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Resolving Ethical Dilemmas

Author: Kathleen E. Murphy, Ph.D., Chair, National NASW Committee on Inquiry

FOCUS Newsletter - October 1997

Reprinted with permission from the Illinois Chapter of NASW.

The word "ethics" means a system or code of morals of a particular profession. The word "moral" or to be "moral" means to be capable of making the distinction between right and wrong. Moral reasoning/ethical reasoning in social work practice means being able to make the distinction between right and wrong in how one conducts the practice of social work.

There are ethical and nonethical aspects of social work. The "nonethical" aspects include various aspects of clinical practice, for example, particular intervention techniques, process notes, where to conduct one's practice, whether or not to collect fees or methods of assessment. In and of themselves these are the tasks of clinical practice or business decisions which require the development of certain skills or techniques, or the acquisition of certain knowledge, but do not necessarily involve the ability to judge between what is right and wrong.

On the other hand, the "ethical" aspects of social work include questions and concerns about the obligations and duties of the social worker about what is morally right and wrong in carrying out one's practice. It is important to keep in mind that while all aspects of practice may have implications which are ethical, not all aspects of practice involve ethical dilemmas per se.

One measure of ethical conduct in any occupation is the continuity between what the practitioner is supposed to do and what is actually done. The more what one is supposed to do and what one does coincide, the more ethical the practice. The problem, however, is that what the social worker is "supposed to do" is not always evident, nor is it one-dimensional even when the issues are clear. Because of the complexity of what social workers do, all the interests affected by an ethical issue in practice can not invariably be reconciled. However, ethical practice requires that they be satisfactorily reckoned with, not so much in quest of what may be considered a successful outcome, as in fulfillment of ethical responsibility.

What social workers do is based on values, and social work ethics are social work values in action. Therefore, an ethical dilemma, by definition, is a circumstance which occurs only when two or more social work values are in conflict, i.e., the conflict between the right to self-determination and the right to confidentiality in the case of a suicidal client. In this example, an ethical dilemma exists in that both values, self-determination and confidentiality, cannot be equally and necessarily upheld. Herein lies the difficulty with how to resolve ethical dilemmas--how to contend with all the facets of one's ethical obligations in light of competing social work values.

Ethics in social work practice are social work values up close and personal; and while competent practice is efficient, ethical practice is obligatory. But not all ethical practices are necessarily cost-effective or time efficient. In fact, quite to the contrary, ethical practice at times is laborious and time-consuming. However, this is at the very heart of the social worker's difficulty in sorting out any given service situation, for it is at this interface where what one can do and what one should do that ethics transcends practice and we encounter ethical dilemmas.

When thinking about how to resolve a particular ethical dilemma, it is helpful to ask, and formally answer the following questions. This can be done individually or in a group process such as a multidisciplinary team or a department. These steps are a modified form of those found in "Truth Telling: An Ethical Dilemma" by K. Lowe-Phelps in Caring, VII(1): 4 12, 1988, and "Ethical Dilemmas in Social Service" (2nd edition) by F. Reamer, 1992:

1. Who are the key players? Who is involved? Who is/will be affected?

2. What is the proposed action to be taken which needs to be evaluated as ethical or unethical? Are there relevant legal issues to be considered? Are there other standards which apply?

3. What is the context of the proposed action?

4. What is the purpose of the proposed action? What is expected to be achieved by either taking a certain action or by not taking a certain action?

5. What are the alternative actions which could be taken? What are the consequences of each alternative?

6. What are the social work values which are in conflict? Is there any way to "rank" order the values? (i.e. the prevention of harm takes precedence over enhancing self esteem.)

7. What other values and/or moral philosophy pertains to the dilemma being considered? (Be sure to include the personal values of the client and the professional values of other involved parties.)

8. Who has the responsibility to make the decision? Who has the right to make the decision? Who should participate in the decision? Why?

9. What are the possible resolutions (must include at least two)?

10. Resolution of choice: Specify the moral reasoning behind the resolution of choice regarding how and why any given action contends with the conflict of values.

Frequently social workers confuse a clinical or nonmoral aspect of practice with a moral or ethical aspect of practice. It is important to ascertain whether what you have is truly an ethical issue or a clinical issue. If it is primarily a clinical issue, the social worker needs to consider the ethical implications or ramifications of certain choices. However, it is important to remember, that for there to be an ethical dilemma, there must be two or more competing social work values which are in conflict. It is important to actually go through the exercise of writing out what the competing values are to make sure you are thinking through the situation rationally.

If there is only one value at stake then the social worker is obligated to actively support that social work value. It is where there are two or more competing values that the social worker is obligated to proceed with a full "ethical analysis" using ethical principles, not clinical principles, to contend with the demands of reconciling the conflict.

 


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