Ethics and Values

 

Frederic G. Reamer

 

In the face of significant changes that have taken place in the practice of social work throughout its history, social workers have continued to embrace a set of values central to the profession. There have been both challenges to and constructive changes in the value base of the profession, but the key ele­ments of this foundation have endured.

 

Although there has been considerable stability in the core values of the profession, it would be a mistake to conclude that the day-to-day ethical issues that social workers encounter have remained static. To the contrary applications of core values in social work have undergone sub­stantial change over the years in response to social, political, and economic developments.

 

The subject of ethics and values in social work is broad in scope. In general it encompasses three distinguishable, though related, sets of issues. The first concerns the relevance of the profession's value base to its overall mission, goals, and priorities, especially as reflected in the NASW Code of Ethics (NASW, 1994). The second pertains to ethical decisions and dilemmas that social workers encounter as they carry out their professional duties, and the third relates to practi­tioner misconduct and the enforcement of ethical standards in the profession.

 

VALUE BASE OF SOCIAL WORK

 

The profession of social work historically has been committed to enhancing the welfare of people who encounter problems related to poverty, mental health, health care, employment, shelter and hous­ing, abuse, aging, childhood, hunger, and so on. As the profession has evolved, it has continually stressed the need to attend both to the needs of individual clients and to the ways that the commu­nity and society respond to these needs. Thus, there has always been a simultaneous concern in social work for individual well being and the envi­ronmental factors that affect it.

 

Social workers' appreciation of the complex interaction between individuals and their environ­ment has been grounded in an enduring set of val­ues. As Timms (1983) suggested, discussions of values in social work have been of three types: (1) broad overviews of the profession and social work's mission, which include general references to "value" or "values" (for example, Hamilton, 1940; Younghusband, 1967); (2) critical assess­ments of social work values or of a particular value (for example, McDermott, 1975); and (3) reports of empirical research on values held by social workers (for example, Varley, 1968).

 

According to Pumphrey (1959), individuals' values are "formulations of preferred behavior held by individuals or social groups. They imply a usual preference for certain means, ends and con­ditions of life, often being accompanied by strong feeling" (p. 23). Rokeach (1973) offered what has become a classic definition of value in The Nature of Human Values: "an enduring belief that a spe­cific mode or end state of existence is personally or socially preferable to an opposite or converse mode or end state of existence" (p. 5).

 

From this point of view, one must distinguish among ultimate, proximate, and instrumental val­ues. Ultimate values are broadly conceived and provide general guidance to a group's long-term aims. In social work, values such as respect for people, equality, and nondiscrimination might con­stitute ultimate values. Proximate values are more specific and suggest shorter-term goals. In social work they might take the form of policies related to welfare clients' right to health care or affordable housing, or psychiatric patients' right to refuse certain types of treatment. Finally, instrumental values specify desirable means to desirable ends. In social work respecting clients' right to confiden­tiality, self-determination, and informed consent might be considered instrumental values.

 

Common Base

 

Although the core values of the profession identi­fied by different authors vary, there is a common base. Frequently cited values in social work are individual worth and dignity respect for people, valuing individuals' capacity for change, client self-determination, confidentiality and privacy provid­ing individuals with opportunity to realize their potential, seeking to meet individuals' common human needs, commitment to social change and social justice, seeking to provide individuals with adequate resources and services to meet their basic needs, client empowerment, equal opportu­nity, nondiscrimination, respect of diversity and willingness to transmit professional knowledge and skills to others (Bartlett, 1970; Biestek, 1957; Gordon, 1962; Keith-Lucas, 1977; Levy, 1973; Plant, 1970; Reamer, 1987c, 1990, 1994b, 1995; Teicher, 1967; Timms, 1983).

 

Pumphrey (1959) offered a comprehensive typology of social work values, placing them into three categories of value-based objectives. The first focuses on the relationship between social work values and values operating in the culture at large with respect to, for example, social justice, social change, and basic human needs. The sec­ond category focuses on internal relationships within the professional membership, for example, the ways in which the profession interprets and implements its values and encourages ethical behavior. The final category focuses on social workers' attempts to understand and respond to clients' values.

 

Levy (1973) also provided an important clas­sification of the profession's values. The first of Levy's three groups includes "preferred concep­tions of people” such as the belief in individuals' inherent worth and dignity, capacity and drive toward constructive change, mutual responsibility, need to belong, uniqueness, and common human needs. The second group includes "preferred out­comes for people” such as the belief in society's obligation to provide opportunities for individual growth and development; to provide resources and services to help people meet their needs and to avoid such problems as hunger, inadequate educa­tion or housing, illness, and discrimination; and to provide equal opportunity to participate in the molding of society. Levy's third group includes "preferred instrumentalities for dealing with peo­ple” such as the belief that people should be treated with respect and dignity, have the right to self-determination, be encouraged to participate in social change, and be recognized as unique individuals.

 

Personal Values

 

A significant portion of social work literature focuses on the need for social workers to clarify their own personal values. Practitioners' personal values influence their views of clients, intervention frameworks and strategies, and definitions of suc­cessful and unsuccessful outcomes. Workers' per­sonal values also affect their willingness to en­dorse and act on the profession's value base. For example, a worker's personal views about the ethics of abortion are likely to have a significant bearing on the worker's response to a pregnant adolescent who is considering abortion. Also, will­ingness to comply with relevant statutes and agency policy and support of NASW's position on abortion would be affected by the worker's per­sonal views.

 

The emphasis placed on specific core values has varied considerably throughout social work's history. For example, around the beginning of the 20th century, the emphasis was on ways clients create and contribute to their own problems. Social workers of that era, influenced in part by the methods of the charity organization societies, frequently viewed clients' problems as evidence of character defects rather than as evidence of flawed communities or social policies that did not respond adequately to human needs (Davis, 1967). Thus, the values of concern to social workers at the turn of the century often centered on a client's morality or lack of virtue. A key part of a case­worker's mission was assumed by many to be the inspiration of clients to lead morally upright, pru­dent lives.

 

Environmental Determinants

 

Social workers gradually became more aware of ways environmental factors shape individuals and limit their opportunities. The Progressive Era, the settlement house movement, and the Great Depression of the 1930s, for example, helped turn social workers' attention to social and economic problems that contributed substantially to the misery suffered by many who lived during those years. As a result of this increased sensitivity, con­cern about clients' personal morality waned and concern about the need for social change and the enhancement of opportunity increased.

 

Interest in the environmental determinants of individual problems declined somewhat during the relatively tranquil years immediately following World War 11, during which many members of the profession were drawn to the development of psy­chiatric social work. But widespread concern about large-scale social change emerged once again during the turbulent 1960s. Thus, during the earliest years of the profession, practitioners often focused on the depth and decency of clients' val­ues. Attention gradually shifted to analyses of the broader society's values and commitment to the needs of those who were poor, ill, or otherwise disadvantaged. More recently, especially since the 1970s, there has been increased interest in exam­ining the values of social workers themselves and the ethical aspects of their practice.

 

Ethics of Practitioners

 

The relatively recent surge of interest in the ethics of practitioners is not unique to social work. It is also characteristic of nearly every profession and field, including law, medicine, nursing, dentistry, journalism, engineering, law enforcement, the mili­tary, and business. Several reasons account for this growth of interest in professional ethics and values. Technological and other developments have presented professionals with ethical choices that simply were unknown to previous generations of practitioners. Developments in medicine, nuclear power, and computer technology, for example, have been accompanied by enormously complicated issues related to ethics and values. The beginning of the acquired immune deficiency syndrome (AIDS) crisis in the early 1980s, for instance, trig­gered a series of new and unanticipated ethical questions related to privacy (protection of sexual partners and contact tracing), mandatory testing, the obligation to treat human immunodeficiency virus (HIV)-infected clients, and access to health care (Reamer, 1991). In addition, contemporary professionals have been faced with decisions about the allocation of a growing list of scarce or limited resources, such as food, land, health care, social services, and money, and this has height­ened their awareness of ethics and values in professional life. Widely publicized scandals that have taken place in nearly every profession, rang­ing from mismanagement and fraud to the abuse or exploitation of clients (Reamer & Abramson, 1982), have also contributed to the growing inter­est in professional ethics.

 

However, this growth also seems to reflect in large part the maturation of the professions them­selves. During its early years, a profession tends to be preoccupied with the technical aspects of its mission. After all, if a profession does not have the capacity to carry out technical tasks skillfully, it has little claim to expertise and to the use of the term "profession." Most professions have focused much greater attention on issues of ethics and val­ues once their reputations for technical expertise have been firmly established. This may explain why the modern or young professions-mainly those other than law and medicine-have recently paid increased attention to ethical issues.

 

NASW CODE OF ETHICS

 

There are several codes of ethics related to social work. Prominent examples include those of NASW National Association of Black Social Workers, National Federation of Societies for Clinical Social Work, and Canadian Association of Social Workers.

 

The best-known ethics code to which social workers in the United States subscribe is the NASW Code of Ethics (NASW, 1994). The NASW Code of Ethics has been a living document, revised periodically to reflect changes in the broader cul­ture and in social work's own standards.

 

Historical Development

 

The earliest known attempt to formulate a code was an experimental draft code of ethics printed in the 1920s and attributed to Mary Richmond (Pumphrey 1959). Although several other social work organizations formulated draft codes during the early years of the profession-for example, the American Association for Organizing Family Social Work and several chapters of the American Asso­ciation of Social Workers-it was not until 1947 that the latter group, the largest organization of social workers of that era, adopted a formal code (Johnson, 1955). In 1960 NASW adopted its first code of ethics, five years after the association was formed.

 

The 1960 NASW Code of Ethics consisted of a series of proclamations concerning, for example, every social worker's duty to give precedence to professional responsibility over personal interests; to respect the privacy of clients; to give appropri­ate professional service in public emergencies; and to contribute knowledge, skills, and support to programs of human welfare. First-person state­ments (that is, "I give precedence to my profes­sional responsibility over my personal interests" and "I respect the privacy of the people I serve") were preceded by a preamble that set forth social workers' responsibility to uphold humanitarian ideals, maintain and improve social work service, and develop the philosophy and skills of the profession. In 1967 a principle pledging nondiscri­mination was added to the proclamations.

 

Soon after the adoption of the 1960 code, however, NASW members began to express con­cern about its level of abstraction, its scope and usefulness for resolving ethical conflicts, and its provisions for handling ethics complaints about practitioners and agencies (McCann & Cutler, 1979). In 1977 the NASW Delegate Assembly estab­lished a task force to revise the code and enhance its relevance to practice.

 

The 1979 code, which formed the foundation of the current code, included six sections of brief, unannotated principles preceded by a preamble setting forth the general purpose of the code, the enduring social work values on which it was based, and a declaration that the code's principles provided standards for the enforcement of ethical practices among social workers. The 1979 code has been revised twice. In 1990 several principles related to solicitation of clients and fee setting were modified following an inquiry into NASW pol­icies by the U.S. Federal Trade Commission, begun in 1986, concerning possible restraint of trade. As a result of the inquiry, principles in the code were revised in order to remove prohibitions concerning solicitation of clients from colleagues or one's agency (original principles II.F.2 and III.I.1) and to modify wording related to accepting compensation for making a referral (principle NASW also entered into a consent agreement with the Federal Trade Commission concerning the issues raised by the inquiry.

 

In 1993 the NASW Delegate Assembly voted to further amend the code of ethics to include five new principles-three related to the problem of social worker impairment and two related to the problem of dual relationships. The first three prin­ciples address instances when social workers’ own problems and impairment interfere with their professional functioning, and the latter two address the need to avoid social or nonprofes­sional relationships with clients. The Delegate Assembly also passed a resolution to establish a task force to review and rewrite the code for sub­mission to the 1996 Delegate Assembly.

 

Current Principles

 

The sections of the current code set forth princi­ples-related to the social worker's general conduct and comportment and ethical responsibilities to clients, colleagues, employers, employing organiza­tions, the social work profession, and society. (The NASW Code of Ethics is presented as Appendix I of this encyclopedia.) The code's principles are both prescriptive ("The social worker should act to pre­vent the unauthorized and unqualified practice of social work") and proscriptive ("The social worker should not exploit relationships with clients for personal advantage"). Several of the code's principles are concrete and specific ("The social worker should under no circumstances engage in sexual activities with clients" and "The social worker should respect confidences shared by colleagues in the course of their professional relationships and transactions"), whereas others are more abstract, asserting ethical ideals ("The social worker should promote the general welfare of society" and "The social worker should uphold and advance the values, ethics, knowledge, and mission of the profession").

 

The wide range of principles in the code indi­cates that it was designed to serve several pur­poses. The more abstract, idealistic principles concerning social justice and general welfare provide social workers with important aspirations, as opposed to enforceable standards. Other princi­ples, however, set forth specific rules with which practitioners are expected to comply Violations provide grounds for the filing of a formal ethics complaint. In addition, a major purpose of the code is to provide social workers with principles to help them resolve ethical dilemmas encoun­tered in practice, a topic that has received consid­erable attention in recent years.

 

ETHICAL DILEMMAS IN SOCIAL WORK

 

Social workers encounter a wide variety of ethical decisions and dilemmas as a result of their diverse and sometimes conflicting obligations to clients, employers, colleagues, the social work profession, and society at large. Many ethical decisions are routine, such as obtaining clients' consent before releasing confidential information and avoiding sexual contact with clients. In some instances, however, ethical decisions are complex and trou­bling. Most troubling are decisions that require social workers to choose between two or more conflicting duties or obligations. For example, the NASW Code of Ethics (1994) states that the "social worker should not engage in any action that vio­lates or diminishes the civil or legal rights of clients" (p. 6). However, the code also states that the "social worker should adhere to commitments made to the employing organization." It is not diffi­cult to imagine a situation in which these two principles conflict, such as when an agency policy to which a worker is committed results in the vio­lation of a client's civil rights.

 

Other ethical conflicts that are particularly disquieting include those related to confidentiality and privileged communication; truth-telling; pater­nalism and self-determination; the obligation to adhere to laws, policies, and agency regulations; whistle-blowing; allocation of limited resources; and the relationship between personal and profes­sional values.

 

Confidentiality and Privileged Communication

 

Social workers assume that information shared by clients should be kept confidential. Although confi­dentiality certainly is appropriate in nearly every instance, on occasion practitioners need to con­sider disclosing confidential information, perhaps against a client's wishes, such as when a client seriously threatens to injure a third party or has abused a child or an aged person. In fact, this pos­sibility is recognized by the NASW Code of Ethics (1994), which states that social workers may reveal confidential information for "compelling professional reasons." Unfortunately, there is no consensus in the profession about all of the condi­tions that warrant such disclosure, although there is general agreement that it is appropriate only under extreme circumstances.

 

Similar problems can arise related to privi­leged communication. In many states clients of social workers have the right of privileged commu­nication, which provides grounds for social work­ers to resist disclosure of information about clients in a court of law. However, in states where clients of social workers do not have this right (and occasionally in states where they do), social workers must sometimes choose between a court order to disclose information shared by a client in confidence (for instance, related to a child custody dispute) and a client's right to confidentiality (Wil­son, 1978).

 

Telling the Truth

 

Another principle ordinarily embraced in the profession is the client's right to truthful informa­tion about matters relevant to his or her care, treatment, and welfare. Yet some social workers argue that in rare instances it may be permissible, or even obligatory, either to withhold the truth from a client or to provide misinformation. Such action is ordinarily defended on grounds that it is sometimes needed to protect a client from harm. Many social workers claim that it is never justifia­ble for a practitioner to withhold truthful informa­tion-or provide misinformation to a client, but others point to cases involving, for example, seri­ously ill clients or children for whom truthful information is considered to be harmful, at least under certain circumstances (Bok, 1978; Gert & Culver, 1976).

 

Paternalism and Self-Determination

 

The tendency to protect clients from harm raises a complex series of issues related to paternalism in social work. Paternalistic action involves interfer­ing with a client's wishes or freedom "for his or her own good ' " Restraining self-destructive clients or requiring them to receive services against their wishes, withholding information from clients, or providing clients with misinformation ar6 exam­ples of paternalism when these actions are carried out to protect clients from themselves.

 

Again, however, social workers often disagree about the conditions under which paternalism is justifiable (Reamer, 1983a). There are those who believe that clients have the right to engage in some forms of self-destructive behavior and to take risks, whereas others claim that social work­ers have a responsibility to protect clients from themselves when they fail to exercise "good" judg­ment. Debates about these issues frequently revolve around the concepts of self-determination, informed consent, and the extent to which clients are able to exercise sound, informed judgment regarding their own welfare (Culver & Gert, 1982; Dworkin, 1971; McDermott, 1975; Reamer, 1987b).

 

Laws, Policies, and Regulations

 

Another widely held belief in social work is that practitioners should adhere to laws and to agency policies and regulations. On occasion, however, social workers claim that laws, policies, and regu­lations ought not be obeyed because of the harm that presumably would result. In a number of cases, for example, social workers have chosen not to comply with a local law mandating the report­ing of child abuse because of a belief that the child would be exposed to greater risk if the case were reported to the local protective services authority.

 

Another common example involves social workers' decisions not to report clients' income or assets when doing so would deprive the clients of needed services or benefits. Although the vast majority of social workers do not condone such violations, some defend them, believing that any action to protect a client's welfare is justifiable, even if it violates another ethical principle, law, or policy (Wasserstrom, 1971).

 

Whistle-Blowing

 

Social workers who violate laws or agency regula­tions place a special burden on colleagues who become aware of these violations. It is tempting to conclude that social workers are always obliged to report such violations, along with instances of fraud, deception, abuse, or exploitation. In prac­tice, however, social workers who have become aware of such transgressions have sometimes found it difficult to blow the whistle.

 

Friendships, professional loyalties, and the risk to personal job security and reputation have dis­couraged some practitioners from revealing wrongdoing in the profession. Social workers who obtain evidence of professional indiscretion and misconduct must weigh carefully their obligation to the profession and its clientele, along with com­peting commitments to colleagues, one's agency, and the risk to one's own career (Reamer & Siegel, 1992; Westin, 1981).

 

Distributing Limited Resources

 

A persistent ethical problem in social work is the need to allocate scarce resources. These resour­ces may include emergency food and shelter, program funds, admission to rehabilitation pro­grams, or a caseworker's time. Social workers use a variety of criteria to distribute limited resources.

 

In some instances they rely on the principle of equality either by dividing a resource into equally sized portions (for example, money or a worker's time), or by providing clients with equal opportu­nity to apply or compete for a resource (first come, first served). On occasion a lottery may be used to provide clients with equal opportunity.

 

Another criterion social workers rely on is need. Many programs have a policy of providing services first to those most in need of them, rather than allocating equal shares or providing equal opportunity to apply for them. Yet another strategy is to give priority to people who have suffered some form of injustice or past discrimination. This principle has formed the basis of affirmative action programs.

 

Many social workers also allocate limited resources based on a client's ability to pay or to contribute to his or her community in the future. Of course, in many instances those clients who are most persistent, visible, and vocal become recipients of limited social services resources (Reamer, 1990).

 

Personal and Professional Values

 

Conflict between a worker's personal and profes­sional values underlies many ethical decisions and dilemmas (Levy, 1976). In addition, a worker's val­ues may conflict with a client's personal or reli­gious values. For example, a hospital social worker who-believes in taking full advantage of the resources of modem medicine may have difficulty respecting the right to self-determination nation of a patient who refuses a lifesaving blood transfusion for religious reasons. There are no simple answers in these cases, and social workers do not always agree about whether personal or professional val­ues ought to take precedence when they conflict. In each case, workers must weigh the competing obligations of the client, the employer, the profes­sion, and third parties against the requirements of their own conscience. In addition, they must con­tinually examine the nature of their personal val­ues and the ways in which those values influence their understanding of clients' problems, social problems, application of social work knowledge, and strategies of intervention.

 

ETHICAL DECISION MAKING

 

In the mid-1970s, social workers began to analyze systematically the ways practitioners make ethical decisions and to attempt to resolve ethical dilem­mas encountered in practice. Although discussions of ethics and values have taken place since the profession's formal beginning in the late 19th cen­tury the deliberate, systematic study of social workers' ethical conflicts is more recent.

 

The recent growth of interest in ethical deci­sion making has also occurred in most other professions. Practitioners and scholars in many fields have become interested in examining the ways that principles of ethics and ethical theory ­drawn largely from the discipline of moral philos­ophy and, at times, from theology-can be applied to ethical dilemmas in the professions. Much of the work in this area has focused on two major questions: (1) What are the ethical duties of professionals in relation to clients, colleagues, employers, the profession itself, and the broader society?, and (2) What criteria or guidelines can professionals draw on when their ethical duties and responsibilities conflict? (Callahan & Bok, 1980).

 

Although professionals tend to look to their respective codes of ethics for guidance, most would acknowledge that a code of ethics is limited in its ability to provide full and detailed answers. Codes of ethics are necessarily written in general terms and at a relatively high level of abstraction to address a broad range of issues. Consequently, professionals often will not find specific guidelines in codes that address ethical dilemmas that arise in practice. In addition, as noted earlier, codes of ethics typically contain principles that on occa­sion may conflict.

 

To approach the analysis of such ethical dilemmas systematically, social workers and other professionals sometimes draw on theories and principles of ethics. For centuries moral philoso­phers have been developing a variety of theories and principles related to issues of right and wrong, the nature of duty and obligation, justice, and so on. They have devoted substantial attention to the­ories of normative ethics, or theories intended to guide decisions in ethically complex situations. Although moral philosophers themselves do not agree entirely on ways to distinguish morally right and wrong actions (debates about what is known as meta-ethics), there is considerable agreement about major schools of thought that can be applied when faced with ethical dilemmas (Frankena, 1973; Reamer, 1989, 1993, 1995).

 

For example, the deontological point of view claims that certain actions are inherently right or wrong (that is, as a matter of principle). Propo­nents of this point of view might argue, for instance, that it is inherently wrong for a social worker to lie to a client and, therefore, that no cir­cumstances can possibly justify such deception. Or they might argue that social workers have an inherent obligation to keep information shared by clients confidential, no matter what the extenuat­ing circumstances.

 

A competing school of thought claims that actions are not inherently right or wrong, but rather that the rightness of an action is deter­mined by the goodness of its consequences. This so-called consequentialist, utilitarian, or teleologi­cal point of view emphasizes the outcome of an action and promotes actions that result in the greatest good. Thus, a strict utilitarian might jus­tify some form of deception, lying, or breach of confidentiality if the good that would likely result would outweigh the harm done (Gorovitz, 1971).

 

The merits of these points of view have been debated vigorously among philosophers and professionals. Critics of the deontological position have argued that rules and principles may need to be broken in extreme cases, as in an attempt to protect a client or third party from serious harm. To do otherwise, they argue, would be immoral and unprofessional. On the other hand, utilitarian­ism has been criticized for its impracticality and the difficulty involved in quantifying and weighing possible harmful and beneficial consequences. Perhaps the most serious criticism of utilitarian­ism is that it may be used to justify acts that vio­late the rights of a few in order to promote a greater aggregate good. Philosophers continue to disagree about the validity of these different claims. However, such debates and analyses have alerted professionals to critical issues that ought to be considered in ethical dilemmas, especially dilemmas in which professional duties conflict and choices must be made.

 

ETHICS ENFORCEMENT

 

Sometimes ethics complaints are filed against social workers. Members of NASW, for example, may be named in ethics complaints alleging viola­tion of principles in the association's code of eth­ics. Over the years there has been a steady increase in the number of ethics complaints filed against social workers, covering a wide range of alleged violations involving social workers' behav­ior and relationships with clients, colleagues, employers, and the profession (Berliner, 1989).

 

Ethics complaints filed against NASW mem­bers are handled initially by chapter committees on inquiry (COls), which may accept or reject a complaint on the basis of specific criteria. Using a process of peer review, a chapter COI conducts a hearing during which the complainant, respondent, and witnesses have an opportunity to present tes­timony. After deliberation and discussion, the COI presents a report to chapter officers summarizing its findings and recommendations. Recommenda­tions may include sanctions or various forms of corrective action, such as suspension from NASW, mandated supervision or consultation, censure in the form of a letter, or instructions to send the complainant a letter of apology. In some cases, the sanction may be publicized. The parties involved in the complaint may appeal the outcome, first to the NASW Committee on Inquiry and then, if nec­essary, to the executive committee of the NASW Board of Directors.

 

NASW staff monitor and facilitate ethics adju­dication and promote various ethics education activities. In addition to monitoring and facilitating the handling of ethics complaints filed against NASW members, the staff also oversee COW han­dling of complaints filed by social workers against employing organizations alleging violations of an agency's own personnel standards. Furthermore, the NASW staff also oversee COW handling of complaints by NASW members when their employ­ers have allegedly restricted their freedom to engage in various forms of professional or social action on behalf of their clients (for example, efforts that seek to eliminate discrimination, enhance access to services, or change policy or legislation). These various activities are designed to enhance, as constructively as possible, the quality of social work services provided to the public (NASW, 1991).

 

In many instances social workers involved in ethical misconduct are impaired. Professional impairment may involve an inability or unwilling­ness to comply with professional standards; an inability to develop professional skills or minimal professional competency; or an inability to man­age personal stress, psychological dysfunction, or other forms of stress that interfere with profes­sional functioning (Lamb et al., 1987). Impairment and related ethical misconduct may take the form of sexual contact with clients, incompetent deliv­ery of services, financial exploitation of clients, fraudulent activity or neglect or abandonment of clients.

 

Impaired social workers also may have a seri­ous substance abuse problem or may be victims of professional burnout. It is essential for social workers to be aware of the warning signs of impairment and be willing to address the problem of impairment whenever it appears in their own or in colleagues' lives. It is also important for social workers to become acquainted with strategies to prevent impairment and the ethics complaints and liability claims that may result from impairments (Reamer, 1992a, 1994b, in press).

 

FUTURE OF SOCIAL WORK ETHICS

 

Social workers have been concerned about ethics and values since the profession began. Social work has a long-standing history of commitment to issues of social justice and to the dignified, fair treatment of people in need of assistance. Although many of the ethical issues of current concern in the profession have been the focus of attention for decades, others have emerged only recently Future changes in the profession will no doubt lead to new ethical issues and questions.

 

There is no way to know with certainty what issues are likely to emerge in the future, but sev­eral trends are worth noting. First, it will be important for social workers to pay close attention to the ethical issues created by technological advances that affect the profession. For example, developments in computer technology will con­tinue to lead to difficult issues related to privacy and confidentiality. Developments in medical tech­nology will raise new questions related to the allo­cation of health care, the right to life, and the right to die. Developments in industry and the economy will affect employment patterns and thus raise ethical questions about the right to work and to obtain public assistance. In response to these advances, many social work agencies are forming ethics committees to consult on difficult decisions and educate staff members who face difficult ethi­cal choices (Reamer, 1987a).

 

A second trend worth observing relates to shifts in employment patterns among social work­ers themselves. In recent years social workers have been entering the mental health field in increasing numbers, many in private practice, whereas the number of social workers in public social services agencies has declined. Such shifts suggest important questions about the mission of social work and its value base (Reamer, 1992b). To what extent should social work place primary emphasis on the poor and oppressed as opposed to more affluent clients? What portion of the profession's resources should be devoted to clini­cal issues as opposed to social action, such as advocacy on behalf of the least advantaged? How much attention should be paid to those with mea­ger financial resources as opposed to those who have ample assets or insurance coverage to pay for services?

 

In addition, as social work develops new spe­cialties, novel questions of ethics and values are likely to emerge. For example, as industrial or occupational social work and social workers' involvement in employee assistance programs have grown, so too have problems related to confi­dentiality, privileged communication, and conflicts between the practitioner's loyalty to the client and employer. Also, as social workers develop increas­ingly specialized private practices, questions are likely to emerge related to the ethics of advertis­ing, solicitation of clients, and competence.

 

Finally the perennial tension between the roles of the public and private sectors in social welfare is likely to continue. The extent to which the public sector has assumed responsibility for social welfare has waxed and waned for decades. In the 1930s and 1960s, there was considerable support for large-scale government involvement in the provision of aid to the poor and oppressed. At other times federal and state officials and the gen­eral citizenry have been far less supportive of social welfare underwritten by the public sector. The early 1980s saw the beginning of a significant transfer of responsibility for social services to the for-profit (proprietary) and nonprofit private sector, including private social services agencies, charita­ble organizations, religious groups, and other vol­untary associations. The merits of this shift have been debated widely and will need to be examined continually for their effect on the ability of social workers to fulfill the moral and ethical purposes of the profession (Reamer, 1983b).

 

The future of social work cannot be predicted with precision, but it is certain that ethical and value issues will continue to permeate the profes­sion. Although some of these issues will change in response to new trends and developments, the fundamental issues related to ethics and values in social work will persist, such as practitioners' moral duty to aid those in need, clients' right to self-determination, and the formulation of criteria for allocating scarce social services resources. Hence, it will always be essential for social work­ers to examine these issues, which in the end form the very foundation of the profession.

 

REFERENCES

 

Bartlett, H. M. (1970). The common base of social work practice. New York: Columbia University Press.

 

Berliner, A. K. (1989). Misconduct in social work practice. Social Work, 34, 69-72.

 

Biestek, F P (1957). The casework relationship. Chicago: Loyola University Press.

 

Bok, S. (1978). Lying: Moral choice in public and private life. New York: Pantheon Books.

 

Callahan, D., & Bok, S. (Eds.). (1980). Ethics teaching in higher education. New York: Plenum Press.

 

Culver, C. M., & Gert, B. (1982). Philosophy in medicine: Conceptual and ethical issues in medicine and psychia­try. New York: Oxford University Press. Davis, A. E (1967). Spearheads for reform. New York: Oxford University Press.

 

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Gert, B., & Culver, C. M. (1976). Paternalistic behavior Philosophy and Public Affairs, 6, 45-57

 

Gordon, W E. (1962). A critique of the working definition. Social Work, 7 6.

 

Gorovitz, S. (Ed.). (1971). Mill: Utilitarianism. Indianapo­lis: Bobbs-Merrill.

 

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Lamb, D. H., Presser, N. R., Pfost, K. S., Baum, M. C., Jack­son, V R., & Jarvis, P A. (1987). Confronting profes­sional impainnent during the internship: Identification, due process, and remediation. Prokssional Psychology: Research and Practice, 18, 597-603.

 

Levy, C. S. (1973). The value base of social work. Journal of Education for Social Work, 9(l), 34-42.

 

Levy, C. S. (1976). Social work ethics. New York: Human Sciences Press.

 

McCann, C. W, & Cutler, J. P (1979). Ethics and the alleged unethical. Social Work, 24, 5-8.

 

McDermott, F E. (Ed.). (1975). Self-determination in social work. London: Routledge & Kegan Paul.

National Association of Social Workers. (1991). NASW chapter guide for the adjudication of grievances (rev. ed.). Silver Spring, MD: Author.

 

National Association of Social Workers. (1994). NASW code of ethics. Washington, DC: Author.

 

Plant, R. (1970). Social and moral theory in casework. London: Routledge & Kegan Paul.

 

Pumphrey, M. W (1959). The teaching of values and ethics in social work education. New York: Council on Social Work Education.

 

Reamer, E G. (1983a). The concept of paternalism in social work. Social Service Review, 57(2), 254-271.

 

Reamer, F G. (1983b). Social services in a conservative era. Social Casework, 64(8), 451-458.

 

Reamer, F G. (1987a). Ethics committees in social work. Social Work, 32, 188-192.

 

Reamer, F G. (1987b). Informed consent in social work. Social Work, 32, 425-429.

 

Reamer, F G. (1987c). Values and ethics. In A. Minahan (Ed.-in-Chief), Encyclopedia of social work (18th ed., Vol. 2, pp. 801-809). Silver Spring, MD: National Associ­ation of Social Workers.

 

Reamer, F G. (1989). Toward ethical practice: The rele­vance of ethical theory Social Thought, 15(3/4), 67-78.

 

Reamer, F G. (1990). Ethical dilemmas in social service (2nd ed.). New York: Columbia University Press.

 

Reamer, F G. (Ed.). (1991). AIDS and ethics. New York: Columbia University Press.

 

Reamer, F G. (1992a). The impaired social worker. Social Work, 37 165-170.

 

Reamer, F G. (1992b). Social work and the public good: Calling or career? In P N. Reid & P R. Popple (Eds.), The moral purposes of social work. Chicago: Nelson­Hall.

 

Reamer, F G. (1993). The philosophical foundations of social work. New York: Columbia University Press.

 

Reamer, F G. (I 994a). Social work malpractice and liabil­ity. New York: Columbia University Press.

 

Reamer, F G. (1994b). Social work values and ethics. In F G. Reamer (Ed.), The foundations of social work knowledge. New York: Columbia University Press.

 

Rewner. F G. (1995). Social work values and ethics. New York: Columbia University Press.

 

Reamer, F G. (in press). Malpractice and liability claims against social workers: First facts. Social Work.

 

Reamer, F G., & Abramson, M. (1982). The teaching of social work ethics. Hastings-on-Hudson, NY: The Has­tings Center.

 

Reamer, F G., & Siegel, D. H. (1992). Should social work­ers blow the whistle on incompetent colleagues? In E. Gambrill & R. Pruger (Eds.), Controversial issues in social work (pp. 66-78). Boston: Allyn & Bacon.

 

Rokeach, M. (1973). The nature of human values. New York:Free Press.

 

Teicher, M. (1967). Values in social work: A re-examina­tion. New York: National Association of Social Workers.

 

Timms, N. (1983). Social work values: An enquiry. Lon­don: Routledge & Kegan Paul.

 

Varley, B. (1968). Social work values: Changes in value commitments of students from admission to MSW graduation. Journal of Education /br Social Work, 4, 67-85.

 

Wasserstrom, R. A. (Ed.). (1971). Morality and the law. Belmont, CA: Wadsworth.

 

Westin, A. (Ed.). (1981). Whistle blowing? Loyalty and dis­sent in the corporation. New York: McGraw-Hill.

 

Wilson, S. J. (1978). Confidentiality in social work. New York: Free Press.

 

Younghusband, E. (1967). Social work and social values. London: Allen & Unwin.

 

FURTHER READING

 

Beauchamp, T L. (1982). Philosophical ethics: An intro­duction to moral philosophy. New York: McGraw-Hill.

 

Callahan, J. C. (Ed.). (1988). Ethical issues in professional life. New York: Oxford University Press.

 

Emmet, D. (1962). Ethics and the social worker. British Journal of Psychiatric Social Work, 6(6), 165-172.

 

Joseph, M. V (1989). Social work ethics: Historical and contemporary perspectives. Social Thought, 15(3/4), 4-17

 

Levy C. S. (1972). The context of social work ethics. Social Work, 17 95-101.

 

Loewenberg, F, & Dolgoff, R. (1992). Ethical decisions for social work practice (4th ed.). Itasca, IL: F E. Peacock.

 

Reamer, F G. (1982). Conflicts of professional duty in social work. Social Casework, 63(10), 579-585.

 

Reamer, F G. (1983). Ethical dilemmas in social work practice. Social Work, 28, 31-35.

 

Reamer, F G. (1985). The emergence of bioethics in social work. Health & Social Work, 10, 271-281.

 

Rhodes, M. L. (1986). Ethical dilemmas in social work practice. London: Routledge & Kegan Paul.

 

Siporin, M. (1982). Moral philosophy in social work today. Social Service Review, 56(4), 516-538.

 

Siporin, M. (1989). Morality and immorality in working with clients. Social Thought, 15(3/4), 42-52.

 

 

Frederic G. Reamer, PhD, is professor, Rhode Island College, School of Social Work, Providence, RI 02908.