Ethics and Boundaries

Ethics and Boundaries Jeff Wright, MSW, LCSW

agenda • Introductions • Bioethics video • End of Life Small group discussion • Review Code of Ethics/MPSW 20 • Break… • Boundaries discussion (small group exercise) • Models for framing ethical dilemmas • Sharing and resolving your ethical dilemmas • Wrap-up

Introductions • Name and where you work • How many years have you been a Social Worker?

Why are these trainings relevant? • We’re all practicing Social Workers, do we really need help with this stuff? • Does resolving ethical dilemmas get easier? • What gets in our way of really being able to think about, and resolve issues that happen everyday? • What do you hope you get out of this presentation today?

End of life ethics(bioethics)

Small groups • What issues do you encounter around end of life decisions? • How do you feel your employer addresses end of life issues with families and residents? • What could be done better? • What types of ethical dilemmas do you encounter, from the standpoint of our Code of Ethics?

NASW standards for palliative & end of life care • Ethics and values • Encompasses both profession and contemporary bioethics standards • Knowledge • Particularly around family systems • Assessment • Foundation of practice. May need to reassess and revise treatment plans frequently. • Intervention/treatment planning • Utilizes assessment strategies

Standards cont’d • Attitude/self-awareness • Compassion, sensitivity, and belief in the client’s rights to self-determination and dignity. • What else here? • Empowerment and advocacy • Sometimes we are the only voice for our clients • Documentation • Guessing you all could teach this part! • Interdisciplinary Teamwork • Essential in end of life care

Standards cont’d • Cultural competence • What are challenges for us here? • Continuing education • This is a changing field, we need to stay ahead of the curve • Supervision, Leadership, and Training • Share your expertise when you can

Lunchtime?

What are Ethics? • Ethics: the “rightness” or “wrongness” of an action. • The Code of Ethics does not require a particular theory as a base • Many ethical theories, positing a base on which ethics may be constructed: • Absolutist • Something is intrinsically right or wrong • Relativist • All ethical situations are different • Teleological/Consequentialism • “The ends justify the means”

Core Beliefs and values • Most likely drives you to do what you do. • What are your inherited values? • How have these changed through the years? • How do you navigate the challenge of having your personal and professional values conflict? • Managing value conflicts can be just as challenging as ethical dilemmas. The key is self-awareness.

Law and ethics are not the same. • Law – legal justice; following the norms established by society through the political process (legislature): Chapter 457, MPSW 20 • Ethics – focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws: NASW Code of Ethics • Examples of this in your settings? • Examples from the political world?

Let’s Review MPSW 20 • Note: • MPSW 20 addresses principally the obligations to clients. • MPSW 20 is phrased in negative terms, I.e., what you should not do. • Almost all of what is contained in MPSW 20 appears also in the NASW Code.

MPSW 20 Conduct • 20.01 Gross negligence: “…the performance of professional services that does not comply with an accepted standard of practice that has a significant relationship to the protection of the health, safety or welfare of a patient, client, or the public and that is performed in a manner indicating that the person performing the service knew or should have known, but acted with indifference to or disregard of, the accepted standard of practice.”

MPSW 20 Conduct • 20.02 Unprofessional conduct…includes, but is not limited to, engaging in, attempting to engage in, or aiding and abetting the following conduct….. • Comparison sheet.

Applicability of Codes of Ethics • Rule of the court: In legal matters regarding ethical practice, the code of ethics of the largest professional organization in the field shall apply.

Structure of the NASW Code • Preamble(includes Core Values) • Purpose • Ethical Principles • Ethical Standards: Ethical responsibilities • To clients • To colleagues • In practice settings • As Professionals • To the social work profession • To the broader society

Core Values • Service • Social Justice • Dignity and worth of the person • Importance of Human relationships • Integrity • Competence

Service • “Social workers’ primary goal is to help people in need and address social problems.” [NASW Code] • Service to others, above self-interest • Encouraged to engage in pro bono service [volunteer skills with no expectation of significant financial return.

Social Justice • “Social workers challenge social injustice.” [NASW Code]. • Social workers pursue social change, esp. on behalf of vulnerable and oppressed groups. • Focus on poverty, unemployment, discrimination, and other forms of social injustice. • Promote sensitivity to and knowledge about oppression. • Strive to ensure access to needed information, services, and resources. • Equality of opportunity and meaningful participation in decision making.

Dignity and Worth of the Person • “Social workers respect the inherent dignity and worth of the person.” [NASW Code] • Mindful of individual differences and cultural, social diversity. • Promote socially responsible self-determination. • Enhance self-determination. • Cognizant of responsibilities to both client and society.

Importance of Human Relationships • “Social workers recognize the central importance of human relationships.” [NASW Code] • Recognize that relationships are the vehicle for change. • Engage people as partners. • Strengthen relationships among people in order to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities.

Integrity • “Social workers behave in a trustworthy manner.” [NASW Code of Ethics] • Continually aware of social work’s mission, values, ethical principles, and ethical standards. • Act in accord with them. • Act honestly and responsibly. • Promote ethical practices in organizations with whom they are affiliated.

Competence • “Social workers practice within their areas of competence and develop and enhance professional expertise.” [NASWCode] • Strive to increase professional knowledge and skills. • Apply the knowledge and skills in practice. • Aspire to contribute to the knowledge base of the profession.

Ethical Responsibilities: 1. To Client • Primary commitment to clients • Self-determination • Informed consent • Competence of social work skills • Cultural & social diversity competence • Avoidance of conflict of interests • Proper boundary setting • Privacy and confidentiality • Client access to records

Ethical Responsibilities:To Client (continued) • No sexual relationships or harassment • Proper physical contact • Accurate & respectful language • Fair & reasonable fees • Clients who lack decision-making capacity • Proper termination

Ethical Responsibilities: 2. To Colleagues • Respect • Confidentiality • Interdisciplinary collaboration • Consultation • Proper referrals • Proper boundary setting • Resolution of unethical conduct of colleagues • Action to resolve incompetence of colleagues

Ethical Responsibilities:3. In Practice Settings • Supervision & consultation • Education & training • Performance evaluation • Proper record keeping • Proper billing practices • Proper transfer of clients • Administration • Staff development • Commitment to employer • Resolution of labor disputes

Ethical Responsibilities:4. As Professionals • Competency • Non-discrimination • Non-interference of private conduct • No use of dishonesty, fraud or deception • Treatment for impairments • Accurate representations • No solicitation of clients • Proper acknowledgment of credit

Ethical Responsibilities:5. To the Profession • Integrity • High standards of practice • Advancement of ethics, values, knowledge & mission • Evaluation & research • Prevent unqualified practice of social work • Monitor policies & programs • Keep current with knowledge • Informed consent for research • Protection of research subjects • Confidentiality in research & evaluation

Ethical Responsibilities:6. To the Broader Society • Promotion of general welfare • Facilitation of informed participation in public policies & institutions • Assistance in public emergencies • Engagement in social & political action to ensure equal access • Action to expand choice & opportunity • Promotion of respect for cultural & social diversity • Prevention of discrimination & exploitation

Confidentiality • Essential to the full and satisfactory completion of the work • Basis of the fiduciary relationship • Shared: • With informed consent • Compliance with law • Prevent serious, foreseeable, and imminent harm

Federal Laws regarding Privacy • HIPAA – The Health Insurance Portability and Accountability Act of 1996 • Food, Drug, and Cosmetic Act (21 USC 301 seq.) • ERISA of 1974 (PL 93-06) • Gramm-Leach-Bliley Act (GLBA - PL 106-102) - privacy regulations for financial institutions and health care companies • FERPA provisions regarding school health records and educational records (20 USC 1232 g) • FIA (5 USC 552a) and the Privacy Act of 1974 (5 USC 552) regarding records maintained by federal agencies • Clinical Laboratory Improvement Amendments (42 USC 263 a, and 42 CFR, Part 493)

common ethical situations • Client asking for advice • Therapist or life coach? • Taking a public stance on a controversial subject. • Client gifts. • Client invitations to events. • Cultural differences. • Other common ones…?

Break time…

Boundaries • A systems concept: social boundaries • Within personal boundaries, we enact our roles. • Dual relationships: entering into a relationship in addition to worker-client

Distinguish: Boundary Violations/Boundary Crossings • Deliberate, constructed • Providing benefits for the professional • Crosses the line of ethical practice • Ethical obligation: avoid the violation to begin with • Inadvertent, unintended • Neutral in regard to any benefits • Creates ethical quandaries which can be resolved. • Ethical obligation: attend to the ethical issue.

Boundary Crossings and Violations • Intimate relationships • Personal benefit • Emotional and dependency needs • Altruism • Unavoidable circumstances [Frederic Reamer]

Note: • Boundary violations and crossings can occur at the • Micro level – in our work with individuals • Mezzo level – in our work with families and groups, and • Macro level – in our administration, management, supervision, organizational change efforts, community development, and social action efforts

Boundary Violations • Are potentially exploitative • Produce a service or benefit outside of the worker-client relationship • Cross the boundaries of ethical practice • May impair the judgment of the professional • May produce negative consequences in the client: anger, low self-esteem, inability to use professional services

Attend to: • The Before: clients you have reason to believe will make their way to you. • The During: Attend to the lines which are not to be crossed • The After: Basic consideration: potential of harm to the client

Small groups • What are recurring boundary issues that happen in working with the population that you work with? • How do you avoid them, or resolve them when they do occur?

Ethical Decision Making • Determine: an ethical issue or an ethical dilemma? [conflicts of values, rights, responsibilities]. • Identify key values and principles; rank them. [Go deep into the Code] • Identify key persons, groups, organizations with a stake in the issue/dilemma • Identify all possible courses of action • Examine reasons for & against each action • Consult with colleagues, supervisor, ethics board; do not do this alone. • Select the strategy, implement it, document it. • Reflect on outcomes: Monitor, evaluate, document [From: Reamer, Frederic G. (2001). Ethics education in social work. Alexandria, VA: Council on Social Work Education, pp. 106-112].

Let’s take a shot at resolving your ethical dilemmas • We will use Reamer’s framework on the previous slide

Wrap-up • Questions, random thoughts, etc… • If you have suggestions or feedback for me, feel free to stop and chat after we end, or send me an email at: wrightjd@uwec.edu

Ethics and Boundaries