Eye on Ethics
Leah sought counseling from Emma, a social worker in independent practice, to cope with a recent divorce and child custody dispute pending in court with her ex-husband. During most of their sessions, Emma and Leah focused on constructive ways for Leah to manage the intense anger and resentment she felt toward her ex-husband and difficulty she was having managing the behavior of her four-year-old son.
One day, Leah left Emma a telephone message requesting a copy of Emma’s clinical notes. During a follow-up telephone conversation, Leah explained that she expected her ex-husband’s lawyer to subpoena Emma during the child custody dispute in his effort to discredit his ex-wife. “I’m pretty sure his lawyer is going to try to get you to testify about my emotional problems and he’s going to try to convince the judge that I’m not a good parent,” Leah said.
Emma talked with Leah about her concerns and fears and promised she would do her best not to disclose information that would harm Leah. After Emma explained that she does not ordinarily provide clients her clinical notes, Leah became very upset and refused to return to counseling. Several weeks later, Leah filed an ethics complaint with the state licensing board alleging that Emma violated her rights by refusing to release her clinical notes. At the licensing board hearing, Emma explained that at the time Leah asked to see the clinical notes, Emma was concerned that Leah was “very unstable emotionally” and would “probably become distraught” if she read the descriptions of her clinical symptoms.
Social workers have always recognized that clients have various rights. Throughout the profession’s history, social workers have especially understood the fundamental importance of clients’ right to confidentiality and self-determination.
The concept of client rights flourished during the 1960s, consistent with that era’s noteworthy preoccupation with a wide range of newly emerging, legally recognized rights—civil rights, patients’ rights, women’s rights, prisoners’ rights, welfare rights, consumers’ rights, and so on. Over time, social workers have broadened and deepened their understanding of client rights. The current NASW Code of Ethics addresses numerous important client rights not broached in the predecessor codes (the 1960 and 1979 codes), such as the rights of deceased clients, clients with respect to social workers’ relationships with the media and third-party payors, and clients who are illiterate.
Social workers should be clear about the range and nature of clients’ rights and provide clients with clear information about them. Informing clients about their rights is important ethically and can also help prevent ethics complaints and lawsuits filed by clients who allege that social workers violated their rights. Ideally, social workers and their agencies should develop clear, understandable summaries of client rights. In typical social work settings, these rights concern the following:
• Confidentiality and privacy. Clients should be informed about their rights to confidentiality and privacy and about relevant exceptions. Examples of key issues include social workers’ disclosure of confidential information to protect clients from self-harm and protect third parties from harm inflicted by clients; release of confidential information pertaining to alcohol and substance abuse treatment; disclosure of information about deceased clients; release of information about minors to parents and guardians; sharing of confidential information among participants in family, couples, marital, and group counseling; disclosure of confidential information to media representatives; protection of confidential written and electronic records and information transmitted to other parties through the use of computers and fax machines; disclosure of information to third-party payors; and disclosure of confidential information during legal proceedings (see NASW Code of Ethics standards 1.07 [a-r]).
• Informed consent. Social workers should have clear policies and procedures for obtaining client consent to various treatment and service options available to them and for releasing confidential information. These policies should recognize that some clients may not be competent to consent (for example, for psychiatric reasons or because clients are under the influence of alcohol or other drugs) or may have difficulty understanding English (see NASW Code of Ethics standards 1.03 [a-f]).
• Access to services. Clients should understand the extent to which they have the right to the range of services available in social workers’ agencies (see NASW Code of Ethics standard 1.03 [a]).
• Service plans. Clients should know the extent to which they have the right to participate in the development of their service or treatment plan (see NASW Code of Ethics standard 1.02).
• Options for alternative services and referrals. Clients should be informed about any opportunities they have to obtain services from other service providers and their right to be referred to other professionals for assistance (see NASW Code of Ethics standards 2.06 [a-c]).
• The right to refuse services. In many settings, clients have the right to refuse services (exceptions include court-ordered services). Clients should be informed about the right to refuse services and possible consequences (see NASW Code of Ethics standard 1.03 [a]).
• Termination of services. Clients should be informed about social workers’ policies concerning the termination of services, for example, the circumstances under which services may or will be terminated and relevant criteria and procedures (see NASW Code of Ethics standards 1.16 [a-f]).
• Access to records. Ordinarily, clients have the right to inspect their records. Social workers concerned that clients’ access to their records could cause misunderstanding or harm to the client should provide assistance in interpreting the records and consultation with the client regarding the records. Only in exceptional circumstances—when there is compelling evidence that a client’s access to his or her records would cause serious harm to the client—are social workers permitted to limit clients’ access to all or a portion of their records (see NASW Code of Ethics standard 1.08 [a]).
• Grievance procedures. In many social work settings, clients have the right to challenge or appeal decisions and actions with which they disagree. Examples include decisions about eligibility for service, financial benefits, and termination of services. Social workers should inform clients about their right to file grievances and about relevant procedures (see NASW Code of Ethics standard 2.02).
• Evaluation and research. Many social service agencies involve clients in evaluation and research activities (for example, clinical research and program evaluation projects). Social workers should inform clients about policies and procedures designed to protect evaluation and research participants (for example, clients’ right to refuse to participate and confidentiality of research or evaluation data) (see NASW Code of Ethics standards 5.02 [a-p]).
Social workers’ understanding of clients’ rights has matured significantly throughout the profession’s history. Practitioners’ efforts to identify clients’ rights, inform clients about their rights, and safeguard clients’ rights reflect the profession’s deep-seated commitment to ethical practice.
— 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.