Author: Nancy M. Levine, LICSW, Chair, NASW Ethics Hotline Committee
FOCUS Newsletter - December 2000
The ethical principle in each of the following cases is client confidentiality, despite the callers’ ethical concerns about "greater public good":
A caller has been seeing a client who is in recovery from substance abuse and suffering from a chronic medical condition. The client, who feels harassed at work by co-workers’ derogatory remarks about her condition, has told the caller the names of co-workers who are trafficking drugs in the workplace. The caller asks if she can "drop a dime", in other words reveal anonymously the material about the drug transactions to authorities, without breaking confidentiality. The caller adds that he would like to do this because he lives in this same town and would like to get the drug dealing cleaned up.
Committee Discussion: The committee noted that the ethical dilemma arose from conflicting commitments: the commitment to maintain client confidentiality and the social worker’s ethical responsibility to the broader society. It may be tempting, especially when there is an "anonymous" means available, to alert authorities to destructive and criminal activities in the community. Discussion focused on the best interests of the client. There is concern that the client may well be singled out by the drug dealers, (especially given the harassment in the client’s environment already) and subjected to further and worse harassment as a result of the caller’s "intervention." The motivation to "clean up one’s own town", while noble and falling within the purview of a social worker’s responsibility, should not be acted upon since the source of the information is confidential client material. The committee encouraged the caller to help the client to try to address the twin issues of workplace harassment and illegal drug activity directly through administrative channels in the workplace and/or legal authorities within the town.
Caller’s client has reported a "crush" on her doctor and tells the caller of inappropriate and sexual touching by the physician. The client warns the caller that if he ever tells anyone about this, she [client] will deny it and claim that the caller is "crazy." The caller’s supervisor has suggested that the caller phone the physician and have a "colleague-to-colleague chat" warning the physician about the client’s infatuation and the implications of inappropriate touching. Caller asks what to do with this information.
Committee Discussion: The Ethics Hotline Committee deals with questions like this often. If we are aware of inappropriate relationships, especially of a sexual nature, occurring between a professional of any discipline (including our own) and a client, are we obligated to report the unethical behavior? The answer, in all cases where the alleged victim is an adult, is that not only are we not obligated to report the ethical transgression, but also we are specifically prohibited from reporting it as it breaches client confidentiality. (Additionally, in legal terms, our information is hearsay and hence would not have the value of evidence in court.) In cases like this one, it is recommended that the caller work with the client to evaluate the nature of the relationship with the physician and help the client to remediate the situation. Only with the client’s express permission, can the social worker take direct steps to intervene in unethical or illegal behavior perpetrated by a third party.
The suggestion to contact the physician would clearly violate client confidentiality. If this is an agency situation where there is a high volume of shared practice between medical and mental health specialists, it may be possible to examine whether this situation can be addressed in general terms at parallel administrative levels (supervisor-to-supervisor, for instance). However, client confidentiality must still be carefully protected.
In both cases, the callers were also reminded of section 2.05 "Consultation" in the Code of Ethics, which encourages social workers to "seek the advice and counsel of colleagues whenever such consultation is in the best interests of clients." In both cases, clinical consultation may well help the callers to maintain their objectivity and treat the client "where the client is at" without undue pressure from the caller’s conflicting ethical demands.
Think you are in an ethical dilemma? Please feel free to consult your colleagues in the NASW Ethics Hotline, at (617) 227-9635. Leave your name and phone numbers where you can be reached with the operator. Your call will be returned within 24 hours by a member of the Committee.
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