Eye on Ethics
In the late 1970s several colleagues and I began our deep dive into the subject of social work ethics. This was an exciting time rich with possibility. The broad field of professional ethics was in its infancy, relatively speaking, having emerged from the centuries-old classic discipline of moral philosophy. The field of medicine led the way, in part because of the growing recognition of the profoundly complex ethical dilemmas health care professionals face related to life and death and the quality of life.
At the time, both moral philosophers and a relatively small group of professionals discovered that well-known theories of ethics and the conceptually rigorous tools of ethical analysis could be applied to the practical ethical dilemmas faced by doctors, nurses, lawyers, social workers, journalists, engineers, businesspeople, policy makers, military and law enforcement officials, and others. Indeed, that's how the terms "applied ethics" and "practical ethics," which continue to be used, emerged. Ethics was no longer limited to discussions by luminaries such as Socrates, Plato, Aristotle, Kant, Mill, and Bentham.
Within a very short period of time, an entirely new specialty was developed that drew on classic moral theories and conceptual frameworks to address and attempt to resolve difficult ethical challenges across the professions. How should doctors think about the moral distinction between active and passive euthanasia? If several people are in desperate need of a heart transplant and there is only one heart available, what criteria should be used to determine who shall be the recipient? Are genetic engineering and selection immoral? Under what circumstances can life-support technology be unplugged? Can psychiatric patients refuse treatment? Is it ethical for police to lie to crime suspects in order to obtain a confession? Under what circumstances is it ethical for social workers to disclose confidential information without clients' consent? Is it ethical for a journalist to disclose the name of an anonymous source in order to prevent a terrorist act? When, if ever, is war just? And so on.
In those early years of the professional ethics movement, one of the principal goals was to apply traditional ethics theories to the practical problems faced by professionals. For quite some time, ethicists in the professions explored the implications of what moral philosophers call deontological and teleological theories to ethical dilemmas. I was among them. As a group we asked whether certain actions by professionals are inherently right or wrong (deontology) or whether the rightness or wrongness of professionals' actions should be determined by the goodness of their consequences (teleology). For many years those perspectives dominated ethical analyses in the professions. For example, social workers asked whether lying to a client or interfering with a client's right to self-determination is always wrong, or whether there are justifiable exceptions. They also explored whether certain actions, such as violating allegedly unjust and unfair laws or agency regulations, can be ethical if the result is ensuring that clients' needs are met. That is, can the morally important "ends" (client well-being) justify the unethical "means" (disobeying laws or regulations)?
Over time, both ethicists and professionals questioned whether these two principal perspectives were sufficient. One concern is that deontology and teleology fail to consider the character or virtue of the people making the ethical decisions. That is, the cognitively oriented theoretical perspectives were just that: too cognitive and too preoccupied with decision-making rules. Isn't it important, critics asked, to explore the morally relevant human qualities of the decision makers? Of course, the answer is yes. And thus we have what has become known as virtue ethics.
Perhaps the best known contemporary formulation of virtues related to professional ethics was developed by biomedical ethicists Tom Beauchamp, PhD, and James Childress, PhD, who were early pioneers in the applied ethics field. This framework, first published in the 1970s, continues to be central to professional ethics and is highly relevant to social work. Beauchamp and Childress identify several core, or "focal," virtues that are critically important when professionals make ethical judgments and decisions, including the following:
• Compassion. This involves active regard for another person, a form of caring and beneficence that attempts to alleviate the suffering of another person.
• Discernment. This is the use of sensitive insight, acute judgment, and understanding that leads to action.
• Trustworthiness. This is a belief by those who have contact with professionals that professionals will act with the right motives and in accord with widely accepted moral norms.
• Integrity. Moral integrity means soundness, reliability, and being faithful to moral virtues.
• Conscientiousness. Being conscientious means being motivated to do what is morally right and making every effort to do what is right.
In their classic formulation, Beauchamp and Childress link these five focal virtues to the following four core moral principles, which, the authors believe, constitute the moral foundation of professional practice. Clearly these are closely connected to social work:
• Autonomy. This recognizes a person's right and ability to act freely and in accord with a self-chosen plan. This is consistent with the traditional social work value of client self-determination.
• Nonmaleficence. This entails the professional's obligation to act in a way that does not cause harm.
• Beneficence. This entails acts that benefit others and acts of mercy, kindness, altruism, humanity, and charity.
• Justice. This entails that which is considered fair, equitable, and what people have a right to.
The Ethics of Care
Explorations of virtue ethics and the ethics of care have added considerable richness to social workers' understanding of ethical decisions. It is not enough to examine rules—such as those created by deontological and teleological theories—about what constitutes right and wrong action. Virtue theory reminds us that the qualities of the decision makers matter. Social workers who are virtuous have admirable attributes that make them compassionate, trustworthy, discerning, and conscientious practitioners who have real integrity. Certainly making the "right" ethical decision when necessary is important. But the qualities of the social worker who makes that decision are as important.
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He's the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.