whether or not the activity requires review; the general rule is that if there is any element of research in an activity, that activity should undergo review for the protection of human subjects. (Department of Health, Education, and Welfare, 1979) The commission had decided that human research needed to follow three ethical principles: ● Respect for persons : This principle aligns with the ethical principle of autonomy, and the related principle of self- determination that is so important in social work ethics. But, as with other ethical principles, dilemmas arrive. The capacity for self-determination matures during an individual's life, and some individuals lose this capacity wholly or in part because of illness, mental disability, or circumstances that severely restrict liberty. Respect for the immature and the incapacitated may require protecting them as they mature or while they are incapacitated. ● Beneficence : In the report, the commission seems to conflate the ethical principle of non maleficence (do no harm) with the classification of beneficence. However, this conflation, which seems strange to contemporary professionals who work within lengthy ethical codes, serves to illustrate that even in the middle to late twentieth century the idea of carefully codifying ethical research and practice was fairly new. In any case, the report points out an ethical dilemma that would now be recognized as an attempt to balance beneficence with non maleficence: Learning what will in fact benefit may require exposing persons to risk. The problem posed by these imperatives is to decide when it is justifiable to seek certain benefits despite the risks involved, and when the benefits should be foregone because of the risks. It is easy to see how such an ethical dilemma can arise during a public health crisis, for example, when the need for new vaccines and therapies might cause debates over possibly fast-tracking some medicines (Maschke & Gusmano, 2020). ● Justice : The report addresses problems that are always present, but that can become magnified during a health emergency: It can be seen how conceptions of justice are relevant to research involving human subjects. For example, the selection of research subjects needs to be scrutinized in order to determine whether some classes (e.g., welfare patients, particular racial and ethnic minorities, or persons confined to institutions) are being systematically selected simply because of their easy availability, their compromised position, or their manipulability, rather than for reasons directly related to the problem being studied. Finally, whenever research supported by public funds leads to the development of therapeutic devices and procedures, justice demands both that these not Competence (or professional and ethical competence) Another issue that relates to informed consent, competence , is mental health professionals’ responsibility to represent themselves and to practice only within the boundaries of their education, experience, training, license or certification, and level of supervisory or consultant support. For example, poor practice, or the failure of a worker to provide services within accepted standards, was the second most common form of violation found in Strom-Gottfried’s study of code violation allegations resulting in findings of ethical misconduct in social work practice (2000). The study also revealed findings of incompetence in conjunction with other forms of unethical behavior in 21% of the cases. In these cases, reasons that a social worker was not competent to
provide advantages only to those who can afford them and that such research should not unduly involve persons from groups unlikely to be among the beneficiaries of subsequent applications of the research. The Belmont Report remains an important basic document in human research, and is especially important as it relates to informed consent, which according to the report requires information, comprehension, and “voluntariness.” However, informed consent is an important concept not just in research and experimentation but also in the provision of services. In the NASW Code of Ethics, informed consent falls within Standard 1, Social Workers’ Ethical Responsibilities to Clients. Standard 1.01, Commitment to Clients, and Standard 1.02, Self-Determination, both figure in the concept of informed consent, and the first sentence under Standard 1.03(a), reads, “Social workers should provide services only in the context of a professional relationship based, when appropriate, on valid informed consent.” Informed consent services should only be provided when valid informed consent can be obtained. Therefore, clients must know the exceptions to self-determination before consenting to treatment or other services. Mental health professionals working in child welfare or forensic practice settings are faced with additional challenges. In their article about informed consent in court-ordered practice, Regehr and Antle (1997) state: Informed consent is a legal construct that is intended to ensure that individuals entering a process of investigation or treatment have adequate information to fully assess whether they wish to participate. This concept of informed consent is closely linked with the value of self- determination. Generally, potential threats and factors to be considered in insuring the validity of informed consent are: ● Language and comprehension. ● Capacity for decision making. ● Limits of service refusal by involuntary clients (including court-mandated clients). ● Limitations and risks associated with electronic media services. ● Audio and video taping. An informed consent has been called the “quintessential document” in the provision of mental health services (Bradshaw, Donohue, & Wilks, 2014). In addition to being one of the first documents to comprise a record, it is one of the best risk- management tools. Informed consent in today’s healthcare milieu demands details not previously considered, including potential benefits and risks of engaging in treatment, the nuances of technology use, limitations on confidentiality, and mandated reporting. Ingrao (2015) outlined five generally agreed-upon core competencies of social work practice: ● Practicing with professionalism : Every social worker is a representative of the profession, and for this reason all social workers should know the history of social work and commit themselves to the conduct and growth of the profession. They should advocate for access to social work services and constantly reflect on their work and ways to improve. They should be aware of professional roles and boundaries, make use of supervision and consultation, and keep learning. It is also important that social workers maintain a professional demeanor. ● Practicing ethically : Practicing in an ethical manner involves education in and an understanding of ethics and a willingness to tolerate the ambiguity encountered in ethical dilemmas. Social workers need to use ethical reasoning to come to principled decisions.
deliver services included: ● Personal impairments. ● Lack of adequate knowledge or preparation, or ● Lack of needed supervision.
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