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March/April 2007

The Importance of Ethics Consultation
By Frederic G. Reamer, PhD
Social Work Today
Vol. 7 No. 2

Benita was a clinical social worker at Bayside Center, a residential drug and alcohol treatment program. Benita provided individual and group counseling to residents and supervised several program staff.

One afternoon, Benita received a telephone call from a local police detective. The detective said she was conducting a homicide investigation and one of the crime’s witnesses told the detective that a Bayside client, Kelvin, had information about the murder. The detective explained that she wanted to arrange to interview Kelvin about the homicide.

Benita was unsure about how to respond to the detective’s request. Benita understood why the detective was eager to speak with Kelvin, particularly given the gravity of the crime. However, Benita knew she had to be careful about disclosing confidential information to a law enforcement official without Kelvin’s consent, including acknowledgement that she even knew who Kelvin was and that he was a Bayside resident. Benita quickly realized she needed ethics consultation.

In recent years, a number of professions—including social work—have developed a cadre of ethics consultants. Ethics consultation—first provided in hospitals—began in the late 1960s and early 1970s at The Pennsylvania State University, the New Jersey College of Medicine (now the University of Medicine and Dentistry of New Jersey), and the University of Wisconsin. In 1978 and 1979, bioethicists Edmund D. Pellegrino, MD, and Mark Siegler, MD, FACP, published several influential papers that proposed a role for “clinical ethics” as a separate field of expertise, and in 1985, the University of California, San Francisco, and the National Institutes of Health cosponsored a conference on ethics consultation.

Over the years, ethics consultation—which is especially prominent in healthcare settings—has assumed various forms and tasks that can be usefully incorporated into many social work settings. Ethics consultation is typically available to practitioners who encounter challenging, case-specific dilemmas, for example, related to disclosure of confidential information, conflicts of interest, dual relationships and boundary issues, client consent to treatment, and termination of services to noncompliant clients.

Ideally, ethics consultants have obtained formal education in ethical theory, practical ethics, and professional ethics to supplement their substantive expertise in their profession. Ethics consultants are trained to identify, analyze, and help resolve difficult ethical issues.

Ethics Consultant Roles
Ethics consultants in social work can assume various roles, depending on their employment setting and responsibilities. These roles include those of professional colleague, educator, mediator, and advocate. As a professional colleague, the ethics consultant’s mission is to provide a social worker with a thoughtful reaction to ethical issues or dilemmas. This consultation may be relatively informal and may consist of little more than a focused discussion of complex issues that the consultant examines from a variety of angles. For example, Benita might consult with a colleague with expertise related to confidentiality issues surrounding substance abuse treatment, particularly regarding disclosure of information to law enforcement officials without client consent.

An ethics consultant can also be an effective educator. Many ethics consultants provide in-service training to agency staff about ethical issues they encounter. Through lectures, case illustrations, and group discussions, the ethics consultant can enhance staffers’ ability to recognize and address ethical issues in practice. The consultant may acquaint staff with common ethical challenges and prevailing views on ethically appropriate responses. The consultant can also present staff with an overview of various models of ethical decision-making that can be used in practice. As an illustration, on occasion I have conducted “ethics grand rounds” in healthcare settings, a valuable form of ethics education and consultation.

As a mediator, the ethics consultant may help resolve differences of opinion among parties who have a vested interest in a particular case’s outcome. For example, if Benita and her supervisor disagree about how to respond to the detective’s request for confidential information, an ethics consultant may help them resolve the dispute.
An ethics consultant can also serve as an effective advocate, particularly in instances where a client or social worker believes his or her rights have been violated. For example, if Kelvin believed his rights were violated with regard to the detective’s request for confidential information, an ethics consultant may help Kelvin voice his concerns with agency administrators or other appropriate parties.

Essential Skills
To carry out these various roles, ethics consultants need a variety of skills. They must have a firm grasp of key concepts related to ethical theory and the field of practical and professional ethics, particularly related to conceptual frameworks used for analyzing ethical issues and making ethical decisions. Also, consultants must have refined interpersonal skills that enable them to negotiate agreements or mediate ethics-related disputes. Social workers with solid clinical skills may be particularly well equipped in this respect.

In addition, ethics consultants must be able to communicate effectively as trainers for groups of professionals and be able to model appropriate ethical decision-making. Finally, ethics consultants must understand the complex relationship between ethical issues and social work practice issues (that is, ethical issues that arise related to the delivery of services to individuals, couples, families, groups, organizations, communities, and in policy arenas). Often, an ethics consultant’s most effective intervention involves the adept use of clinical instincts and communication skills to manage group process and interpersonal conflict.

Social workers interested in becoming ethics consultants should seek formal ethics education offered by various universities and continuing education programs. Ideally, social work ethics consultants would become well versed in basic ethical theory, the history of professional and practical ethics, ethical standards in social work, and ethical decision-making frameworks and protocols. In recent years, various professions—for example, medicine, law, business, nursing, psychology, journalism, engineering, and social work—have become more earnest about incorporating ethics-related content into professional education. Professional and continuing education programs are now much more likely to teach content related to core principles in moral philosophy and their relevance to practical ethics challenges. In addition, ethical standards in nearly all professions, as reflected in their respective codes of ethics, have become more detailed and ambitious. No longer are codes of ethics superficial and vague documents that resemble oaths. Instead, contemporary ethics codes tend to be comprehensive guides that highlight a wide range of complex issues in the professions. This is certainly true in social work.

In recent years, across the professions, scholars and practitioners have also developed widely used conceptual frameworks and protocols to organize practitioners’ thinking when they encounter ethical dilemmas. These decision-making protocols do not guarantee simple and unequivocal solutions to complex ethical challenges. Rather, they provide frameworks to help practitioners identify and highlight key ethical issues, examine them from diverse perspectives, draw on critically relevant concepts and resources (such as code of ethics standards, statutes, regulations, case law, and agency policy), and consider and critique a range of competing views and arguments. The skills involved in this process can be enormously helpful to ethics consultants.

As valuable as ethics consultation can be, social workers should not assume that they should always defer to consultants’ judgment. Social workers should regard ethics consultation as a useful supplement and complement to their own ethics expertise, not a replacement. Social workers should continue to assume primary responsibility for their own ethical judgments and acquire the knowledge and cultivate the conceptual skills necessary to make those judgments.

— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work, Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, healthcare, criminal justice, and professional ethics.