Professional Values and Ethical Issues

Question 1

Who are Sw responsible to?

Answer 1

• Responsibility to clients/client systems, colleagues, the profession, and society

Question 2

What are the 5 distinct law requirements:

Answer 2

1. Constitutional Law
   
   2. Statutory Law
   3. Regulatory Law
   4. Court Made/Common Law
      
      5. Executive Orders

Question 3

What are the 4 categories of Ethical & Legal issues

Answer 3

1. Actions compatible with both legal & ethical standards in SW
   
   2. Actions that are neither legal nor ethical in SW according to prevailing standards
   3. Actions that are legal but not ethical according to prevailing standards (legal, but not ethical)
      
      4. Actions that are ethical but not legal according to standards and laws

Question 4

What should a SW do when Ethical & Legal standards conflict

Answer 4

• When there are conflicts between ethical & legal standards, a SW should identify mandates that conflict
  
  • Also identify those that are likely to be affected by the outcome of the conflict (individuals, groups, organizations)
  • All possible benefits & risks of each alternative should be considered - including reasons to support and oppose
  • Colleagues & appropriate experts should be consulted
  • All steps in the decision making process should be documented
    Results should be monitored & evaluated

Question 5

What are the core SW Values!!!

Answer 5

○ Service
		○ Social Justice
		○ Dignity & Worth of the Person 
		○ Importance of Human Relationships
		○ Integrity
               - Competence

Question 6

What are some values that can inhibit the therapeutic relationship?

Answer 6

1. Universalism - there is one acceptable norm or standard for everyone
   
   2. Dichotomous - either/or thinking; differences are inferior, wrong, bad vs. differences are just different & coexist
   3. Heightened ability/value on separating, categorizing, numbering, “left-brain” vs. “right brain” or “whole picture”
      
      • Mental activity highly valued to the exclusion of physical & spiritual experiences
      • Persons are studied in isolation not as part of a group or interrelated with their environment
   4. High value on control - constraint, restraint vs. value on flexibility, emotion, feelings, expressiveness, spirituality
      
      • What cannot be controlled & defined is nonexistent/unimportant/unscientific or deviant/inferior
      • Reality defined with objectivity
   5. Measures of self come from outside - only in contrast to others vs. value coming from within
      
      • Worth measured by accumulation of wealth or status, can only feel good if one is better than someone else or has higher status
   6. Power is defined as “power over” others, mastery over environment vs. power through or in harmony with others
      By sharing power, it can be expanded and each becomes more powerful

Question 7

What are the dynamics of diversity in the SW-Client relationship

Answer 7

• Self awareness about own attitudes, values, and beliefs about cultural differences and willingness to acknowledge cultural differences
  
  • SW is responsible for bringing up and addressing issues of cultural difference with a client & responsible for being culturally competent

Question 8

What SHOULD a SW do to ensure cultural competency/respect for diversity in therapeutic relationship?

Answer 8

1. Move from being culturally unaware to being aware of their own heritage and heritage of others
   
   2. Value and celebrate differences of others rather than maintaining an ethnocentric stance
   3. Have an awareness of personal values and biases and how they may influence relationships with clients
   4. Demonstrate comfort with racial & cultural differences between themselves & clients
   5. Have an awareness of personal & professional limitations
   6. Acknowledge their own racial attitudes, beliefs and feelings

Question 9

What is an ethical dilemma?

Answer 9

Ethical Dilemma: when a SW must decide between two viable solutions that seem to have similar ethical value
- Should be aware of any conflicts between personal & professional values
In instances where SW ethical obligations conflict with agency policies or relevant laws/regulations, they should make an effort to resolve the conflict in a manner that is consistent with ethical values, principles & standards

Question 10

What are the steps for resolving an ethical dilemma?

Answer 10

1. Identify ethical standards as defined by professional code of ethics that are being compromised (NASW)
   
   2. Determine whether there is an ethical issue or dilemma
   3. Weight ethical issues in light of key social work values and principles as defined by NASW COE
   4. Suggest modifications in light of prioritized ethical values & principles that are central to the dilemma
   5. Implement modifications
   6. Monitor for new ethical issues or dilemmas

Question 11

What should a SW do when there are limits to client competency & self-determination?

Answer 11

• Ex. Financial decisions, treatment decisions, emancipation, age of consent, permanency planning
  
  • World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) can assist in determining assistance needed in functional life domains for those who need assistance with ADL’s
  • When limitations are mental there are concerns about consent - all those over age of majority are presumed to be competent to consent unless legal proceedings have found otherwise
    
    • When clients lack capacity to provide consent, SW should protect client interests by seeking permission from an appropriate 3rd party and informing clients in a manner consistent with their level of understanding
    • SW should seek to ensure that the third part acts in a manner consistent with client’s wishes & interests
      SW should take reasonable steps to enhance such client’s ability to give informed consent

Question 12

What is emancipation & the age of consent? Why are they important?

Answer 12

• Need to be well versed in state & federal laws related to consent & confidentiality
  
  • Age at which minors can obtain services without parent/guardian permission varies by state and type of service
  • Minors don’t have same legal rights to confidentiality in some instances where parents/guardians have access to their records
  • In problem solving, Sw should make clear limits to self-determination imposed by legal, financial, other constraints
  • Emancipation ends rights & responsibilities of parents/guardians over minor children - can be partial or complete
    
    • Upon achieving emancipation, minor assumes rights, privileges & duties of adulthood before reaching the age - can enter a contract, sue others, make healthcare decisions etc.
      Still cant drink or get a license

Question 13

How do SW’s inform clients they have a right to refuse services?

Answer 13

• Ex. Medication, medical treatment, counselling, placement
  
  • Services should be provided in context of professional relationship, when appropriate and based on valid informed consent
  • Should use clear & understandable language to inform clients of the purpose of services, risks related to services, limits because of 3rd party payer, relevant costs, reasonable alternatives, clients right to refuse/withdraw consent, time frame covered by consent
    When services are involuntary, SW should provide info about nature & extent of services & extent of client’s right to refuse services

Question 14

What are the dynamics of Power & Transparency in the SW-Client relationship?

Answer 14

• Critical to be conscious of privileges because there is a responsibility to challenge hierarchical assumptions & power dynamics
  
  • Should use egalitarian & collaborative approaches that give choice, decision making power and opportunities for honest feedback
  • Role expectation should be discussed & power differentials acknowledged
  • Transparency & Power are linked!! - if clients aren’t informed, they cannot fully participate
    If SW deliberately withholds observations or knowledge from clients, they are reinforcing the power differential

Question 15

What are the professional boundaries in the SW-client relationship?

Answer 15

• Ex. Power Differences, conflicts of interest etc. – sexual relationships, physical contact, sexual harassment
  
  • Setting clear, appropriate, sensitive boundaries that govern physical contact are essential for professional practice
  • Should not engage in physical contact when there is a possibility for psychological harm as a result of contact
  • No sexual activities with current clients, their relatives/friends with whom they maintain a close relationship when there is risk of exploitation/harm to client – SW assumes full burden for setting clear, appropriate, culturally sensitive boundaries
  • Also should not engage with former clients - still assume burden to demonstrate that former client has not been exploited, coerced, manipulated intentionally or unintentionally
    Should not provide clinical services to those with whom they have had a prior sexual relationship

Question 16

What are dual/multiple relationships?

Answer 16

Dual/Multiple Relationships: when SW’s relate to clients in more than one relationship whether professionally, socially, or business wise. Can occur simultaneously or consecutively

- Must ensure SW don't engage in dual/multiple relationships that may impact treatment of clients 
- Should be alert to avoid conflicts of interest that interfere with exercise of professional discretion & impartial judgement 
- Should inform clients when a real/potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes client's interests primary 
- In some cases, protecting client interests may require termination of professional relationship with proper referral 
- Should not take unfair advantage of any professional relationship or exploit others for personal gain 
- When SW provide services to 2+ people who have a relationship with each other, SW should clarify with all parties which individuals will be considered clients & natural of professional obligations to each 
	- If a conflict of interest is anticipated (testifying in custody dispute or divorce proceedings) should take appropriate action to minimize conflict of interest SW involved in evaluation/research should inform participants of conflicts of interest

Question 17

What are legal/ethical issues regarding mandatory reporting

Answer 17

• Ex. Abuse, Threat, Impaired Professionals
  
  • Required by law to report suspected cases of abuse and neglect - can be varying levels of civil & criminal liability for failing to do so
  • Ethical issues for responsibility to client & larger society
    Majority of all reports of abuse/neglect come from professionals

Question 18

What are legal/ethical issues regarding documentation?

Answer 18

• Consultations should be documented as well
  
  • Should include informed consent & release of information documents
  • All contact info should be stated clearly
  • Unethical to alter casenotes after the fact - can add new notes with current date to correct inaccuracies
  • To ensure continuity - documentation must happen in a timely manner
  • Keeping psychotherapy notes separate

Question 19

What are legal/ethical issues regarding death & dying?

Answer 19

• Right to have informed consent to receive/refuse treatment, advance directives, establishing living wills
  
  • By law, treating professionals must give clients opportunity for informed consent
    
    • Involves explaining options for treatment, benefits & risks of each, recommendations with rationales
    • Clients must know they have a right to choose - particularly with chronic/terminal illness
  • Advance directives may be in the form of living wills - which express clients preferences for medical care, a durable power of attorney, or both
  • Those who may die soon should have Physician Orders for Life-Sustaining Treatment (POLST) documents - written doctors orders that reflect preferences for care
    
    • Kept in records & at home - used to direct emergency medical personnel
    • May include info about CPR, transport to hospital, aggressive treatments like blood transfusions or chemo
  • Many clients who are dying at least consider suicide - discussing this may help sort out these issues & correct problems
    Pain medicine can help comfort, spiritual guidance can help find meaning

Question 20

What are some research ethicS?

Answer 20

• SW have an ethical mandate to monitor & evaluate policies, the implementation of programs & practice interventions
  
  • Must promote & facilitate evaluation & research to contribute to development of knowledge
  • Must keep current with emerging knowledge & fully use evaluation & research evidence in professional practice
  • Must consider consequences - protect participants from unwarranted physical or mental distress, harm, danger, or deprivation - institutional review boards should be consulted
    
    • When participants incapable of giving informed consent, SW should provide appropriate explanation to participants, obtain assent to the extent they are able, and obtain written consent from a proxy
  • Never design or conduct evaluation or research that does not use consent procedures such as naturalistic observation and archival research unless rigorous and responsible review has found it to be justified because of its prospective value
  • SW should inform participants of their right to withdraw from evaluation & research at any time without penalty
  • Ensure participants have access to appropriate & supportive services
  • Ensure anonymity & confidentiality of participants & their data
  • Inform participants of limits to confidentiality, measure to ensure confidentiality, and when any records containing data will be destroyed

Question 21

What are ethical issues in Supervision & Management?

Answer 21

• Ex. Regarding commitment to clients, self-determination, informed consent, competence, cultural competence & social diversity, conflicts of interest, privacy & confidentiality, access to records, sexual relationships, physical contact, sexual harassment, derogatory language, payments, clients who lack decision making capacity and interruption/termination of services
  
  • Should evaluate supervisee’s performance in a manner that is fair and respectful
  • Those in managerial roles should take reasonable steps to ensure adequate agency resources are available to provide appropriate staff supervision
  • Those in managerial roles should advocate within and outside their agencies for adequate resources to meet client’s needs and ensure resource allocation procedures are open, fair and non-discriminatory
  • Fees should be fair & reasonable with services - consideration should be given to client’s ability to pay
  • SW should avoid accepting goods/services from clients as payment for services - creates potential for conflicts of interest, exploitation, inappropriate boundaries
    
    • If accepted, SW accepts full burden of responsibility
  • Should not solicit a private fee/other renumeration for services
    Should obtain info on proceudres for using insurance coverage

Question 22

What are some methods to create, implement, & evaluate policies & procedures for SW safety?

Answer 22

• Can be targets of verbal, physical assaults - some injured, lost their lives
  
  • Most that SW’s serve do not pose threats
  • SW’s have right to work in safe environments and to advocate for safe working conditions
  • Those who fear for their safety should not bave to fear retaliation or blame, questioning from supervisors or colleagues
  • Should routinely practice universal safety precautions at work
  • Thorough understanding of risk factors associated with elevated risk for violence can inform safety assessments
  • Should be aware of potential for personal info on the internet (social media) can be accessed by anyone
  • Safety plans should be established
    Specific policies for dangerous tasks to reduce harm