THE THERAPEUTIC RELATIONSHIP
The relationship between the social worker and client sets the course for providing ethical treatment. Although many issues concerning this topic will be addressed throughout this course, the initial contact with the potential client sets the tone for treatment. For example, the first communication with the client can convey an atmosphere of support that sets the foundation for building trust. Professionals must also carefully consider that when services begin, the professional relationship should proceed with Ethical dilemmas Not every issue of ethics can be covered by published standards or by codes of ethics. Social workers may find themselves confused about whether a situation borders on an ethical violation because the issue may not be clearly defined by the code. There also may not be an obvious violation or the social worker may not know how to proceed. These situations represent ethical dilemmas that are likely to occur in every social work practice. Barsky (2014) defines an ethical dilemma as a situation that creates some tension. He explains that in a true dilemma, there is no clear, single answer that satisfies all of the different ethical and legal imperatives that apply to the case. This situation may occur when: ● There are two ethical standards or rules that conflict. ● There are conflicts between the values of the social worker and those of the client. ● A conflict occurs between the obligations to an agency, versus the obligations to a client. ● Conflicts may occur due to religious, cultural, or political beliefs. ● No clear answer is apparent to meet the obligations or the ethical and the legal directives of the profession. One example of a common dilemma involves issues in decision making in end-of-life situations. An individual in an end-of-life stage may claim the right to terminate his or her own life. The laws vary concerning these issues throughout the United States. As of July 2019, nine states and the District of Columbia recognized legal physician-assisted suicide. Most other states considered the act to be illegal, and a few had left the legality or illegality unclear (ProCon.org, 2019). Some individuals may support this right; others believe the act would be committing suicide, and therefore wrong. Tensions develop between a social worker’s religious beliefs and professional beliefs, as well as what that social worker would do if he or she were either “pro-life” or “pro- choice.” Defining law According to Saltzman & Furman (2016), law can be defined as those standards, principles, processes and rules – usually written down in some manner – that are adopted, administered, and enforced by governmental authority and that regulate behavior by setting forth what people may and may not do and how they may and may not do it. Simply put, law is a “pronouncement of the rules which should guide one’s actions in society” (Gifis, 2016). Reamer (2005) describes five distinct types of legal requirements and guidelines that may affect practice: 1. Constitutional Law : Examples include protection from unreasonable searches and rights of privacy and free speech. 2. Statutory Law : This includes laws enacted by federal, state, and local legislative bodies and covers such issues
cultural sensitivity. During the course of treatment, an effort must be made to revisit informed consent issues as the treatment plan evolves, as well as consult with other professionals to avoid the risk of potential ethical conflicts. Professionals need to take reasonable steps to ensure that clients understand the implications of any diagnosis, assessments, treatment, methods, HIPAA (Health Insurance Portability and Accountability Act) precautions, fees, and billing arrangements. The tension in such an ethical dilemma may be seen as a conflict between the ethical concepts of beneficence and non maleficence. The idea of beneficence is to promote good, and for a suffering patient, death may appear as a mercy, sparing the individual from chronic pain or some other form of suffering. Non maleficence is best characterized using the sentence “First, do no harm,” which is often incorrectly ascribed to the Hippocratic Oath. Allowing a patient to commit suicide may be seen as bringing harm. (The principles of beneficence and non maleficence will be further discussed later in the course.) Also in play in this ethical dilemma is the concept of client self-determination. According to the NASW Code of Ethics (2017), “Social workers may be faced with complex ethical dilemmas that have no simple answers,” and for many, physician-assisted suicide fits this characterization. Another example of an issue that may lead to ethical dilemmas would be abortion. True dilemmas often involve issues that are controversial in our society as well. In these types of dilemmas, the cultural contexts of the community and the client are important factors to consider. It is important to remember that although each principle in a professional code of ethics has its own merits, the principles do not stand alone. They complement one another but at the same time often conflict with one another when ethical dilemmas occur. An ethical dilemma is a situation in which no best course of action exists; the person must choose between at least two options that have advantages and disadvantages. To solve ethical dilemmas, it is essential to identify which principles apply, how they conflict, and which ones take priority in a given scenario. Practitioners must also consider professional obligations and standards of care. Although professional codes of ethics are based on principlism, a basic understanding of consequentialism, deontology, and even virtue ethics can help in working through an ethical dilemma.
THE LAW AND MENTAL HEALTH
as confidentiality of records and obligations around suspected child or elder abuse. 3. Regulatory Law : These are legally enforced guidelines disseminated by government agencies such as the Department of Health and Human Services and Department of Justice. 4. Court-Made Law and Common Law : These result from court rulings, for example a recent court ruling in one state that prohibits child welfare workers from using office space for temporary sleeping accommodations for children removed from their homes. 5. Executive Orders : Chief governmental executives, such as mayors or governors, may issue orders that resemble regulations – examples being the State of Florida’s governor Jeb Bush prohibiting a husband from terminating life support measures in the Terri
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