2001 Finding Better Ways Conference Presentation Recap
Management of Ethical Issues and Conflicts of Interest
Pamela R. Montgomery and Elizabeth D. Still
Montgomery and Still, Inc.
Child welfare and domestic relations cases typically involve a constellation of professionals including social workers, medical providers, educators, therapists and attorneys. With overlapping and sometimes conflicting professional codes of ethics, and a multitude of statutory requirements, the helpers in these complex cases can often find themselves lost in ethical dilemmas. As practitioners, it is imperative that basic ethical principles be understood. Further, a clear method for identifying, preventing and resolving these conflicts must be a part of every professional's practice.
Codes of Ethics
Many have written about basic moral or ethical principles that guide the helping professions. Meara, Schimdt, and Day (1996) describe six basic characteristics that seem to serve as the foundation of most professional codes of ethics: autonomy, nonmaleficence, beneficence, justice, fidelity and veracity. The principle of autonomy involves the promotion of client self-determination and the freedom of people to choose their own direction. Nonmaleficence requires the practitioner to avoid doing harm and to refrain from actions that risk hurting others, either intentionally or unintentionally. Beneficence requires the promotion of good for others in general and the greater good for all. Justice is the basic concept of fair and equitable treatment for all, regardless of individual characteristics such as race, gender, socioeconomic level, and religion. The principle of fidelity holds the professional to honoring promises and commitments made to others, and veracity is the responsibility to tell the truth. Each of these principles can be found in the codes of ethics for social workers, psychologists, physicians, nurses, teachers, attorneys and other professionals involved in child welfare and domestic relations cases.
While these principles appear fairly universal, there is, of course, considerable cultural diversity in the way in which these appear in values and behaviors. For example, Ho (1985) studied the differences between people raised in the United States and in Hong Kong and found considerable diversity between the two cultures on such seemingly basic values and ethical principles as independence vs. interdependence, competition vs. cooperation, individual responsibility vs. collective responsibility and nonconformity vs. conformity. It is important for child welfare practitioners to become familiar with the various cultures within their community, as it is clear there is not an absolute and universal framework for ethical decision-making.
Ethics as a Part of Daily Practice
With a basic understanding of the foundation of ethical principles, and a realistic appreciation of cultural diversity, the child welfare professional needs to recognize that ethical issues and the potential for conflicts of interests are a daily part of his/her practice. While most professions require members to follow the 'official' code of ethics, and perhaps even have annual training on the topic, it is the rare practitioner who actually has good knowledge of their profession's code. For example, most social workers in the United States are members of the National Association of Social Workers (NASW). There is a code of ethics for NASW that, in theory, has been studied and understood by all the members of the organization. In a recent workshop at a conference for social workers, the authors asked participants if they had a copy of the NASW code of ethics at their offices. Not a single social worker in the workshop could state definitively that this document was in their office or that any of their colleagues had a copy of it either!
Even if a code of ethics was reviewed on a daily basis by a helping professional, such a document is inherently limited in its ability to guide ethical practice. Many codes lack clarity or are contradictory, making ethical decision-making and enforcement difficult if not impossible. Practitioners who belong to more than one association or profession, or who hold more than one license, may have different and/or contradictory codes of ethics. Personal values, agency policies, and governmental policies or statutes may be in conflict with professional codes of ethics. Some issues, quite frankly, just can't be addressed completely by any code of ethics. In 1996, NASW issued the following statement: "A code of ethics cannot guarantee ethical behavior. Moreover, a code of ethics cannot resolve all ethical issues or disputes, or capture the richness and complexity involved in striving to make responsible choices with a moral community. Rather a code of ethics sets forth values, ethical principals and ethical standards to which professionals aspire and by which their actions can be judged."
Common Ethical Violations
In general, ethical violations tend to fall in to the following categories: confidentiality, duty to warn others about potential harm, personal value conflicts, dual or sequential relationships, financial issues, professional competence and cultural competence. What are the limits of confidentiality? Can a practitioner refuse to tell a parent about the content of therapy sessions? If child abuse must be reported to authorities, must elder abuse also be reported? If it is believed a client is going to physically harm another person, can confidentiality be broken and that person be warned? If the practitioner believes that abortion is morally wrong, can s/he advise a client to not get this procedure? Is it ever acceptable to become sexually involved with a current or former client? Can a counselor provide mental health treatment to the child of a best friend? Should a practitioner terminate services because the client can't pay and the insurance benefits have ended? Can a professional who is suffering from active substance abuse continue to work in an alcohol treatment center? If a professional has no knowledge of the family values of Yupik Eskimos, should s/he accept a position as a counselor at a school in the Alaskan Arctic?
Ethical Decision Making
These questions and more have no simple and definitive answers. This is the challenge for child welfare professionals on a daily basis. How does one make ethical decisions and avoid conflicts of interest? Every practitioner needs to follow a logical, and thorough, process to prevent and address these many dilemmas. We suggest at least the following seven-step process.
First, it is important to obtain knowledge of relevant laws and governmental policies that apply to the professional's area of practice. A teacher, for example, would want to know specifically how the child abuse reporting laws apply to educators, or a physician would want to know if there is a law in his/her community that requires reporting of gunshot wounds or sexually transmitted diseases.
Next, it is important to have a thorough understanding of one's own professional code of ethics. If a person is a member of more than one profession, it is imperative that both codes be compared to identify, in advance, any conflicts or discrepancies. It is also useful to have an understanding of the codes of ethics for similar professions. For example, while the National Association of Social Workers does not have specific ethical guidelines for conducting custody investigations in divorce litigation, the American Psychological Association (APA) does have such standards in place for their members. While a social worker would not be legally bound to the APA requirements, it is wise to be aware of the other professions standards to avoid the appearance of inappropriate or unethical practice.
Agencies should maintain clear and comprehensive policies and procedures manuals and these should be reviewed and, if needed, revised on an annual basis. Staff at agencies should actually read and understand these policies, not just put the big manual up on the shelf to collect dust! The professional should compare the laws, codes of ethics and agency policies to ascertain if there are any inherent conflicts between them.
Individual practitioners should be aware of their own personal values as they practice every day. As much as possible, these values should not be in overt conflict with the codes of ethics, laws and policies that govern the person in his/her work. If there is an irreconcilable conflict that exists, the practitioner may well have to seek another line of work or, at least, employment in a different social service setting. For example, if a person vehemently opposed capital punishment, it would present an ongoing ethical dilemma to accept employment as a counselor for inmates on 'Death Row' in a correctional facility.
After examining ones personal values, relevant laws and regulations, codes of ethics and agency policies, it is important to identify the exact role the professional is playing in the current job. Many helping professionals have a wide area of practice, changing roles several times through the course of a week. For example, a social worker in a school setting might act as a counselor for two children arguing on the playground, report a parent to the authorities for child abuse, advocate for a child's special education needs, and present a lesson to students on birth control choices--all in one afternoon! Each of these distinct roles may require different ethical perspectives, and it is important for the practitioner to be aware of his/her role to avoid ethical violations or conflicts of interest.
Prevention of ethical conflicts is imperative. Clients need to be informed, for example, of confidentiality limitations. If a client is told prior to beginning counseling that the therapist is required by statute and agency policy to notify the police if a crime has been committed, it would come as no surprise to the client when their confidentiality is violated upon disclosure of an assault or an armed robbery. Likewise, clients need to be made aware of their financial responsibilities, and any repercussions for non-payment of fees (e.g., only ten sessions will occur or collection litigation could ensue if bills aren't paid within 60 days). Any issue that the practitioner believes might result in an ethical conflict should be addressed proactively with the client in advance of service delivery if at all possible.
But even the best proactive efforts will not prevent ethical conflicts from arising. When such issues do occur, the practitioner needs to immediately begin a problem-solving process. First, identify what ethical issue or conflict of interest is believed to exist. Next, research the law, governmental regulations, agency policies, and codes of ethics for guidance. If there is conflicting information in these various documents, attempt to prioritize them to identify the controlling rule. For example, in general, federal laws in the United States take precedence over state laws, and state laws take precedence over city laws. When in doubt, it is wise to consult with an attorney when attempting to determine which law or ethical code is controlling for the specific situation.
It is also useful to examine ones' own personal values and biases again in this analysis to be sure that these are not clouding one's judgment or interpretation of an ethical issue. Using colleagues and supervisors to 'brainstorm' these issues is critical. To attempt to examine ethics and conflicts in a vacuum is futile and dangerous.
Finally, it is important to create an 'action plan' in writing that is consistent with the laws, policies, ethical codes and the consultation of peers and supervisors. For example, if it has been discovered that the teenaged client has become romantically involved with her counselor's son, unbeknownst initially to the counselor, an action plan would include immediately transferring the client to another therapist for continued services and, perhaps, even to another agency entirely. This plan would be given to the teen client, her parents, the current counselor and the new counselor. It would be agreed to, in writing, by all concerned and become part of the client's file at the agency. After the plan is implemented, it is important to reflect upon the outcome and to revise it as needed.
While not an absolute guarantee for ethical practice and the avoidance of conflicts of interest, the process of becoming aware of relevant laws, policies and ethical codes, combined with proactively addressing potential problem areas allows one to avoid many ethical dilemmas and conflicts. When these issues still arise, the clear and consistent problem-solving process described can successfully address and resolve these issues.
- Ho, D.Y.E. (1985). Cultural values and professional issues in clinical psychology: Implications from the Hong Kong experience. American Psychologist, 40(11), 1212-1218.
- Meara, N. M., Schimdt, L. D., & Day, J.D. (1996). Principles and virtues: A foundation for ethical decisions, policies and character. The Counseling Psychologist, 24(1), 4-77.
Pamela Montgomery and Elizabeth Still
Montgomery and Still
1101 W. 7th Avenue
Anchorage, AK 99501
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