Award from the National Association of Social Workers (1997).
Dr. Reamer can be contacted by email at freamer@ric.edu
