Eye on Ethics
Impropriety and the Appearance of Impropriety
Here's the good news: Ethics-related impropriety in social work is rare. Very few social workers become involved in egregious misconduct, e.g., engaging in sexual relationships with clients, submitting fraudulent bills to health care insurers for services that were never provided, or falsifying administrative records to deceive funding agencies. The overwhelming majority of social workers would never engage in any such misbehavior; of course, even one such case is unacceptable.
Now here's the bad news: In many cases that lead to ethics complaints, social workers behave in ways that rise to the level of an appearanceof impropriety, and the consequences are often severe. Typically these social workers intend no harm. But, to a panel of peers (in a licensing board case) or to a judge or jury (in cases where social workers are named as defendants in malpractice cases), even the appearance of impropriety can be problematic. Examples include the following:
• A clinical social worker provided counseling to a woman who struggled with marital issues; the client reportedly felt deep despair about the relationship. Late one night the social worker was thinking about his client, with concern, and thought that this client might be comforted by a poem about hope that the social worker had written. The social worker decided to send the poem to the client as an attachment using his personal (not agency) e-mail address. About a year later the clinical relationship ruptured and the former client filed a licensing board complaint alleging that the social worker harmed the client when she used nontraditional treatment techniques. During the hearing the licensing board investigator introduced a copy of the social worker's e-mail message and poem as evidence of the social worker's poor boundaries.
• A social worker at a center that serves trauma victims provided case management services to a client who was the victim of multiple incidents of domestic violence. The client struggled financially and was diagnosed with clinical depression and PTSD. To get away from her abuser, the client rented a small apartment that she could barely afford, given her very modest single income. During one of their meetings, the client told the social worker that she was far behind on her rent and had received an eviction notice. The client burst into tears and told the social worker that she wasn't sure she could continue living like this. Impulsively, the compassionate, altruistic social worker told the client that she could stay in a spare basement room in the social worker's home until the client could get back on her feet. The client moved in. After a month, the social worker became concerned about the length of stay and broached the issue of the client's plans to find alternate housing. The client told the social worker she was too anxious to look for another place to live. The social worker told the client she would need to move within three weeks. The client became upset and called the social worker's supervisor to complain about being mistreated by the social worker. The supervisor was stunned to learn that the social worker allowed a client to live in her home. The agency fired the social worker.
• A clinical social worker in independent practice counseled a client who was coping with the sudden death of her infant child. The pair had a strong therapeutic alliance and the client reported that the social worker's services were profoundly helpful. About six months after their counseling relationship began, the client became curious about the social worker and googled her. The client discovered that the social worker had started a nonprofit foundation to provide free or low-cost clinical services to children with special needs and their families. The client, who was independently wealthy, donated $25,000 to the foundation as a gesture of gratitude. The social worker was unsure as to whether accepting the donation would constitute a conflict of interest.
This is a good analogy for ethical decision making, especially when there is a risk of an appearance of impropriety. Even the most ethical social workers can suffer from blind spots; we can be so immersed in complex circumstances that we fail to see the ethical challenges, and the possible appearance of impropriety, right in front of us.
Prudent social workers would do well to think like skilled bridge players, carefully considering each and every move, forecasting possible outcomes, and weighing the relative advantages and disadvantages. For example, the social worker who was concerned about her distraught client and e-mailed her a poem about hope late at night and from his personal e-mail address—an act of compassion—would have done well to think ahead and imagine how this would look if the e-mail message and personally written poem were viewed by a panel of his social work peers. He might have reconsidered sending the correspondence.
Similarly, the altruistic social worker who invited her homeless client to stay temporarily in the social worker's spare room would have done well to think several moves ahead. How would it appear if other clients and the social worker's colleagues knew that the client moved into the social worker's home? What boundary issues could in time emerge and cast doubt on the social worker's judgment?
The NASW Code of Ethics includes some helpful and cautionary guidance. First, with regard to making ethical judgments amidst ambiguous circumstances, "Reasonable differences of opinion can and do exist among social workers with respect to the ways in which values, ethical principles, and ethical standards should be rank ordered when they conflict. Ethical decision making in a given situation must apply the informed judgment of the individual social worker and should also consider how the issues would be judged in a peer review process where the ethical standards of the profession would be applied."
Second, in such circumstances, the Code of Ethics encourages social workers to seek collegial consultation: "For additional guidance, social workers should consult the relevant literature on professional ethics and ethical decision making and seek appropriate consultation when faced with ethical dilemmas. This may involve consultation with an agency-based or social work organization's ethics committee, a regulatory body, knowledgeable colleagues, supervisors, or legal counsel."
Finally, given that many problematic ethics cases that feature the appearance of impropriety involve complex boundary issues, the Code of Ethics states, "Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients' interests primary and protects clients' interests to the greatest extent possible. In some cases, protecting clients' interests may require termination of the professional relationship with proper referral of the client."
As in bridge, the quality of social workers' ethical judgments is likely to be enhanced when they think ahead. This is the very best way to avoid even the appearance of impropriety.
— Frederic G. Reamer, PhD, is a professor in the graduate program of the School of Social Work at Rhode Island College. He is the author of many books and articles, and his research has addressed mental health, health care, criminal justice, and professional ethics.