Eye on Ethics
Hobson’s Choices in Social Work Ethics — The Illusion of Options
According to legend, Thomas Hobson, a 17th century English livery stable owner, required every customer to take the horse nearest the door. Hobson rented out horses, mainly to Cambridge University students, but refused to let customers choose their horse. In contemporary times we have come to define “Hobson’s choice” as “take it or leave it.”
In my experience, social workers sometimes face something like a Hobson’s choice when they confront daunting ethical choices. In these situations, theoretically there are several “horses” from which to choose, but in reality there is no true choice; despite our understandable wish for alternatives, there is only one option available, a so-called forced choice.
Consider this example: Melinda W. was a social worker employed by her state’s Department of Corrections. Melinda provided casework and counseling services to inmates incarcerated in the state’s maximum and medium security prisons for men. Her responsibilities included individual and group counseling.
One of Melinda’s individual clients was a 37-year-old inmate, Wayne F., who was serving a six-year sentence for possession and distribution of a controlled substance (heroin). This was Wayne’s third prison sentence. He told Melinda he was “sick and tired of being sick and tired.” Wayne told Melinda about his trauma history, which included childhood neglect, severe child abuse at the hands of his stepfather, and a series of foster and group home placements and his pattern of self-medicating with cocaine, heroin, and alcohol since his adolescent years. Melinda was impressed with Wayne’s earnest efforts to grapple with what he described as his “demons” and Wayne’s sustained commitment to recovery and rehabilitation. Wayne was a faithful participant in the prison’s 12-step meetings and formal substance abuse treatment program.
Wayne explained that as part of his efforts to follow the 12 steps of his addiction recovery, he needed to conduct an honest and thorough moral inventory and frankly acknowledge his wrongful behavior.
That being said, every well-trained social worker understands that there are limits to clients’ right to confidentiality. State laws typically require social workers to report suspected child and elder abuse and neglect, and disclose information to protect third parties who have been threatened with serious harm by a client, even when clients object to the disclosure. According to the NASW Code of Ethics, “The general expectation that social workers will keep information confidential does not apply when disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person” (standard 1.07[c]). Further, social workers are sometimes forced to disclose clients’ confidential information without their consent in response to a court order, for example, when a judge determines that disclosure is necessary during legal proceedings (for example, a child custody dispute or malpractice case) despite clients’ privileged communication rights.
In this respect, Melinda must decide which takes precedence: Wayne’s right to confidentiality or a social worker’s duty to disclose confidential information without a client’s consent in order to resolve an unsolved murder. On its face, this situation seems to offer two reasonable choices. But if we draw on ethical principles and a rigorous decision-making protocol, we will discover that there is only one reasonable option. A close reading of the language in the NASW Code of Ethics should focus on the prominent and important stipulation that social workers are permitted to disclose confidential information without client’s consent only when “disclosure is necessary to prevent serious, foreseeable, and imminent harm to a client or other identifiable person” (standard 1.07[c]). Although it is tempting to conclude that the social worker, Melinda, would be permitted to, or should, disclose information about Wayne’s confession in order to resolve an unsolved murder, this Code of Ethics standard requires Melinda to demonstrate that this disclosure would prevent serious, foreseeable, and imminent harm. The word prevent implies that Melinda’s disclosure would thwart future serious harm that is both foreseeable and imminent. Assuming that Wayne does not currently manifest behaviors that would lead Melinda to conclude that he poses a serious, foreseeable, and imminent threat of harm, I believe Melinda would not be able to satisfy the threshold criteria required by the NASW Code of Ethics to justify disclosure of confidential information without her client’s consent.
I fully understand that a social worker may want to share this information in order to resolve an unsolved murder; this is a reasonable instinct considering social workers' concern about serious crime and victim impact in such a serious case. However, social workers have a fundamental duty to uphold clients’ rights in accordance with prevailing ethical standards, even when they may wish to do otherwise. In this instance, the social worker must protect her client’s confidentiality, even though she may not want to. The client is actively engaged in counseling and has impressed his social worker with his earnest wish to address the complex issues with which he has struggled for years. Part of this difficult process, it appears, is acknowledging his past wrongs, including a murder he says he committed. All of the evidence suggests that the social worker’s disclosure of information about the murder would not prevent serious, foreseeable, and imminent harm.
When faced with difficult ethical decisions, social workers sometimes identify what appear to be several reasonable options and must decide among them. In other instances, social workers have only one choice, the moral equivalent of Hobson’s choice. Put differently, social workers must be mindful of the important distinction between what they may believe is the right thing to do in the midst of an ethical dilemma and what they have a right to do.
— 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.