ETHICS RELATING TO A PUBLIC HEALTH CRISIS
When a public health crisis such as the one surrounding the COVID-19 pandemic arises, social workers and other providers of services to already troubled populations can experience greater stress. The National Association of Social Workers (2020a) offers ethics-related suggestions for getting through an especially difficult time: ● In order to avoid burnout and compassion fatigue, self-care remains important. ● In keeping with NASW Standard 1.15, Interruption of Services, social workers need to have a plan in place to provide continuity of services. Social workers should be able to provide remote services if need be, and they should have an emergency backup person or system in place, and have communicated the plan or policy and acquired the necessary valid consents. ● Social workers need to communicate, although this can be challenging in a new and ever-changing situation. It is important to be aware of and coordinate with local, state, and federal resources. Social workers need to keep communications secure, to the extent possible, and avoid breaching privacy and confidentiality. ● In keeping with NASW Standard 1.04(d), Competence, social workers need to be competent in the technology to provide appropriate telehealth services, if necessary. ● In keeping with Standard 1.07, Privacy and Confidentiality, it is important to ensure the privacy and confidentiality of electronic communications in every way. ● In keeping with Standard, 1.03(e), Informed Consent, social workers need to discuss their policies involving the use of technology with their clients. ● When a crisis involves a communicable disease, special ethical issues arise around testing and reporting. Social workers need to understand the law as well as the ethical issues around confidentiality and the disclosure of information. ● In keeping with Standard 6.03, Public Emergencies, “Social workers should provide appropriate professional services in public emergencies to the greatest extent possible.” The NASW also instructs social workers to check with their licensing boards, their liability insurance providers, other regulatory bodies, and their employers for changes in policy and exceptions in the time of crisis. Related personal and professional integrity issues Mental health practitioners must also address issues related to personal and professional integrity. They are: ● Dishonesty, fraud, and deception. ● Misrepresentation. ● Solicitations. ● Failure to acknowledge credit. Practitioners have an obligation to avoid actions that are dishonest, fraudulent, or deceptive. Such actions, or in some cases, lack of action, put the continued integrity of both the individual mental health worker and the profession at risk. Some examples include: ● Falsifying records, forging signatures, or documenting services not rendered. ● Embellishing one’s education and experience history or qualifications (refer also to “Misrepresentation”). ● Lying to a client or the client’s family to “protect” them from unpleasant information. ● Not sharing legitimate options with a client because they violate the professional’s beliefs. ● Misleading potential donors or current funders with false outcome data. Misrepresentation occurs when mental health professionals present opinions, claims, and statements that are either false or lead the listener to believe facts that are not accurate. Three
A public health crisis can give rise to numerous stressful ethical dilemmas for individual professionals, their employing agencies, and all levels of government. Compromises may need to be made in standards of care (Leider, DeBruin, Reynolds, Koch, and Seaberg, 2017). Individuals may need to surrender privacy in the case of contact tracing or the tracking of movements through cell phone locations. An extremely distressing dilemma arises through the necessity for triage, in which choices need to be made concerning who will get available treatment when there is not enough to go around. The COVID-19 crisis forced the Office for Civil Rights (2020), an arm of the U.S. Department of Health and Human Services, to issue guidance concerning the disclosure of confidential health information in certain circumstances. For example, the individual’s HIPAA authorization is not needed when disclosure is necessary: ● To provide treatment. ● When the notification is required by state law. ● To notify public health authorities to prevent spread of disease. ● When first responders are at risk of infection. ● When first responders need the information for the sake of an individual or the public in the case of an imminent public health threat. ● In certain circumstances, when the information is requested by a correctional institution or law enforcement official having lawful custody of an inmate or other individual. Social workers, who are ethically obliged to maintain clear boundaries may be forced, during a public health crisis, to communicate with clients using personal devices and accounts, or to work at odd hours, simply because of the massive need of the public. They may encounter clients who have no means of communicating electronically, which might require that the agency supply the means. According to Barsky (2020), these actions are not boundary violations, but they are boundary crossings that require risk-reduction strategies, such as informing clients that after a certain hour in the evening, they should call 911 instead of the social worker. Although HIPAA regulations were eased during the COVID-19 crisis to allow the use of communication apps that were not HIPAA compliant, Barsky advised that social workers use HIPAA- compliant apps where possible and try to gain access to HIPAA- compliant apps for the long term. actions must be taken to ensure that clients and the public receive accurate information: 1. Clearly distinguish between private statements and actions and those representative of an organization, employer, etc. 2. Accurately present the official and authorized positions of the organization being represented or on whose behalf the professional is speaking. 3. Ensure accurate information about, and correct any inaccuracies regarding, professional qualifications/ credentials, services offered, and outcomes/results. Admonitions against client solicitation stem from a concern for clients whose situations may make them vulnerable to exploitation or undue influence. Such clients’ circumstances create the potential for manipulation and coercion. Mental health practitioners should refrain from doing the following: 1. Engaging in uninvited solicitation, or 2. Soliciting testimonial endorsements from current clients or other potentially vulnerable persons. Mental health practitioners also have an ethical responsibility to the contributions of others by acknowledging credit. They should: 1. Take responsibility and credit only for work they have actually performed and contributed to, and 2. Honestly acknowledge the work and/or contributions of others
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