Ethical Decision-Making

1. Ethical Decision-Making Chapter 3

2. Chapter Purpose • Discuss the purposes and functions of ethical decision making • Identify and discuss the legal duties of professional helpers • Access the laws that regulate the practice of social work in their locale • Identify and discuss the fundamental values of social work • Discuss the ethical principles and standards that guide social work practice • Identify the relevant legal duties and ethics that might apply in various professional contexts • Analyze and determine the relative priority of competing legal and ethical obligations though the development and use of a case-specific values hierarchy • Use critical thinking skills to reach and ethical decision and plan appropriate action

3. Obey? Pledge? Social Work …Laws, Values and Ethics Abide?

4. Social worker investigated for missing government money, January 31, 2005 • Saskatchewan social worker was convicted, tried and found guilty in connection with a million dollars in missing government money. • Hynes started welfare files for 16 fictitious people, issuing cheques in their names and starting bank accounts and credit cards for several of them, boosting her income by about $7,000 a month. At least a million dollars went missing over a 10-year period. • Hynes was convicted of defrauding a bank in Newfoundland in the 1980s for more than $600,000 but was later pardoned after spending two years in jail. • She then obtained a Masters in social worker and moved to Saskatoon. Her criminal record was not checked when she was hired in 1989 as mandatory criminal record checks were not instituted until 1997. • She was found guilty of fraud and sentenced to 4 years in a federal penitentiary • This minister comments "This is a very huge breach of trust

5. Kitchener-Waterloo CAS worker commits PERJURY in courtFeb 5, 2004 (Canada Court Watch Report) • A Kitchener, Ontario couple submit documents which appear to show that a worker with the Waterloo, Ontario, Children's Aid Society made false and misleading statements under Oath to a court in which the Waterloo CAS worker, • Seana Dobbin-Gayowsky, • Said she was a social worker.  Yet, a letter from the Ontario College of Social Workers indicates that Ms. Seana Dobbin-Gayowsky was not registered with the College  • Under the law in the Province of Ontario, workers cannot claim to be social worker unless they are duly licensed and registered with the Ontario College of Social Workers.

6. Which of these social workers have exposed themselves to the threat of a malpractice suit? • A social worker finds himself attracted to a client and begins a sexual relationship with her. • A second social worker quits the profession before starting a relationship with her client. • A third social worker meets with a divorced father who asks the social worker to provide therapy for his children who are suffering emotional trauma because of the divorce and the therapist agrees without the mother’s consent. • A fourth social worker, wishing to help a poor client, agrees to trade services and lets the client do carpentry on his house in exchange for therapy.

7. Answer: All of Them • In a litigious age when it’s said that anybody can sue anyone for anything, social workers in clinical and therapeutic practice appear to be especially vulnerable. • According to records kept by the National Association of Social Workers (NASW) Insurance Trust, malpractice suits against social workers have increased dramatically over the past 25 years. • Part of this increase is due, no doubt, to the infamously litigious climate we live in, in which social workers’ clients are simply more aware of their opportunities to sue and seek monetary compensation for real or imagined damages.

8. Understanding Your Legal Obligations

9. Malpractice • “A form of negligence that occurs when a practitioner acts in a manner inconsistent with the profession’s standard of care —the way an ordinary, reasonable, and prudent professional would act under the same or similar circumstances” (Reamer, 1994)

10. Misfeasance Malfeasance Nonfeasance Common Features of Malpractice

12. Malfeasance • Where the professional intentionally engages in a practice known to be harmful • Malfeasance is ordinarily defined as the commission of a wrongful or unlawful act (Bernstein & Hartsell, 1998; Gifis, 1991). • Thus, • A social worker who engaged in a sexual relationship with a client after convincing her that this would be therapeutic • A social worker who used so-called rebirthing techniques without proper training or empirically based evidence of effectiveness • A social worker who traveled with a client and misappropriated some of the client’s funds, in the name of re-parenting therapy, • Could all potentially be accused of malfeasance

13. Misfeasance • Where the professional makes a mistake in the application of an acceptable practice Employer • Getting in trouble for things you did • Most common malpractice acts among NASW members (Reamer, 1995). • Thus, • A social worker who used hypnosis, art, or wilderness therapy techniques negligently • Either because of inadequate training or lack of skill • Might be accused of misfeasance; these clinical approaches, which are based on solid research and theoretical foundations, should only be used by practitioners who have sufficient training, knowledge, and competence.

14. Nonfeasance • Where the professional fails to apply a standard, acceptable practice when action is needed • Getting in trouble for what you didn’t do (e.g., visit a client at a prescribed time). • Not visiting a client at a specified and agreed up time and place would be an example • Failure to refer a client for consultation or treatment

15. The GOOD NEWS • In the US between 1969 and 1990 a total of 634 claims were filed against the NASW Insurance Trust, compared to the 60,000 NASW members insured through the trust (Reamer, 1995) • Canada has a good track record too • Most complaints against social workers in the popular media do not translate to actions against individuals, and in fact the number of formal complaints submitted to the regulatory boards remains consistently low from year to year. • Ontario, the province with the largest number of registered social workers, received 30 complaints in 2000. • Quebec had 28 open files at the end of the last fiscal year. • Alberta was next highest with 8 complaints. http://www.casw-acts.ca/SW-Forum/CdnSWForum-Regulation.htm

16. Protecting Yourself • To reduce the risk of civil claims or disciplinary complaints against social workers, AON Reed Stenhouse Inc., in co-operation with the CASW and your insurer offer protection • CASW PROFESSIONAL LIABILITY INSURANCE PROGRAM • PROFESSIONAL LIABILITY • For damages resulting from a negligent act, error, omission or malpractice arising out of your professional capacity as a social worker. • SOCIAL WORK • It is not the role of your insurer to define the activities of a social worker. If the activity is approved by your Provincial Organization (CASW member), then your professional liability insurance coverage would apply. • DISCIPLINARY COSTS • Provides for the cost of defending you against a disciplinary action brought against you. 

18. Sanctions Paying the Consequences of Professional Misconduct

19. CONSEQUENCES

20. Repressed Memories To Trust or Not to Trust…

21. Trust Memory? Question: Trust Memory? Answer: Don’t!!!

22. Repressed memories • A hot issue since the mid 90s. Number of • Cases exloded.  Into the thousands. • People have been sued and convicted • Of ghastly crimes (often involving relatives) • Based on concept of repression (Introduced by Freud).

23. Trust Memory? ‘Repressed’ Memories? • So-called “Repressed Memories” brought back by therapists and hypnotists are very dubious in terms of scientific support, and the hazards this dubious hypothesis presents is profoundly frightening!

24. Case in Point… • Eileen was 8 years old when her friend Susan died in 1969.  Twenty years later Eileen had grown up and had a daughter who reminded her of her long lost friend Susan.  • One day when Eileen was looking into her daughter’s eyes she suddenly remembered what had happened to her friend Susan 20 years previously.  • Eileen had witnessed her own father sexually assault and then murder Susan by hitting her with a rock.  He had then threatened to kill Eileen if she told anyone.  • Her father was subsequently found guilty of murder and sentenced to life.  (Reported by Zimbardo et al 1995).

25.   Susan                 Eileen in later life          Eileen’s father

26. Trust Memory? ‘Repressed’ Memories? • George Franklin (the father) served 6 years of his sentence before being acquitted of the murder.  • At trial Eileen had failed to inform the court that she’d been hypnotized prior to the return of the memory.  • Franklin later sued Eileen, her hypno-therapist and the prosecuting counsel (outcome unknown!).  • He claimed it had all been a case of ‘false memory syndrome’ in which a false memory had been created by the process of hypnosis.

27. Repressed memories • While it is impossible to tell in an invididual case, some things are very troubling... • Scientific concept of Repression is extremely shaky. No evidence that it can happen. In fact, the opposite seems to be true (PTSD) • It has been shown that very vivid memory can be implanted into the minds of both adults and children. The subjects can´t discriminate real vs. implanted memories. • The process of recovery (recovery therapy) is very similar to the process used for artificial implantation. • Evidently wrong recovered memories seem to be progressive,  the reports of the abuse get more and more severe over time.

28. What’s the issue? • We potentially have a situation in which someone who is having troubles in life and is seeking answers is told to determine whether or not memories for historical events in their lives exist • What are some techniques that are used to “assist” recollection? • hypnosis, imagery, dream analysis, story telling

29. Conclusion: • We cannot know with certainty (without corroborating evidence) whether a derepressed memory is true • Therapists should engage in probing this possibility very carefully • avoiding suggestive questions • remaining unconvinced without corroborating evidence • being “gently confrontational” to encourage patient to consider the possibility that the events didn’t happen

30. Disability Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.

31. Disability… • Disability is difficult to define because it is a multi-dimensional concept with both objective and subjective characteristics • According to the Ontario Human Right’s Commission: • Pyhsical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness, and without limiting the generality of the foregoing, including diabetes mellitus, epilepsy, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or on a wheelchair or other remedial appliance or device, • A condition of mental retardation or impairment, • A learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language, • A mental disorder, or an injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997. • "Disability" should be interpreted in broad terms. It includes both present and past conditions, as well as a subjective component, namely, one based on perception of disability.

32. Disability in Canada • Some 3,601,000 Canadians have a disability — that’s one in eight. • The rate of disability increases with age • Disability rates are highest among older seniors (75 and over), with fully 53.3 percent in this age group reporting a disability • The majority of Canadians with disabilities have mild to moderate disabilities. • Childhood disabilities is more likely to be severe to very severe compared to working-age disabilities.

33. Disability Rates by Age, Canada and Provinces

34. Disability in Canada • Mobility, agility, and pain-related disabilities are by far the most common types, each accounting for approximately 10 percent of reported disabilities nationally. Four percent of respondents reported a hearing limitation. • About 1 percent of the population overall have psychological disabilities, while 2 percent have learning- and 2 percent memory-related disabilities. • Learning disabilities are prominent among children of school age and young adults, but less common among seniors.

35. Types of Disability in Canada

38. Canadian with Disabilities: Accountability Framework

39. For More Information • http://www.disabilitypolicy.ca/resourcesNational.php

40. Ontarians with Disabilities Act, 2005

41. What’s a HIPAA?

42. What is HIPAA? • HIPAA ( Health Insurance Portability and Accountability Act) was passed in 1996. • Department of Health & Human Services (DHHS) issued the final Privacy rule in April 2001. • Regulation requires compliance by: April 14, 2003

43. What Information is covered under HIPAA • Personal Health Information (PHI) • Anything that can potentially identify an individual Name Zip code of more than 3 digits Dates (except year) Telephone and fax numbers Email addresses Social Security Numbers Medical Record Numbers Health Plan Numbers License numbers

44. Privacy Objectives • Protect patients rights by giving them accessto their health information and control over how it will be used • Improve the quality of care by restoring trust in the health care system • Protect the security & privacy of all medical records that are used or shared in any form

45. Why do we need a Privacy Rule? • HIPAA came about as the result of concerns from patients regarding: • Breeches in Confidentiality • Three cases in point: • Accidentally, hospital in Michigan posted thousands of patient medical records on the Internet • Employee from a Florida health department took home a disk containing names of 4,000 patients w/ positive HIV tests. • Congressional Candidate stated that her campaign was derailed when the media published her psychiatric treatment after a suicide attempt.

47. Personal Health Information Protection Act  (PHIPA), 2004 • Canadian counterpart to HIPAA • Provides consistent and comprehensive rules governing the collection, use, retention, disclosure and disposal of personal health information in the custody and control of health information custodians

48. According to ocswssw…

49. Student Activity The following scenario deals with professional integrity as it relates to protection of client identity Did the student intern act in the right way? What might you have done?

50. Standards for Privacy of Individually Identifiable Health Information