By: Karen Allen, Ph.D., LMSW Show
Social workers are routinely confronted with ethical dilemmas in practice, and social work programs infuse their courses with professional ethics and values to help students prepare for this eventuality. The Council on Social Work Education (2008) requires that students learn how to “apply social work ethical principles to guide practice, engage in ethical decision making, recognize and manage personal values in a way that allows professional values to guide practice, and tolerate ambiguity in resolving ethical conflicts” (EPAS 2.1.2). Social work students become familiar with the Code of Ethics, learn one of the various models on ethical decision making (Congress, 1999; Dolgoff, Loewenberg, & Harrington, 2009; Reamer, 1995) and, at some point in their education, are typically required to write a paper on an ethical dilemma. However, students are not routinely taught how to recognize what an ethical dilemma is. Correctly identifying an ethical dilemma is the first step in resolving it. What Is an Ethical Dilemma? There are three conditions that must be present for a situation to be considered an ethical dilemma. The first condition occurs in situations when an individual, called the “agent,” must make a decision about which course of action is best. Situations that are uncomfortable but that don’t require a choice, are not ethical dilemmas. For example, students in their internships are required to be under the supervision of an appropriately credentialed social work field instructor. Therefore, because there is no choice in the matter, there is no ethical violation or breach of confidentiality when a student discusses a case with the supervisor. The second condition for ethical dilemma is that there must be different courses of action to choose from. Third, in an ethical dilemma, no matter what course of action is taken, some ethical principle is compromised. In other words, there is no perfect solution. In determining what constitutes an ethical dilemma, it is necessary to make a distinction between ethics, values, morals, and laws and policies. Ethics are prepositional statements (standards) that are used by members of a profession or group to determine what the right course of action in a situation is. Ethics rely on logical and rational criteria to reach a decision, an essentially cognitive process (Congress, 1999; Dolgoff, Loewenberg, & Harrington, 2009; Reamer, 1995; Robison & Reeser, 2002). Values, on the other hand, describe ideas that we value or prize. To value something means that we hold it dear and feel it has worth to us. As such, there is often a feeling or affective component associated with values (Allen & Friedman, 2010). Often, values are ideas that we aspire to achieve, like equality and social justice. Morals describe a behavioral code of conduct to which an individual ascribes. They are used to negotiate, support, and strengthen our relationships with others (Dolgoff, Loewenberg, & Harrington, 2009). Finally, laws and agency policies are often involved in complex cases, and social workers are often legally obligated to take a particular course of action. Standard 1.07j of the Code of Ethics (NASW, 1996) recognizes that legal obligations may require social workers to share confidential information (such as in cases of reporting child abuse) but requires that we protect confidentiality to the “extent permitted by law.” Although our profession ultimately recognizes the rule of law, we are also obligated to work to change unfair and discriminatory laws. There is considerably less recognition of the supremacy of agency policy in the Code, and Ethical Standard 3.09d states that we must not allow agency policies to interfere with our ethical practice of social work. It is also essential that the distinction be made between personal and professional ethics and values (Congress, 1999; Wilshere, 1997). Conflicts between personal and professional values should not be considered ethical dilemmas for a number of reasons. Because values involve feelings and are personal, the rational process used for resolving ethical dilemmas cannot be applied to values conflicts. Further, when an individual elects to become a member of a profession, he or she is agreeing to comply with the standards of the profession, including its Code of Ethics and values. Recent court cases have supported a profession’s right to expect its members to adhere to professional values and ethics. (See, for example, the Jennifer Keeton case at Augusta State University and the Julea Ward case at Eastern Michigan University.) The Council on Social Work Education states that students should “recognize and manage personal values in a way that allows professional values to guide practice” (EPAS 1.1). Therefore, although they can be difficult and uncomfortable, conflicts involving personal values should not be considered ethical dilemmas. Two Types of Dilemmas An “absolute” or “pure” ethical dilemma only occurs when two (or more) ethical standards apply to a situation but are in conflict with each other. For example, a social worker in a rural community with limited mental health care services is consulted on a client with agoraphobia, an anxiety disorder involving a fear of open and public spaces. Although this problem is outside of the clinician’s general competence, the limited options for treatment, coupled with the client`s discomfort in being too far from home, would likely mean the client might not receive any services if the clinician declined on the basis of a lack of competence (Ethical Standard 1.04). Denying to see the patient then would be potentially in conflict with our commitment to promote the well-being of clients (Ethical Standard 1.01). This is a pure ethical dilemma because two ethical standards conflict. It can be resolved by looking at Ethical Standard 4.01, which states that social workers should only accept employment (or in this case, a client) on the basis of existing competence or with “the intention to acquire the necessary competence.” The social worker can accept the case, discussing the present limits of her expertise with the client and following through on her obligation to seek training or supervision in this area. However, there are some complicated situations that require a decision but may also involve conflicts between values, laws, and policies. Although these are not absolute ethical dilemmas, we can think of them as “approximate” dilemmas. For example, an approximate dilemma occurs when a social worker is legally obligated to make a report of child or domestic abuse and has concerns about the releasing of information. The social worker may experience tension between the legal requirement to report and the desire to respect confidentiality. However, because the NASW Code of Ethics acknowledges our obligation to follow legal requirements and to intervene to protect the vulnerable, technically, there is no absolute ethical dilemma present. However, the social worker experiences this as a dilemma of some kind and needs to reach some kind of resolution. Breaking the situation down and identifying the ethics, morals, values, legal issues, and policies involved as well as distinguishing between personal and professional dimensions can help with the decision-making process in approximate dilemmas. Table 1 (at beginning of this article) is an illustration of how these factors might be considered. Conclusion When writing an ethical dilemma paper or when attempting to resolve an ethical dilemma in practice, social workers should determine if it is an absolute or approximate dilemma; distinguish between personal and professional dimensions; and identify the ethical, moral, legal, and values considerations in the situation. After conducting this preliminary analysis, an ethical decision-making model can then be appropriately applied. References Allen, K. N., & Friedman, B. (2010). Affective learning: A taxonomy for teaching social work values. Journal of Social Work Values and Ethics, 7 (2). Retrieved from http://www.socialworker.com/jswve. Council on Social Work Education. (2008). Education policy and accreditation standards (EPAS). Retrieved from http://www.cswe.org/NR/rdonlyres/2A 81732E-1776-4175-AC42-65974E96BE66/0/2008EducationalPolicyandAccreditationStandards.pdf. Dolgoff, R., Lowenberg, F. M., & Harrington, D. (2009). Ethical decisions for social work practice (8th Ed.). Belmont, CA: Brooks/Cole. Congress, E. P. (1999). Social work values and ethics: Identifying and resolving professional dilemmas. Belmont, CA: Wadsworth Group/Thompson Learning. National Association of Social Workers. (1996, revised 1999). Code of Ethics of the National Association of Social Workers. Washington, DC: Author. Reamer, F. (1995). Social work values and ethics. New York: Columbia University Press. Robison, W., & Reeser, L. C. (2002). Ethical decision making for social workers. New York: Allyn & Bacon. Wilshere, P. J. (1997). Personal values: professional questions. The New Social Worker, 4 (1), 13. Karen Allen, Ph.D., LMSW, is an associate professor at Oakland University’s Social Work Program. This article appeared in THE NEW SOCIAL WORKER, Spring 2012, Vol. 19, No. 2. All rights reserved. Please contact the publisher/editor for permission to reprint/reproduce. Related articles:
To do or not to do, that is the question you ask yourself every morning when you hit the snooze on your alarm. Life offers plenty of little dilemmas that kill you with a smile. Choosing between two of your favorite shirts, struggling to decide whether or not to get a haircut, choosing between the dinner you promised your girlfriend and an impromptu guys’ night out—you make a variety of decisions every day. The little choices that you make in your daily life are probably quite different than ethical decisions. Ethical decisions involve analyzing different options, eliminating those with an unethical standpoint, and choosing the best ethical alternative. But that begs the question, what are ethics? Recommended Video for you: What is an Ethical Dilemma? What are ethics?Ethics are the well-grounded standards of right and wrong that dictate what humans ought to do. These are usually put in terms of rights, duties, benefits to the society, fairness, and other specific virtues. They outline a framework to establish what conduct is right or wrong for individuals and broader groups in society. It’s important to recognize that our individual ethics must also engage with the ethics of other people involved in the situation, e.g., our parents, colleagues, clients, etc. The laws of the land, rules set by society, and policies set out by the organization one works for, philosophical schools of thought, moral foundations, and many other such considerations govern ethics. Thus, doing ‘the right thing’ becomes a combination of personal, professional, and societal ethics. How can you decide if something is ethically right or wrong?While deciding if what you are doing is ethically right or wrong, you can ask yourself the following questions: Legal TestIs there a law being broken? If yes, the issue is of disobedience with enforceable laws instead of the unenforceable principles of a moral code. If it is legal, there are three more tests to decide whether it is right or wrong. Stench TestDoes the course of action have the stench of corruption? This is a test of your instincts and determines the level of morality on a psychological level. Front Page TestHow would you feel if your action showed up on the front page of the newspaper the next day? Most people would never do certain things if there was a chance that other people would find out about it. This is a test of your social morals. Mom TestThis test involves asking oneself, ‘What would mom think if she knew about this?’ When you put yourself in the shoes of another person (who cares deeply about you), you get a better idea of what you’re doing. These are the basic tests to find out if what you’re doing is right or wrong. However, you often face situations where you find yourself in a conflict between two right things. What is an ethical dilemma?An ethical dilemma is a conflict between alternatives where choosing any of them will compromise some ethical principle and lead to an ethical violation. A crucial feature of an ethical dilemma is that the person faced with it should do both the conflicting acts, based on a strong ethical compass, but cannot; he may only choose one. Not choosing one is the condition that allows the person to choose the other. Thus, the same act is both required and forbidden at the same time. He is condemned to an ethical failure, meaning that he will do something wrong no matter what he does. When people encounter these tough choices, an ethical failure rarely occurs because of temptation, but simply because choosing any of the conflicting actions will involve sacrificing a principle in which they believe. Truth vs. LoyaltyConforming to facts or reality sometimes stands against your allegiance to a person, corporation, government, etc. Truth is right, and so is loyalty. Individual vs. CommunityIndividualism assumes that the rights of a person must be preserved since social goodwill automatically emerges when each person vigorously pursues his interests. However, ‘community’ means that the needs of the majority outweigh individual interests. It is right to consider the individual, but also right to consider the community. Short term vs. Long termMost people think it’s obvious to plan for the long term, even if it means sacrificing things in the short term. However, it gets tough to choose when short-term concerns demand the satisfaction of current needs to preserve the possibility of a future. Thus, it is right to think about both short-term and long-term concerns. Justice vs. MercyJustice urges us to stick to the rules and principles and pursue fairness without giving personal attention to given situations. Mercy urges us to seek benevolence in every possible way by caring for the peculiar needs of individuals on a case-by-case basis. Both justice and mercy are right. When faced with an ethical consideration, we need to be clear about which values are at play. We need also to realize how easy it is to discard one of the values or to justify dishonesty because we want to avoid unpleasant confrontations. We do this by thinking things like ‘Everybody does it’ or ‘I will do this one last time’. Ethical dilemma examples
Approaches to ethical decision makingThere can be different approaches to thinking about ethical decision making, although struggling with these dilemmas might give you a headache: Ends BasedThe utilitarian approach or the ends-based approach says that the actions are ethically right or wrong depending on their effects. It argues that the most ethical choice is the one that does the greatest good for the greatest number. Rules-BasedThis approach rests on the belief that rules exist for a purpose and must therefore be followed. Basically, stick to the rules and principles and don’t worry about the result! Care BasedThis approach puts love for others first. It is most associated with ‘Do unto others as you would have them do unto you’. How to resolve an ethical dilemmaWhat do you do when you find yourself in an ethical dilemma? How do you figure out the best path to take? Before thinking about which path is the most ethical one, be sure to spell out the problem and the feasible options at hand. Our mind often limits itself to two conflicting options and does not see the presence of a third, better option. Generally, philosophers outline two major approaches in handling ethical dilemmas after assessing the legality of the actions. While focusing on the consequences of the ethical dilemma, one approach argues ‘no harm, no foul’. In contrast, the other focuses on the actions themselves, claiming that some actions are simply inherently wrong. While these approaches seem to conflict with each other, they actually complement the other in practice. A brief three-step strategy can be formulated by combining these two schools of thought. Step one – Analyze the consequences.When you have two options, considering the positive and negative consequences connected with each option gives you a better outlook on which option is better. It is not enough to count the number of good and bad consequences an option has; it is also important to note the kind and amount of good it does. After all, certain ‘good things’ in life (e.g., health) are more significant than others (e.g., a new phone). Similarly, a small quantity of high-quality good is better than a large quantity of a low-quality good, and a small quantity of high-quality harm (like betraying someone’s trust) is worse than a large quantity of low-quality harm (like waiting a few more months before asking for a promotion). Step two – Analyze the actions.Now, look at those options from an entirely different perspective. Some actions are inherently good (truth-telling, keeping promises), while others are bad (coercion, theft). No matter how much good comes from these bad actions, the action will never be right. How do your actions measure up against moral principles of honesty, fairness, and respecting the rights and dignity of others? If there is a conflict between one or more of these principles, consider the possibility of one principle being more important than the others. Step three – Make a decision.Each of the above approaches acts as a check on the limitations of the other and must therefore be analyzed in combination. They provide the basic elements that we can use in determining the ethical character of the options at hand and make the process relatively easy. When you find yourself in a fix, consider speaking to others about the situation and getting the opinion of more knowledgeable people to find a possible solution. Once the decision is made, explain it to those who will be affected by your decision. Be aware and reactive to new developments in that situation that may require you to make changes in your course of action. It will also help reflect on your past actions and consider whether there is anything you can do to prevent the dilemma from happening again. Most importantly, stay ethical and stay proud!
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