I.Understanding Your Legal Obligations

Chapter 3 Ethical Decision Making

A.Malpractice—“a form of negligence that occurs when a practitioner acts in a manner inconsistent with the profession’s standard of care—the way an ordinary, reasonable, and prudent professional would act under the same or similar circumstances” (Reamer, 1994)

1.Three common forms of malpractice (Kitchener, 2000; Reamer, 1995)

a.Malfeasance—where the professional intentionally engages in a practice known to be harmful

b.Misfeasance—where the professional makes a mistake in the application of an acceptable practice

c.Nonfeasance—where the professional fails to apply a standard, acceptable practice when action is needed

2.A total of 634 claims were filed between 1969 and 1990 against the NASW Insurance Trust, compared to the 60,000 NASW members insured through the trust (Reamer, 1995)

3.Litigation may result from many kinds of professional misbehavior

4.Examples of malfeasance and misfeasance

5.Examples of nonfeasance

6.Exploration of repressed memories

7.Americans with Disabilities Act (ADA)

8.Health Insurance Portability and Accountability Act of 1996 (HIPAA)

9.Standards for Privacy of Individually Identifiable Health Information

10.Box 3.2: Legal Obligations of Helping Professionals (Everstine & Everstine, 1983)

a.Duty of Care

b.Duty to Respect Privacy

c.Duty to Maintain Confidentiality

1)Confidentiality—refers to the professional norm that information shared by or pertaining to clients will not be shared with third parties

2)Privilege—refers to the disclosure of confidential information in court proceedings

3)Informed consent—under most circumstances, clients must give informed consent before you may share information with another person or organization

d.Duty to Inform

e.Duty to Report

f.Duty to Warn and Protect

1)Tarasoff v. California Board of Regents

2)United States v. Hayes (2000)

B.Exercise 3-1: Legal Obligations

II.Understanding the Fundamental Values and Ethics of Social Work

A.International Federation of Social Workers (IFSW)

B.National Association of Social Workers’ Preamble to the Code of Ethics

C.Council on Social Work Education’s endorsement of the NASW Code of Ethics

D.NASW Procedures for Professional Review (National Association of Social Workers, 2005)

E.Most common ethical violations (Strom-Gottfried)

1.Sexual activity

2.Dual relationship

3.Other boundary violations

4.Failure to seek supervision or consultation

5.Failure to use accepted practice skills

6.Fraudulent behavior

7.Premature termination

8.Inadequate provisions for case transfer or referral

9.Failure to maintain adequate records or reports

10.Failure to discuss policies as part of informed consent

F.Exercise 3-2: Social Work Values and Ethics

III.Identifying Ethical and Legal Implications

A.Box 3.3: NASW Code of Ethics: Applicable Values

1.Service

2.Dignity and worth of the person

3.Integrity

4.Competence

B.Box 3.4: NASW Code of Ethics: Applicable Ethical Principles

C.Box 3.5: NASW Code of Ethics: Applicable Legal Obligations

1.Duty of care

2.Duty to inform

3.Duty of confidentiality

4.Duty to respect privacy

D.Exercise 3-3: Identifying Ethical Standards

IV.Addressing Ethical Dilemmas

A.ETHIC Model of Decision Making (Congress, 2000)

B.Seven-step process for ethical problem-solving (Reamer & Conrad, 1995; Reamer, 2000)

C.Approaches to ethical dilemmas

1.Utilitarian

2.Deontological

3.Teleological

4.Inductive

D.Dimensions in considering contextual or situational aspects of moral and ethical issues

1.Motives—Consider your primary and secondary purposes both as a person and as a social worker

2.Means—Consider the “ways” you might act

3.Ends—Consider the nature of the envisioned “ends” (goals) and determine if they are personal or professional

4.Effects—Consider the additional consequences that could result from use of the identified means and accomplishment of the envisioned ends

E.Ethical Principles Screen (a hierarchical system addressing ethical dilemmas (Loewenberg, Dolgoff, and Harrington, 2005)

1.Protection of human life

2.Equality/inequality—fairness and justice

3.Autonomy and freedom

4.Least harm

5.Quality of life

6.Privacy and confidentiality

7.Truthfulness and full-disclosure

F.Basic moral values (Beauchamp & Childress, 1983; Koocher & Keith-Spiegel, 1990)

1.Beneficence

2.Nonmaleficence

3.Justice

4.Autonomy

5.Privacy

6.Confidentiality

7.Fidelity