Eye on Ethics
The Evolution of Social Work Ethics
When I became a social worker in the late 1970s, the NASW Code of Ethics was one page long. One page. Oh, how times have changed.
The hard copy of the current Code of Ethics—only the third version since the NASW was created in 1955—is 27 pages long, and the committee that wrote this code, which I was privileged to chair, tried to keep it as short and succinct as possible.
What accounts for this remarkable trend, one that has had such a profound impact on the profession? To fully appreciate the evolution of social work ethics, it is important to start at the beginning.
Social work was formally inaugurated in the late 19th century. In my view, social workers’ ideas on ethical issues have evolved since then during the course of five conceptually distinct, albeit sometimes overlapping, periods, including the following:
• Morality period: Social work’s historical literature suggests that, for many years, the profession was focused much more on the morality of clients rather than practitioners. In many discussions one finds references to concern about the moral fiber, or the alleged lack thereof, of clients who struggled with issues such as poverty, unemployment, alcohol use, or poor health. The phrase “professional ethics” did not exist. Some of the discussions of clients’ morality during this period had a rather paternalistic tone.
• Values period: As social work matured, a handful of scholars and practitioners began exploring and writing rich commentaries about the profession’s core values, such as client dignity, self-worth, self-determination, and confidentiality. These important discussions and analyses sought to explore the implications of social work’s central values, especially when there were conflicts among the profession’s values, the broader society’s values, and social workers’ personal values. Especially during the turbulent 1960s and early 1970s, several social work authors wrote about the complex connections between social work values and contemporary controversies surrounding civil rights, women’s rights, welfare rights, discrimination, and abortion.
• Ethical dilemmas and decision-making period: The scholarly winds began to shift significantly during the late 1970s and early 1980s, largely because of the dramatic emergence of the broader field of applied and professional ethics, especially bioethics. During this period, increasing numbers of scholars and practitioners in a wide range of professions (e.g., medicine, nursing, psychology, social work, journalism, business, law enforcement, engineering) focused explicitly for the first time in their respective histories on the nature of challenging ethical dilemmas facing practitioners.
Scholarship burgeoned on the subjects of ethical dilemmas in practice and ethical decision-making protocols. The richest discussions identified links between ethical theory, drawn from the discipline of moral philosophy, and real-life challenges faced by professionals, particularly those involving conflicts between professional duties and obligations.
Textbooks in diverse professions included, for the first time, in-depth overviews of ethical dilemmas and conceptual frameworks practitioners could use to address them. In social work common topics concerned professional paternalism, the limits of clients’ confidentiality rights, managing informed consent challenges, complicated boundary issues, dual relationships, conflicts of interest, allocation of limited resources, and compliance with allegedly unjust laws. Over time, social work education programs developed curricula to teach students about ethical dilemmas and decision making.
• Ethical risk management period: In the early 1990s, the winds shifted yet again. Although many social workers sustained their interest in ethical dilemmas and decision making, new concerns emerged regarding ethics-related risk management.
Data began to circulate concerning increases in lawsuits and licensing board complaints that raised ethical issues. Increased publicity alerted social workers to relatively new information about the ways in which social workers’ ethical judgments could lead to litigation and licensing board complaints. Social workers discovered how disgruntled clients and others could file formal complaints alleging, for example, mismanagement of clients’ confidential and privileged information, boundary and dual relationship violations, conflicts of interest, negligent service delivery, and inappropriate termination of services.
For the first time in social work’s history, literature emerged about the links between social workers’ ethical judgment and potential malpractice, negligence, and professional discipline. Licensing boards developed websites listing social workers who were sanctioned because, for example, they committed fraud, had sex with clients, and disclosed sensitive confidential information without proper authorization.
Professional ethics no longer was limited to questions such as what’s the right thing to do in this complicated situation? For many social workers, ethics now included questions such as “Can I be sued or have a licensing board complaint filed against me if I...?” Ethics-related risk management became a relatively new component of social work education and training.
• Digital period: And now we have embarked on a new period, one which few of us, I suspect, could have anticipated. Today’s social workers can provide services online or via video counseling or text messages to clients they never meet in person. They may receive Facebook friend requests from clients or former clients that lead to boundary challenges. In this digital era, social workers can use e-mail as a therapeutic tool and provide clients with specialized smartphones that enable them to record and transmit summaries of their moods to their clinicians and caseworkers, receive therapeutic messages and alerts, and communicate with other people in their digital network who face similar life challenges (a virtual support group).
The advent of this technology—applauded by some and decried by others—has introduced unprecedented ethical challenges related to informed consent, privacy and confidentiality, boundaries, documentation, client abandonment, and the delivery of services across jurisdictional borders. Licensing boards and regulatory bodies are actively engaged in earnest efforts to develop constructive guidelines to govern entirely new forms of social work practice.
Social work’s pioneers, including Jane Addams, Mary Richmond, Grace Abbott, Edith Abbott, and Sophonisba Breckinridge, could not have forecast the evolution of social work ethics. Although some of the ethical challenges faced by today’s practitioners resemble those encountered in the late 19th and early 20th centuries, others were unimaginable during the profession’s earliest years. No one during those early years could have anticipated complex confidentiality issues related to HIV and AIDS, managed care, or social workers’ use of digital technology to communicate with clients and deliver services. Indeed there are new phenomena under the sun that require fresh analyses and new conceptual frameworks.
And that’s the moral of the story. Social work ethics is a moving target. Practitioners cannot afford to become complacent, assuming that age-old tenets will suffice as we move forward. Once upon a time a one-page code of ethics sufficed. It no longer does.
— 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.