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This essay will look at how social workers address ethical dilemmas in their work with service users and carers. This will be evidenced in case examples illustrating how the codes of practice and codes of ethics guide social work decisions while making them accountable for their work. When working with ethical dilemmas social workers have to understand the origins of these values and codes. Taking into account their own personal values and being aware of how these could influence their decisions.
Values and ethics are one of the most important characteristic of an individual the fundamentals define who we are and what we believe (Banks, 2001). Whether individuals are consciously aware of them or not, every individual has a core set of values and ethics. Values are socially constructed moral codes that guide and control our actions within the social world (IFSW). Values and ethics start to develop from birth and are mainly developed by major influences in an individual life. Factors of culture, religion and many more affect our beliefs and ethics. According to Banks (2001, p.6) values are "particular types of belief that people hold about what is regarded as worthy or valuable, values "determine what a person thinks he ought to do".
Social work values are based on the principal of "respect for persons" which comes from the Deontological approach of German philosopher Immanuel Kant (1724-1804). From these writings Biestek a Catholic priest developed seven principles for effective practice. Kantian principles are individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality (Shardlow, 2002).
Although Kantianism is primarily focused on the sense of people's duty, critics have argued that the perspective gives no allowance for compassion and sympathy to motivate people's actions. Furthermore, Kantian has a lack of guidelines when dealing with conflicting requirements. Kant's moral philosophy has been influential in the values and ethics of social work, in particular respect for people and self- determination. These philosophical underpinnings are a major influence in the social care profession.
On the other hand Utilitarianism believes that action is right if it generates, or tends to generate the best possible outcome for the majority of people that are affected by that action. Utilitarianism is a form of consequentialism where the rightness of an action is determined by its consequences. There are three main types of utilitarianism act, rule and preference. Act takes into account the individual circumstances, maintaining that the action is good if it generates the best possible outcome in a particular situation. Rule is concerned with the amount of good that a moral action produces, conforming to a rule or law. The rule or law is correct and is determined by the amount of good that is generated when the rule is followed. Preference is one of the more popular forms of utilitarianism it takes into account people's preferences. The moral action is right if it produces a satisfaction of each person's individual desires or preference (Banks,2001).
All of these are open to interpretation and will mean different things to different people, which is why social work codes should be referred to. Social work codes set out an expected code of conduct that social workers have to comply with in order to gain the trust of the public so that service users are informed of what they can expect from their social workers. Protect the rights and promote the interests of service users and carers the codes are as follows: Strive to establish and maintain the trust and confidence of service users and carers, Promote the independence of service users while protecting them as far as possible from danger or harm, Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people, Uphold public trust and confidence in social care services, Be accountable for the quality of our work and take responsibility for maintaining and improving our knowledge and skills.
The COP form part of the wider package of legislation, practice standards and employers policies that social care workers must meet. When codes are not adhered to there can be serious repercussions involved for all (CCW, 2002).
Social work's professional values, as described in the British Association of Social Workers (BASW) code of ethics (COE), including respect for all person's including service users belief's values, culture, goals, needs and preferences, relationships and affiliations, and a commitment to social justice, including the fair and equitable distribution of resources to meet basic needs.(BASW, 2002, 3.1, 3.2). These are a set of moral principles used to set standards which regulates the social work profession. These offer a general guidance and as yet carry no sanctions if broken (Shardlow, 2002). An ethical code also contributes to the strengthening of professional identity. They add clarity to the tasks and should lead to greater ethical observance within the organisation, but the primary objective of the COE is the protection of the clients (Banks, 2001).
Ethics are generally distinguished in three different ways by philosophy, meta-ethics, normative ethics and descriptive ethics. Meta-ethics seeks to understand the nature of morality, moral judgements and moral terms such as 'good', 'bad' and 'duty'. Normative ethics endeavours to answer moral questions, such as what is the right action to take in a particular situation or what is the right direction to take? Descriptive ethics examines how individual's moral opinions and beliefs reflect their behaviour and attitudes towards it (Bowles, 2006). A good social worker needs to be aware of the societal and professional values underlying his or her work so as to empower individuals, families and communities. Both Anti-oppressive practice and values are embodied in the BASW code of ethics (BASW, 2012).
Parrott (2006) describes Anti-oppressive practice (AOP) as 'a general value orientation towards countering oppression experienced by service users on such grounds as race, gender and culture.' AOP are also values of working in partnership and empowerment. It is also a way of linking our lived experience with the categories of the relations of ruling (Parrot, 2006). While Thompson (2001) saw oppression as an inhuman or degrading treatment of individuals or groups; in hardship and in justice brought about by the dominance of one group over another; the negative and demeaning exercise of power. Oppression often involves disregarding the rights of an individual or group and this is a denial of citizenship.
Social work is often seen as the caring profession who work with service users who need help. Every service user is unique and very social worker is an individual who uses their own lived experiences and to be an effective helper needs insight into her own formation with its potentials for strength and weakness (Clark, 2011). At the core of this is what service users expect of social workers a relationship that is built on trust, being open and honest with each other and achieved by communicating in a clear way that service users understand (Care Council for Wales, 2002, 2.1 & 2.2) as well as committed, reliable and punctual. Social workers rely on traditional values of confidentiality, acceptance and user self-determination while being non-judgemental in order to gain the trust of service users. These core values are not unique to social work but shared with other caring professions in medicine, nursing and counselling (Banks, 1995).
Values have a variety of meanings referring to one or all of moral, political or ideological principles, religious, beliefs or attitudes. However the social work context uses values to mean a set of fundamental moral/ethical principles by which social workers show commitment. While moral judgements promote the satisfaction of human needs and happiness and apply to all people in similar circumstances. On the other hand ethics refers to the study and analysis of right or wrong and good or bad in social work practice. Ethical dilemmas leave social workers using careful consideration to choose between two unwelcome alternatives relating to human welfare (Banks, 1995).
Having choices does not make the decision any easier and social workers have to take responsibility and accountability for the outcomes of any decisions they make. Decisions are made by conducting investigations with both the legal and moral rights of all parties involved being taken into account. Societal values and norms are often reflected in laws, although there are some laws which we may regard as immoral the immigration laws being one. How we interpret the law is influenced by our values and ethical principles (Banks, 1995).
Social work involves balancing the complexities between one's own moral integrity to the user, society and agency. The ability to analyse a situation and make the best decision is a critical skill which involves recognising our beliefs and behaviours and how they influence our ideas and actions. These values are derived from our culture and social norms and can change over time and across cultures. Therefore social workers need to maintain and improve their knowledge and skills in order to protect the learning and development of others (CCW, 2002, 6.8). Codes of practice(COP) guide and protect service users not be telling them what they can or cannot do but by establishing a professional identity for workers who agree to work in a trustworthy, honest, skilled and respectful manner (Bowles, 2006).
However many believe that misuse of codes can be dangerous and cause unethical actions in particular in Western Australia in 1991 emergency foster care was sought for a 4 year-old girl while her mother was in hospital. The worker of a non-government agency placed the girl in an approved foster home which they frequently used. In the home was a 15 year old youth who was a ward of state who held a prior record for sexual offences against young children. The home also had another young foster child and a 4 year-old grandchild of the foster family. The social worker who approved the foster home for the youth and foster carers were unaware of the youth's sex offending history. Although his history was known by the youth's previous foster carers and 4 days after the girl was placed she died from being raped by the youth (Bowles, 2006, p.78). This illustrates the issues that arise when prioritising confidentiality over client safety and welfare when applied out of context.
While the foster-carer is not a professional and does not have to abide by the COP she is guided by a moral code of ethics. Therefore confidentiality can be broken when it is considered the information puts either the client or others at harm. The foster-carer is a part of a team and a member of a child care agency so there would be employer's policies and procedure that would have guided this ethical dilemma. Social workers have a responsibility to maintain the trust and confidence of service users and carers by respecting confidential information and explaining agency policies around confidentiality (CCW, 2002, 2.3).
Postmodernist believe that there is no single truth and that ethics have no relevance in today's society, as they do not replicate the numerous realities of the same society, and ignore peoples individual perspectives and interpretation. Omitting cultural diversity and reinforcing the oppressive and dominant voices of the most powerful. Furthermore they are rarely used when making ethical decisions so they are considered irrelevant (Bowles, 2006). As in the above example there would have been a number of other professionals involved with the youth such as youth offending team and medical professionals so this is a prime example of lack of information sharing and poor communication as the new foster-carers should have been made aware of the issues on a need to know basis.
Below are further examples of some of the ethical dilemmas that social workers face every day:
An Asian woman with 5 children under the age of 6 years, who has fled a violent husband but still gets harasses by him. Has been locking up her children in the house and going out for help or a break. One of the workers on the Asian Women's Project she has recently joined to help with her feelings of isolation has discovered this. The worker has spoken with the woman explaining the risks and implications of her actions. However the woman has continued to leave the children unattended. The worker eventually informed social services as she felt the welfare of the children was paramount and she had repeatedly discussed the risks and implications of her behaviour including the British Laws and her responsibilities as a social care worker (CCW,2002, 3.2 & 3.8). The worker felt the dilemma was due to the view that generally social services and other agencies have often been insensitive the holistic wellbeing of the Asian women and fail to take into account their life experiences, religious and cultural background (Banks,2012.p.156). (BASW, 2002, 2.1,4, 2.2,5)
A social worker who has been involved in admitting a woman to hospital for 28 days under the Mental Health Act starts to notice deterioration in her physical health. The woman then dies from pneumonia. The social worker felt that the deterioration in her physical health was due to the medication she received. Although at the time he felt unable to question the consultants and trusted that the hospital was the best place to pick up on any serious physical problems (BASW, 2002, 2.2,4). This is often attached to a hierarchy of power where the social worker felt the consultant was in a higher position and had more medical knowledge so was better equipped to make the decision. However in hindsight the social worker felt that he should have questioned the treatment before renewing the section for six months. While the social worker acted within the law and according to agency rules. Did he have a moral responsibility to question the diagnosis? (Banks, 1995, p.150). Also social workers should maintain clear, impartial and accurate records and provision of evidence to support professional judgements.
A young pregnant woman tells her community health counsellor that she will seek to have her child 'circumcised' because a girl cannot be offered for marriage if she is not clean. The woman explains that she was also a subjected to 'Female genital mutilation' (FGM) in her country of origin. The woman is aware that the practice is illegal and that she would have to go to a 'backyard' operator in her community to have it done. While the counsellor is not a social worker she would still have to abide by the rules of confidentiality and this would have been explained to the woman at the beginning of the counselling sessions (CCW, 2002, 2.3 & BASW,2.3,5). The counsellor should also explain the penalties for breaking the law including the law on child abuse. However it would be more beneficial to engage the young woman with other's from her community who are endeavouring to break out of traditional roles who can provide her with support. Social workers have a duty to support service users' rights to control their lives and make informed choices about the services they receive, whilst respecting diversity and their different cultures and values (CCW,2002, 1.3, 1.6).
Furthermore social workers must promote the independence of the service user this is done by identifying and providing information and support enabling her to make informed choices. The social worker also has a responsibility to the unborn child. The social worker can prevent the harm to the mother by making her aware of the law regarding FGM which is illegal in this country, which is why no hospital will perform it. She also has to make her aware of the consequences of her actions that she could have her child removed or face imprisonment. The social worker can help prevent harm to the child by putting her mother into contact with others from the same community who could help support her make the right decision (CCW, 2002, 3). In modern day society social workers have to work as part of a multi-disciplinary team and at the core of this is information sharing so that everyone is responsible for the health and welfare of service users. As with any dilemmas guidance and support should be discussed with the social workers manager.
While dealing with such ethical dilemmas social workers have to be aware of their own personal values and make sure that they do not influence the decisions that they make and while we may not always choose the options given for ourselves it does not mean that they are wrong (Bowles, 2006).
The social work role is about empowering the user by providing the service user with the information, resources and support they need to make an informed choice and be prepared to accept the consequences. Many believe that ethical dilemmas in social work may be related to ideological issues. For example to what degree are the public society responsible for an individual's situation and how much responsibility should an individual take for their own situation. Social workers are often seen as agents of social control. This can lead to domineering and coercive practices where social workers dealing with marginalised groups or cultures can mistake their emotional reactions for firm moral truths (Bowles, 2006). While showing tolerance and doing nothing brings us back to the central tenents of ethical social work.
As the above examples show the contents of the codes of practice are very general and therefore provide little help to social workers or service users when determining how social workers behave towards client. As in the above examples its does not provide the answer to 'Is it the social worker's duty to inform the police if they discover that the service user has committed a crime? (Shardlow, 2002). The codes do however outline how social workers should work and interact with service users. Below is an example of when a social work student crossed these boundaries.
A social work student is allocated to the case of two children siblings who live with their parents. The social worker has access to confidential information about the family which was given to her by the mother who herself is a vulnerable adult. During her placement the social work student meets the children's father in a night club and starts a relationship with him. She even left the children stay at her home while the mother was in hospital. The social worker did not inform her employers of this relationship. The relationship with the father is compromising her judgement, and the relationship between service users and social workers is about meeting the needs of the client not their own needs. The codes of practice state that as a social worker, you must uphold public trust and confidence in social care services (CCW, 2002, 5). It goes on to state that you should not exploit service users in any way (CCW, 2002, 5.2), abuse their trust or the access you have to personal information (CCW, 2002, 5.3) or behave in a way, outside of work which would call into question your suitability to work in social care services (CCW, 2002, 5.8). In addition social workers must inform their employer or the appropriate authority about any personal difficulties that might affect their ability to do their job competently and safely.
What are evident from the above examples are the complex issues that face social workers in their everyday practice. The core foundations of this work are values and ethics and while these can often conflict due to the variety of sources that social workers are accountable for instance the service user, carer and employer. The social worker must be prepared to explain and justify their actions and be open to scrutiny if they are to work in a professional manner (Clark, 2005). Values and ethics are a combination of thoughts and feelings which are used to weigh up the pros and cons of an argument and help make an ethical decision. However there needs to be distinctions on how to apply social work values and ethics into their professional work, without causing personal conflict. Above all the social worker must remain non-judgemental, and stay focused on the task ahead while upholding public trust in social care services.