Social work is one of the noblest professions in existence. It concerns itself with downtrodden individuals, families, groups, and communities, and seeks to alleviate their suffering and improve their physical and socioeconomic conditions through various means (Segal, Gerdes, & Steiner, 2015). It has many ties with medicine, religion, economics, law, and the criminal justice system. As social work has the potential to change peoples’ lives for better or worse, its representatives are required to have a solid grasp of the movement’s core values and ethics.
The purpose of this paper is to analyze and apply ethical values and standards of the NASW (National Association of Social Workers) Code of Ethics, the CSWE (Council on Social Work Education) Educational Policy and Standards, and HIPAA (Health Insurance Portability and Accountability Act), and highlight some of the most difficult ethical dilemmas in the profession.
The Ethics of NASW, CSWE, and HIPAA: Key Points
The NASW Code of ethics aids social workers by articulating its basic values, ethical principles, and ethical standards. Its core ethical principles include helping people in need (service), challenging social injustice (social justice), respecting the inherent dignity and worth of a person (dignity), facilitating healthy interpersonal relationships (relationship), behaving in a trustworthy manner (integrity), and providing competent assistance within one’s area of expertise (competence) (NASW, 2017). The code’s ethical standards outline a social worker’s ethical responsibilities to clients and colleagues, ethical behavior in the field, and ethical responsibilities to the profession and broader society.
The CSWE features a list of ten core competencies of social work practice as part of its educational policy and standards. These competencies define a social worker as a professional whose purpose is to assist those in need through advocacy, active participation, competent practice, supervision, and consultation (CSWE, n.d.). It makes a reference to the NASW code of ethics in regards to solving ethical dilemmas. It also highlights the necessity of ethical ambiguity tolerance and ethical reasoning in making decisions.
Lastly, the HIPAA guidelines for clinical practice are concerned with the protection of patient private medical records from various medical and governmental agencies as well as interested parties. According to HIPAA, healthcare providers have an ethical and legal duty to protect their patients’ information from release and request permission to operate or disclose information deemed sensitive by the HIPAA code (HSS, 2013). However, the HIPAA code recognizes the need to waive informed consent in instances when the patient is not capable of responding, and when the information contained in private records is absolutely necessary to save their lives.
The Most Challenging Ethical Issues in Social Work
Social work, by definition, is a field wrought with conflicts and difficulties. The role of a social worker is a controversial one, as these people are required to take responsibility for the management of financial, material, and time resources in order to help people in need. Drawing boundaries becomes increasingly difficult, which is highlighted by various codes of ethics available to the social workers. Some of the most challenging ethical issues in social work are individual and community autonomy, practicing distributive justice and welfare maximization, defining the role of a social worker, defining professional values, and performing poor/inefficient work.
Individual and community autonomy is, probably, the most common ethical issue that social workers have to face. The conflict between respecting a patient’s choice and individuality versus objective concerns for their wellbeing will always be present, especially during situations where the patient does not agree with the course of action proposed by the social worker (Kadushin & Harkness, 2014).
The ethical issue lies in the controversial role of the service itself, which aims to care and control, while at the same time promoting independence, empowerment, and participation. There are no clear guidelines for when the choice of the patients become more important than their health or even their lives. Decisions have to be made on a case-by-case basis, and their correctness can be judged only by examining the aftermath.
Maximization of welfare and practicing distributive justice is another major ethical dilemma of social work. By definition, social workers are supposed to assist those in need, including the sick, the elderly, the malnourished, children, homeless, and numerous other vulnerable subgroups (Beckett, Maynard, & Jordan, 2017). Often, and especially in times of crisis, social services have to operate with limited resources. This prompts the use of utilitarian and triage working ethics. However, herein lies the ethical dilemma. It is difficult to decide which social group deserves more attention and decide how much resources should be spent to help out. Managerialism brings up many ethical dilemmas, for which the ethical codes and guidelines do not provide a definitive answer.
The ethical issues of professional values and the role of a social care professional are intertwined. They arise from the inability to clearly define professional boundaries for services and for personal values and beliefs. Social workers are required to keep a certain professional distance from their clients in order to maintain a healthy working relationship and not endanger them by becoming personally involved and biased about the situation and conditions (Reamer, 2013).
Another ethical dilemma frequently encountered requires social workers to compromise their personal values and beliefs for the sake of the client, which begets the question of whose health and emotional wellbeing is more important (Reamer, 2013).
The ethical dilemma regarding poor and inefficient work often concerns standards and actions of social workers or services, which can be seen as ineffective by other practitioners (Parrott, 2014). The conflict of interest between social services and the police are frequently mentioned. At the same time, it is hard to determine which approach is necessary, as every individual client or patient requires a personalized approach.
Ethical Issues in Family and Child Welfare
Family and child welfare is a unique category of social work that has to deal with family problems as well as spouse and child abuse. One of the greatest challenges in this practice lies in the fact that the social worker must not consider the interests of one single person, but of the entire family. Numerous ethical issues arise during the decision-making process and value prioritization. This is especially true in instances of abuse.
The social worker needs to weight in not only the potential threat to a child or a spouse but also the negative effects of institutional interference on family cohesion (Maluccio, 2017). In many cases, the direct interference of a social worker may ruin a family instead of fixing it, resulting in two suffering adults developing psychological issues and addictions, as well as a child effectively left as an orphan.
Another ethical issue lies in determining the truth and acting upon learning it. In many situations of child neglect and child abuse, there is more than a single party to blame (Gambrill, 2017). Stories are twisted in order to shift blame on one another, and it is up to the social worker to determine the correct course of action and be held accountable for it. However, determining responsibility is hard in these situations. If the decision made by a social worker led to a poor outcome, it is hard to determine who should be held responsible – the worker who operated on incomplete or faulty information, or the clients who lied or withheld information.
Lastly, there are many unique ethical dilemmas surrounding the protection of children who cannot speak. These children are effectively voiceless and cannot state their perspectives, beliefs, or points of view. It becomes the duty of a social worker to protect the interests of that child, in a situation where its parents are potentially violating their rights (Shireman, 2015). However, it is where the ethical dilemmas of boundaries, authority, and welfare maximization come into play. The professional is forced to operate using incomplete data in order to determine what is best for the family and the child. Parents may resist such intervention, creating a conflict of interest. There are many variables to be taken into the equation, some of which may be hidden from the social worker.
Reflection: Core Values and Social Values Conflict
As outlined by the NASW code of ethics, the core values of social working profession include service, social justice, respecting the dignity, maintaining healthy relationships, behaving in a trustworthy manner, and providing competent aid in one’s area of expertise (NASW, 2017). These values are meant to serve as guiding lights to social workers in times of uncertainty and ethical conflict. However, as it was stated, none of these values are to be treated as dogmas, as the realities of social work require flexibility and decision-making on a case-by-case basis.
My personal values clash with this code in several instances. One of these conflicts revolves around the concept of integrity and behaving in a trustworthy manner. From my experience of interpersonal relationships, I can say with complete certainty that always telling the truth leads to inflexibility and can potentially be harmful in scenarios where doing so would only lead to further damage. This pertains to individuals found in a state of emotional stress and turmoil, or scenarios where telling the truth could potentially destroy individuals and families.
My personal values revolve around the maximization of welfare. Telling white lies for that purpose is completely acceptable, in my opinion. However, I recognize the value of moral and professional integrity. In order to solve this conflict of interest, I will consort with my fellow colleagues in order to avoid bias, and make my decision based on the long-term perspective for the individuals in question as well as the social work profession as a whole. At the same time, I will ensure maximum protection of personal information, so that, when looking for advice, I would not jeopardize their privacy or their personal effects.
NASW, CSWE, and HIPAA provide valuable ethical and practical guidelines for social workers. However, there are no rules upon which professionals could rely during their day-to-day operations. It creates ambiguity, which results in numerous ethical dilemmas. Social workers are forced to undertake the difficult task of prioritizing some issues over others, which can result in various conflicts of interest. As it is often seen in family and child welfare, social workers are often forced to break families in order to ensure the safety of its individual members, earning them the collective hate of the society.
As a social worker, I will utilize the provided guidelines to serve as a framework for my decision-making process. However, I will maintain a level of flexibility in order to ensure the best possible outcome for all individuals involved and the society in general.
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