The Routledge Handbook of Social Work Ethics and Values 9781138343931, 9780429438813

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“This impressive volume provides an excellent illustration of how social work values and ­ethics demand clarity regarding both relevant questions and sensible solutions. In advocating for lucidity of thought and inquiry, this book is a valuable resource for those wishing to engage in thinking about and practicing social work in a variety of settings.” – Daniel Pollack, Professor at Wurzweiler School of Social Work, Yeshiva University, New York City “Stephen Marson and Robert McKinney have compiled the most comprehensive resource on social work values and ethics available. With a cadre of diverse experts and authors, this book contains a wealth of information and guidance for both neophyte and experienced practitioners. It is a remarkable and timely undertaking.” – Grafton H. Hull, Jr. EdD., Professor Emeritus, University of Utah College of Social Work “Marson and McKinney have pulled together a thorough anthology of essays and research articles about ethics in social work and the principles that should guide our professional work. There is nothing more important in professional education than teaching students how to confront ethical issues and to solve ethical problems while maintaining the dignity of all persons. We sometimes give ethics short shrift, but this collection of work from these world-wide authors helps us understand the range of moral and ethical problems we face In practice as well as the means by which we are able to ethically mitigate the human suffering that abounds in our world.” – Kay Seeley Hoffman, PhD, Professor Emeritus, University of Kentucky “I congratulate the editors of this volume for seeking out a range of reasoned views on the contentious subject of abortion. Most social workers will, at one time or another, encounter clients with strongly pro-life convictions. This volume will surely stimulate a rigorous discussion of this important topic, and the social work profession will be the better for it.” – Jennifer Roback Morse, PhD, Founder and President of the Ruth Institute

The Routledge Handbook of Social Work Ethics and Values

The Routledge Handbook of Social Work Ethics and Values is a comprehensive exploration and assessment of current and future issues facing social work practice and education. It is the first book to codify ethical practices for social workers from across the globe and in myriad workplace settings. Each section meaningfully captures this complex subject area: • • • • • • • • • • •

ethics writ large visions of diverse values abortion relationship and gender issues micro and mezzo practice settings social work education technological issues spirituality globalism economic issues special topics

Leaving no stone unturned, this handbook comprehensively addresses the most controversial topics in an evenhanded manner. Among professional social workers, values and ethics traverse political boundaries, cultural identifications, and languages. This handbook will help to make sense of this unity within diversity. With contributions from the world’s leading scholars, this book will be a valuable resource for all social work students, academics, researchers, and practitioners who seek a coherent and objective analysis in the abstract arena of ethics and values. Stephen M. Marson was educated at the North Carolina State University (PhD) with his minor from the University of North Carolina at Chapel Hill in social work, The Ohio State University (MSW), and Ohio Dominican University (BA). After 40 years, he retired from



his professorship at the University of North Carolina at Pembroke and is now a Professor Emeritus. He has published and presented numerous papers in the area of social work values and ethics and is the founder and editor of The Journal of Social Work Values and Ethics. Robert E. McKinney, Jr. was educated at The University of Alabama (PhD, MSW) and at Mississippi State University (BA, philosophy). He is an Assistant Professor, jointly appointed at The University of Alabama College of Community Health Sciences and School of Social Work. He teaches learners from myriad health care disciplines about ethical behaviors and the social determinants of health in an interprofessional educational residency setting at The University of Alabama Family Medicine Residency – Tuscaloosa Campus. He is a clinical social worker and registered yoga therapist.

The Routledge Handbook of Social Work Ethics and Values

Edited by Stephen M. Marson and Robert E. McKinney, Jr.

First published 2019 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 selection and editorial matter, Stephen M. Marson and Robert E. McKinney, Jr.; individual chapters, the contributors The right of Stephen M. Marson and Robert E. McKinney, Jr. to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record has been requested for this book ISBN: 978-1-138-34393-1 (hbk) ISBN: 978-0-429-43881-3 (ebk) Typeset in Bembo by codeMantra

Contents

List of illustrations xiii List of contributors xiv Acknowledgments xxv 1 A historical foundation to ­social work values and ethics 1 Stephen M. Marson and Robert E. McKinney, Jr. Section I

Ethics writ large 5 2 International analysis of human rights and social work ethics 7  Annie J. Keeney, Abdulaziz Albrithen, Shannon Harrison, Linda Briskman, and David Androff 3 Ethical theories and ­social work practice 15 Frederic G. Reamer 4 Then and now: the history and ­development of social work ethics 22 Terricka Hardy 5 An integrated principle-based approach to international ­social work ethical principles and ­servant leadership principles 28 Sandra R. Williamson-Ashe and Charles M. S. Birore 6 Social worker self-care: an ethical responsibility 36 Dorothy S. Greene and Karen T. Cummings-Lilly 7 The test of a good conscience 44 John Solas 8 Narrative ethics in ­social work practice 51 Allan Edward Barsky vii

Contents

9 How a relational approach to ­practice can encourage social work to return to its ethical endeavor 58 Elizabeth C. Reimer and Lester J. Thompson 10 Ethical action in challenging times 65 Kim Strom-Gottfried Section II

Visions of diverse values 73 11 Social work ethics and values within the context of South African social work education and practice 75 Sue Cook 12 Barriers to ­designing a code of ethics for social ­workers in the Arab society 83 Fakir Al Gharaibeh 13 Disability ethics: a confluence of human and distributive rights 90 Elizabeth DePoy and Stephen Gilson Section III

Abortion 99 14 Self-determination and abortion access: a pro-choice perspective on the International Statement of Ethical Principles 101 Heather Witt, Erica Goldblatt Hyatt, Carly Franklin, and Maha N. Younes 15 Social work’s first obligation: the role of social workers in protecting unborn children 109 William C. Rainford and Bruce A. Thyer 16 Mercy or murder: social work and ambivalence over abortion 117 Mary S. Sheridan Section IV

Relationship and gender issues 125 17 Advocating for self-­determination, arriving at safety: how social workers can address ethical dilemmas in intimate partner violence 127 Amber Sutton and Catherine Carlson viii

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18 Social work clinical practice and intimate partner violence: a system approach to help reverse the macro and individual effects of violence 135 Maria E. Taylor 19 The legal and ethical ­consequences of human trafficking 143 Michelle Sunkel Section V

Micro practice settings 149 20 Social work ethics and ­values: global issues in ­criminal justice practice 151 Kathi R. Trawver, Kelli E. Canada, and Stacey Barrenger 21 Boundary issues and dual ­relationships in social work: a global perspective 157 Frederic G. Reamer 22 Social workers’ dilemma in ­patients’ rights on end-of-life care and ­ nder the new act in South Korea 165 decision-making u Sooyoun K. Han 23 An effective theoretical ­approach to ethical problem-solving in cross-cultural social work 173 Valerie Bryan, Laura Kaplan, Scott Sanders, Stephen Young, and Paul Mwangosi Section VI

Mezzo practice settings 181 24 Ethics and values in ­social group work 183 Mark Doel 25 Ethical challenges in group work: potential perils and preventive practices 191 Mary Banach and Roshini Pillay Section VII

Macro practice settings 199 26 The ethical ­geography of macro practice: human rights to utilitarianism 201 Ogden Rogers 27 Ethical dilemmas when ­working with extreme right-winged youth cultures in Germany 206 Stefan Borrmann ix

Contents

28 Toward response-able social work: diffracting care through justice 215 Vivienne Bozalek Section VIII

Social work education 223 29 Moral courage and moral distress in social work education and practice: a literature review 225 Eleni Papouli 30 Disagreement about ­ethics and values in practice: using vignettes to study social work 233 Morten Ejrnæs and Merete Monrad 31 Ethical study abroad: good ­intentions aren’t enough 240 Melody Aye Loya and Katherine Peters Section IX

Technological issues 249 32 Ethical social work practice in the technological era 251 Jim Gough and Elaine Spencer 33 Social work and human services leadership in the new genomic era 257 Kelley Reinsmith-Jones 34 Navigating social and ­d igital ­media for ethical and ­professional social work practice 265 Melanie Sage, Becky Anthony, and Laurel Iverson Hitchcock 35 Cross-border social work ­practice and ethics in a digital age 272 Aloha VanCamp, Martin G. Leever, and G. Brent Angell 36 Data justice and ­international development: an ethical imperative for policy and community practice John G. McNutt

280

Section X

Spirituality 287 37 An ethical decision-making model: an Islamic perspective Nada Eltaiba x

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Contents

38 Social work ethics and values: an Arabic-Islamic perspective 297 Abdulaziz Albrithen 39 The Pope Francis’ philosophy and the social work values 304 Silvana Martínez and Juan Agüero Section XI

Globalism 313 40 Essential ethics ­k nowledge in social work 315 Frederic G. Reamer 41 Welcoming the stranger: the ethics of policy and practice with migrant and refugee populations 323 Susan Schmidt 42 From the Welfare State to welfare markets: organization and management of UK social work/social care 331 Stephanie Petrie 43 Trading the hard road: social work ethics and the politicization of food distribution in Zimbabwe Edmos Mthethwa

338

44 The ethics of social work and its professionalization: the Italian case 347 Carlo Soregotti and Annamaria Campanini 45 The ethical question in the Argentine social work 354 Silvana Martínez and Juan Agüero Section XII

Economic issues 363 46 Ethical decision-making in the age of austerity in the UK 365 Andrew Wills 47 Some ethical limitations of ­privatization within social work and social care in England for children and young people 371 Malcolm Carey

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Contents

Section XIII

Special topics 379 48 Unconscious awareness: the implicit and oppressive ethical context of bilingual social work practice 381 Pablo Arriaza 49 Interprofessional ethics: working in the cross-disciplinary moral and practice space 388 Donna McAuliffe 50 Social work practice and ­bullying in the workplace 396 Jim Gough 51 Ethics in the end 403 Robert E. McKinney, Jr. and Stephen M. Marson Index 407

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Illustrations

Figures 5.1 Contextualizing characteristics 5.2 Social work/servant leadership integrated principle-based approach 12.1 Map of Arab League countries

32 33 84

Tables 2.1 Univariate analysis of codes of ethics 9 13.1 Comparative analysis of selected global disability rights policies and practices 96

Box 23.1 The Lukala family 177

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Contributors

Juan Agüero (Argentina) was educated at the National University of La Plata (PhD in ­social work), Buenos Aires University (PhD in economic sciences), and National University of Entre Ríos (MSW). He is Professor at the National University of Misiones. He has published numerous papers, books, and book chapters in the area of ethics, social work, public policies, social development, and social sciences. Abdulaziz Albrithen (Saudi Arabia) received his PhD from the University of Liverpool, MSW from King Saud University, BSE from Al-Imam Mohammad Ibn Saud Islamic University. He joined the United Arab Emirates University and serves as a director of the MSW. He worked as an Assistant Professor at Umm Al-Qura University and then as an Associate Professor at King Saud University, Saudi Arabia. He published articles on social work, both Arabic and English. In 2004, he received an International Prize for his remarkable work of translating The Encyclopedia of Autism Spectrum Disorders into the Arabic language. His research interests include social work ethics, and social work and human rights. David Androff (USA)  studied social welfare at the University of California, Berkeley (PhD, MSW) and sociology at the University of Virginia (BA). He is an Associate Professor in the School of Social Work at Arizona State University where is a Faculty Affiliate of the Lincoln Center for Applied Ethics. His work encompasses human rights, global social work, and social development. He is the author of Practicing Rights: Human Rights-based Approaches to Social Work Practice (Routledge). G. Brent Angell (Canada)  was educated at Case Western Reserve University (PhD), ­ ilfrid Laurier University (MSW), and Trent University (BA). As a Professor Emeritus at W the University of Windsor, his scholarly interests focus on redefining critical perspectives related to diversity and community practice. He is the Editor in Chief of the online periodical Critical Social Work: An Interdisciplinary Journal Dedicated to Social Justice and provides consultation to a broad constituency on topics related to ethics in research and practice. Currently, he holds an appointment on the Indigenous Advisory Panel of the Research Ethics Board at the University of Windsor. Becky Anthony (USA) is an Assistant Professor of Social Work at Salisbury University and holds degrees in social work from Widener University (PhD, MEd), West Chester University (MSW), and Lock Haven University (BSW). She is interested in the infusion of social work and technology, specifically how technology can be utilized within the framework of social work ethics to increase access to services for those most in need. xiv

Contributors

Pablo Arriaza (USA) graduated from the University of Alabama (PhD) and Florida State University (MSW and BS). Currently he is an Associate Professor of Social Work at West Chester University in Pennsylvania. His research, publications, and professional presentations have focused on cultural and ethical variables intersecting bilingual social work practice. Mary Banach (USA) was educated at Columbia University (DSW), New York University (MSW), and the University of Wisconsin-Milwaukee (BA). After 15 years of practice as a social worker in New York City, she began teaching at the University of New Hampshire. She has published and presented several papers about group work practice. She has also served for many years on the NH NASW Ethics Committee and is certified as a mediator for NASW ethics complaints. Stacey Barrenger (USA)  received her PhD in social welfare at the University of ­Pennsylvania, obtained an AM (MSW equivalent) from the School of Social Service ­Administration at the University of Chicago, and was granted a BA in social sciences at Michigan State University. She is currently an Assistant Professor at the Silver School of Social Work at New York University. She has interest in how social workers maintain their values while working in settings, such as the criminal justice system, where other values are given priority. Allan Edward Barsky (USA) was educated at University of Toronto ( JD and PhD) and ­ arvey at Yeshiva University (MSW). He is a Professor of Social Work at the Phyllis and H ­ ational ­Sandler School of Social Work at Florida Atlantic University. He is a past chair of the N Association of Social Worker’s (NASW) National Ethics Committee and past chair of the NASW Code of Ethics Review Committee. His book authorships include Conflict Resolution for the Helping Professions, Clinicians in Court, and Ethics and Values in Social Work. He has a regular ethics column published online in The New Social Worker. Charles M. S. Birore (Tanzania) was educated in social work and public health at J­ackson State University, (PhD, MPH), Alabama A&M University (MSW), University of Wales-­ ­ ingdom), Swansea (MSc) in Economic Development, Planning and Management (United K and National Social Welfare Training College (BA) in Social work. Currently, he is an Assistant Professor at Norfolk State University. He has taught social work values and ethics. Stefan Borrmann (Germany) was educated at the Technical University of Berlin (Dr Phil) where he also completed his graduation in social work. Since 2009 he has been a Full Professor for international social work research at the University of Applied Sciences in Landshut (Germany). Currently he is the dean of faculty. His research includes the ethical dimension of social work into his theoretical approaches and has published several monographs about this connection. Vivienne Bozalek (South Africa)  has degrees from Utrecht University (PhD), University of Cape Town (Masters in Social Science, Clinical Social Work), University of the ­Witwatersrand (Bachelor of Social Work). Currently, she is a Professor of Social Work and Director of Teaching and Learning at the University of the Western Cape. She has coedited five books and has presented and published scholarly articles and chapters on social work values and ethics. xv

Contributors

Linda Briskman (Australia) has qualifications from Australia, including Monash University (BA and PhD) and University of Melbourne (MSW). She currently holds the Margaret Whitlam Chair of Social Work at Western Sydney University. She writes on social work ethics and values in relation to human rights, including Indigenous rights, asylum seeker rights, and challenging Islamophobia. Valerie Bryan (USA) University of Kentucky (PhD, MSW, and BASW), Associate Professor of Social Work, University of South Alabama. Ethics scholarship: BSW and MSW course development, state and national ethics workshops, three peer-reviewed articles, ethics book lead author. Kelli E. Canada (USA) received PhD at the University of Chicago, her MSW at Columbia University and her BA from Depauw University. She is an Assistant Professor at the University of Missouri, Columbia. Her research focuses on interventions for people with mental illnesses who become involved in the criminal justice system including pre-arrest interventions, alternative sentencing, community supervision, and programming within institutions. She also examines the policies and practices impacting recidivism. Annamaria Campanini (Italy), was educated in social work at Parma University, and in sociology at Urbino University, has obtained the PhD in sociology, Theory and ­Methodology of Social Work at Trieste University and is Professor at the University of Milano-­Bicocca. She is the President of the International Association of Schools of Social Work. She has many publications in the area of social work at national and international levels and serves in the editorial board of numerous international journals. Malcolm Carey (UK)  was educated at the University of Liverpool (PhD), ­C ardiff University (PostGraduate Diploma in Social Work), and the City of London University (BA  Hons). He teaches and is Professor of Social Work at the University of Chester. His numerous books include Practical Social Work Ethics and he has published widely in peer-­ reviewed journals including Ethics and Social Welfare, the British Journal of Social Work, and Ageing & Society. Catherine Carlson (USA) was educated at Columbia University (PhD), The University of Georgia (MSW), and Emory University (BA). She is an Assistant Professor of Social Work at the University of Alabama. She has managed and consulted with gender-based violence and child protection programs on best practices for how to utilize social work ethics and values for several international NGOs and UN agencies. Sue Cook (South Africa) was educated at the University of Pretoria (DPhil Social Work; MA Social Work Health and Mental Health) and the University of South Africa (BA Hons Social Work). After over a decade in practice in South Africa she is now employed at the University of Plymouth as a lecturer and module lead in social work. She has published and presented papers in the area of social isolation and the ethics of care. Karen T. Cummings-Lilly (USA)  was educated at the University of Tennessee, Knoxville (DSW), San Diego State University (MSW), and California State University, Northridge (BA). She is currently an Assistant Professor in the Department of Social Work at East ­Tennessee State University. During her 30-year career, she has attended numerous trainings on social work values and ethics and has infused this knowledge into her clinical supervision and in the classroom. xvi

Contributors

Elizabeth DePoy (USA) received degrees from the State University of New York at ­Buffalo (BS) and University of Pennsylvania (MSW, PhD). She has been teaching in the School of Social Work and in Interdisciplinary Disability Studies at the University of Maine. Her work ­ uman in the application of progressive disability theory proposing the redesign of disability as h diversity is well known nationally and internationally, with her most collaborative work displayed at the Smithsonian Cooper Hewitt Museum in New York. Mark Doel (UK)  was educated at Birmingham City University (PhD), Hull University (CQSW), and Oxford University (MA/BA). He is a Registered Social Worker and Emeritus Professor at Sheffield Hallam University, England. He has 20 years of direct social work practice experience and 20 years as an academic, training consultant, and writer. He was coeditor of Groupwork journal and his publications include Rights and Wrongs in Social Work: Ethical and Practice Dilemmas and A-Z of Groups and Groupwork. Morten Ejrnæs (Denmark)  was educated as a sociologist (MSS) at the University of ­ openhagen in 1974, and has worked as a social worker both as a volunteer and an emC ployee in a Settlement. Since 1998, he has been an Associate Professor at Aalborg University, ­Department of Sociology and Social Work, and has made research about ethics, values, and attitudes in social work using the vignette method. Nada Eltaiba (Qatar) was educated at the University of Western Australia in Social Work and Social Policy (PhD), University of Jordan in Counselling and Guidance (MA), and ­Tripoli University, Libya Science and Education specializing in Social Work. She has experience as a practitioner in various settings. She has published and presented a numbers of papers in ethics and social work. Carly Franklin (USA) was educated at the University of Arkansas (MSW, BSW, BA). Her work as a hospice and palliative care social worker has informed her knowledge of social work values and ethics and she continues to explore and apply these principles in a wide variety of social work courses taught to both undergraduate and graduate social work students. Fakir Al Gharaibeh (Jordan)  was educated at the Curtin University of Technology in Australia (PhD) in social work and social policy, and the University of Jordan (MSW and BA). Currently, he is an Associate Professor at the University of Sharjah in United Arab Emirates. He has published many articles internationally in the area of ethics, social work, and social policy. Stephen Gilson (USA)  received degrees from Long Beach State University (BFA), Denver ­University (MSW), and the University of Nebraska (PhD). He is Professor of Social Work and Coordinator of Interdisciplinary Disability Studies at the University of Maine. Stephen is committed to social justice and full inclusion and has well published in these arenas. His collaborative work is currently on display at the Smithsonian Cooper Hewitt Museum in New York. Jim Gough (Canada) received his PhD from Waterloo University, and his MA and BA from Guelph University. He received his AOCAD from the University of Toronto. Currently, he is an Adjunct Professor of Philosophy at Athabasca University in Alberta, Canada. He teamed with Dr. Shankar Yelijah to create a textbook entitled Ethical Issues in Social Work. With Professors Elaine Spencer and Duane Massing, he authored Social Work Ethics: Progressive, Practical, and Relational Approaches. xvii

Contributors

Dorothy S. Greene (USA) was educated at the University of Utah (PhD), University of North Carolina at Chapel Hill (MSW), and Western Carolina University (BSW). She is an Assistant Professor in the Department of Social Work at East Tennessee State University. Her scholarship was focused on the ethical considerations of practitioner and social work student well-being, self-care, impairment, and relapse. Sooyoun K. Han (Republic of Korea)  was educated at Sookmyung University (PhD, MS, BS) and the City of New York, Columbia University (MSW). She has been an Associate Professor at Namseoul University in South Korea since 2013. She is the founder of NGO, CARE RIGHTS, aiming to protect and advocate for elderly patients’ rights on their endof-life care and decision-making. She has published and presented papers in social work and health care. Terricka Hardy (USA) was educated at the University of Tennessee, Knoxville (MSSW) and the University of Memphis (BS). Terricka has presented numerous professional development presentations on social work values and ethics nationally. She currently serves as a member of the National Association of Social Worker’s (NASW) National Ethics Committee and has served on the NASW Professional Impairment Policy Statement Panel. Shannon Harrison (USA) was educated at Colorado State University (PhD, MSW) and Stephen F. Austin State University (BS). She has worked as a licensed clinical social worker for 20 years. Currently, she works as a psychotherapist for the Department of Defense. In addition to the study of human rights, her research interests include child and adolescent suicide prevention. Laurel Iverson Hitchcock (USA) is an Associate Professor of Social Work at the University of Alabama at Birmingham. She holds a degree in public health (MPH) from the University of Alabama at Birmingham and degrees in social work (MSW, PhD) from the University of Alabama. She blogs about ethical issues with social media at Teaching and Learning in Social Work, and is a coauthor of the Social Media Toolkit for Social Work Field Educators. Erica Goldblatt Hyatt (USA) was educated at the University of Pennsylvania (DSW, MSW, MBE) and McGill University (BA). She is currently the Assistant Director of the Doctorate in Social Work and an Assistant Professor at Rutgers University. Incorporating her master’s degree in bioethics with her education and experience in social work, she has served on ethics committees and teaches graduate students about the role of social work values/ethics. Laura Kaplan (USA) University of Kentucky (PhD and MSW), City University of New York (BA in sociology), LCSW, Adjunct Faculty, University of Southern California, independent contractor. Ethics scholarship: MSW/BSW course development, NASW curricula/ ethics tip sheets, NASW chapter ethics committee, hospital ethics committee member, manuscript editor, nine peer-reviewed articles, one ethics book. Annie J. Keeney (USA)  was educated at Colorado State University (PhD) and Eastern Washington University (MSW, BA). She is the Senior Research Associate at the Social Policy Institute at San Diego State University and a lecturer for SDSU School of Social Work. Her interests are aimed toward improving the health and well-being of communities through research and action. This is her second publication in the field of social work ethics and values. xviii

Contributors

Martin G. Leever (USA) holds an MA in philosophy from Marquette University and a PhD in philosophy from Loyola University of Chicago. He teaches ethical theory and professional ethics at the University of Detroit Mercy. His books include Ethical Child Welfare Practice and Ethics in Action. His work has been published in journals such as The Journal of Social Work Ethics and Values, Dialogue, Nursing Ethics, Teaching Ethics, Philosophy in the Contemporary World, Health Care Ethics Committee Forum, and Health Progress. Melody Aye Loya (USA)  was educated at Capella University (PhD in human services with a specialization in social work and community services), University of Texas at Arlington (MSW), and West Texas A&M University (BSW). She is currently an Associate Professor and the Department Head of Social Work at Tarleton State University in Stephenville, Texas. She has presented numerous ethics-themed workshops, including ethical study abroad, and has taught ethics in social work programs at both the undergraduate and graduate levels. Stephen M. Marson (USA) was educated at the North Carolina State University (PhD) with his minor from the University of North Carolina at Chapel Hill in social work, The Ohio State University (MSW), and Ohio Dominican University (BA). After 40 years, he retired from his professorship at the University of North Carolina at Pembroke and is now a Professor Emeritus. He has published and presented numerous papers in the area of social work values and ethics and is the founder and editor of The Journal of Social Work Values and Ethics. Silvana Martínez (Argentina)  was educated at the National University of Entre Ríos (PhD in social sciences). She holds degrees from the National University of Misiones and National University of Entre Ríos (MSW). She is Professor of the National University of Misiones and researcher at the Institute of Social and Human Studies of National University of Misiones & National Council of Scientific and Technique Researches. She has published numerous papers, books, and book chapters in the area of ethics, social work, and social sciences. Donna McAuliffe (Australia) completed her PhD at the University of Queensland, and is now Professor and Head of School in the School of Human Services and Social Work, ­Griffith University. She has been actively involved in professional ethics education and research, and is author of the text Inter-professional Ethics: Collaboration in the Social, Health and Human Services. She has led revisions of the Australian social work code of ethics, is a reviewer for The Journal of Social Work Values and Ethics, and is editor for Ethics & Social Welfare. Robert E. McKinney, Jr. (USA) was educated at The University of Alabama (PhD, MSW) and at Mississippi State University (BA, philosophy). He is an Assistant Professor, jointly appointed at The University of Alabama College of Community Health Sciences and School of Social Work. He teaches learners from myriad health care disciplines about ethical behaviors and the social determinants of health in an interprofessional educational residency setting at The University of Alabama Family Medicine Residency – Tuscaloosa Campus. He is a clinical social worker and registered yoga therapist. John G. McNutt (USA) was educated at the University of Tennessee (PhD), the University of Alabama (MSW), and Mars Hill College (BA). He is currently Professor, School of Public xix

Contributors

Policy and Administration, University of Delaware. He has presented and published numerous articles on social work and social justice and serves on the editorial board of The Journal of Social Work Values and Ethics. Merete Monrad (Denmark) was educated at Aalborg University (PhD) with her master in sociology from the University of Copenhagen (MSc). She is currently Associate Professor at Aalborg University. She has conducted several studies of social work judgments in different fields of practice, focusing in particular on the attitudes and values of practitioners regarding poverty and vulnerable children. Edmos Mthethwa (Zimbabwe)  graduated from the University of Zimbabwe (PhD, MSC, BSW with honors). He has been a lecturer at the University of Zimbabwe, School of Social Work since 2009 and is an experienced researcher and dissertation supervisor at both undergraduate and postgraduate levels. He has more than 30 publications to his credit including book chapters, conference papers, consultancy modules, and journal papers published in referred journals. Paul Mwangosi MSSW (Tanzania) Stockholm University, Sweden (MSS, social work), advanced certifications in social work (Institute for Social Work), Faculty, Institute of Social Work (ISW), Dar es Salaam, Tanzania. Worked with UNICEF concerning children in ­Tanzania, and children/families in England. Eleni Papouli (Greece) received her BSW from the Technological Educational Institute of Athens and obtained her PhD from the University of Sussex. She also holds a Master in International Child Welfare from the University of East Anglia. She is a Lecturer in social work at the Department of Social Work, University of West Attica, Greece. She has published widely on social work values and ethics, both in Greece and internationally and is a member of the editorial board of The Journal of Social Work Values and Ethics. Katherine Peters (Costa Rica)  was educated at the Facultad Latinoamericana de Ciencias Sociales (Latin American Faculty on Social Sciences) (Master’s Rural Development, thesis pending), Framingham State University (MEd with specialization in International Teaching), and Valparaiso University (BAs in Spanish and International Service). She served nearly eight years as the Assistant Director of the Institute for Central American Development Studies in San José, Costa Rica, where she also taught courses on Latin American Perspectives, field research methods, and undergraduate internships, and designed ethical study abroad programs for undergraduate students. She also worked for ten years as a community organizer in immigrant communities in both the United States and Costa Rica. Stephanie Petrie (UK)  was educated at the University of Liverpool (PhD), University of Birmingham (M SocServ), University of Hull (Diploma in social studies/Certificate of Qualification in social work), and the University of Newcastle-upon-Tyne (BA). She has been involved in training, teaching, researching, and publishing about ethical practices with children and young people. Since retirement from teaching in 2011, she has maintained academic work as an Honorary Senior Research Fellow in the School of Law and Social Justice at the University of Liverpool.

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Contributors

Roshini Pillay (South Africa)  was educated at the University of the Western Cape (PhD) with her MA from the University of Pretoria and her BSW from the University of KwaZuluNatal. She is lecturing at the University of the Witwatersrand. She has presented at local and international conferences. She has taught values and ethics to undergraduate social work students. William C. Rainford (USA)  earned his PhD in social welfare from the University of ­California at Berkeley, MSW from Washington University (St. Louis), and BSW from San Jose State University. Currently, he is the Dean of the National Catholic School of Social Service at The Catholic University of America. He is nationally recognized as a practitioner of Catholic Social Teaching, receiving the Catholic Charities USA National Volunteer of the Year Award in 2009, and the Larry Selland Humanitarian Award at Boise State University. Frederic G. Reamer (USA) received his PhD from the University of Chicago, School of Social Service Administration. He is Professor in the graduate program, School of Social Work, Rhode Island College. He is the author of many books and articles on social work and professional ethics and values. Reamer chaired the task force that wrote the National Association of Social Workers (NASW) Code of Ethics. Elizabeth C. Reimer (Australia)  was educated at the University of South Australia (PhD) with her undergraduate degree from Western Sydney University in Community Welfare (BCWelf Hons 1st Class). She is Senior Lecturer at Southern Cross University. She has lectured and published many papers in the area of relational and ethical social work practice. Kelley Reinsmith-Jones (USA)  was educated at Gonzaga University (PhD), Eastern Washington University (MSW and Health Care Administration Certificate), and University of Alaska Southeast-Juneau (BLA). She is currently an Associate Professor and Director of the BSW Program at East Carolina University (ECU) School of Social Work. She has presented research on the intersection of genetics and social work values and ethics. Ogden Rogers (USA)  is Professor and Chair of Social Work at University of Wisconsin River Falls where he also serves as the Associate Dean of the College of Education and Professional Studies. He completed his PhD and MSW from The University of ­Maryland-Baltimore, and his AB in public health from Albright College, Reading, ­Pennsylvania. He consults on issues of human rights and international humanitarian law. Melanie Sage (USA)  earned degrees in social work from Portland State University (PhD), East Carolina University (MSW), and University of North Carolina at Pembroke (BSW). She is an Assistant Professor at the University at Buffalo, State University of New York. She has trained thousands of practitioners on the ethical use of social media in social work, serves as a colead of the American Academy of Social Work and Social Welfare Grand Challenge Harness Technology for Social Good, and is a coauthor of the book Teaching Social Work with Digital Technology. Scott Sanders (USA)  University of Kentucky (PhD), Grand Valley State University (MSW), Eastern Michigan University (BSW). BSW Program Director, Professor of Social Work, Cornerstone University. Ethics scholarship: dissertation, state and national ethics workshops, ethics book.

xxi

Contributors

Susan Schmidt (USA)  holds a doctorate from St. Catherine University/University of St. Thomas School of Social Work (DSW), with master’s degrees from Columbia University School of Social Work (MSSW) and Boston University School of Theology (MTS), before which she studied philosophy and psychology at Houghton College (BA). She is a Professor of Social Work, and field director, at Luther College, and she has worked for more than 20 years on policies and programs affecting refugees and immigrants. Mary S. Sheridan (USA)  was educated at the University of Hawaii (PhD in American Studies); the University of Illinois, Chicago Circle (MSW); and Northwestern University, Evanston, IL (BA). She practiced as a medical social worker for 20 years before founding the BSW and MSW at Hawaii Pacific University, from which she retired as Emeritus Professor of Social Work in 2010. She served on the medical ethics committee at Pali Momi Medical Center, Hawaii; the Institutional Research Board (IRB) at Straub Hospital, Hawaii; and chaired the IRB at Hawaii Pacific University. John Solas (UK) was educated at the University of Queensland (PhD; BSW) and Central Queensland University (BA). He is senior lecturer in social work at the University of Bradford and holds a Research Fellowship in the Department of Politics, Philosophy, International Relations and Environment at Keele University. He has taught social work ethics and ethics, human rights, and social justice for the past 15 years, in Australia and the United Kingdom. Carlo Soregotti (Italy) is a registered Italian Social Worker. He obtained the Ph.D. in Applied Sociology and Social Research Methodology at Milano-Bicocca University. He was educated in Social Work and Social Politics (MSW), Social Work Sciences (BA), and Philosophy (BA) at Verona University, where he currently is employed as adjunct professor. He teaches courses on Social Work Principles, Fundamentals, and Professional Ethics. He is a Social Workers’ Regional Council elected member for Lombardy, and he publishes contributions in books and conferences about social work codes of ethics, values, and education. Elaine Spencer (Canada) is a Registered Clinical Social Worker (Alberta) and Approved Clinical Supervisor. She obtained her MSW from the University of Toronto and her BSW from the University of Calgary. She has been a social work educator at Red Deer College since 2005. She has an extensive presentation and publication history in rural, clinical, and progressive social work practice and ethics. She recently coauthored/edited Social Work ­Ethics: Progressive, Practical and Relational Approaches. Kim Strom-Gottfried (USA) was educated at Case Western Reserve University (PhD), Adelphi University (MSW), and The University of Maine (BA). Smith P. Theimann Jr., ­Distinguished Professor of Ethics and Professional Practice. Director University of North Carolina Office of Ethics and Policy. Former Chair NASW Committee on Inquiry. International researcher, trainer, and author on ethics and moral courage. Michelle Sunkel (USA) was educated from Capella University (Doctor of Social Work); obtained a second masters from a European Consortium Partnership at Katholieke Universiteit Leuven, Belgium, Radboud Universiteit Nijmegen, Netherlands, and Universita degli

xxii

Contributors

Studi di Padova, Italy (Masters in bioethics); attended San Diego State University (Masters in social work) and Lincoln University (Bachelors in psychology). She is an Assistant Professor at Colorado Mesa University. She teaches a course on social work values and ethics. Amber Sutton (USA) will be attending the University of Alabama (PhD) beginning the fall of 2018, and holds degrees from Washington University in St. Louis (MSW) and from the University of Montevallo (BSW). She has utilized her training in social work to implement ethics and values within her direct practice experience as well as trained on and discussed these topics with employees in her role as a supervisor. Maria E. Taylor (USA) attended the University of South Florida (MSW) and Eckerd College (BA). She is employed as an LCSW at the Bay Pines Veterans Affairs Health Care System as a Social Work Supervisor, Intimate Partner Violence Assistance Program Coordinator, Life Sustaining Treatment Decisions Initiative Coordinator, and Ethics Consultation Coordinator. Lester J. Thompson (Australia)  was educated at the University of Queensland (PhD) completing bachelor degrees in science and social work before completing his Master’s degree in regional science. He is Senior Lecturer at Southern Cross University and publishes in areas related to social justice, cross-cultural policy analysis, ethics, and relational social work practice. Bruce A. Thyer (USA)  attended the University of Michigan (PhD), the University of ­Georgia (MSW), and University of Maryland (BSc). He is a Distinguished Research Professor of Social Work with Florida State University, and an Extraordinary Professor at North West University in South Africa. He is the Editor of Research on Social Work Practice and ­Coeditor of the Journal of Evidence-based Practice and of the Child and Adolescent Social Work Journal. He has published articles dealing with ethical human services. Kathi R. Trawver (USA) received a PhD from the University of Texas at Austin, an MSW from the University of Alaska Anchorage, and a BSW from the University of Northern Iowa. With the LMSW, she is currently an Associate Professor at the University of Alaska ­A nchorage School of Social Work. She has presented both nationally and internationally on ethical considerations within problem-solving courts. Aloha VanCamp (USA) received a PhD in education research and evaluation from Wayne State University, a Masters in social work (MSW), and an undergraduate degree (BA) in liberal arts from Michigan State University. She is a tenured Professor at the University of Detroit Mercy and has numerous presentations and publications on topical issues in social work education. Sandra R. Williamson-Ashe (USA) was educated in higher education administration and leadership at The George Washington University (EdD), Norfolk State University (MSW), and The University of North Carolina at Charlotte (BS) in criminal justice. Currently, an Assistant Professor in The Ethelyn R. Strong School of Social Work, she has published in The Journal of Social Work Values and Ethics on student group work values. Continuous research includes ethics in leadership.

xxiii

Contributors

Andrew Wills (UK) was educated at Anglia Ruskin University (PhD) and Lancaster University (MA systems in management; DipSW). He is a Fellow of HEA, and a member of BASW. He is currently employed as a lecturer at the University of Plymouth. His current research interests include social workers “risk thinking;” emerging novel social work/social enterprises; and the ethics of social work decision-making in “the age of austerity.” Heather Witt (USA) received her two master’s degrees in social work and human sexuality education, a PhD from Widener University, and her BS in psychology from Boise State University. She is currently an Assistant Professor in the School of Social Work at Boise State University. She has authored multiple research articles on these topics and a special topics chapter on infertility in Sexuality Concepts for Social Workers and Human Service Professionals. Maha N. Younes (USA)  received her education at the University of Nebraska at Lincoln (PhD), University of Nebraska at Omaha (MSW), and Kearney State College (MSEd) (BSW). She is a Professor of Social Work at the University of Nebraska at Kearney. She is a published scholar, cultural humility trainer, and a strong advocate for responsive legislation that promotes general well-being. Stephen Young (USA)  University of Georgia (PhD), Indiana University Indianapolis (MSW), Indiana University Bloomington (BSW). Assistant Professor/BSW Program ­Director, University of South Alabama. Ethics scholarship: dissertation research evaluating ­decision-making model used internationally by HIV/AIDS treatment providers.

xxiv

Acknowledgments

What molds a scholar to be a leader in the academic arena? We believe that institutions of higher education are the catalysts of intellectual advancement. We wish to pay tribute to the institutions of higher education to which each of our authors is connected. In alphabetical order, they are: Al-Imam Mohammad Ibn Saud Islamic University, Ruskin University, ­Birmingham City University, Boston University, Brody School of Medicine at East Carolina U ­ niversity, Brown University, Buenos Aires University, California State University, Capella University, ­Cardiff University, Case Western Reserve University, Catholic University of Temuco, Central Queensland University, City of London University, City University of New York, ­Cleveland State University, Colorado State University, Columbia University, ­Curtin ­University of T ­ echnology, Denver University, Depauw University, East Carolina University, Eastern ­M ichigan University, Eastern Washington University, Eckerd College, Facultad ­Latinoamericana de Ciencias Sociales, Fielding Graduate University, Flinders University, Florida State University, Framingham State University, George Washington ­University, Gonzaga University, Grand Valley State University, Guelph University, ­Houghton ­College, Hull University, Indiana State University, Indiana University, Indiana University ­Bloomington, ­Indiana University Indianapolis, Institute for Social Work – Sweden, J­ackson State University, Katholieke Universiteit Leuven, Kearney State College, King Saud University, Lancaster University, Lincoln University, Lock Haven University, Long Beach State ­ hicago, Marquette University, Mars Hill College, M ­ cGill University, Loyola University of C University, ­McMaster University, McMaster University in Hamilton, Michigan State University, Minnesota School of Social Work, Mississippi State University, Missouri State University, National Social Welfare Training College, National University of Entre Ríos, National University of Misiones, National University of La Plata, Nebraska at Omaha, New York University, Newman Theological College, Norfolk State University, North Carolina State University, North West University, Northridge University of Houston, Northwestern University, Ohio Dominican University, Ohio State University, Oxford University, Parma University, Portland State University, Purdue University, Radboud Universiteit Nijmegen’, Radford University, Rhode Island College, Rutgers, the State University of New Jersey, Salisbury University, San Diego State University, San Jose State University, Sookmyung University, Southwest Baptist University, Spring Hill College, St. Catherine University/ University of St. Thomas, St. Thomas College, State University of New York at Buffalo, Stephen F. Austin State University, Stockholm University, Tata Institute of Social Sciences, Technical University of Berlin, Technological Educational Institute of Athens, Trent University, Trieste University, Tripoli University, University of Oxford, Universidad de La Frontera, Universita degli Studi di Padova, University at Albany in New York, University xxv

Acknowledgments

at Buffalo, University of Alabama, University of Alabama at Birmingham, University of Alaska Anchorage, University of Alaska Southeast-Juneau, University of Alberta, University of A ­ nkara, University of Arkansas, University of Arkansas Little Rock, University of ­Birmingham, University of C ­ algary, University of California at Berkeley, University of Cape Town, University of C ­ hicago, University of Copenhagen, University of Denver, University of East Anglia, University of Eastern Finland, University of Exeter, University of Georgia, University of Georgia Emory, University of Hawaii, University of Houston-Downtown, University of Hull, University of Illinois – Champaign-Urbana, University of Illinois at Chicago Circle, University of Jordan, University of Kentucky, University of Kwazulu-Natal, University of Lincoln, University of Liverpool, University of Maine, University of Mary Washington, University of Maryland-Baltimore, University of Memphis, University of Michigan, University of Montevallo, University of Nebraska, University of Nebraska at Lincoln, University of Nebraska at Omaha, University of Nevada, Las Vegas, University of Newcastle, University of North Carolina at Chapel Hill, University of North Carolina at Charlotte, University of North Carolina at Pembroke, University of Northern Iowa, University of Pennsylvania, University of Pretoria, University of Queensland, University of Queensland, University of Salford, University of South Africa, University of South Alabama, University of South Florida, University of Sussex, University of Tarapacá, University of Tennessee, University of Tennessee, Knoxville, University of Texas at Arlington, University of Texas at Austin, University of the Witwatersrand, University of Toledo, University of Utah, University of Virginia, University of Virginia’s College at Wise, University of Wales-Swansea, University of West Florida, University of Western Australia, University of Wisconsin-Milwaukee, University of Zimbabwe, Utrecht University, Valparaiso University, Verona University, Virginia Commonwealth University, Washington University, Waterloo University, Wayne State University, West Chester University, West Texas A&M University, Western Carolina University, Western Sydney University, Widener University, Wilfrid ­Laurier University, Yeshiva University. We humbly thank these colleges and universities for their contributions. Stephen M. Marson and Robert E. McKinney, Jr.

xxvi

1 A historical foundation to ­social work values and ethics Stephen M. Marson and Robert E. McKinney, Jr.

One of the earliest recorded social work ethical dilemmas can be found in Acts of Apostles (Marson & MacLeod, 1996). Theologians who specialize in the study of Acts of Apostles have given label “social worker” to the protomartyr, Stephen. In modern social work terminology, Stephen would be called a case manager in his role as the first diakonate or social ministry. As a first recorded deacon (derived from the Greek word “to serve”), he was responsible for the distribution of resources to widows and orphans, but he insisted that these scarce resources be distributed equitably. Systematic discrimination was the standard and fairness was contrary to the cultural norm. In the end, Stephen faced a trial for blasphemy and was subsequently stoned to death. His death may not have been intention of the court – that part is unclear; however, it is clear that his death was the result of his application of values and ethical principles as they related to the equitable distribution of resources. Allegations of blasphemy were used to cover the hidden agenda (suppress the minority group). Notwithstanding, the “legal” standards for blasphemy – for which Stephen was accused – were not met. If a social work code of ethics had existed during Stephen’s time, he would have been unambiguously exonerated. Nevertheless, the contempt for minority groups was so pervasive within this communal setting, Stephen might have been assassinated anyway, regardless of a positive court finding. Even without a social work code of ethics, Stephen was able to ascertain appropriate ethical conduct and was able to withstand the pressures of the political elite. However, he did this by sacrificing his life. Social work codes of ethics (of which there are many) have two primary functions. First, they serve as guidance for professional behavior. In Stephen’s case, it was clear that the ethical road was to make sure that everyone received food and drink. The ethical course of action can be contaminated by governmental regulation, tradition, and cultural perimeters. Similar to the story of Acts of Apostles, in 2018 the President of the United States established a policy of separating infants from mothers among those who allegedly passed the border by illegal means. With all the unambiguous evidence of the long-term impact of mother-infant bonding, this separation was deemed ethically disturbing – even by those strongly supporting border security. US citizens who had no written code of ethics but immediately recognized the problematic nature of the policy. Many elected officials did not recognize the ethical problem. Rather, they focused on the goal of securing the border and 1

Stephen M. Marson and Robert E. McKinney, Jr.

ignoring all else. Codes of ethics facilitate clarity for ambiguous social circumstances. However, if a code of ethics is not read or ignored, it is useless. Second, codes of ethics protect the social worker from the actions of others and more importantly codes protect social service recipients from unethical actions of social workers. In most countries, the judiciary recognizes a professional code of ethics as the standard which governs the activities of a social worker. If others are distressed about the activities of a social worker, the code of ethics becomes a catalyst for legal protection. Currently, the most frequently cited unethical behavior occurs when a social worker becomes involved in a dual relationship (Reamer, 2012). Even though social workers are trained to avoid intimate relationships with clients, an uncomfortable number fall into this trap. More disturbing is the fact that social work practitioners with 10 or more years of practice experience are those who are most likely to become initiate with clients (unpublished data from NASW). This is the best reason to require in-service training about ethics every year for ever practitioner. There exists a third, but more mercenary, function of ethical codes. Part of the definition of a profession is ability to “self-organize” and regulate. Thus, to comply with the definition of “professional,” a code of ethics is a necessary condition. The existence of a social work code of ethics addresses one of the concerns in Abraham Flexner’s renowned speech entitled “Is Social Work a Profession?” Although written in 1915, Flexner’s work continues to vibrate influence in today’s work of social work practice and education on an international level. The speech remains available in book form today (Flexner, 1915) and continues to be read. If social work must be identified as a profession, a code of ethics is required. On October 13, 1960, the National Association of Social Workers in the United States formalized their first edition of a code of ethics. Later, in 1994, the International Federation of Social Workers formalized a code of ethics in 1994. Throughout the world, many codes of ethics exist. They are very similar in nature, but also include elements that are founded in the cultural and judicial perimeters of the country of origin. We offer a sampling of a variety of ethical codes: International Federation of Social Workers http://ifsw.org/policies/statement-of-ethical-principles/ Australia https://www.aasw.asn.au/practitioner-resources/code-of-ethics Canada https://casw-acts.ca/en/Code-of-Ethics Denmark http://www.world-psi.org/en/danish-association-social-workers-dasw France https://www.anas.fr/Le-code-de-deontologie_a735.html Germany https://www.dbsh.de/ India https://ispsw.wordpress.com Ireland https://www.iasw.ie/resources.aspx?contentid=47 2

A historical foundation to ­social work

Israel http://www.socialwork.org.il/ Italy http://www.cnoas.it/La_professione/Codice_deontologico.html Japan http://www.japsw.or.jp/syokai/rinri/sw.html Luxembourg http://cdn.ifsw.org/assets/Luxembourg_code.pdf Norway https://www.fo.no/getfile.php/1320310/01 Om FO/Hefter og publikasjoner/Yrkesetisk grunnlagsdokument_2015.pdf Portugal http://cdn.ifsw.org/assets/ifsw_80111-4.pdf Russia http://cdn.ifsw.org/assets/Russian_ethical.pdf Singapore https://www.sasw.org.sg/public/documents/SASWCodeof Ethics2004.pdf South Korea http://cdn.ifsw.org/assets/ifsw_12405-10.pdf Spain https://www.cgtrabajosocial.es/consejo/codigo_deontologico Sweden http://www.semalia.se/att/Yrkesetik.pdf Switzerland https://www.ssi-suisse.org/en/our-values/101 Turkey http://www.shudernegi.org.tr.tc UK https://www.basw.co.uk/codeofethics/ USA https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English By the time this book is published, more codes from more countries will be endorsed and used. Within this volume, top social work scholars across the globe provide analysis and insight into ethical issues that enlighten social work ethics and values for both education and practice. It is the goal of the editors and contributors of this volume that the information and insights that are provided can help social workers across a broad array of settings and in diverse cultural and legal settings make informed decisions about their own ethical practice. Although no code of ethics or book about ethics can provide hard and fast rules for every 3

Stephen M. Marson and Robert E. McKinney, Jr.

situation, we believe that the topics and themes covered here will provide guidance to help practitioners in our ever-shrinking world to make ethical decisions that are based on principle and that maintain the integrity of the profession and the professional.

References Flexner, A. (1915). Is social work a profession? London: FB & C. Marson, S. M., & MacLeod, E. (1996). The first social worker. The New Social Worker, 3(1), 11. Reamer, R. (2012). Boundary issues and dual relationships in the human services. New York, NY: Columbia University Press.

4

Section I

Ethics writ large

2 International analysis of human rights and social work ethics Annie J. Keeney, Abdulaziz Albrithen, Shannon Harrison, Linda Briskman, and David Androff

Introduction On December 10, 1948, the Universal Declaration of Human Rights (UDHR) was officially adopted by the United Nations General Assembly. This was a landmark document that brought human rights into international law. The Declaration consists of a preamble and 30 articles that affirm fundamental rights and freedoms to all peoples and all nations. The field of human rights is defined by three domains of rights: (1) civil and political rights; (2) socioeconomic and cultural rights; and (3) natural world and the right to work (IFSW, European Region, 2010). Human rights permeate the daily lives of people in every society. Its themes have been linked to political science, law, and social work, among many disciplines. Since its establishment, social work has highlighted human rights issues through humanitarian activities with individuals, groups, and communities, in both institutional and voluntary work (Albrithen & Androff, 2015). A central tenet of the social work profession is the defense of people who are vulnerable, oppressed, underserved, exploited, and susceptible to poverty and violence. This central focus of the social work profession deeply aligns with what human rights pioneers assert as the purpose of the UDHR – the protection and safeguard of human dignity, without charges or convictions. The human rights discipline’s humanitarian approach and the social work profession’s contribution to the welfare of communities exhibit a clear and fundamental point of convergence. Regardless of the type of human rights, whether political or economic, the prevention of violations and protection of these essential basic rights must be taken seriously. Indeed, there is growing attention to human rights within the social work profession. However, there remains a significant gap in the literature that disconnects human rights from the consciousness and practice of many social workers (Albrithen & Androff, 2015). The International Federation of Social Workers (IFSW, 2014) is a global professional body that strives to promote social justice, human rights, and inclusive, sustainable social development. This occurs through social work best practices and engagement in international cooperation. The Federation acknowledges a strong link between the UDHR and the 7

Annie J. Keeney et al.

principles of social work. This link is demonstrated by the IFSW’s definition of social work and through the IFSW’s Statement of Ethical Principles. The Federation defines social work as: A practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility, and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities, and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing. (IFSW, 2014) Further, the Statement of Ethical Principles provides an overarching framework to guide the social work profession. A commitment to uphold the core values and principles outlined in the statement is expected. Promoting human rights, according to the IFSW, is an ethical standard of the social work profession. The social work profession asserts that social workers embrace and promote the fundamental and inalienable rights of all human beings, working to find an appropriate balance between competing human rights (IFSW, 2018).

Purpose of the study Human rights are central to the social work profession. The IFSW (2018) affirms this through the Statement of Ethical Principles. However, for a profession that encourages, educates, and supports the pursuit of social justice, Keeney et al. (2014) found that explicit reference to the UDHR in formalized country-specific codes of ethics was not common practice. Using a cross-case comparison research design, we sought to answer the following research question: “How do the social work Codes of Ethics that do not make reference to the UDHR address issues of human rights and social justice?”

Sample The IFSW website lists 22 national codes of ethics adopted by IFSW member organizations across the globe. The 22 codes of ethics were reviewed for reference to the UDHR. Seven countries did not explicitly reference the UDHR. However, of these seven, two countries ( Japan and Ireland) did reference the IFSW. We determined that referencing the IFSW indicated a strong link between principles of human rights and social justice; therefore, those two codes were also excluded from our analysis. Data were collected on five codes of ethics that did not have an explicit reference to the UDHR (Italy, Israel, Singapore, South Korea, and the United States). Codes of ethics of the five nations were available online through the IFSW website; four out of five were available in English. The Codice deontologico dell’Assistente Sociale (Ordine Assistenti Sociali Consiglio Nazionale, 2002) from Italy was translated into English using Google Translate.

Instrument A basic meta-matrix was used to collect and document information about each of the five codes of ethics that did not reference the UDHR. Meta-matrices are used to assemble data across several cases (i.e. codes of ethics) in a standardized format (Miles & Huberman, 1994). The following data were sought: title of the code of ethics, date the code was last revised, a 8

International analysis of human rights

yes/no indication if the term “human rights” was used; a yes/no indication if the term “social justice” was used; a summary of how the code addressed first-, second-, and third-generation rights, and reviewer comments.

Procedure and analysis The codes of ethics were divided among the researchers, with two researchers assigned to each county’s code of ethics. A meta-matrix was constructed to record the extracted information from each code of ethics for descriptive and cross-case analysis. Univariate analysis was used to describe the use of specific terms (social justice and human rights). The second data analysis procedure was a qualitative procedure of cross-case analysis of the extracted information. Key concepts (i.e. themes) were identified that cut across all codes of ethics (Krueger & Casey, 2009; Miles & Huberman, 1994). Inter-rater reliability between the researchers was 95%.

Results To address the research question, a cross-case analysis was used to identify and describe themes found across the five international social work codes of ethics that did not explicitly reference the UDHR. We examined how the codes of ethics addressed the fundamental first-, second-, and third-generation rights outlined in the UDHR.

Univariate analysis None of the codes of ethics referenced the UDHR or the IFSW (2018) Statement of Ethical Principles. South Korea had the only code of ethics that used the juxtaposed term “human rights” (n=1); this term was not found in the codes from Italy, Israel, Singapore, or the United States. South Korea, the United States, Singapore, and Israel all used the term “social justice” in the formalized codes of ethics (n=4). Italy was the only reviewed code of ethics that did not include the terms “social justice” or “human rights” (Table 2.1). Table 2.1  U  nivariate analysis of codes of ethics Country

Document title

Last revision

Human rights Social justice mentioned mentioned

Italy

Ordine Assistenti Sociali Consiglio Nazionale [National Council of Social Worker] Codice deontologico dell’assistente sociale [Code of ethics of the social worker] The Association for the Advancement of Social Work Code of Professional Ethics of the social workers Singapore Association of Social Workers Code of Professional Ethics Korea Association of Social Work Code of Ethics National Association of Social Workers Code of Ethics

(April 2002)

No

No

(June 2007)

No

Yes

(July 2017)

No

Yes

(n.d.)

Yes

Yes

(November 2017)

No

Yes

n=1 (20%)

n=4 (80%)

Israel

Singapore South Korea United States of America Total

9

Annie J. Keeney et al.

Cross-case analysis Data pertaining to the ways that each of the five codes of ethics addressed the fundamental first-, second-, and third-generation rights were summarized per country. Patterns emerged around the key concepts of human rights and social justice. The overarching theme across the five codes of ethics was the use of “alternative language” to describe the fundamental aspects of social work practice – human rights and social justice. All five of the international codes of ethics reviewed described the primary roles of social workers and the guiding beliefs of the country’s social work profession through the use of alternative language. For example, codes of ethics reviewed used “common welfare,” “human well-being,” or “basic needs” as opposed to human rights. This occurs throughout all the formalized codes of ethics when alluding to concepts found in the UDHR.

Italy The Ordine Assistenti Sociali Consiglio Nazionale [National Council of Social Workers] (2002) Code of Ethics does not specifically refer to human rights. The term “rights,” however, appears at various points in the document. For example, one of its stated principles calls on “the enforcement of universally recognized rights” (p. 2). This specific use of language is without reference to international norms; however, it has provisions that can broadly be attributed to first-generation rights such as freedom, equality, sociability, solidarity, and participation. The Code suggests that the duty of a social worker is to provide extensive information to “customers” concerning their rights. In addition, the Code expects social workers to safeguard the interests and rights of users and customers, particularly those who are “legally incapable.” Social workers are asked to build a social fabric that is welcoming and respectful of rights, including recognizing families as a primary resource. Italy is the only nation whose code of ethics does not explicitly use the term “social justice.”

Israel The Israeli Association for the Advancement of Social Work’s (IAASW, 2007) Code of Professional Ethics of the Social Workers addresses first- and second-generation rights; however, third-generation rights are not discussed. The opening statement of the Code articulates an expectation to uphold or protect human right principles: “Social work directs its professional activities towards helping the individual and society to achieve conditions in which man’s basic needs are fulfilled, and independence, equality and freedom from unnecessary coercion prevail” (IAASW, 2007, p. 2). First-generation concepts are referred to in the Code by addressing clients’ rights to self-determination, freedom from unnecessary coercion, participation in decision-making, and nondiscrimination. The Code encourages social workers to help clients achieve independence, rights, and responsibilities. Social workers are called to promote democratic principles and commit to the pursuit of equal rights for all. According to the Code, social workers are to work to fulfill peoples’ basic needs and ensure access to resources, services, and necessary opportunities. Interestingly, the IAASW (2007) Code was the only reviewed code to use a gendered pronoun. Throughout the document, the use of “man,” “he,” and “him” are used when referring collectively to social workers.

10

International analysis of human rights

Singapore The Singapore Association of Social Workers’ (SASW, 2017) Code of Professional Ethics outlines core values of the social work profession and ethical responsibilities in relation to clients, colleagues, practice settings, the social work profession, and society. Only in terms of the client’s self-determination, autonomy, and informed consent does the Code refer to “rights.” No acknowledgment regarding responsibilities to “human rights” is found, but such acknowledgment is alluded to in the social work mission statement and other aspects of the Code. For example, the mission statement expresses a commitment to “enhancing the lives of human beings” (SASW, 2017, p. 1). The Code calls upon social workers to address rights of those served. Social workers are called on to commit “to the welfare of society” and are “obliged not only to the welfare of those served but also the groups and communities they represent with due regard to the common welfare” (SASW, 2017, p. 9).

South Korea The Korea Association of Social Workers’ (KASW, n.d.) Code of Ethics was the only reviewed code that explicitly used the term “human rights.” Social workers are explicitly called to “respect human rights and [the] equality of every person” (KASW, n.d., p. 5). First- and second-generation rights concepts are also addressed in the ethical standards set forth in the Code. The Code calls for social workers to never discriminate against clients, to improve the well-being of clients, and to strive for social justice while promoting the rights of all social workers. Interestingly, the Code also discusses social workers’ behavior toward financial return by articulating that a lack of payment is not a basis for discrimination, and does not constitute the exploitation of fees for services. Third-generation rights are not addressed in the Code.

United States The National Association of Social Workers’ (2017) Code of Ethics from the United States seeks to describe a set of values, principles, and standards that guide professional social work practice. “Rights” only appears in the Code in terms of clients’ rights to privacy, confidentiality, and informed consent for social work services and research. Concepts related to first-generation rights are mentioned and call for social workers to (a) end discrimination and oppression on any basis, (b) promote the self-determination of everyone, (c) participate in ­decision-making, and (d) safeguard clients’ rights while receiving services. Second-­ generation themes are also mentioned. One of the goals for social workers is to promote social justice, ensuring the full development of all people. The Code notes that the duty of social workers is to promote policies of equality and social justice, promote the general welfare, and advocate for living conditions that allow people to meet their needs. Second-­ generation themes, such as economic rights, are also included, as social workers are called to help others to meet their “basic human needs.” Ensuring access to resources and services is also described as a social work duty. The theme of cultural rights is included in the call to respect and protect cultural diversity. Third-generation rights are casually referred to in that social workers have an ethical responsibly to the general welfare of individuals, communities, and environments spanning from local to global levels. Interestingly, the NASW Code of Ethics is referenced in the SASW Code of Ethics. This was the only cross-reference to another country’s codes found in the reviewed codes.

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Discussion The IFSW acknowledges a strong link between the UDHR and the principles of social work. The UDHR sets the standards for the international community to defend these rights. When direct reference to the UDHR is absent in the international social work community’s codes of ethics, the commitment to the fundamental and inalienable rights of all human beings deserves further attention. Five international codes of ethics were found to have no direct reference to the UDHR. Univariate analysis found that South Korea was the only formalized country code of ethics reviewed to explicitly use the term “human rights,” with Italy the only country code of ethics reviewed that did not use either the juxtaposed terms “human rights or “social justice.” A cross-case analysis revealed the use of alternative language was the primary theme that cut across all five international codes of ethics reviewed. If the core mandate of the social work profession is “promoting social change, social development, social cohesion, and the empowerment and liberation of people” (IFSW, 2018), why would explicit reference to the UDHR, the document that is considered to define fundamental freedoms and human rights, not be integrated into the core document that is expected to guide professional conduct? Social justice is a concept grounded in the principles of fairness, equality, equity, rights, and participation (Hoefer, 2016). The question of responsibility for social justice is much debated. For example, is it the responsibility of the individual or the government to provide for the least advantaged in society? Social work plays a unique role in this question, as social workers often work within the system to change the system. For instance, Israel’s Code regarding social workers’ behavior by virtue of social responsibilities asserts: He must encourage the participation of the public, both his clients and their family members and civilians in general, in designing the policies of the social institutions, in implementing their policies in actual fact, and in actions whose aims are to change what needs to be changed in these policies. (IAASW, 2007) Codes of ethics in the social work community often identify social justice as a core value of the profession. For example, the Singapore Association of Social Workers describes social justice by asserting, “social workers pursue social change, particularly with, and on behalf of, vulnerable and oppressed individuals and groups of people” (IAASW, 2007, p. 1). The juxtaposed term “social justice” was also found in 80% (n=4) of the reviewed codes, perhaps implying that the use of the term is critical to social activism. It should be noted the term “social justice” was not found in Italy’s code; however, that was the only code to have been translated into English using Google Translate. Human rights are central to social work practice. Social workers are called to “contribute to social justice and human dignity” (Dibbets & Eijkman, 2018, p. 213). Developers of social work policy, as well as social work educators, are beginning to conceptualize human rights as an asset valuable to their profession. Many professions, such as that of journalism and education, are perceived as having a responsibility to ensure human rights (United Nations Human Rights Council, 2010). Social workers share in that responsibility. This is illustrated in the United Nations Human Rights and Social Work Manual (1994): Human rights are inseparable from Social Work theory, values and ethics, and practice… Advocacy of such rights must therefore be an integral part of Social Work, even 12

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if in countries living under authoritarian regimes such advocacy can have serious consequences for Social Work professionals. (p. 5) Because the profession of social work is associated with the rights of individuals, social workers in all countries are called to reflect upon their own responsibility to uphold the rights of humans (Dibbets & Eijkman, 2018). For the social work profession, we see the codes of ethics as the first tangible commitment to this responsibility. The use of alternative language can have strong negative connotations to a profession whose commitment to human rights is a central principle. For example, the National Association of Social Workers from the United States describes the social work professions’ primary mission is “to enhance human well-being and help meet the basic human needs of all people” (NASW, 2017, p. 1). The Merriam-Webster Dictionary (2018) defines well-­being as the “state of being happy, healthy and prosperous” and needs as “of necessity.” Thus, the alternative language does not imply responsibility to the protection or pursuit of all the rights that are believed to belong justifiably to all persons. “Of necessity” or the “state of being happy” can be defined, measured, and debated based on cultural norms and expectations. Our research findings elevate the idea that the commitment to all person’s inalienable and fundamental human rights is grossly absent when alternative language is used to allude to human rights. Explicitly referencing the UDHR in social work codes of ethics is one way for the international social work community to align globally and clearly assert that social work is, at its core, a human rights profession.

Limitations The results of this study need to be carefully considered. First, one code of ethics was translated using Google Translate, which could allow for mistranslation or misinterpretation of equivalent county terms. We caution readers to be aware that such mistranslations can introduce false negatives into the data. In addition, the researchers are social work practitioners from the United States, Saudi Arabia, and Australia, who may introduce unintentional bias into the data collection, analysis, and interpretation of results. The data collected were extremely narrow in scope, meaning we only examined the country’s specific codes of ethics. It is possible that reference to the UDHR is found on the associations’ website or other tangible materials, thus arguing that a strong link between the specific country reviewed and the UDHR does exist.

Conclusion The codes of ethics of five international social work professional bodies that do not reference the UDHR were examined. We argue that the social work profession should refrain from the use of alternative language to address concepts such as human rights and make explicit reference to the UDHR. Social workers have a responsibility to pursue social change by challenging social injustices. When alternative language is used, the intentionality of the social work profession’s purpose is compromised. We encourage social workers to: (1) infuse the specific term “human rights” into their daily practice; (2) critically evaluate how the use of alternative language can impact social workers’ responsibility to clients, the profession, and society; and (3) reference and refer to the UDHR, in addition to their country-specific formalized codes of ethics. We call upon all social workers to recognize that in addition to their professional roles (e.g. brokers, educators, facilitators) they should consider themselves first and foremost as human rights advocates. 13

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References Albrithen, A., & Androff, D. (2015). The convergence of social work and human rights: Analyzing the historical and ethical foundations of allied disciplines. Indian Journal of Social Work, 75(4), 535–552. Dibbets, A., & Eijkman, Q. (2018). Translators, advocates, or practitioners? Social workers and human rights localization. Journal of Human Rights Practice, 10, 212–228. doi:10.1093/jhuman/huy018 Hoefer, R. (2016). Advocacy practice for social justice (3rd ed.). Chicago, IL: Lyceum Books. International Federation of Social Workers (IFSW) European Region E. V. (2010). Executive summary. In A. Aigus (Ed.), Standards of social work practice meeting human rights (pp. 1–40). Retrieved from http://cdn.ifsw.org/assets/ifsw_92406-7.pdf International Federation of Social Workers (IFSW). (2014). Global definition of social work. Retrieved from https://www.ifsw.org/what-is-social-work/global-definition-of-social work/ International Federation of Social Workers (IFSW). (2018). Statement of ethical principles. Retrieved from https://www.ifsw.org/global-social-work-statement-of-ethical-principles/ Israeli Association for the Advancement of Social Work (IAASW). (2007). Code of professional ethics of the social workers. Retrieved from http://www.socialwork.org.il/ Keeney, A., Smart, A., Richards, R., Harrison, S., Carrillo, M., & Valentine, D. (2014). Human rights and social codes of ethics: An international analysis. Journal of Social Welfare and Human Rights, 2, 1–16. doi:10.15640/jswhr.v2n2a1 Korea Association of Social Work (KASW). (n.d.). Code of ethics. Retrieved from https://www.ifsw. org/wp-content/uploads/ifsw-cdn/assets/ifsw_12405-10.pdf Krueger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research (4th ed.). Thousand Oaks, CA: Sage. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage. National Association of Social Workers (NASW). (2017). Code of ethics. Retrieved from https://www. socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English Needs. (2018). In Merriam-Webster Dictionary. Retrieved from https://www.merriam-webster.com/ dictionary/needs Ordine Assistenti Sociali Consiglio Nazionale [National Council of Social Workers]. (2002). Codice deontologico dell’assistente sociale [Code of ethics of the social worker]. Retrieved from https://www. ifsw.org/wp-content/uploads/ifswcdn/assets/italy_codicedeontologico.pdf Singapore Association of Social Workers (SASW). (2017). Code of professional ethics. Retrieved from https://www.sasw.org.sg United Nations Centre for Human Rights. (1994). Human rights and social work: A manual for schools of social work and the social work profession. Geneva: United Nations. United Nations Human Rights Council. (2010). Draft plan of action for the second phase (2010–2014) of the world programme for human rights education. UN High Commissioner for Human Rights. Well-being. (2018). In Merriam-Webster Dictionary. Retrieved from https://www.merriam webster. com/dictionary/well-being

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3 Ethical theories and ­social work practice Frederic G. Reamer

When the field of professional ethics emerged in the 1970s, a common feature included the application of ethical theories – rooted in moral philosophy – to the real-life ethical challenges encountered by practitioners. The earliest architects of conceptual frameworks in the professional ethics field recognized the need for rigorous exploration of the complex connections between theoretical frameworks in moral philosophy and ethical dilemmas in professions such as medicine, social work, psychology, nursing, engineering, journalism, law enforcement, business, the military, and the law, among others (Callahan & Bok, 1980; Reamer, 1993, 2019). These include theories and principles of what moral philosophers call metaethics, normative ethics, and practical (often called applied) ethics (Beauchamp & Childress, 2013). Metaethics concerns the meaning of ethical terms or language and the formulation of ethical principles and guidelines. Typical metaethical questions include the meaning of the morally relevant terms right and wrong and good and bad. What criteria should we use to judge whether someone has engaged in unethical conduct? How should we go about formulating ethical principles to guide individuals who struggle with moral choices? Normative ethics is more practical; it attempts to apply ethics theories and concepts to actual moral problems and dilemmas. Practical (or applied) ethics is the attempt to apply ethical norms and theories to specific problems and contexts such as professions, organizations, and public policy. With respect to metaethics, some philosophers, known as cognitivists, believe it is possible to identify objective criteria for determining what is ethically right and wrong or good and bad. Others, however, question whether this is possible. These so-called noncognitivists argue that such criteria are necessarily subjective and any ethical principles we create ultimately reflect our biases and personal preferences. Like philosophers, social workers disagree about the objectivity of ethical principles. Some, for example, believe that it is possible to establish universal principles upon which to base ethical decisions and practice, perhaps in the form of a sanctioned code of ethics or God-given tenets. Proponents of this viewpoint are known as absolutists. Others, known as relativists, reject this viewpoint, arguing instead that ethical standards depend on cultural practices, political climate, religious beliefs, contemporary norms and moral standards, and other contextual considerations. 15

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The debate between absolutists and relativists has an important bearing on our examination of ethical issues in social work (Reamer, 1990). If one believes that conclusions concerning ethical values and guidelines reflect only opinions about the rightness or wrongness of specific actions and that objective standards do not exist, one has no reason to even attempt to determine whether certain actions are in fact right or wrong in the ethical sense. According to this perspective, one opinion would be as valid as another. For example, there would be no objective way to determine whether it is or is not ethical for a social worker to maintain a social or intimate relationship with a former client, share personal information with clients, become ­Facebook friends with a former client, violate a law or agency policy to protect a client, and so on. If one believes, however, that absolute ethical standards do or can in principle exist, it is sensible to attempt to identify the content of these standards and to subsequently use them to judge the rightness and wrongness of particular actions. From this perspective, social workers should be able to consult strict, universally accepted standards to address ethical challenges. The quest to provide a rational justification of principles that could enable people to distinguish between right and wrong has been one of the most challenging problems confronting moral philosophers. Socrates, Plato, Aristotle, Immanuel Kant, Jeremy Bentham, and John Stuart Mill, among other prominent philosophers, have devoted considerable effort to the task. Others, such as David Hume, Karl Marx, and Friedrich Nietzsche, have questioned whether efforts to formulate firm ethical principles are appropriate or worthwhile. Nonetheless, many modern philosophers have made ambitious attempts to outline ethical standards and principles to guide individuals’ decisions (Gewirth, 1978a). Concern about the need for clear ethical standards in social work has also increased significantly in recent years. During the early years of the profession, many social workers embraced and were guided by strong beliefs in Judeo-Christian values (Woodroofe, 1962). Beginning in the 1960s, however, relativism experienced a surge of popularity in social work. Influenced in part by the unsettling effects of the civil disturbances and social unrest of that decade and by the rise of skepticism about conventional social institutions and standards, significant numbers of social workers began to question the validity of professional codes of ethics that suggested specific standards for judging right and wrong. The result was a tendency on the part of many social workers to resist espousing specific ethical standards and values, and especially the temptation to impose any particular value or values on clients, whether they be individuals, families, groups, or communities (Hardman, 1975; Siporin, 1989). What had been described in earlier years as forms of deviance, such as single-parent families, the use of drugs, and certain sexual mores, began to be more respected, or at least tolerated, by many social workers as reflections of lifestyles and preferences of certain age and ethnic groups that were merely different from those of conventional society. Social workers experienced a dramatic shift in their threshold of tolerance for, and understanding of, nontraditional ways of life. During the 1960s, relativism was especially popular in social work, as it was in many other professions. Since this era, however, interest in the development of formal ethical standards and core values has strengthened. The interest in values and ethical principles has not focused primarily on the morality of clients’ preferences and lifestyles, as it did in earlier chapters of the profession’s history. Rather, the concern has been focused on practitioners’ ethics – on the justifications provided for intervening or failing to intervene in clients’ lives, the acceptability of specific forms and methods of intervention, management of complex ethical challenges in clinical social work, the moral dimensions of specific public policies, and the criteria used for distributing services and resources, among others. Practitioners’ willingness to tolerate relativism and the absence of standards as they relate to social workers’ actions and decisions has declined significantly (Emmet, 1962). 16

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Although social workers tend to acknowledge that achieving consensus about a comprehensive set of unequivocal, absolute, and objective ethical standards for the profession may be difficult, the belief is widespread that the profession embraces a number of core values and that social workers’ actions and decisions frequently have ethical dimensions that warrant thoughtful attention. Indeed, prominent codes of ethics in the profession throughout the globe make it clear that although social workers are sensitive to diverse cultural, religious, and social values and norms (a form of relativism), the profession subscribes to a number of bedrock values, ethical principles, and ethical standards (Congress, 2013). Thus, the belief that relativism provides an acceptable strategy for making difficult ethical decisions has grown somewhat anachronistic.

Theories of normative ethics In contrast to metaethics, which is often abstract, normative ethics tends to be of special concern to social work because of its immediate relevance to practice. Normative ethics consists of attempts to apply ethical theories and principles to actual ethical dilemmas. Such guidance is especially useful when social workers face ethical challenges, for example, whether practitioners are obligated to disclose confidential information, without clients’ consent, to protect third parties from harm; manage boundaries skillfully; or allocate limited resources ethically. Theories of normative ethics are generally grouped under two main headings. Deontological theories (from the Greek deontos, meaning “of the obligatory”) claim that certain actions are inherently right or wrong, or good or bad, without regard for their consequences. Thus, a deontologist – the best known is Kant, the 18th-century German philosopher – might argue that telling the truth is inherently right, and thus social workers should never lie to clients, even if it appears that lying might be more beneficial to the parties involved. The same might be said about keeping promises made to colleagues, upholding contracts with vendors, obeying a mandatory reporting law, and so on. For deontologists, rules, rights, and principles are sacred and inviolable. The ends do not necessarily justify the means, particularly if they require violating some important rule, right, principle, or law (Frankena, 1988; Herman, 1993; Rachels & Rachels, 2015). One well-known problem with this deontological perspective is that it is easy to imagine conflicting arguments that use similar language about inherently right (or wrong) actions. One deontologist might argue that all human beings have an inherent right to life and that it would be immoral for a social worker to help a client locate abortion services or to be involved in an act of physician-assisted death, for example, with a client who is gravely ill and wants to end his life. Another deontologist, however, might argue that social workers have an inherent obligation to respect clients’ right to self-determination so long as the actions involved are voluntary and informed, and that it therefore is permissible for social workers to help clients locate abortion services and to be involved in an act of assisted suicide. The second major group of theories, teleological theories (from the Greek teleios, meaning “brought to its end or purpose”), takes a different approach to ethical choices. From this viewpoint, the rightness of any action is determined by the goodness of its consequences. Teleologists think it is naive to make ethical choices without weighing potential consequences. To do otherwise is to engage in what the philosopher Smart (1971) referred to as “rule worship.” Therefore, from this perspective (sometimes known as consequentialism), the responsible strategy entails an attempt to anticipate the outcomes of various courses of action and weigh their relative merits (Frankena, 1988; Rachels & Rachels, 2015). 17

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Teleology has two major schools of thought: egoism and utilitarianism. Egoism is not typically found in social work; according to this viewpoint, when faced with conflicting duties, people should maximize their own good and enhance their self-interest. By and large, social workers act primarily in clients’ best interest, not their own. For example, ordinarily social workers make ethical decisions to enhance clients’ well-being, not to further their own ­career interests. In contrast, utilitarianism holds that an action is right if it promotes the maximum good; historically, it has been the most popular teleological theory and has, at least implicitly, served as justification for many decisions made by social workers. According to the classic form of ­utilitarianism – as originally formulated by the English philosophers Jeremy Bentham in the 18th century and John Stuart Mill in the 19th century – when faced with conflicting duties, one should do that which will produce the greatest good. In principle, then, a social worker should engage in a calculus to determine which set of consequences will produce the greatest good. One form of utilitarian theory is known as good-aggregative utilitarianism; it holds that the most appropriate action is that which promotes the greatest total, or aggregate, good. Another theory is locus-aggregative utilitarianism, which holds that the most appropriate action is that which promotes the greatest good for the greatest number, considering not only the total quantity of goods produced but also the number of people to whom the goods are distributed (Gewirth, 1978a). The distinction between these two forms of utilitarianism is important in social work when one considers, for example, whether to distribute a fixed amount of public assistance in a way that tends to produce the greatest aggregate satisfaction (which might entail dispensing relatively large sums to relatively few people) or produces the greatest satisfaction for the greatest number (which might entail dispensing smaller sums of money to a larger number of people). One problem with utilitarianism is that this framework, like deontology, sometimes can be used to justify competing options. Some philosophers argue that distinguishing between act and rule utilitarianism (Gorovitz, 1971) is important and helpful. According to act utilitarianism, the rightness of an action is determined by the goodness of the consequences produced in that specific case or by that particular act. One does not need to look beyond the implications of this one instance. In contrast, rule utilitarianism takes into account the long-term consequences likely to result if one generalizes from the case at hand or treats it as a precedent. From this point of view, consistency across similarly situated cases is important. Another illustration of the distinction between act and rule utilitarianism concerns the wellknown mandatory reporting laws related to child abuse and neglect. According to these laws, social workers and other mandated reporters are required to notify child welfare or protective service authorities whenever they suspect child abuse or neglect. Circumstances sometimes arise that lead social workers to conclude that a client’s best interests would not be served by complying with the mandatory reporting law. In these instances, social workers believe that more harm than good would result if they obeyed the law. The alleged harm might take the form of bureaucratic inefficiencies and insensitivities. What these social workers are claiming, at least implicitly, is that violating a law is permissible when it appears that greater good would result. This is a classic example of act utilitarianism. An act utilitarian might justify violating a mandatory reporting law if it can be demonstrated convincingly that this would result in greater good (e.g. if the social worker is able to show that he would not be able to continue working with the family if he reported the suspected abuse or neglect and that his continuing to work with the family offers the greatest potential for preventing further neglect or abuse). A rule utilitarian, however, might argue that the precedent established by this deliberate ­v iolation of the law would generate more harm than good, regardless of the benefits 18

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produced by this one particular violation. A rule utilitarian might argue that the precedent established by this case might encourage other social workers to take matters into their own hands rather than report suspected abuse or neglect to local protective service officials and that this would, in the long run, be more harmful than helpful, especially if some social workers do not exercise sound judgment. A key problem with utilitarianism, then, is that different people are likely to consider different factors and weigh them differently, as a result of their different life experiences, values, religious beliefs, political ideologies, and so on. In addition, when taken to the extreme, classic utilitarianism can justify trampling on the rights of a vulnerable minority to benefit the majority. In principle, a callous utilitarian social worker (an unlikely phenomenon) could argue that policies that protect the civil rights of people with mental illness (e.g. extensive competency evaluations before involuntary commitment) are too costly, especially when compared to the costs and benefits of simply removing “public nuisances” from the streets. In light of countless instances throughout history in which the rights of minorities and other oppressed groups have been insensitively violated to benefit the majority, social workers have good reason to be concerned about such strict applications of utilitarian principles.

Rights-based theories Perhaps the best-known alternative to utilitarianism is proposed by philosophers who embrace what is known as the rights-based theory. According to this perspective, statements about people’s fundamental rights – for example, the right to life, liberty, expression, property, and protection against oppression, unequal treatment, intolerance, and arbitrary invasion of privacy – provide the basic language and framework for ethical guidelines (Beauchamp & Childress, 2013). A Theory of Justice, by the contemporary philosopher Rawls (1971), is perhaps the most famous book on this subject. Rawls’s theory, which has profound implications for social workers, assumes that individuals who are formulating a moral principle by which to be governed are in an “original position” of equality such that each individual is unaware of her own attributes and status that might produce some advantage or disadvantage. The assumption is that under this “veil of ignorance,” in which people have no awareness of social or status differences among them, individuals will formulate a moral framework that ultimately protects the least advantaged based on a ranking of priorities. Preoccupation with the least advantaged is a core social work value. Rawls made another distinction that is important for social workers to consider: the distinction between natural duties – that is, fundamental obligations such as helping others in dire need or not injuring other people – and supererogatory actions – that is, actions that are commendable and praiseworthy but not obligatory. Rawls’s work highlighted a concept that has become critically important in ethics and in social work: the ranking of values and ethical duties. For Rawls and many other moral philosophers, ethical decisions often reduce to difficult judgments about what values or duties take precedence over others. Rawls calls this lexical ordering. For example, should a vulnerable client’s right to self-determination take precedence over the social worker’s duty to protect the client from engaging in self-harming behavior (such as when a person who is homeless in dire weather conditions refuses offers of assistance by a social worker)? Other philosophers have also offered important rights-based theories about the most appropriate way to rank conflicting duties. The philosopher Donagan argued in The Theory of Morality (1977) that when choosing among duties that may result in harm, one should do that which results in the least harm. Popper (1966) called this the minimization of suffering, and Smart and Williams (1973) called this negative utilitarianism. 19

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In another prominent example of a rights-based theory that is relevant to social work, the philosopher Gewirth (1978b) has offered a number of arguments that are particularly relevant to social workers’ thinking about the ranking of conflicting duties (Reamer 1979, 1990). Gewirth’s approach in his Reason and Morality (1978b) also provides a useful illustration of the ways moral philosophers think about ethical dilemmas. Gewirth claims that human beings have a fundamental right to freedom (similar to social workers’ conceptualization of self-determination) and well-being, and that there are three core “goods” that human beings must value: basic goods – those aspects of well-being that are necessary for anyone to engage in purposeful activity (e.g. life itself, health, food, shelter, mental equilibrium); nonsubtractive goods – goods whose loss would diminish a person’s ability to pursue his goals (e.g. as a result of being subjected to inferior living conditions or harsh labor, or as a result of being stolen from, cheated on, or lied to); and additive goods – goods that enhance a person’s ability to pursue her goals (e.g. knowledge, self-esteem, material wealth, education). Like all moral philosophers, Gewirth recognizes that people’s various duties and rights sometimes conflict and that they sometimes need to choose among them; social workers certainly encounter such conflicts. Gewirth argues that conflicting duties can be ranked or placed in a hierarchy based on the goods involved (1978b).

Virtue ethics and the ethics of care Another prominent ethical theory is known as virtue ethics. From this perspective, an ethical person has virtuous values and character traits and acts in a manner consistent with them. Ethical judgments spring from these core values and character traits rather than from ethical rules and standards per se. The biomedical ethicists Beauchamp and Childress (2013) developed the best-known framework for understanding professionals’ virtues in the 1970s when the fields of biomedical ethics and professional ethics were just emerging and gaining prominence. This popular framework, first published in 1979, continues to be central to the professional ethics field and is highly relevant to social work. Beauchamp and Childress (2013) identify several core, or “focal,” virtues that are critically important in the work carried out by professionals: compassion, discernment, trustworthiness, integrity, and conscientiousness. These focal virtues are linked directly to four core moral principles that, Beauchamp and Childress (2013) claim, constitute the moral foundation of professional practice: autonomy, nonmaleficence, beneficence, and justice. These moral principles clearly have broad application to, and implications for, social work practice. Two other ethical perspectives have important implications for social workers, although they tend to be appreciated more for the values they endorse than their practical relevance when social workers have to make difficult ethical decisions: communitarianism (also known as community-based theory) and the ethics of care. According to communitarianism, ethical decisions should be based primarily on what is best for the community and communal values (i.e. the common good, social goals, and cooperative virtues) as opposed to individual self-­ interest (Beauchamp & Childress, 2013). The ethics of care, in contrast, reflects a collection of moral perspectives more than a single moral principle (Gilligan, 1983). This view emphasizes the importance in ethics and moral decision-making of the need to care for, and act on behalf of, persons with whom one has a significant relationship (Beauchamp & Childress, 2013). For social workers, this perspective emphasizes the critical importance of their commitment to their clients. Proponents of the ethics of care perspective typically embrace a feminist perspective and are concerned that the predominant ethical theories – especially deontology and teleology – are too reliant 20

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on universal standards that do not take into consideration the critically important role of human relationships and interdependency. Instead of focusing on individuals’ universal rights and obligations, care theorists have built their theory around relationships. Key themes in the ethics of care include: the centrality of caring relationships; shared ties of mutuality; the view that caring both establishes and transforms who we are as people; the requirement that genuine caring gives rise to actions that address actual needs; and the importance of care ethics as a normative theory for people’s relationships, for people as individuals, and for how we might nurture caring values in others (Reamer, 2019).

Conclusion Ethical theory is an essential component of professional and social work ethics. Familiarity with diverse, prominent ethical theories can help social workers appreciate the complexity and relevance of moral analysis when they encounter ethical dilemmas in clinical practice, community organizing, advocacy, administration, and research. Ethical theories highlight morally relevant factors in ethical decision-making. Further, they provide a valuable supplement to more concrete ethical standards, especially those embedded in codes of ethics, that social workers rely on to make sound ethical judgments.

References Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press. Callahan, D., & Bok, S. (Eds.). (1980). Ethics teaching in higher education. New York, NY: Plenum Press. Congress, E. (2013). Codes of ethics. In C. Franklin (Ed.-in-Chief ), Encyclopedia of social work. Retrieved from https://doi.org/10.1093/acrefore/9780199975839.013.64 Donagan, A. (1977). The theory of morality. Chicago, IL: University of Chicago Press. Emmet, D. (1962). Ethics and the social worker. British Journal of Psychiatric Social Work, 6, 165–172. Frankena, W. (1988). Ethics (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall. Gewirth, A. (1978a). Ethics. In Encyclopedia Britannica (15th ed., pp. 982–983). Chicago, IL: University of Chicago Press. Gewirth, A. (1978b). Reason and morality. Chicago, IL: University of Chicago Press. Gilligan, C. (1983). In a different voice: Psychological theory and women’s development (rev. ed.). Cambridge, MA: Harvard University Press. Gorovitz, S. (Ed.). (1971). Mill: Utilitarianism. Indianapolis, IN: Bobbs-Merrill. Hardman, D. G. (1975). “Not with My Daughter, You Don’t!”, Social Work, 20 (4), 278–285. Herman, B. (1993). The practice of moral judgment. Cambridge, MA: Harvard University Press. Popper, K. (1966). The open society and its enemies (5th ed.). London: Routledge and Kegan Paul. Rachels, J., & Rachels, S. (2015). Elements of moral philosophy (8th ed.). New York, NY: McGraw-Hill. Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University Press. Reamer, F. (1979). Fundamental ethical issues in social work: An essay review. Social Service Review, 53, 229–243. Reamer, F. (1990). Ethical dilemmas in social service (2nd ed.). New York, NY: Columbia University Press. Reamer, F. (1993). The philosophical foundations of social work. New York, NY: Columbia University Press. Reamer, F. (2019). Social work values and ethics (5th ed.). New York, NY: Columbia University Press. Siporin, M. (1989). The social work ethic. Social Thought, 15, 42–52. Smart, J. J. C. (1971). Extreme and restricted utilitarianism. In S. Gorovitz (Ed.), Mill: utilitarianism (pp. 195–203). Indianapolis, IN: Bobbs-Merrill. Smart, J. J. C., & Williams, B. (1973). Utilitarianism: For and against. Cambridge: Cambridge University Press. Woodroofe, K. (1962). From charity to social work in England and the United States. Toronto, ON: University of Toronto Press. 21

4 Then and now: the history and ­development of social work ethics Terricka Hardy

Social work is a practice-based profession and discipline that promotes the empowerment and liberation of people (IFSW, 2014). According to Jamal and Bowie (1995), ethical ­standards are imperative for professions as they provide guidance to the prospective professionals and satisfy the public’s demand for ethical conduct ( Jamal & Bowie, 1995). Ethical standards are defined as standards that help professionals recognize and navigate through ethical ­d ilemmas (Reamer, 2006). Thus, it is in the best interest of professions, such as social work, to establish a professional code of conduct comprised of ethical standards and provisions that are acceptable to the moral views of the public ( Jamal & Bowie, 1995). Further, it is essential that members of the profession are held accountable to adhere to the code ( Jamie & Bowie, 1995). The purpose of professional codes of ethics is to address ethical lapses faced ( Jamal & Bowie, 1995). Jamal and Bowie (1995) conclude that professional codes of ethics should ­classify provisions in three broad categories. Codes should first address concerns when the profession’s interest conflicts with the public’s interest (Reamer, 2006); this can also be referred to “problems of moral hazard” ( Jamal & Bowie, 1995). An example of this would consist of when a social worker is faced with the dilemma of breaching client confidentiality by a law enforcement officer regarding a client that admitted to breaking the law in the past during session. Second, the code should provide guidelines on what is deemed to be appropriate profession behavior; this is also referred to as “the norms of professional courtesy.” This category refers to examples such as if a social worker should solicit services from a client and/or if sexual relationships between social workers and former clients would be deemed acceptable. Finally, codes should provide guidance regarding the professional’s duty to serve the public interest. For example, should social workers donate professional time to care for the public after a natural disaster or if a social worker in private practice provide pro bono services to a client that needs service but is unable to pay for services. Over the years, the social work profession has established inclusive ethical standards. The International Federation of Social Workers (IFSW) Statement of Ethical Principles serves as a predominant framework for social workers to strive toward professional integrity. Though many social work organizations have created codes of ethics, the National Association of Social Workers (NASW) Code of Ethics serves as one of the most visible compilations for 22

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the profession’s ethical standards (Reamer, 2006). Nevertheless, social work codes of ethics are charged to uphold the following key themes established in the IFSW Statement of Ethical Principles: recognition of the inherent dignity of humanity, the promotion of hung rights, the promotions of social justice, the promotion of the right to self-determination, the promotion of the right to participation, respect for confidentiality and privacy, treating people as whole persons, the ethical use of technology and social media, and professional integrity (IFSW, Statement of Ethical Principles, 2012). Few formal ethical standards existed in the early days of social work. Social work pioneer, Mary Richmond, is credited for the first attempt to establish an experimental draft in the 1920s (Pumphrey, 1959; Reamer, 2006). Richmond was a strong advocate in working to professionalize social work. Though Richmond’s efforts happened in 1920, the original NASW Code of Ethics was not approved by the NASW Delegate Assembly until October 13, 1960 (NASW, 2018). The 1960 NASW Code of Ethics helped to define the social work profession and established 14 standards of behaviors for social workers (NASW, 2018). The 14 standards were comprised of “I” statements such as “I give precedence to my professional responsibility over my personal interests,” “I respect the privacy of the people I serve,” “I practice social work within the recognized knowledge and competence of the profession” (NASW, 1961). The first revision to the code was made in 1967 as the 15th principle was added addressing nondiscrimination. Not only were there concerns for the current code’s usefulness in providing guidance for ethical struggles, but there were also concerns for the code’s lack of ability to provide resolution for ethical complaints against social workers (Reamer, 2006). In response to the expressed apprehensions by NASW members, the 1977 NASW Task Force was established to revise the code to provide overall guidance and relevance to practice, as a result the 1979 NASW Code of Ethics was established. The 1979 Code provided guidelines for professional conduct and established the social worker’s ethical responsibilities to clients, colleagues, employers, the social work profession, and society. The code was created to serve as a guide for everyday conduct amongst social workers and also as a basis for the adjudication of ethical complaints when the conduct of social workers is alleged to have been unethical (NASW, 1979). The 1979 Code of Ethics differed from the previous Code as it included both “prescriptive” and “proscriptive” ethical principles (Reamer, 2006). The 1979 Code provided ethical standards that could be enforced and for which social workers could be held accountable; thus, ethical complaints could be filed on social workers in violations of the standards (Reamer, 2006). The next revision to the code was initiated as a result of an inquiry from the US Federal Trade Commission in 1986 regarding possible constraints of trade (Reamer, 2006). Modifications included code revisions removing exclusions regarding social workers’ allowance to solicit clients from colleagues and/or agencies (Reamer, 2006), fee setting, and the accepting of compensation for referrals (NASW, 2018). In 1993, a recommendation was submitted to add five principles to the existing code addressing professional impairment and dual relationships (Reamer, 2006). The recommendations were made as a result of the need to bring awareness to the importance of addressing professional impairment and how unclear client/social worker boundaries can negatively affect service delivery (Reamer, 2006). The 1993 Delegate Assembly not only approved the additions but also passed a resolution to establish a new task force to create a new code of ethics that would be relevant and current to contemporary social work practice (Reamer, 2006). The additions included three principles that addressed professional impairment and two principles that addressed dual relationships. 23

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A new code of ethics was warranted as social workers had developed an enhanced understanding of ethical issues which were not addressed in the 1979 Code. The increased interest in ethics was a result of new controversial health care developments, increased litigations regarding practitioner ethical misconduct, the establishment of bioethics, patient rights, and media publicity about professional misconduct (NASW, 2018; Reamer, 2006). The rise of the applied and professional ethics field was also a direct result of the need for a new code. During this time many undergraduate and graduate programs added courses about applied and professional ethics to their curricula (Reamer, 2013). The 1996 Code of Ethics served as a major revision to the 1979 Code. It introduced a new format including organizing the code into four large sections. The first section, “Preamble,” defined the social work mission and listed core values. This was the first time in NASW’s history that a formalized mission statement and core values were established, revealing many themes that were key to the social work profession (Reamer, 2006). The code included the six social work values: service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. The second section was “Purpose of the NASW Code of Ethics.” This section provides the six functions of the code and guidance for ethical dilemmas. The third section “Ethical Principles” features six ethical principles, a principle for each of the core values. The purpose of the principles is to provide aspiration to social workers. “These principles set forth ideals to which all social workers should aspire” (p. 5). The last section of the code “Ethical Standards” presented 155 standards to provide guidance regarding social workers conduct and basis for adjudication of ethics complaints filed against NASW members. The standards address three major issues: (1) mistakes SW might make could cause ethical infractions, (2) ethical dilemmas that require ethical decision-making, (#) issues involving misconduct on the social worker’s behalf (Reamer, 2006). The ethical standards section has six categories that make up the social worker’s ethical responsibilities. The social worker’s first responsibility is to the client. This section is the longest section and most comprehensive. This section provides guidance pertaining to how social workers provide services to groups, families, individuals, couples, etc. This section addresses issues regarding self-determination, cultural competence, privacy, and confidentiality, just to name a few. The second section is the social worker’s responsibility to colleagues. This section addresses the relationships social workers have with colleagues such as having respect for colleagues, collaborating with colleagues, and consultation. The third section highlights the social worker’s responsibility in the practice setting. Ethical dilemmas often arise in social work practice settings. The standards in this section address proper supervision, the social worker’s commitment to employing organization, consultation, client records, etc. The fourth responsibility is the social worker’s responsibility as a professional. This section addresses how social workers should behave and conduct themselves, remain competence in his/her area of practice, address professional impairment, and refrain from discriminatory acts. The fifth responsibility is the profession. This standard speaks to the social worker’s responsibility to uphold the fidelity of the social work profession by involving themselves in research to enhance the profession, providing consultation, and serving the community. The sixth responsibility is the social worker’s responsibility to the broader society. This section involves the social worker’s obligation to promote social justice within the broader society such as providing service during a public emergency such as natural disasters and lobbying for the rights of vulnerable populations. Additional code revisions were made to the 1996 Code. A revision was made in 1999 that clarified when it is appropriate for social workers to share confidential information without client consent (NASW, 2018). In 2006, a Social Work Ethics Summit was held. The purpose 24

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of the summit was to examine the current NASW Code of Ethics to determine if the current code needed to be revised. The summit included social workers from various practice areas, social work regulatory board members, and attorneys (NASW, 2018). At the conclusion of the summit, it was determined that the current code did not need to be revised and that efforts to develop education and practice tools were encouraged (NASW, 2006). The second revision was made in 2008. The 2008 revisions added to the nondiscriminatory standards by incorporating sexual orientation, gender identity, and immigration status into the existing standards (NASW, 2018). The most current changes to the code were approved by the NASW Delegate Assembly on August 4, 2017. The current changes involve significant changes since the 1996 version of the code was approved (Barsky, 2017). One of the first noted changes to the code is the change in language from “disability” to “ability.” The term “disability” was changed to “ability” throughout the code. This important language change communicates the importance to remain strength-based by focusing on client’s abilities versus disabilities (Barsky, 2017). Changes to the code in regards to technology use were not only included in the preamble but also throughout the entire code. Technology is often used within the day-to-day social work practice. Thus, it was imperative that changes involved ethical standards that addressed the various ways in which the use of technology can be applied to the ethical standards. The code emphasizes the importance of social workers applying ethical standards when servicing clients face to face and/or through the use of technology (Barsky, 2017). New standards were added to the code pertaining to informed consent. Standards include promoting social workers to explain polices regarding the use of technology when providing services, to obtain the client’s consent to use technology during service provision, and also assess the client’s capacity to not only provide informed consent to use technology but also the client’s capacity to access and use technology; this is also true when conducting evaluation and research. It is also important that when social workers are not meeting with a client in person the client’s location is verified for safety reasons. Social workers are also cautioned to obtain informed consent from clients to perform electronic searches. New standards pertaining to competence were added relating to technology. The term competence now includes the social worker having the knowledge and ability to appropriately use technology as communication issues are possibilities when utilizing technology (Barsky, 2017). Social workers must be aware of possibly communication barriers as it relates to technology and know-how to address the barriers. Utilizing technology also allows social workers to service clients in various jurisdictions. The code addresses this and offers provision for social workers to comply with the laws of the jurisdiction governing the social worker’s regulation and location and the jurisdiction of the client’s location. When discussing diversity and culture, it was imperative that standards are reflective of changes related to such issues. The section previously entitled “Cultural Competence and Social Diversity” was changed to “Cultural Awareness and Social Diversity.” Although the wording of the standards under this section did not change, competence was replaced with awareness as the term “competence” could be interpreted such that social workers can become competent in another culture other than their own (Barsky, 2017). Terms such as cultural awareness, cultural responsiveness, and cultural humility are used to continue to hold social workers accountable in being aware of client’s culture and to ensure that services are tailored to the needs of the clients’ diverse cultural backgrounds (Barsky, 2017). One new standard, 1.05 (d), urges social workers to assess and respond to the cultural and social diversity issues when utilizing technology to serve clients (NASW, 2017). Use of technology in service delivery systems should help not hinder clients. 25

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With the growing trend of social media and online networking platforms, social workers must be cognizant of maintaining appropriate boundaries with clients both face to face and online. Standard 1.06 (e) was added to deter social workers from communicating with clients for any reasons other than professional reasons (NASW, 2017). Social workers are also urged to employ professional judgment when posting personal information online as clients are privy to such information which could lead to potential conflicts of interest (NASW, 2017). Social workers are discouraged from participating in personal relationships with clients even avoiding requests from clients via online (NASW, 2017). It is imperative that social workers understand performing unethical conducts electronically could breed negative effects. ­Standard 2.10 (a) was amended to encourage social workers to take actions to discourage unethical conduct of colleagues when using technology (Barsky, 2017; NASW, 2017). The use of technology has increased the amount of information one can potentially gather from and/or about a client. Amendments to the code were made to uphold client privacy and confidentiality. Social workers are held accountable for the information implored and/ or gathered from and/or about clients. All information received from and/or about clients, including information received electronically, must be used for “compelling professional reasons” (NASW, 2017). Social workers are encouraged to obtain informed consent from clients when gathering information (Barsky, 2017; NASW, 2017). When working with groups and families, strict privacy and confidentiality guidelines must be established regarding whether clients are at liberty to discuss confidential information outside of counseling sessions which includes social media, email, and even amongst group members (Barsky, 2017). Standard 1.07 (f ) was modified to encourage social workers to address such concerns in family, couple, and group counseling sessions. Social workers are discouraged in discussing confidential information via technology or face to face unless the social worker has taken the necessary steps to ensure confidentiality (Barsky, 2017; NASW, 2017). Social workers are required take reasonable steps to protect the privacy. It is the social worker’s responsibility to remain educated on the most effective ways to protect privacy and confidentiality both in-person and electronically. Further, social workers must have policies and procedures in place to alert clients about any breach in confidentiality in a timely manner (NASW, 2017). Social workers are discouraged from engaging in sexual relationships with clients, ­supervisees, students, or colleagues (NASW, 2017). Amendments to the code were made to include electronic communications and in-person communications (Barsky, 2017; NASW, 2017). Standards 1.11 and 2.07 were amended to ensure that electronic and written contacts of unwanted sexual advances are considered harassment (NASW, 2017). Standard 1.12 was amended adding electronic communication, as social workers are not to use derogatory ­language verbally, electronic, or written. When using technology to service clients, the possibility of interruptions of services is ever present. Standard 1.15 was amended to include “disruptions of electronic communication” (Barsky, 2017; NASW, 2017). It is imperative that social workers are knowledgeable about the technological equipment used during service delivery and that policies and procedures are in place in preparation for such possibility. The use of technology even extends to supervision and consultation standards 3.01 (a) and 3.01 (c) were amended to include that all standards regarding supervision and consultation apply “whether in-person or remotely” and caution supervisors in creating dual relationships when “using social networking or other electronic media” (Barsky, 2017). Social work educators are also cautioned in standard 3.02 (d) regarding forming dual relationships with students when “using social networking or other electronic media” (Barsky, 2017). 26

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The use of technology is also important as it pertains to client records as many social workers and agencies employ electronic records and documentation. Standard 3.04 was amended to include both electronic and paper forms of client records. It is important that the storage of client records, whether in paper form or electronic form, abides by the laws, agency policies, and relevant contracts (Barsky, 2017; NASW, 2017). The history and development of social work ethics have been influenced by the needs and demands of both clients and social work professionals. Whether it was a historical event, the need for more guidance, and/or new advances such as technology, all were used to shape and mold the social work code of ethics to what it is today. According to the NASW Code of Ethics Preamble, “the primary mission of the social work profession is to enhance well-being and help meet the basic human needs of all people” (NASW, 2017). The NASW Code of Ethics continues to serve as a compass to help social workers effectively serve clients. Though future advances and changes to the code are inevitable, staying relevant to the demands of clients and social work professionals remains paramount.

References Barsky, A. (2017). Ethics alive! The 2017 NASW code of ethics. What’s new? Retrieved June 13, 2018, from http://www.socialworker.com/feature-articles/ethics-articles/the-2017-nasw-code-of-ethicswhats-new/ International Federation of Social Workers. (2012, March). Statement of ethical principles. Retrieved July 15, 2018, from https://www.ifsw.org/statement-of-ethical-principles/ International Federation of Social Workers. (2014, July). Global definition of the social work profession. Retrieved August 16, 2018, from https://www.ifsw.org/what-is-social-work/global-definition-ofsocial-work/ Jamal, K., & Bowie, N. E. (1995). Theoretical considerations for a meaningful code of professional ethics. Journal of Business Ethics, 14, 703–714. National Association of Social Workers. (1961). Code of ethics. Washington, DC: Author. National Association of Social Workers. (1979). NASW code of ethics. Washington, DC: Author. National Association of Social Workers. (2017a). Code of ethics. Washington, DC: Author. National Association of Social Workers. (2017b). NASW, ASWB, CWSE, and CSWA standards for technology in social work practice. Washington, DC: Author. National Association of Social Workers. (2018). History of the NASW code of ethics. Retrieved August 1, 2018, https://www.socialworkers.org/About/Ethics/Code-of-Ethics/History Pumphrey, M. W. (1959). The teaching of values and ethics in social work education. New York, NY: Council on Social Work Accreditation. Reamer, F. G. (2006). Ethical standards in social work: A review of the NASW code of ethics. Washington, DC: NASW Press. Reamer, F. G. (2013). Social work values and ethics. New York, NY: Columbia University Press.

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5 An integrated principle-based approach to international ­social work ethical principles and ­servant leadership principles Sandra R. Williamson-Ashe and Charles M. S. Birore

International social work is a helping profession that defies barriers, creates change, and embraces challenges as opportunities. Servant leadership (SL) uses service to help and influence others, incorporates an awareness of self, and empathetically puts others first. The combination of international social work and SL may seem like an unlikely pair, but they both share integrity and service as fundamental underpinnings. Building upon this shared basis, the integrated principles of humanity, community, and intelligence originate to form the integrated principle-based approach (IPA). These principles show a coalescence of international social work principles and SL principles and they function as a method of categorization. International social work – a profession of principles and empirical research – and SL – a model of leadership best practices to manage people into purposeful success – are not as unlikely a pairing when the principles of each are grouped according to similar characteristics. The ideology used in SL is reminiscent of the ethos and morals threaded throughout international social work and both international social work and SL commence with their most essential resource for investment, people.

Evolution of international social work ethical principles and values Contemporary moral values and beliefs in social work and many other helping professions have roots in the Western countries and can be traced to Greek and Roman eras (Bauman, 1993, 1995; Hugman, 2005). The major philosophical questions relating to ethics for many centuries have been “What is the good and right thing to do to other people or to myself?” “What kind of person should I be as a practitioner or as a leader?” “How as a moral human being, should I demonstrate compassion, care, virtue, respect, justice, benevolence, equity, and utility in my daily life?” Our beliefs, choices, and answers to these questions are consciously or unconsciously influenced by the cultural and environmental contexts in which we live. For Aristotle, moral values are based on virtuous character of the person, which can be developed (Hugman, 2003a, 2005; Pellegrino & Thomasma, 1993). The belief that people 28

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have capacity to reason, make choices, and act in a good way (rationalism) has also influenced ethics in helping professions. The notion that this rationality can be applied universally to demonstrate compassion, care, virtue, respect, justice, benevolence, equity, and utility in daily lives suggests the possibility that universal or global ethical principles apply equally and perhaps impartially to every person in the same situation (Hugman, 2005). For Immanuel Kant (1724–1804), father of deontological ethics, the person’s motives and the actions must be good and right to justify the means to an end (Hinman, 2003b; Hugman, 2005). For Jeremy Bentham (1748–1832) (teleologist), the person’s duties and actions are relatively good and right only when they produce the greatest happiness to the greatest number of people in a given situation. Most helping professions, including social work, apply these moral values and beliefs in their professional activities. The International Federation of Social Workers (IFSW), founded in 1928, applies deontological, teleological, and virtue ethics principles to guide global social work standards of practice. The biggest challenge to IFSW since its inception has been how to implement global social work ethics in a diverse world in terms of culture, economic development, and political ideologies (Hugman, 2003b; Hugman & Carter, 2016). The apparent controversy is whether universalism or relativism should prevail (Banks, Hugman, Healy, ­Bozalek, & Orme, 2008; Healy, 2007; Hugman, 2008, 2012). While some scholars support universal standards, ­others support relative, culture-centered standards (Hugman & Carter, 2016; ­Pedersen, 1995), and still others favor virtue-based standards (Ibrahim, 1996; Meara, Schmidt, & Day, 1996). Given the critical role of ethical principles in social work practice, policy, and leadership, and in consideration of the cultural and human diversity aspects of global ethics, Banks argues that ethics work or virtue ethics is as important as universal and relative ethics (Banks, 2012, 2016).

IFSW international social work ethical principles The IFSW adopted the first international code of ethics in 1976 and has revised it multiple times to reflect the dynamic cultural, economic, and political development of many countries (Healy, 2008; IFSW, 1994; Reamer, 2014). Currently, there are three major areas of IFSW ethical principles: (1) human rights and human dignity (self-determination, participation, respect, privacy, strength, interdependence); (2) social justice (diversity, equity, justice, solidarity); and (3) professional integrity (IFSW, 2018). These areas reflect the moral values and beliefs associated with the IFSW and all global countries where the social work profession is practiced. These ethical principles also pay attention to diverse cultural, economic, and political developments characterizing specific countries in the world. This is a milestone and a foundation for IFSW hard work ahead in the 21st century of social work global ethics. Equally important are SL principles that reflect the moral values and beliefs espoused by the social work profession and global ethics. Laterally, with international social work, SL experienced a turning point in work ideals (Reamer, 2006). Robert Greenleaf, a retired corporate trainer, initiated the Center for Applied Ethics and introduced consultative services for fortune 500 companies and elite higher education institutions (Smith, 2005). In university settings, students were responding to the social division of the 60s. Greenleaf ’s readings and research reflected this (Smith, 2005). As a result, in the 70s, Greenleaf published an essay titled The Servant as Leader (Smith, 2005). Service and help are principles of both SL and international social work. Serving others is the notable difference between servant and other leadership theories, thereby making servant theory uniquely congruent with international social work (Russell & Stone, 2002). 29

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Servant leadership principles SL is not a new theoretical perspective on guidance, but rather an expanding model of leadership. SL principles originate from the unselfish “others-directed” character inspiration that comes from within the leader (Smith, 2005). SL prioritizes helping, starts with looking at the motivation of the leader, and is proficient with relationship building (Smith, 2005), which are the practices and priorities in international social work. Greenleaf introduced SL in 1970, remarking, “…The great leader is seen as servant first…” (Smith, 2005, p. 11). He intentionally pursued a theory that causes people to stop, think, and challenge expectations about the relationship dynamics between leaders and followers (Smith, 2005). With society and organizations seeking ways to intensify individual character, Greenleaf flipped the hierarchy pyramid onto its head, changing the expected upside down. Greenleaf challenged the widely accepted relationship concept between leaders and followers and intentionally married two contradictory terms and entitled his essay, The Servant as Leader (Smith, 2005). SL has ten major characteristics, nine functional attributes, 11 accompanying attributes, and four SL principles (Smith, 2005). The four central principles emphasized by SL are service to others, holistic approach to work, promoting a sense of community, and the sharing power in decision-making (Smith, 2005). These SL principles expand the understanding of SL and are the primary focus of the integration with international social work. The four SL principles and their complement of the international social work principles make the alignment of the two principles putative. The golden rule of leadership states that the opportunity for leaders to lead is not a right as many operate through; it is a privilege (Sindel & Sindel, 2013). The first commitment of the leadership role is service (Sindel & Sindel, 2013). This is the first of the four SL principles, service to others. When Greenleaf expressed his thoughts about SL, he described it as the natural result of leaders providing sincere help to others (Smith, 2005). A servant leader absorbs the blame and allows others to receive credit, looks for the opportunity to give recognition to others, provides praise with appreciation, listens when individuals speak, and gets people out of murky situations (Magas, 2009), all to encourage the best from others (Smith, 2005). By allowing individuals to be themselves, leaders demonstrate respect, a worthy requirement in ethical behavior and shows how individuals are valued (The Principles of Ethical Leadership). Incorporating significant areas, personal and professional, creates a holistic view. This holistic approach to work is the second of the four SL principles (Smith, 2005). A unified group or a group operating with a commonality defines a community (­Community, 2018). Working toward a common goal through the direction of a leader demonstrates the level of ethical dimension (The Principles of Ethical Leadership). Appropriately, the servant leader selflessly is concerned with the individuals’ desires. The result of this ethical relationship is that both the leader and the follower benefit (The Principles of Ethical Leadership; Smith, 2005). The third SL principle is promoting a sense of community (Smith, 2005). The individuals that comprise the community, which is the organization, are the benefactors of a nurturing and empowering participatory environment, resulting in a motivated workforce that operates through the cyclic exchange of SL (Brown & Bryant, 2015; Smith, 2005). This type of atmosphere, in which servant leaders are at the bottom and followers and constituents are on top, emulates a culture of reciprocity, that is, what the leader delivers is absorbed and redistributed in the workplace by the followers, resulting in a milieu of successful results. Followers feel safe and a climate of trust is created and returned as the servant leader operates with humility (Brown & Bryant, 2015). 30

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Sharing in decision-making is the fourth and final SL principle. The sharing of power in decision-making will be rephrased as inclusion in decision-making as Spears (2010) notes that SL is purposeful in securing the involvement of others for making decisions. Greenleaf recognizes inclusivity as he notes that not only does the follower need to engage voluntarily but also the servant leader must serve with genuine volunteerism (Brown & Bryant, 2015). The ideals of SL are rooted in interpersonal trust, utilizing respect and empowerment (Brown & Bryant, 2015) to deliver and result in an authentic genuine climate. Because servant leaders possess integrity, they express themselves with honesty, authenticity, and hope, which strengthens trust and allows these leaders to be seen as dependable and reliable (Stallard, 2016). These are important characteristics in social work, SL, and community volunteerism. Integrity is a solid foundation upon which SL is built; indeed, it is an essential component (Stallard, 2016) that is necessary for the four foundational principles of SL. “Integrity is specifically alluded to when describing the very elements that make up the concept of servant leadership” (Anderson, 2017, p. 31). Palanski and Yammarino (2007) have categorized the ideals of integrity into five descriptors. These five types of integrity are: 1 integrity as wholeness – integrity is synonymous with the person’s complete character; 2 integrity as consistency in words and actions – this refers to the congruency between what a person says and what a person does; 3 integrity as consistency in adversity – this refers to the unwavering manner in which people continue with integrity during challenging situations; 4 integrity as being true to oneself – this refers to a person’s being authentic and reflecting moral behavior in his or her personal identity; and 5 integrity as moral and ethical behavior – this relates to honesty, morality, justice, and compassion as demonstrated in a person’s ethical behavior (Anderson, 2017). Servant leaders communicate human value in their exchanges because their interaction with others is always honorable and ethical, the accepted definition of integrity (Stallard, 2016).

Integrated principles-based approach (IPA) There is an obvious solidarity between international social work and SL; helping is the goal and result of both international social work and SL. Research by Reamer (2006) suggests that there are nine identifiable social work primary standards. These are dignity, uniqueness, respect, personal worth, self-determination, equality, justice, individuation, and autonomy. Spears (2005) identified ten servant leader characteristics that correlate with the profession of social work (as cited in Packard, 2009). They are listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to people’s growth, and building community through research (Spears, 2010). Reamer (2006) and Spears (2005) have expanded the features and principles for social work and SL, respectively. Servant leaders make gains by helping individuals accomplish their aspirations (Magas, 2009). They are able to do this by serving and influencing others. Social workers achieve their targets by assisting those in need to make individual changes using ethical knowledge and skills in the social work profession (Macht & Quam, 1986) (Statement of Ethical Principles, 2012). The published research does not reveal a direct birth of the principles of international social work from SL. The principles of international social work and Greenleaf ’s principles of SL both highlight a commitment to the value of people and servicing them while prioritizing 31

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SW and SL Foundational Characteristics 1. Integrity 2. Services SW Principles 1. Importance of human relationships 2. Social Justice 3. Dignity/Worth of person 4. Competence

SL Principles 1. Holistic approach to work 2. Promoting a sense of community 3. Inclusion in decision-making

Figure 5.1  Contextualizing characteristics

a set of standards that guide behaviors and individual interactions. The doctrines are readily similar in characteristics. Although both arenas are of different disciplines, it appears that their development may have been responding to society’s humanity and social justice tone and climate. Contextualizing the characteristics of both, the one temperament essential in each is integrity. Integrity must exist for the success of each international social work principle and each SL principle. Integrity is identified in the social work code of professional conduct, while Ebener and O’Connell (2010) note that a leader’s integrity is built through the practice of moral behavior. This quantifies integrity as an integral measure of SL principles, since leaders exercising SL are practicing moral behavior. The integrity that characterizes all elements of social work principles and SL principles, respectively, influences the servitude importantly carried out by individuals to inspire the operating climate in the workplace. Figure 5.1 shows integrity as the most prominent and leading foundational characteristic that directly influences service. Service is the second and final foundational characteristic for both disciplines. This element is distinguishable as a specifically named component for both international social work principles and SL principles. Service allows social workers to provide helping elements to those in need so that they may flourish and it allows leaders to aid their staff members, who then promote growth for the organization. The servant leader initiates the role of leader by serving followers and inspiring greatness in them (Smith, 2005). This selfless act of helping others first is essential in SL. For genuine service – human relations efforts, demonstrations of personal worth, labor of social justice elements, and intellectual stimulation – there must be the social work core value of integrity. Figure 5.2 shows service as the second foundational characteristic, directly influenced by integrity and the bridge between integrity and the integrated principles. In the preceding paragraphs, integrity and service are referenced as the foundational characteristics for the IPA. The foundational characteristics are the supporting base; they provide the necessary building blocks for the integrated principles. There are three integrated principles – humanity, community, and intelligence. The three coalesced principles are the categories that encapsulate social work core values and SL principles. The principles that formulate the IPA intersect one another within their category as well and are influential of each other in different categories. The social work and SL principles best align with their specific integrated principles through the literature research that defines the traits in combination with the objectivity of the researcher. SL principles humbly emphasize the behavior of leaders because leaders’ integrity is built through the practice of virtuous behavior (Ebener & O’Connell, 2010). Virtuous behavior entails wisdom, justice, courage, humility, and other concepts (Ebener & O’Connell, 2010). The integrated principle of humanity consists of the social work principles of the importance of human relationships and the dignity and worth of a person. Respecting the 32

An integrated principle-based approach

Integrated Principle-Based Approach

SW/SL Principles

Integrated Principles Foundational Characteristics

Humanity

• Importance of Human Relations • Dignity/Worth of Person

Integrity

Service

Community

Intelligence

• Holistic Approach to Work • Promote a Sense of Community • Social Justice

• Competence • Inclusion in Decision-Making

Figure 5.2  Social work/servant leadership integrated principle-based approach

individual person is a necessary element for prioritizing human relationships. Without the prioritization on persons and how they formulate relationships, there is no path to transfer influence and no receptor to comprehensively affect the workplace. SL echoes these same principles as intentional social work to serve first. Both principles are equal to the promotion of the integrated principle of community and, because SL focuses on the individual influencing the company, it is only natural that this is achievable through prioritization. Community is affected by the climate of social work and SL that results in an air of improvement. Social justice actions promote a sense of community. Exercising social justice rights means understanding and valuing human rights and societal domains, which encourages group cohesion (community). Individuals with interconnectedness form a community, a group of individuals with common interests. In order to promote a sense of community, servant leaders must prioritize the human service aspect in the organization and create a community cohort among followers to advance the organization toward success (Smith, 2005). Building an organizational community results from the practice of SL principles (Ebener & O’Connell, 2010). The service of servant leaders positively influences others and, as a result, creates new servant leaders (Smith, 2013). The intelligence-integrated principle sums up competency and inclusion in decision-­ making. Competency denotes that the international social worker will have the intellectual proficiencies to perform tasks required for servicing individuals. In SL principles, power inclusion in decision-making is emphasized. Leaders, the power source, often have significant decision-making responsibilities. The best decisions are usually informed decisions. SL recognizes the need for decisions not to rest solely with the leadership but with a multitude of experts. The inclusion in decision-making for SL requires competency which is specified in international social work principles. In order to exercise that competency, there is a need for exposure to SL power sharing in decision-making; this advances comprehension and expertise. Inclusion in decision-making for SL means that a servant leader creates a sense of service in others (Smith, 2005). 33

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Conclusion The impact of recognizing and acknowledging a dual system of integrity and service may provide new and distinguishable opportunities for both servant leaders and international social workers. The analogous international social work principles and SL principles mimic corresponding messages of humanity, community, and intelligence. This may be a viable model to incorporate as a standard for the international social work education curriculum. With the founding of the IPA, this concise version is prime to initiate a model shift with three operating principles and around it build a strategic platform. This bridge of international social work and SL as an approach bound by integrity and service is an opportunity for exploratory research into the possible application of a leadership model for the international social work education curriculum. The concepts addressed in the IPA for leadership can aid in closing the knowledge gap and create discussion and research with adjoining international social work professionals and higher education curriculum planners. This combination of SL, social work, and the IPA is not intended to rewrite SL or international social work, but it is meant to generate thought and discussion about two different disciplines that have similarities in standards.

References Anderson, R. (2017, December). SUNScholar research respository. Retrieved from Stellenbosch University Library and Information Services: http://scholar.sun.ac.za/handle/10019.1/102821 Banks, S. (2012). Ethics and values in social work (4th ed.). Hampshire: Palgrave Macmillan. Banks, S. (2016). Everyday ethics in professional life: Social work as ethics work. Ethics and Social Welfare, 10(1), 35–52. doi:10.1080/17496535.2015.1126623 Banks, S., Hugman, R., Healy, L., Bozalek, V., & Orme, J. (2008). Global ethics for social work: Problems and possibilities. A paper from Ethics and Social Welfare Symposium, Durban (Ireland), July 2008. Ethics and Social Welfare, 2(3), 276–290. doi:10.1080/17496530802481722 Bauman, Z. (1993). Postmodern ethics. Oxford: Basil Blackwell. Bauman, Z. (1995). Life in fragments. Oxford: Basil Blackwell. Retrieved July 7, 2018, from The Principles of Ethical Leadership: http://homepages.se.edu/cvonbergen/files/2012/12/Principles-of-­ Ethical-Leadership1.pdf Brown, S., & Bryant, P. (2015, February). Getting to know the elephant: A call to aadvance servant leadership through construct consensus, empirical evidence and multilevel theoretical development. Servant Leadership, Theory and Practice, 1(2), 10–35. Retrieved from http://www.sltpjournal. org/uploads/2/6/3/9/26394582/sltp_volume_2_issue_1_-_complete_interior.pdf Community. (2018, June 26). Retrieved from Merriam-Webster: https://www.merriam-webster.com/ dictionary/community Council on Social Work Education. (2017, April 20). Retrieved from Centers and Iniatives: https://www. cswe.org/Home.aspx Ebener, D., & O’Connell, D. (2010, Spring). How might servant leadership work. Nonprofit Management and Leadership, 20, 315–335. Retrieved February 17, 2015, from http://www.interscience.wiley.com. Final 2015 Education Policy and Accreditation Standards. (2017, June 9). Retrieved from Council on Social Work Education: https://www.cswe.org/getattachment/Accreditation/Accreditation-­Process/ 2015-EPAS/2015EPAS_Web_FINAL.pdf.aspx Healy, L. M. (2007). Universalism and cultural relativism in social work ethics. International Social Work, 50(1), 11–26. Healy, L. M. (2008). International social work: Professional action in an interdependent world. New York, NY: Oxford University Press. Hinman, C. (2003). Multicultural considerations in the delivery of play therapy services. International Journal of Play Therapy, 12(2), 107–122. History of the NASW Code of Ethics. (2014). NASW. Retrieved June 2014, from the National Association of Social Workers: http://www.socialworkers.org/nasw/ethics Hugman, R. (2003a). Professional ethics in social work: Living with the legacy. Australian Social Work, 56, 5–15. 34

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Hugman, R. (2003b). Professional values and ethics in social work: Reconsidering postmodernism? British Journal of Social Work, 33, 1025–1041. Hugman, R. (2005). Looking back: The view from here. British Journal of Social Work, 35, 609–620. Hugman, R. (2008). Ethics in a World of Difference. Ethics & Social Welfare, 2, 118–132. Hugman, R. (2012). Social work in extremis: Lessons for social work internationally. Journal of Social Work, 12, 444–445. Hugman, R. & Carter, J. (2016). Rethinking values and ethics in social work. London, UK: Palgrave Macmillan. Ibrahim, F.A. (1996). A multicultural perspective on principle and virtue ethics. The Counseling Psychologist, 24(1), 78–85. International Federation of Social Workers (IFSW). (1994). Ethics in social work, statement of principles. Retrieved from http://www.ifsw.org/en/p38000324.html International Federation of Social Workers (IFSW). (2018). Statement of ethical principles. Retrieved from https://www.ifsw.org/global-social-work-statement-of-ethical-principles/ Macht, M., & Quam, J. (1986). Social work: An introduction. Columbus, OH: Charles E. Merrill. Magas, G. (2009, December 3). Servant leadership concepts. Inside Business 360*. Andover, MA: Helium. Meara, N. M., Schmidt, L. D., & Day, J. D. (1996). Principles and virtues: A foundation for ethical decisions, policies, and character. The Counseling Psychologist, 24(1), 4–77. Packard, T. (2009). Leadership and performance in human services organizations. In R. Patti, The handbook of human services management (pp. 143–164). Thousand Oaks, CA: Sage. Palanski, M. E., & Yammarino, F. J. (2007). Integrity and leadership: clearing the conceptual confusion. European Management Journal, 25(3), 171–184. Pedersen, P. (1995). The five stages of culture shock: critical incidents around the world. Westport, CN: Greenwood. Pellegrino, E. D. & Thomasma, D.C. (1993). The virutes in medical practice. New York, NY: Oxford University Press. Rank, M., & Hutchinson, W. (2000). An analysis of leadership witin the social work profession. Journal of Social Work Education, 36(3), 487–502. Raza, A. (2017, February). Leadership. Retrieved from Wisetoast: http://wisetoast.com/12-differenttypes-of-leadership-styles/ Reamer, F. (2006). Social work values and ethics (Third ed.). New York, NY: Columbia University Press. Reamer, F. (2014). Risk management in social work: Preventing professional malpractice, liability, and disciplinary action. New York, NY: Columbia University Press. Russell, R. F., & Stone, A. G. (2002). A review of servant leadership attributes: Developing a practical model. Leadership & Organization Development Journal, 23(3), 145–157. Servant leadership. (n.d.). Retrieved from Changing Minds: http://changingminds.org/disciplines/leadership/ styles/servant_leadership.htm Sindel, T., & Sindel, M. (2013, June 6). The golden rule of leadership, leading others is a privilege not a right. Retrieved July 7, 2018, from Psychology Today: https://www.psychologytoday.com/us/blog/ the-end-work-you-know-it/201306/the-golden-rule-leadership Smith, C. (2005, December 4). Servant leadership: The leadership theory of Robert K. Greenleaf. Retrieved 2014, from The Greenleaf Centre for Servant-Leadership UK: http://www.greenleaf.org.uk/whatissl.html Smith, M. (2013, November). Putting best practices to work. Retrieved from Servant Leadership Culture Builds Efficient & Results-Focused Teams: www.qualityprogress.com Spears, L. (2005, August). The understanding and practice of servant-leadership. The Servant Leadership Research Roundtable. Retrieved from: https://www.regent.edu/acad/global/publications/ sl_proceedings/2005/spears_practice.pdf Spears, L. (2010). Character and servant leadership: Ten characteristics of effective, caring leaders. The Journal of Virtues and Leadership, 1(1), 25–30. Retrieved from https://www.regent.edu/acad/global/ publications/jvl/vol1_iss1/Spears_Final.pdf Stallard, M. (2016, April 9). Leading with character: Integrity. Retrieved from Michael Lee ­Stallard, Helping Leaders Create Cultures that Connect: http://www.michaelleestallard.com/leadingwith-character-integrity Statement of Ethical Principles. (2012, March 3). Retrieved June 9, 2018, from International Federation of Social Workers: http://ifsw.org/policies/statement-of-ethical-principles/ Teaching with documents:The Civil Rights Act of 1964 and the equal employment opportunity commission. (2013). Retrieved from The U.S. National Archives and Records Administration: http://www. archives.gov/education/lessons/civil-rights-act/ 35

6 Social worker self-care An ethical responsibility Dorothy S. Greene and Karen T. Cummings-Lilly

Social workers are not immune to the difficulties of the human experience, with many having experienced stress, mental illness, trauma, and substance misuse. Often, social workers are drawn to their career by adverse life experiences (Straussner, Senreich, & Steen, 2018). If left unaddressed, the potentially harmful impact of these issues, professionally, may be far reaching. The chapter begins by exploring the relationship between ethics and self-care. The next section examines the theoretical rationale for self-care, utilizing the Wounded Healer construct, followed by the “occupational hazards” of the profession. A discussion of self-care regarding both social work practice and education follows, concluding with self-care’s impact on resilience across all levels of social work practice.

Ethics and self-care The ethics of self-care is receiving increased attention, with two ethical principles warranting specific mention. Non-malfeasance, first, do no harm (Kitchener, 1984), is a core moral principle in all ethical discourse, and constitutes the foundation for social work practice (Reamer, 2017). The second principle, beneficence, or do good (Kitchener, 1984), is the bedrock of social work’s mission as our “primary responsibility is to promote the well-being of clients” (National Association of Social Workers [NASW], 2017, p. 8). When social workers consistently engage in activities that nurture their personal and professional well-being, they may be at lower risk for the occupational hazards of the profession and less likely to risk harming their own or their clients’ bio-psycho-social-spiritual well-being. Social worker self-care is essential for preventing harm and doing good, and may even prevent ethical violations (NASW, 2017; Newell, 2017). Although professional self-care is not explicitly identified in the NASW Code of Ethics, it is certainly implied. Standard 4.05 directs social workers to avoid allowing personal problems, psychosocial challenges, substance misuse, and legal problems, to impede professional competency, impair judgment, or interfere with client welfare (NASW, 2017). Moreover, social workers are required to take remedial action (self-care) when personal problems interfere with professional functioning, i.e. adjusting workloads, engaging in professional help, terminating practice, or other actions that protect client welfare. “The primary mission of 36

Social worker self-care

the social work profession is to enhance human well-being” (p. 2), particularly those most vulnerable in society (NASW, 2017). So important to social work is self-care that social work leaders have declared it an ethical imperative (Newell, 2017), an ethical obligation (Barsky, 2015), an ethical responsibility (Newell & Nelson-Gardell, 2014), and a nonnegotiable ­element of social work practice and education (NASW, 2009).

What is self-care and why is it important? Defining self-care is challenging as it depends on the context and discipline in which the term is used. We define self-care as an essential activity crucial to the development of skills and strategies needed to maintain one’s professional effectiveness as well as one’s personal, familial, emotional, and spiritual well-being, while simultaneously attending to the well-­ being of those we serve (Greene, Mullins, Baggett, & Cherry, 2017; NASW, 2009; Newell & Nelson-Gardell, 2014). Four domains of self-care are commonly noted in the social work literature: physical/­ biological, emotional/psychological, social/leisure, and spiritual (Cox & Steiner, 2013; Greene et al., 2017; Lee & Miller, 2013.) In the physical domain, proper nutrition, adequate sleep, exercise, regular health care, and dental checkups are recommended. Participation in personal psychotherapy, addressing psychological wounds, and engagement in self-reflection can enhance self-awareness and contribute to a healthy emotional self. Spending time with friends and family while enjoying fun and relaxing activities nurtures social and leisure well-being. Finally, activities promoting a sense of meaning and purpose, such as participating in religious activities and communing with nature, may encourage spiritual wellness. Mindfulness has also received much attention. (Gockel, Burton, James, & Bryer, 2012; ­McGarrigle & Walsh, 2011; Napoli & Bonifas, 2011). Before answering the question, why self-care?, consider this statement from the NASW (2009): “Professional self-care is an essential underpinning to best practice in the profession of social work…” (p. 268). Essential means absolutely necessary and extremely important; underpinning is defined as a solid foundation (dictionary.com). Therefore, professional self-care is absolutely necessary to the foundation of social work practice. The question remains – why is self-care necessary to the profession? An ancient Greek myth may answer this question.

The Wounded Healer framework Helping professionals often use the Greek myth of Chiron, the Wounded Healer, to describe those who enter their profession motivated by personal pain and suffering or “wounding.” Chiron, a centaur, rejected and abandoned at birth, was rescued by Apollo who provided a safe and supportive environment, nurturing his development into a great leader and healer (Holmes, 1991). Chiron was later speared in the leg by an arrow, creating a wound that never healed. His continual search for healing the “unhealable” wound is what allowed Chiron to become a great healer (Holmes, 1991). However, it is not the wound itself that produces the ability to heal, rather the process of healing generates insight into the healer’s own woundedness and healing processes (Zerubavel & Wright, 2012). Wounded healers are thought to have more credibility since they have experienced pain and suffering (Zerubavel & Wright, 2012). They may be more empathic, more understanding when client progress is slow, and may have a greater understanding and appreciation for the therapeutic process (Zerubavel & Wright, 2012). Holmes (1991) suggests that a therapist’s understanding of personal woundedness is an important part of the client’s cure. 37

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Research shows that social workers and other professional helpers have higher rates of mental health problems, traumatic childhood experiences, and other challenging personal histories than the general population and workers in other professions (Pooler, Siebert, Faul, & Huber, 2008). Out of 55 occupations studied, social service occupations reported the third highest prevalence rate for depression (Wulsin, Alterman, Bushnell, Li, & Shen, 2014). Moreover, over 40% of social workers in a national sample reported a mental health problem prior to entering the profession, increasing to 52% during their career, with 28% reporting current mental health issues (Straussner et al., 2018). Research has also examined personal histories of helping professionals regarding childhood abuse and other challenges. In a sample of 192 child welfare workers, Howard et al. (2015) found higher ACE scores (4 or more) among child welfare workers, 25.1%, versus the comparison group, 12.5%. Another study involving child welfare workers found a significant correlation between abuse history and later development of secondary traumatic stress (STS) (Nelson-­ Gardell & Harris, 2003). Jeffreys, Hartley, and Kennedy (1993) compared familial trauma histories of MSW students and business students and found MSW students’ frequencies of trauma were significantly higher on several variables: substance misuse, physical abuse, mental illness, death, separation and divorce, and suicide. Left unacknowledged, social workers’ psychological wounds may place them at higher risk for the occupational hazards of the profession.

Occupational hazards of the social work profession Social work is unique in that despite the joys and benefits of altruistic work, distinct and difficult challenges remain. The most common of these are referred to as occupational hazards: work-related stress, burnout, secondary trauma, vicarious trauma (VT), compassion fatigue (CF), and impairment. Knowledge is power, and the best protection against these hazards is education about them (Newell & MacNeil, 2010).

Work-related stress Stress can be helpful in stimulating motivation to achieve goals or handling challenges; however, in excess, stress has harmful consequences impacting bio-psycho-social-spiritual well-being. Work-related stress occurs when an individual’s emotional and psychological resources cannot keep pace with work demands (Arrington, 2008). Arrington (2008) identified the following work-related stressors among a national sample of social workers. The most reported stressors were not enough time to do the job and having too heavy a workload. Inadequate compensation and challenging clients were also frequently reported. Additional stressors included: unclear job expectations, little opportunity for advancement, more responsibility than one can handle, long work hours, working on tasks that have little inherent value, lack of colleague and supervisor support, and not enough resources to do the job. When organizational support and the necessary resources are lacking, the risk for burnout increases.

Burnout The term “burnout” was coined by Freudenberger (1974), a consulting psychiatrist for a free clinic in New York that assisted people with addiction and homelessness. He observed similar processes within those who were addicted and the volunteers at the clinic. Much like chronic addiction drained the sufferer of hope and energy over time, so, too, did the volunteers become emotionally depleted. 38

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Job burnout is described as “a psychological syndrome emerging as a prolonged response to interpersonal stressors on the job” (Maslach & Leitner, 2016, p. 104). Emotional exhaustion, cynicism and detachment, and a diminishing sense of work-related efficacy and accomplishment define burnout (Maslach & Jackson, 1981). Burnout might manifest psychologically as a social worker feeling (s)he has nothing left to give. Emotionally depleted and drained, feelings of anger, frustration, and resentment (cynicism and detachment) might result. Feelings of inefficacy – “no matter what I do, nothing helps” – may overcome the worker, and (s)he can feel as hopeless and helpless as the client.

Secondary trauma STS is a traumatic response experienced by “those who are close to the victim of trauma” (Barker, 2003, p. 385): a family member, witness, or helping professional. Figley (1995) defined STS as “a natural consequence of caring between two people, one of whom has been initially traumatized and the other of whom is affected by the first’s traumatic experiences” (p. 11). The cost of caring does not come without risks (Stamm, 1999). Secondary traumatization often mimics post-­traumatic stress disorder (PTSD) (Figley, 1995; Knight, 2010; Stamm, 1999), as many social workers “experience repeated or extreme exposure to aversive details of the traumatic event(s)” (American Psychiatric Association, 2013, p. 271). Other symptoms of PTSD may also manifest. Intrusive thoughts and memories of the client’s trauma might occur. Avoidance of the client’s trauma can result in cancelled appointments, absenteeism, or substance misuse. Negative alterations in cognition and mood can manifest in memory impairment and inability to recall details of the trauma experience. A low mood characterized by anger, fear, and guilt may also occur.

Vicarious trauma VT is another common occupational hazard. “It can be understood as related both to the graphic and painful material trauma clients often present and to the therapist’s unique cognitive schemas or beliefs, expectations, and assumptions about self and others” (McCann & Pearlman, 1990, p. 131). Whereas STS is associated with emotional and behavioral aspects of traumatic stress (Figley, 1995), VT is more connected to the shifts that occur in the cognitive schemas of professional helpers (Newell, & MacNeil, 2010; Pearlman, 1999). In response to repeated exposure to traumatic stories, social workers may question core beliefs about human nature, safety, control, trust, intimacy, spirituality, and overall worldview (Pearlman & ­McCann, 1995; Pearlman & Saakvitne, 1995).

Compassion fatigue CF is a construct that contains two negative aspects of helping, burnout and STS (Stamm, 2010). Feelings of inefficacy, being overwhelmed, unhappy, exhausted, disconnected, and insensitive to the work of professional helping are typical of burnout; but when combined with the trauma, fear, and helplessness associated with STS, CF results and may lead to impaired professional functioning.

Impairment Due to the nature of social work, it is not uncommon for social workers to experience some aspects of the occupational hazards. In a large sample of social workers, Siebert (2005) 39

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found 75% had experienced burnout at some point during their career. Social workers don’t stop feeling simply because a helping degree has been conferred. Yet, when social workers’ work-related and/or personal stressors go unacknowledged, accumulating over time, the impact can have harmful effects. In addition, unaddressed stressors and challenges may render social workers vulnerable to ethical violations and malpractice (NASW, 2009; Reamer, 1998). Serious ethical violations such as the failure to provide competent care, inability to perform one’s work responsibilities due to substance misuse or mental illness, and sexual impropriety can occur (Reamer, 1992). Overtime, a social worker who is inattentive to his or her own emotional and psychological needs may become impaired. Impairment occurs when one is unable or unwilling to function adequately and competently as a professional social worker; unable or unwilling to adhere to ethical standards of care; and/or has difficulty managing emotional reactions (Barker, 2003).

Social work practice and self-care This NASW (2009) policy statement underscores the ethical responsibility social workers have to care for themselves. NASW recognizes and acknowledges the unique and valuable contributions of the professional social worker and supports the practice of professional self-care for social workers as a means of maintaining their competence, strengthening the profession, and preserving the integrity of their work with clients. Education, self-awareness, and commitment are considered key to promoting the practice of professional self-care. (p. 270) Self-care is the heart of professional resilience (Newell, 2017), and neglect of self-care can result in disrespecting clients; disrespecting work; increased mistakes; low energy; using work to repress painful emotions such as unhappiness, fear, anxiety, and feelings of disconnection; and loss of interest in work (Pope & Vasquez, 2011). For the protection of practicing social workers, the profession should consider adopting standards of self-care modeled after the Standards of Self-Care Guidelines (Green Cross, 2008). The aims of these standards are twofold: (1) to emphasize non-malfeasance, but with a twist – first, do not harm to yourself; and (2) in order to maintain the integrity of professional practice and to provide high-quality services while helping others, workers must attend to their own bio-psycho-social-spiritual well-being.

Social work education and self-care NASW (2009) asserts that self-care is necessary for professional and ethical conduct and calls for the implementation of self-care policies and practices in agencies and organizations, self-care continuing education, and the integration of self-care content into social work curricula. Social work education has a crucial role in educating social workers on the critical nature of self-care (NASW, 2009). The NASW calls for the inclusion of content on both self-care and occupational hazards. These subjects should be included in both generalist and advanced social work curricula through courses, assignments, policies, student standards, and field internships. Because students may be more vulnerable to the occupational hazards of the profession due to inexperience (Newell & Nelson-­ Gardell, 2014; Stanley & Bhuvaneswari, 2016) and their own traumatic personal histories 40

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(Nelson-Gardell & Harris,  2003), social work education has an ethical responsibility to include this content. “A comprehensive social work education should be the first line of preventing and treating these conditions [­occupational hazards] in social work students and future practitioners” (Newell & Nelson-Gardell, 2014, p. 428).

Macro self-care While self-care is necessary, it is not sufficient at the macro level. An overemphasis on selfcare to combat distress at the individual level does not consider patterns in systems which created it (Bloom, 2013). Many risk factors for the occupational hazards, particularly burnout, occur at the organizational level and are beyond individual control: excessive caseloads; having little control or influence over policies and procedures; unfair treatment; lack of colleague support; and inadequate supervision (Arrington, 2008; Maslach & Leiter, 1997). As such, agencies and organizations have a responsibility to adopt a culture of self-care. Supports at the agency level, such as process-oriented supervision and supportive peers, are critical to maintaining safe work environments (Chiller & Crisp, 2012); yet social relationships can impact the worker by either providing support or creating interpersonal conflict (Maslach, 2003). To combat burnout and CF, collegial support is necessary. Helping with excessive paperwork, taking an exceptionally challenging client, providing emotional support, and the use of humor are all ways support may be provided (Bell, Kulkarni, & Dalton, 2003; Maslach, 2003). Organizations need to set realistic expectations relative to client care and workloads, including advocating adequate rest, recreation, and promoting work breaks (Maslach, 2003). It is essential for organizations to acknowledge occupational hazards as common reactions to the demands of social work, as this could increase workers’ ability to cope with such experiences, and may help reduce stigma associated with occupational hazards (Bell et al., 2003). In addition, workers require personal agency in organizations: they need to have a voice. The ability to access not only information but also receive necessary support and resources for task completion is crucial (McDermott, Laschinger, & Shamian, 1996).

Resilience: implications of self-care Self-care is essential to ethical practice. Promoting professional resilience through self-care has the capacity to mitigate the negative effects of social work allowing focus on the positive aspects of dealing with vulnerable, traumatized populations such as vicarious resilience and post-traumatic growth (Newell, 2017). One study demonstrated that human services providers with higher ACE scores had lower risks for burnout and higher rates of compassion satisfaction (Howard et al., 2015). The goal of self-care is to not only decrease anxiety but also create meaning and self-­ exploration (Sansbury, Graves, & Scott, 2014). A holistic construct of self-care, underpinned by the ecological systems model, permits a wide scope of self-care activities not focused exclusively on aspects of professional practice. The emphasis of self-care on multiple domains helps maintain a healthy work/life balance as an imbalance in one area impacts the others (Newell, 2017). Without commitment to and active engagement in self-care, social workers are at risk of experiencing occupational hazards. Self-care is not limited only to treatment and prevention of occupational hazards; it serves “as a means of empowerment that enables practitioners to proactively and intentionally negotiate their overall health, well-being, and resilience” (Lee & Miller, 2013, p. 96). 41

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References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Arrington, P. (2008). Stress at work: How do social workers cope?. NASW Membership Workforce Study. Washington, DC: National Association of Social Workers. Barker, R. (2003). The social work dictionary (5th ed.). Washington, DC: NASW Press. Barsky, A. (2015). Being conscientious: Ethics of impairment and self-care. The New Social Worker. Retrieved from http://www.socialworker.com/feature-articles/ethics-articles /being-conscientiousethics-of-impairment-and-self-care/ Bell, H., Kulkarni, S., & Dalton, L. (2003). Organizational prevention of vicarious trauma. Families in Society, 84, 463–470. Bloom, S. (2013). The sanctuary model: A best-practices approach to organizational change. In V. L. Vandiver (Ed.), Best practices in community mental health: A pocket guide. Chicago, IL: Lyceum. Chiller, P., & Crisp, B. R. (2012). Sticking around: Why and how some social workers stay in the profession. Practice, 24(4), 211–224. Cox, K., & Steiner, S. (2013). Self-care in social work: A guide for practitioners, supervisors, and administrators. Washington, DC: NASW Press. Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress in those who treat the traumatized. New York, NY: Brunner/Mazel. Freudenberger, H. (1974). Staff burnout. Journal of Social Issues, 30(1), 159–165. Gockel, A., Burton, D., James, S., & Bryer, E. (2012). Introducing mindfulness as a self-care and clinical training strategy for beginning social work students. Mindfulness, 4(4), 343–353. Green Cross Academy of Traumatology. (2008). Standards of self-care guidelines. Retrieved from http:// greencross.org/wp-content/uploads/2017/11/Standards-of-Self-Care-Guidelines.pdf Greene, D. S., Mullins, M. H., Baggett, P., & Cherry, D. (2017). Self-care for helping professionals: Students’ perceived stress, coping self-efficacy, and subjective experiences. Journal of Baccalaureate Social Work, 22(1), 1–16. Holmes, C. A. (1991). The wounded healer. Society for Psychoanalytic Psychotherapy Bulletin, 6(4), 33–36. Howard, A. R., Parris, S., Hall, J. S., Call, C. D., Razuri, E. B., Purvis, K. B., & Cross, D. R. (2015). An examination of the relationships between professional quality of life, adverse childhood experiences, resilience, and work environment in a sample of human service providers. Children and Youth Services Review, 57, 141–148. Jeffreys, N., Hartley, D., & Kennedy, E. (1993). Personal history of psychosocial trauma in the early life of social work and business students. Journal of Social Work Education, 29(2), 171–180. Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. Counseling Psychologist, 12, 43–55. Knight, C. (2010). Indirect trauma in the field practicum: Secondary traumatic stress, vicarious trauma, and compassion fatigue among social work students and their field instructors. Journal of Baccalaureate Social Work, 15(1), 31–52. Lee, J. J., & Miller, S. E. (2013). A self-care framework for social workers: Building a strong foundation for practice. Families in Society: The Journal of Contemporary Social Services, 94(2), 96–103. Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12(5), 189–192. Maslach, C., & Jackson, S. (1981). The measurement of experienced burnout. Journal of Occupational Behavior, 2, 99–115. Maslach, C., & Leiter, M. P. (1997). The truth about burnout how organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass. Maslach, C., & Leitner, M. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111. McCann, L., & Pearlman, L. (1990). A framework for understanding the psychological effect of working with victims. Journal of Traumatic Stress, 3(1), 131–149. McDermott, K., Laschinger, H. K., & Shamian, J. (1996). Work empowerment and organizational commitment. Nursing Management, 27(5), 44–47. McGarrigle, T., & Walsh, C. A. (2011). Mindfulness, self-care, and wellness in social work: Effects of contemplative training. Journal of Religion & Spirituality in Social Work: Social Thought, 30(3), 212–233. 42

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Napoli, M., & Bonifas, R. (2011). From theory toward empathic self-care: Creating a mindful classroom for social work students. Social Work Education, 30(5), 635–649. National Association of Social Workers. (2009). Social work speaks: National Association of Social Workers policy statements, 2009–2012 (8th ed.). Washington, DC: Author. National Association of Social Workers. (2017). The code of ethics of the National Association of Social Workers. Retrieved from https://www.socialworkers.org/About/Ethics/Code- of-Ethics/ Code-of-Ethics-English Nelson-Gardell, D., & Harris, D. (2003). Childhood abuse history, secondary traumatic stress, and child welfare workers. Child Welfare, 83(1), 5–26. Newell, J. M. (2017). Cultivating professional resilience in direct practice. A guide for human service professionals. New York, NY: Columbia. Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: Review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practice in Mental Health, 6(2), 58–68. Newell, J. M., & Nelson-Gardell, D. (2014). A competency based approach to teaching professional self-care: An ethical consideration for social work educators. Journal of Social Work Education, 50, 427–439. Pearlman, L. A. (1999). Self-care for trauma therapists. Ameliorating vicarious traumatization. In B.  H.  Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 51–64). Baltimore, MD: Sidran Press. Pearlman, L. A., & McCann, P. S. (1995). Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists. Journal of Psychology: Research and Practice, 26(6), 558–565. Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York, NY: Norton. Pooler, D. K., Siebert, D. C., Faul, A. C., & Huber, R. (2008). Personal history and professional impairment. Administration in Social Work, 32(2), 69–85. Pope, K., & Vasquez, M. (2011). Ethics in psychotherapy and counseling: A practical guide (4th ed.). ­Hoboken, NJ: John Wiley. Reamer, F. (1992). The impaired social worker. Social Work, 37(2), 165–170. Reamer, F. (1998). Ethical standards in social work: A critical review of the NASW code of ethics. Washington, DC: NASW Press. Reamer, F. (2017). Eye on ethics: Virtue ethics in social work. Social Work Today. Retrieved from http://www.socialworktoday.com/archive/060117.shtml Sansbury, B. S., Graves, K., & Scott, W. (2014). Managing traumatic stress responses among clinicians: Individual and organizational tools for self-care. Trauma, 17(2), 114–122. Siebert, D. C. (2005). Personal and occupational factors in burnout among practicing social workers: Implications for researchers, practitioners, and managers. The Journal of Social Service Research, 32(2), 25–44. Stamm, B. (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators. ­Lutherville, MD: Sidran Press. Stamm, B. H. (2010). The Concise ProQOL Manual. Pocatello, ID: ProQOL.org. Stanley, S., & Bhuvaneswari, G. M. (2016). Stress, anxiety, resilience and coping social work students (a study from India). Social Work Education: The International Journal, 35(1), 78–88. Straussner, S. L. A., Senreich, E., & Steen, J. T. (2018). Wounded healers: A multistate study of licensed social workers’ behavioral health problems. Social Work, 63(2), 125–133. Wulsin, L., Alterman, T., Bushnell, P. T., Li, J., & Shen, R. (2014). Prevalence rates for depression by industry: A claims database analysis. Social Psychiatry and Psychiatric Epidemiology, 49(11), 1805–1821. Zerubavel, N., & Wright, M. O. (2012). The dilemma of the wounded healer. Psychotherapy, 49(4), 482–491.

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7 The test of a good conscience John Solas

What is conscience and why is it important? Central to the modern conception of conscience is the notion of a capacity, attributed to most people, that enables them to discern the commission or omission of acts, both their own and others, as immoral and blameworthy (Strohm, 2011). The notion of conscience emanates from antiquity. Its meaning evolved from the Greek term suneidesis, and Latin derivative, conscientia, both of which connoted a state of or act of sharing knowledge about one’s sense of propriety (Sorabji, 2014). The ancients considered conscience the source of an individual’s typically unpalatable response to some violation of moral sensibility (Van Creveld, 2015). Creeds of various kinds have made conscience sacrosanct, but immersed it in guilt, and there, in large part, it has remained even after the Enlightenment (Van Creveld, 2015). Among its defenders, Kant has arguably been the strongest (Hill, 2000). However, even Kant’s attempt to provide a rational basis for conscience has not freed it of guilt. By the same token, conscience has had to endure some very powerful and sustained criticism, most notably from Nietzsche (1887/1967) and Freud (1923). They, like many of their predecessors, considered conscience to be the cradle of abject weakness and sickness (Ojakangas, 2013; Ridley, 1998). While the term has retained its original meaning, modern interpretations have lost much of the nuance that makes the notion of conscience distinctive and significant. As Langston (2001) observes: Perhaps the long-standing identification of conscience with some set of rules for behavior undercuts its importance. We follow the rules we formulate or are given and try to deduce even more. This reasoning seems much like ordinary moral discussion and need not be under the notion of conscience. Once we remove moral reasoning from conscience, it appears that the only function of conscience is to goad us to proper behavior by making us feel uncomfortable when we do other than we should. Yet, this reduction of conscience to an emotional buzzer hardly preserves the notion of conscience. (p. 1) Contemporary conceptions of conscience fall within two extremes (Hill, 2000), both of which are rooted in the notion of conscience as a faculty. At one end of the spectrum, conscience is 44

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providential. At the other end, conscience is culturally derived and normative. Whether moved by learning or epiphany, whatever suasive effect one’s inner conscience has is relative. Relativity is not problematic in and of itself. A major problem arises, however, when conscience is dogmatic or doctrinaire (Pianalto, 2011). Conscience guided by unreason has driven true believers to excess. Both blind faith and false consciousness have stirred and sanctioned unconscionable behavior of unprecedented proportions from the crusades to the Holocaust and back. On the face of it, it might seem right to condemn and abandon conscience. However, it is tenacious and extremely difficult to become divorced or escape from it. It signals contraventions ranging from minor infractions to capital offences and serves as a constant reminder of these. Conscience is intuitive. But it is not merely the internalized strictures of dogma or culture. Indeed, it may urge a radical departure from rather than a return to convention. It can also be honed through a process of conscientization (Freire, 1970), combining critical reflection and action. Hill (2000) offers a conception of conscience that deftly avoids the contentious problems associated with the metaphysical (faith-based) and deflationary (normative) extremes, parochialism and fundamentalism in particular, and at the same time addresses two key questions, i.e. to what extent and why should individuals (1) treat their conscience as authoritative moral guides, and (2) respectfully tolerate the conduct of others when they are apparently guided by conscience? Hill (2000) notes that individuals are bound to regard their moral sense as decisive since there is no unimpeachable alternative. Moreover, each person has a range of inner (celestial and terrestrial) voices of conscience at their disposal. Nevertheless, while conscience commands respect, it is not foolproof. It is possible for conscience to become misguided, at least for a time. But, in the final analysis, conscience remains a person’s most trusted guide. As Hill (2000) explains, although “a clear conscience is no guarantee that we acted in an objectively right way, it is both necessary and sufficient for morally blameless conduct” (pp. 35–36). The margin of error can be significantly reduced when individuals subject their consciences to deliberate scrutiny and test the force of their moral convictions in public. The imperative to certify the authority of one’s own conscience is a feature generally lacking in conceptions of conscience based on creed and culture (Howard, 2014). Indeed, as Howard (2014) has argued, simply assuming that conscience is an internal and idiosyncratic faculty both restricts individuals’ ability to grasp more fully the insights that conscience discloses from intersubjectivity and limits their ability to appreciate the relational importance of moral reasoning and consensus in examining moral life. Nevertheless, the faculty view of conscience has tended to dominate legal (Vischer, 2010) as well as moral (Van Creveld, 2015) theorization and practice. In claiming moral authority for their own consciences, individuals are obliged to recognize the conscience of others. By the same token, other people’s consciences are also subject to error, and hence, must be held to account. Moral agreement is not always possible. However, disagreements provide opportunities for those involved to reconsider their original conscientious judgments and accede to those of others when warranted. In the event of a moral impasse, one’s own conscience prevails provided it has satisfied the requirements of judicious introspection and reasoned debate. This entails asking oneself a series of searching questions. Was I really applying a sound moral principle to my actions, or was I making a self-serving exception? Did I correctly perceive the morally relevant features of my circumstances, or was I engaging in wishful thinking or some other form of self-deception? Was I adequately attentive and diligent in my moral accounting? Was I blindly influenced by others or by the culture at large? It is this kind of self-criticism, the introspective critique of individuals’ own prior moral reasoning that Hill (2000) claims is a precondition for conscientiousness. 45

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Liberty of conscience As the forgoing shows, conscience is eminently important. We would be cut adrift in a sea of moral chaos without it. However, it is not enough to be cognizant of the difference between right and wrong and good and evil. Conscientiousness demands much more. Individuals must be willing and able to act on their conscience. For Kimberley Brownlee (2012), conscience is not merely moral awareness, but rather a rich set of practical moral skills for enabling responsiveness. However, conscience is seldom freely exercised. Indeed, both ardent critics (Freud, 1923; Machiavelli, 1532/1961; Nietzsche, 1887/1967) and defenders (after Kant, 1797/1999) of the value of conscience agree that consulting one’s conscience incurs a cost. Wrestling with, and following, one’s conscience, even if it accords with others, is never devoid of personal risk. Conscience often encounters censorship, either self-inflicted or forcibly imposed. Denial and repression may be no less painful and dire than retribution for pursuing one’s conscience. Acting on one’s conscience is a liberty that has to be taken if it is not granted. There are at least two ways in which individuals can press the liberty of conscience. These are conscientious objection and un/civil disobedience. These are not the same. In fact, they are very different. Brownlee (2012) defines civil disobedience as “a deliberate breach of law, acting on the basis of steadfast personal commitment, taken in order to communicate condemnation of a law or policy” (p. 18). This stands in sharp contrast to conscientious objection which is the refusal to follow a law or directive on the grounds of perceived personal conviction. In breaking the law, furthermore, the civil disobedient typically aims to advance a reform agenda of some sort (Brownlee, 2007). It is, in large part, this reformist intent that distinguishes civil disobedience from conscientious objection as each has been traditionally understood. The latter, notes Raz (1979), is “essentially a private action by a person who wishes to avoid committing moral wrong by obeying a morally bad law” (p. 264). The conscientious objector wishes to opt out. The civil disobedient, in contrast, is more interested in changing an objectionable law than gaining an exemption from it. Brownlee (2012) argues that whereas conscientious objection is tolerated, civil disobedience is condemned, by the state. This, Brownlee (2012) contends, is unjustified. Not only does civil disobedience have a greater claim than it is given to leniency, but legal, as well as moral, legitimacy. This is because the convictions upon which civil disobedience stand are subject to more stringent criteria than conscientious objection. Brownlee (2012) lists four conditions for a sincere moral conviction: (1) consistency, (2) universal moral judgment, (3) non-evasion, and (4) dialogic effort. The latter two may be considered corollaries of the former. However, all are according to Brownlee (2016): important and non-obvious corollaries, and this justifies the effort to elucidate their features. Non-evasion derives from consistency. It is part of being consistent that we not adjust our conduct when doing so would be expedient but at the cost of the commitment that we purportedly espouse. Non-adjustment implies non-evasion. Dialogic effort derives from universal moral judgment. Part of judging other people and ourselves by common moral standards is being willing to try where possible to engage others in dialogue about conduct we believe is wrong. (Brownlee, 2016, p. 724) These conditions, according to Brownlee (2016), make it possible to distinguish in/sincere conviction: 46

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When a person lacks sincere moral conviction, her behavior will reflect that, and will differ from the behavior of someone with sincere moral convictions. By looking at behavior, we can test, roughly, whether a person displays the consistency, non-evasion, and dialogic effort features of sincere moral conviction. We can ask: is she standing up to be counted for her view? Does she try to engage others in dialogue about her view? How much does she benefit personally from championing this view? How close is the connection between any personal benefit and the actions she is willing to take to defend the view? For how long has she shown a commitment? (p. 727) Civil disobedience is criticized by some as not only unlawful but also undemocratic. Critics such as Weinstock (2016) contend that “those who would presume to disobey their laws simply because they disagree with them are guilty of a form of moral self-indulgence, no matter how deep their convictions are that the laws that they are disobeying are wrong” (p. 709). Such an unqualified view accords the state a rather unjustified omnipotence. Even in a reasonably good society there is an ineliminable gap between the expectations of state authority and an individual’s moral responsibilities. No state can or, indeed, should prescribe what is morally required in every possible situation. It is, of course, also possible to disagree with a law for reasons other than pure moral conviction. Should reasons of inconsistency, redundancy, and disuse be considered self-indulgent? In any event, civil disobedients do not refuse to comply with the law simply because they disagree with it. Rather, they disobey because of a profound belief that the law they oppose is morally wrong and should be changed or repealed. Is not displaying the strength of such conviction publicly evidence of a robust democracy? How is democracy to be preserved if moral protest based on firm conviction remains private and silent? A violent act may in certain cases be necessary, and, in fact, produce less harm than a nonviolent act (Raz, 1979). The evil that a civil disobedient protests against may be so great as to justify some amount of force (Greenawalt, 1987). The Holocaust and other genocides are a case in point. The practice of civil disobedience raises urgent and obvious questions of justification. Insofar as people in a reasonably well-functioning liberal democracy have a prima facie obligation to obey the law, acts of law-breaking are tainted by illegitimacy. Theorists of civil disobedience, accordingly, have devoted substantial attention to the issue of when it may be morally justified, proposing conditions such as the existence of extreme injustice, willingness to submit to punishment, and exhaustion of lawful channels of dissent (Bulman-Pozen, 2015). Acts of uncivil obedience, in contrast, would appear to require no such special defense given that they are understood to abide by the law. On this view, it is the moral skeptic who bears the burden of establishing conditions under which the use of uncivil obedience is illegitimate.

Conscience raising The forgoing raises a number of important points for social workers to consider in cultivating and engaging their own and others’ consciences. For conviction to be genuinely conscientious, i.e. derived from a sound conscience, it must be consistent, universal, non-evasive, and communicated (Brownlee, 2012). Brownlee (2012) has argued, when individuals carry a conscientious conviction that something is wrong, they must (1) avoid the conduct in question to the best extent that they are able; (2) judge such conduct in others to be wrong also; and must be willing (3) to bear the risks of honoring their conviction; as well as (4) ­communicate the reasons that they think justify their conviction to others. These conditions, elaborated below, are the measure of a good or clear conscience. 47

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Consistency Conscience is neither exceptional nor extraordinary. The ability to use conscience in a discriminating manner typically develops early in life (Nunner-Winkler & Sodian, 1988) and evolves with experience and maturity (Malti & Krettenauer, 2013). Most people grow accustomed, and respond in one way or another, to its urgings. It is not the source of virtues, nor, indeed, values, but rather the basis for judging and defending these. As Howard (2014) contends, conscience is neither an instinct nor a faculty for determining right and wrong. Rather, notes Hill (2000), it serves as an internal process of “judicial self-appraisal” (p. 31). Conscience makes individuals aware of, and accountable for, their moral convictions. A guilty conscience, in particular, is hard to ignore or disavow without incurring considerable cognitive dissonance, emotional turmoil, and self-admonition. Nevertheless, it affirms as well as negates (Vischer, 2010). It is not simply a source of internal warrant. The right to freedom of conscience is also the well spring of external empowerment. Conscience functions as a guide to ethical behavior. Social workers are obliged to take all due care in consulting their consciences and arriving at their most reasonable judgments about what is wrong and right. Judgments must be thoroughly probed by them before being acted upon. Their appraisals would simply be rash, impulsive, sanctimonious and, hence, inconsistent, otherwise. However, while conscience acts as a guide to moral behavior, this does not diminish its stature, nor justify dismissing or overriding it.

Universality Although conscience is personal, it is not insular. It urges social workers to think for, but not only about, themselves when considering moral responsibilities. Conscience raising is a necessarily interactive enterprise undertaken in collaboration with others, including, and indeed, most especially, those who are single- and narrow-, as well as like-minded. It requires social workers to recognize when an act they judge to be wrong is wrong not only when they commit it, but also when others in similar circumstances do it. Social workers guided by conscience are not consigned to silent contemplation and protest about moral transgressions that affect others in the same or similar way as themselves. Un/civil disobedience is not only possible in such circumstances but also imperative. Social workers have both a right and an obligation to object to, resist, and put a stop to immoral and unethical acts and directives, and the doctrines, systems, and regimes that give rise to, and perpetuate, these.

Non-evasion The ultimate authority for any appeal to conscience is oneself. There is no requirement for social workers to look to those in authority for guidance in exercising conscience. Needless to say, people in authority are not, by simple virtue of their position, authoritative, and there is no unswerving reason to steer one’s own conscience by them. One ought to regard one’s conscience as one’s surest moral compass. Obedience to authority which exceeds the bounds of propriety is no less a moral than legal violation (Kelman & Hamilton, 1989). Social workers cannot evade moral responsibility by simply claiming to be the instruments or victims of unscrupulous leaders. They are morally accountable for their actions. There is no denying that disobedience carries a risk, but it remains a moral choice, even under duress. But no matter how diligent conscientious reflection and exhaustive deliberative discourse have been, neither guarantees infallibility. The moral judgments rendered by conscience are subjective. However, despite any residual doubt, scrupulous, methodical reasoning sharpens 48

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the quality of moral viewpoints, and, although they remain subjective, removes any basis for unmitigated recrimination or retribution against those social workers who earnestly follow their consciences.

Communication Conscience is not only introspective, but also retrospective and prospective (Sulmasy, 2008). It alerts us to own and others’ misdeeds and serves as a prelude to further conscientious deliberation. It voices the inner conflict that occurs when what we have done, are doing, or are about to do, violates our moral sensibilities, and speaks in a moral vocabulary that we have grown to recognize, understand, and articulate as our own. By the same token, conscience does not speak for us, as if it were some separate spiritual entity or quality, and any insights it reveals is inextricably associated with our experience. To sever the guidance of conscience from the capacity for clear formulation and articulation is to jeopardize, in a fundamental way, its relation to responsible moral motivation and reasoning and the quest for mutual understanding. Although social workers are not at liberty to do whatever they please, those in authority have no jurisdiction over their private consciences. Authorities may be in a position to impose sanctions on our actions. However, any attempt to censor or muzzle conscience constitutes not only a gross violation of moral integrity but also a basic human right. As Kukathas (2003) notes, “among the worse fates that individuals might have to endure is being unable to do what they think is right” (p. 55). An absolute requirement to privilege the rule of law over our deepest moral convictions incurs a cost that social work must not, in all good conscience, condone.

Social work: bystander or upstander? Is social work conscientiousness enough? A number of social work associations, including those in Australia, the United Kingdom, and United States, make no reference to conscience in their mission statements, codes of ethics, or principles and values. Moreover, a national survey of NASW members (n=1,274) by Rome and Hochstetler (2010) showed that while 95% regularly voted, less than half (46.6%) were highly politically active. The more committed activists were older, had more practice experience, and possessed doctorates. The authors also found that only 42% of respondents believed that clients ought to be encouraged to become politically active on their own behalf. Moreover, those in private, for-profit, clinical practice revealed a lower level of political involvement than workers practicing in the public, nonprofit sector. Finally, despite the fact that political action is a professional obligation promoted by the NASW (under section 6.04 of the revised Code of Ethics [2017]), 12.5% of the sample viewed it as “ethically suspect” (p. 121). If conscience is a source of motivation for political action, then this research reveals the need for greater moral conviction and effort among social workers. Being upstanding is, at the very least, a practical test of a good conscience. The legacy of failure, of remaining a bystander, is dire. As Mill (1867) long ago observed: let not any one pacify his conscience by the delusion that he can do no harm if he takes no part, and forms no opinion. Bad men need nothing more to compass their ends, than that good men should look on and do nothing. He is not a good man who, without a protest, allows wrong to be committed”. (p. 36) As social workers, we must realize what is entailed in having a conscience beyond our right to express it. 49

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References Brownlee, K. (2007). The communicative aspects of civil disobedience and lawful punishment. Criminal Law & Philosophy, 1(2), 179–192. Brownlee, K. (2012). Conscience and conviction: The Case for civil disobedience. Oxford: Oxford University Press. Brownlee, K. (2016). A reply to my critics. Criminal Law & Philosophy, 10(4), 721–739. Bulman-Pozen, J., & Pozen, D. (2015). Uncivil disobedience. Columbia Law Review, 115(4), 809–872. Freire, P. (1970). Pedagogy of the oppressed (M. Ramos, Trans.). New York, NY: Continuum. Freud, S. (1923). The Ego and the Id ( J. Riviere, Trans.). London: Hogarth Press and Institute of Psycho-Analysis. Greenawalt, K. (1987). Conflicts of law and morality. New York, NY: Oxford University Press. Hill, T. (2000). Respect, pluralism, and justice: Kantian perspectives. New York, NY: Oxford University Press. Howard, J. (2014). Conscience in moral life: Rethinking how our convictions structure self and society. London: Rowman & Littlefield. International Federation of Social Workers. (1996). Human rights. Retrieved from http://ifsw.org/ policies/human-rights-policy/ Kant, I. (1797/1999). Groundwork of the metaphysics of morals ( J. Timmermann, Trans.). Cambridge: Cambridge University Press. Kelman, H., & Hamilton, L. (1989). Crimes of obedience. New Haven, CT: Yale University Press. Kukathas, C. (2003). The liberal archipelago. Oxford: Oxford University Press. Langston, D. (2001). Conscience and other virtues. University Park: Pennsylvania University Press. Machiavelli, N. (1532/1961). The prince (G. Bull, Trans.). London: Penguin. Malti, T., & Krettenauer, T. (2013). The relation of moral emotion attributions to prosocial and antisocial behavior: A meta-analysis. Child Development, 84(2), 397–412. Mill, J. (1867, February 1). [Inaugural address]. Speech presented at the University of St. Andrew, Fife, Scotland. [Transcript]. Retrieved from https://en.wikisource.org/wiki/Inaugural_address_ delivered_to_the_University_of_St._Andrews,_Feb._1st_1867 National Association of Social Workers. (2017). Code of ethics. Retrieved from https://www.socialworkers.org/about/ethics/code-of-ethics/code-of-ethics-english Nietzsche, F. (1887/1967). On the genealogy of morals (W. Kaufmann, Trans.). New York, NY: Vintage. Nunner-Winkler, G., & Sodian, B. (1988). Children’s understanding of moral emotions. Child Development, 59(5), 1323–1338. Ojakangas, M. (2013). The voice of conscience: A genealogy of Western ethical experience. New York, NY: Bloomsbury. Pianalto, M. (2011). Moral conviction. Journal of Applied Philosophy, 28(4), 381–395. Raz, J. (1979). The authority of law. Oxford: Clarendon Press. Ridley, A. (1998). Nietzsche’s conscience: Six character studies from the genealogy. London: Cornell University Press. Rome, S., & Hochstetler, S. (2010). Social work and civic engagement: The political participation of professional social workers. Journal of Sociology & Social Welfare, 37(3), 107–129. Sorabji, R. (2014). Moral conscience through the ages. Oxford: Oxford University Press. Strohm, P. (2011). Conscience: A very short introduction. Oxford: Oxford University Press. Sulmasy, P. (2008). What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics, 29(3), 135–149. Van Creveld, M. (2015). Conscience: A biography. London: Reaktion. Vischer, R. (2010). Conscience and the common good: Reclaiming the space between person and state. New York, NY: Cambridge University Press. Weinstock, D. (2016). How democratic is civil disobedience? Criminal Law and Philosophy, 10(4), 707–720.

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8 Narrative ethics in ­social work practice Allan Edward Barsky

My foray into social work began on a steamy September day in New York City. I was a true neophyte, having attended just two social work classes prior to the first day at my field placement, a methadone maintenance clinic housed in an old trailer. Having been raised in a small prairie city in Saskatchewan, Canada, I was not only new to addiction counseling but also new to New York and the cultures I would soon encounter. My first client was a 46-year-old man from Puerto Rico, Roberto (not his real name). My supervisor instructed me to conduct an intake assessment. She said the meeting would be relatively easy as I simply had to complete the intake forms with him. As I politely introduced myself to Roberto, I started to perspire – not just from nervousness, but also from the warm, stale air emanating throughout the trailer. I reviewed the standard consent form with Roberto. He was more than willing to sign it. Dutifully, I went through the 35-page assessment form with Roberto, taking copious notes to accurately capture his answers. Initially, I thought I attended well to my ethical obligations. I respected the client’s self-determination. I explained confidentiality. I fulfilled my agency obligations regarding completion of the assessment forms. Reflecting back, however, I missed something very important: empathy (Slote, 2007). For 90 minutes, I was so busy asking questions and completing forms that I did not tune into Roberto’s thoughts, feelings, and experience. I was conducting an objective assessment rather than facilitating a client history (Slesar, 2017). Most questions required Roberto to choose between limited options rather than allowing him to say what he wanted. I did not invite him to share his story. I was so disconnected from his situation that I hardly noticed he was perspiring, yawning, and experiencing heroin withdrawal. I was not aware Roberto was ready to say anything to please me. He viewed me as a gatekeeper who would decide whether he would be given methadone to alleviate his withdrawal. Narrative ethics (NE) is an approach to dealing with ethical concerns by listening, interpreting, and responding to stories told by clients, coworkers, or others affected by the situation (Charon, 2007; Porz, Landeweer, & Widdershoven, 2011). Stories help us understand what others hold to be valuable and right, as well as what they deem contemptible and unethical (Brody & Clark, 2014). Stories shape our identities (Winslade, 2002) and help us form our truths. NE suggests that ethical decision-making is embedded in the stories we tell and the ways we construct our realities. Whereas legalism suggests we should apply fixed rules and deontology suggests we should apply universal principles, NE encourages us to attend to the 51

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unique experiences, emotions, and identities of everyone affected by the issues (Baldwin & Estey-Burt, 2012; Charon & Montello, 2002). NE is closely related to virtue ethics and ethics of care. These approaches encourage us to be caring, attentive, and responsive to others’ needs. They encourage us to immerse ourselves in the situation and embrace the moral complexity that reflects interpersonal relationships and ethical decision-making (Shafer-Landau, 2018). As an inexperienced social worker, I wanted to know what to do, particularly, what agency policies and ethical standards to follow. I had not understood what it meant to be a caring social worker, to be present with and responsive to the client. Instead, I simply followed agency policies and ethical guidelines in a formulaic manner.

Rationale for NE Although many social workers are not exposed to NE in their professional education, narratives are integral to practice. When we ask clients what motivated them to see a social worker, we are asking for narratives. When we invite clients to describe their childhood, we are inviting them to share stories. When we document meetings, we are recording their histories, including choices they have made and contexts for those decisions. When we seek consultation, we are sharing client stories and inviting feedback on how to move the story forward (Magelssen, Pedersen, & Førde, 2016). Further, we use stories when we conduct ethnographic research (Stevenson, 2016), when we explore case studies, and when we learn about our own professional history and identities as social workers. NE fits well with key social work perspectives: respect for the dignity and uniqueness of all people, starting with the client, and cultural humility. To treat clients with respect, we empathize with them, striving to understand their personal stories and perspectives – including their beliefs about leading a good, moral life. Rather than acting as experts in their lives, we use cultural humility, inviting clients to teach us about their values, goals, fears, and preferred ways of pursuing their goals. We show curiosity, concern, and appreciation to clients for sharing their stories. Social workers embrace the person-in-environment perspective, attending to the social and physical context in which clients live. Storytelling allows clients to illuminate their contexts (Baldwin & Estey-Burt, 2012), including sources of support, stress, moral guidance, and strengths (Cooperrider, Hertzel, Mann, & Whitney, 2008). Social workers understand that a client’s sense of what is right and wrong is socially constructed. Rather than looking at ethical issues as right or wrong choices, there may be no single view of what is right. As social workers listen to client stories, they can validate the client’s beliefs whether or not they share those beliefs. Rather than imposing preordained ethical principles or standards on clients, NE suggests listening to each other’s narratives and working as partners to co-construct new narratives about the most ethical ways to proceed. NE fits with a “casuist” or case-based approach to ethical analysis and discussion, allowing us to think critically about ethics on a case-by-case basis. Storytelling allows us to respond to our clients’ individualized truths and moralities. When we attend to their truths, they are more likely to follow through with the plans we establish to manage the ethical concerns (Magelssen et al., 2016). In terms of cultural responsiveness, NE fits with the traditional ways of knowing among various ethnocultural populations. When community elders share folktales, fables, or lived experiences (Wilks, 2005), they are transferring values and morals to the next generation. My mother loved sharing stories of her childhood, including how her family struggled and strengthened through experiences of immigration, poverty, stillbirth, stroke, anti-Semitism, and other challenges. My brothers and I heard the same stories so often that we could recite 52

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them verbatim. Along the way, we learned the lessons well, including the values of integrity, education, family responsibility, community, and resilience. Narratives help social workers pursue social justice. In fact, one of the grand narratives of social work is fighting injustice, inequality, and oppression (Wilks, 2005). As we listen to client stories of discrimination, poverty, violence, and trauma, we witness injustice. Sometimes, we alleviate the pain of injustice simply by the act of listening. We do not listen as objective outsiders, but as caring professionals and partners (Wilks, 2005). We may then go further, empowering clients to share their stories with policy makers to promote social change. As we advocate on our clients’ behalf, we may also share our lived experiences to construct stories that will move people to action.

Elements NE draws from the elements of storytelling literature, including voice, perspective, audiences, plot, character, conflict, and resolution. Although storytelling may emerge naturally from interactions between social workers, clients, and others, workers can facilitate these elements deliberately, attending to ethical issues more effectively. Voice refers to who tells the story (Montello, 2014). Perspective refers to the point of view from which the story is shared. In the opening narrative, the story is written from my voice. Most of the story is told from my perspective, including how I share my values, beliefs, and feelings. I was anxious. I was concerned about following agency policy. At some points, I attended to the client’s perspective, noting he was perspiring and experiencing withdrawal; however, my attention to the client’s experiences and feelings was minimal. Further, I was using an etic rather than an emic perspective. An emic perspective means understanding from within the person’s cultural and experiential frame; an etic perspective means understanding from an outsider’s view. Characters refer to the people involved in the story. In social work contexts, this may include the clients, co-professionals, supervisors, family members, and others affected by the ethical concerns. Stories with purposeful character development allow us to understand the characters’ motivations, including why they do what they do and why they think what they think (Gergen, 2015). Effective storytelling includes rich descriptions of the key characters, including their intersecting sociocultural identities, family backgrounds, values, beliefs, and roles (Wilks, 2005). As we gain deeper understandings of the characters, we begin to enter their world and understand their morality (Phelan, 2014). Given the space limitations for this chapter, the character content in my story is relatively thin, making it difficult to understand each character’s morals and motivations. Describing myself as a Canadian or my client as a Puerto Rican invites some understanding of our backgrounds; however, without further details, we may interpret the stories through broad stereotypes rather than more personalized information about our values, use of language, and so on. Audience refers to the people to whom the story is directed (Montello, 2014). This book is directed primarily toward social work students, practitioners, and educators. I would have shared my story differently if the audience were my supervisor, clients, or the public. As we listen to stories, we should be cognizant of the audience. Clients accused of child abuse may share different stories depending on whether they are speaking with friends, social workers, or police. We need to attend to what is spoken, as well as what is not (Miller, 2017). When we engage others in ethics discussions, the conversation is interactive, meaning that we are both audiences and storytellers. Social workers engage others in a reciprocal exchange of storytelling, listening, discovery, and meaning making as the conversation is created (Miller, 2017). 53

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Plot refers to the temporal ordering of events in the story (Montello, 2014). When serving suicidal clients, for instance, storytelling should include what happened prior to and leading up to their suicidal thoughts, not just what to do at the current time. When we read books or see movies, the stories come complete with beginnings, middles, and ends. When we engage clients and others in NE, the storytellers sometimes start by telling us what is happening now, in the middle. We may need to explore the beginnings for further context: what stresses may have accumulated over time; how has the client coped; what prior events have contributed to the client’s thinking? To resolve ethical issues, the characters can discuss how the plot moves forward. What are the next steps for the clients, workers, and other characters? Conflict refers to differences expressed by the characters. They may have different values, beliefs, or objectives (Barsky, 2017). My goal during the meeting with Roberto was to survive the interview unscathed. One of his goals was to avoid withdrawal. Had I been more attuned to Roberto’s story, we could have alleviated his withdrawal in a more timely manner. When characters present different views on what an ethical outcome means, they may be operating on different histories (Wilks, 2005). Understanding these histories provides insight into the nature of ethical conflicts. Resolution refers to how the characters manage conflicts. Sometimes, ethical issues are managed to everyone’s satisfaction, ending happily. Some stories do not have happy endings (Montello, 2014). A client may commit suicide or a child protection worker may need to remove children against parental wishes. Storytelling allows workers to demonstrate compassion with clients and others, whether or not they agree about how to proceed, and whether or not they are happy with the outcomes. Social workers may use clarification skills to ensure characters understand one another, including areas of consensus and opportunities for developing consensus (Baldwin & Estey-Burt, 2012). Social workers can use various strategies to facilitate effective storytelling. By demonstrating high levels of empathy, authenticity, and respect, they can build trust and encourage others to share stories (Rogers, 1957). Workers may use strategic questions to help others share their stories, including rich details about the characters, plot, conflict, and possibilities for resolution. When clients or others share stories, workers should attend to each component of storytelling, remembering their voice, attending to how the audience may be perceiving the story, and ensuring the audience has sufficient details to understand their beliefs, motivations, and other contextual factors. Workers may share their stories, providing clients or others with insight into alternative experiences, values, and ethical systems (Gergen, 2015). Workers may use purposeful self-­disclosure to facilitate understanding and new insights, without imposing values or solutions. Finally, social workers, clients, and others can construct new stories, determining how to proceed in an ethical manner. When revising original stories, they may question their assumptions, fill in missing information, and explore various options. Rather than removing neglected children from the parents’ home, for instance, the worker could engage the parents in a story where they provide for the children’s needs by using parent education, respite care, or other supports.

Application To demonstrate NE, consider the following situation. Chantal is a French Canadian social worker who works at a community resource center in Hanoi, Vietnam. Dr. Ngo, a physician, refers the Lieu family to Chantal to help them access recreational activities for their 16-yearold son, Huy. During the first meeting, Chantal notices Huy has breathing difficulties and muscle weakness. She asks about Huy’s medical situation. The Lieus say they are not sure, but the doctor says Huy will be fine. They give Chantal consent to speak with Dr. Ngo. 54

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Dr. Ngo informs Chantal that Huy has late-onset Pompe disease and less than three months to live. Chantal is very troubled to learn that Dr. Ngo has not told Huy or his parents about his prognosis. How can a physician withhold critical information? How can the family make informed decisions if they are operating on false or missing information? Rather than raising issues in relation to ethical principles such as informed consent and integrity, Chantal engages Dr. Ngo with a story. I used to work at a Canadian cancer clinic. When doctors shared diagnoses with patients and families, I would often be present. My role was to help families process their thoughts and feelings about the diagnosis. The conversations were often difficult, particularly when families were not expecting to hear their loved ones were going to die. Still, the families appreciated our honesty. It built trust and allowed us to help them make plans. We helped them process the shock and sadness. We helped them with closure, making amends, expressing their love, and engaging in meaningful end-of-life rituals. Chantal does not want to put her audience, Dr. Ngo, on the defensive. She does not lecture him about the right way to handle Huy’s situation. She merely relates where she is coming from, sharing her professional story, beliefs, and experiences. Chantal then invites Dr. Ngo to share his story. Dr. Ngo describes his experience working with the Lieus. During my first meeting, Mr. and Mrs. Lieu said they did not like seeing doctors. They were afraid they would receive bad news. As a doctor, I am trained to help people become healthier. When a person has an incurable and fatal illness, what does healthier mean? I have to look at the patient and family’s perspective to determine the best way to help. I understand that being open and honest with families may be the best approach. I also know that for some families, like the Huy’s, they will suffer more if I share Huy’s full prognosis. They will worry more. They will stop doing enjoyable things with Huy. They will have a better quality of life if I withhold the disturbing information. By listening to each other’s stories, Dr. Ngo and Chantal gain empathy for each other’s views. Chantal understands that Dr. Ngo’s story has a more emic perspective, as he comes from the same culture as the Lieus. Chantal might ask Dr. Ngo whether his decision to withhold information is based on cultural values and experiences, or factors particular to this family. Note that sharing stories does not necessarily resolve the issues. Chantal might still view Dr. Ngo’s approach as paternalistic, making decisions for the family without their consent. Note also that their decision about how to proceed today does not mean this is the end of the story. As they continue to work with the Lieus, they attend to their experiences, values, beliefs, and wishes. One day, the parents may ask questions about Huy’s condition. At this point, Dr. Ngo may decide it is time to share Huy’s full prognosis. Alternatively, his condition may stabilize and there may be no reason to share further medical information. As Chantal continues to work with the Lieus, she considers the elements of storytelling. Regarding characters, should she enquire about Huy’s grandparents or other relatives? Regarding plot, how might additional knowledge of family history help her understand their values, beliefs, and motivations? Regarding voice and perspective, to what extent is Dr. Ngo able to tune into the Lieus’ perspectives? Could Huy have different perspectives from his parents? Also, how does she view her own role as a social worker? How can she balance her role in facilitating client autonomy (including self-determination and informed consent) versus her role in promoting beneficence (happiness and positive quality of life)? 55

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Comparison The primary difference between NE, legalism, deontology, and teleology is that NE embraces subjectivism, immersing oneself in the situation to reflect on the lived experiences and stories of people affected by the ethical issue. In contrast, the other approaches embrace objectivity and rationality. When applying legalism, we are asked to apply the relevant laws, agency policies, or professional standards in a consistent manner. Lady Justice wears a blindfold so she does not see the people before her, making it impossible for her to discriminate for or against people based on their personal traits, ethnic backgrounds, or socioeconomic circumstances. When applying deontology, we are supposed to apply universal duties or categorical imperatives in a rational manner. For instance, we should tell the truth and protect people’s privacy, regardless of the circumstances and consequences. When applying teleology, we should weigh the benefits and costs of various options, making decisions based on which option promotes the greatest good. The cost-benefit analysis should be based on objective measures. We do not need to consider our client’s stories, emotions, and social identities to perform these analyses. Although NE embraces subjectivism, it also allows for objectivity and rationality. Applying NE is not mutually exclusive of other ethical theories (Brody & Clark, 2014). •

•

•

Legalism: Social workers’ narratives may include stories of adherence to their professional code of ethics and agency policy. Chantal may provide examples of how her profession respects client self-determination and informed consent. Deontology: Client narratives may include categorical imperatives derived from their religious beliefs, family values, or cultural backgrounds. Huy’s family history may suggest that compassion is a higher principle than honesty and full disclosure. Teleology: When constructing narratives about how to move forward, workers and clients may consider the risks and benefits of various options. Thus, Chantal and Dr. Ngo could explore how the Lieus’ story might proceed based on different decisions, for instance, disclosing Huy’s full prognosis at once, strategically disclosing information over time, disclosing information only as requested, or providing reassurance to the Lieus regardless of their requests for information.

NE allows for the use of strategies derived from legalism, deontology, and teleology, provided they are not applied to the exclusion of narratives. NE could be used as an extension of other approaches, allowing the social worker to use empathy, compassion, and storytelling as part of the process for managing ethical issues (Halpern, 2018).

Conclusion When social workers encounter ethical issues, they may want clear directions on how to respond. Having clear agency policies, regulatory laws, and ethical codes may provide those directions. In many instances, following these rules, principles, and standards means that social workers are acting ethically. In other instances, social workers need to deal with conflicting obligations, clients, or others who have different ethical obligations or moral systems, and situations that go beyond what is covered in agency policy, regulatory law, and ethical codes. In these circumstances, NE can be particularly useful in providing a process for engaging clients, coworkers, and others in ethics-related dialogues. NE provides us with a way of immersing ourselves in the situation and fostering moral understanding among the people 56

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affected by the ethical concern (Shafer-Landau, 2018). NE also offers a process for engaging people from diverse backgrounds and building better relationships as we work through ethical issues. Given the globalization of many social issues, it is particularly important for social workers to strive for greater appreciation of how people from other countries and backgrounds discuss and understand ethics through the stories they tell. Storytelling is deeply embedded in many aspects of social work practice, research, and education. Although storytelling is also used in some forms of ethics education, ethics consultation, and ethical decision-making, social workers may benefit from using NE in a more strategic manner. Moving forward, it would be useful to have further research on the usefulness and efficacy of NE in practice, as compared to legalism, deontology, teleology, and other ethical theories. In particular, it would be useful to explore how the processes of managing ethical issues may be improved through the purposeful use of storytelling.

References Baldwin, C., & Estey-Burt, B. (2012). Narrative and the reconfiguration of social work ethics. Narrative Works, 2(2). Retrieved from https://journals.lib.unb.ca/index.php/nw/article/view/20169/23262 Barsky, A. E. (2017). Conflict resolution for the helping professions: Negotiation, mediation, advocacy, facilitation and restorative justice (3rd ed.). New York, NY: Oxford University Press. Brody, H., & Clark, M. (2014). Narrative ethics: A narrative. Hastings Center Report, 44(1): S7–11. Charon, R. (2007). What do you do with stories: The sciences of narrative medicine. Canadian Family Physician, 53(8), 1265–1267. Charon, R., & Montello, M. (Eds.) (2002). Stories matter: The role of narrative in medical ethics. New York, NY: Routledge. Cooperrider, D., Hertzel, J., Mann, A., & Whitney, D. (2008). Positive family dynamics: Appreciative inquiry questions to bring out the best in families. Chagrin Falls, OH: Taos Institute. Gergen, K, J. (2015). Relational ethics in therapeutic practice. Australian & New Zealand Journal of Family Therapy, 36(4), 409–418. Halpern, F. (2018). Closeness through unreliability: Sympathy, empathy, and ethics in narrative communication. Narrative, 26(2), 125–145. Magelssen, M., Pedersen, R., & Førde, R. (2016). Four roles of ethical theory in clinical ethics consultation. American Journal of Bioethics, 16(9), 26–33. Miller, M. (2017). Narrative research: Discoveries in listening to clinical-scholars’ experiences of working across trauma and loss. In A. Burack-Weiss, L. S. Lawrence, & L. B. Mijanos. (Eds.). Narrative in social work practice: The power and possibility of story (pp. 213–233). New York, NY: Columbia University Press. Montello, M. (2014). Narrative ethics: The role of stories in bioethics (Special Report). Hastings Institute, 44(1), S2–S6. Phelan, J. (2014). Narrative ethics. The living handbook of narratology. Retrieved from http://www.lhn. uni-hamburg.de/article/narrative-ethics Porz, R., Landeweer, E., & Widdershoven, G. (2011). Theory and practice of clinical ethics support services: Narrative and hermeneutical perspectives. Bioethics, 25(7), 354–360. Rogers, C. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Counseling Psychology, 21, 95–103. Shafer-Landau, R. (2018). The fundamentals of ethics. New York, NY: Oxford University Press. Slesar, K. (2017). Another kind of witnessing: Narrative medicine and the trauma therapist. In A. ­Burack-Weiss, L. S. Lawrence, & L. B. Mijanos (Eds.). Narrative in social work practice: The power and possibility of story (pp. 45–65). New York, NY: Columbia University Press. Slote, M. (2007). The ethics of care and empathy. New York, NY: Routledge. Stevenson, S. (2016). Toward a narrative ethics: Indigenous community-based research, the ethics of narrative, and the limits of conventional bioethics. Qualitative Inquiry, 22(5), 365–376. Wilks, T. (2005). Social work and narrative ethics. British Journal of Social Work, 35, 1249–1264. Winslade, J. (2002). Storying professional identity. International Journal of Narrative Therapy and Community Work, 4, 33–38. 57

9 How a relational approach to ­practice can encourage social work to return to its ethical endeavor Elizabeth C. Reimer and Lester J. Thompson

The integrity of social work demands a core ethical focus toward fostering a society that effectively enables people to flourish. After all, the profession was born out of selfless caring activities in support of people who required personal changes toward greater well-being and meaning in life. In this aim, social workers have had both positive and negative impacts upon human welfare. Recent history provides examples of social work practice being co-opted into disempowering procedures (Ioakimidis, 2015). The ethical foundations of social work have modified and reformed as it has adjusted to government policies, neoliberal worldviews, globalization, multiculturalism, and developments in gender relations (DuBois & Miley, 2014; Hugman, 2003; Reamer, 1998; Thompson & Wadley, 2016). These adjustments are made most obvious when reflecting upon uncaring social work activities which failed people, subsequently leading to harm, worsening social conditions and social injustices toward client populations of indigenous peoples, the poor and, recently, refugees. Reflection is required because the contribution of social work to the lives of others is today subject to important tensions which strongly challenge its ethical focus. This chapter will explore how significant ethical misdemeanors came about. It will also propose strategy that deploys humanistic relational values which guide the multiple ethical frameworks of the profession, diverting it from harmful and damaging practices. Drawing on the relationship between ethics and social work practice throughout Western history, this chapter will argue that a relational approach to practice is imperative if social work practice is to realign with its stated values, and cement its place as a societal foundation.

Social work values Academic critics of the professional project of social work have assumed responsibility for formalizing its identity beyond other professions which share an interest in humans and the human condition. Over the past 100 years, this has involved debate and incremental change regarding core values the social work profession has aimed to embody in practice (Banks, 2008; Hugman, 2003; Reamer, 1998). Recent intellectual developments within social work have actively and earnestly engaged ethical discourses, contextualized in contemporary ­value-based changes (Hugman, 2003; Reamer, 1998). 58

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According to the International Federation of Social Workers and International Association of Schools of Social Work (British Association of Social Workers (BASW), 2014), Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities and indigenous knowledges, social work engages people and structures to address life challenges and enhance wellbeing. Clearly, there is a stated commitment that social work will be driven by a dedication above all else to ethical principles regarding rights, justice, and inclusion of others, but also it supports social conditions that promote human well-being. In this context, there is reason to ask what has permitted the problems that have occurred in the past, and if current ethics mitigates against such issues resurfacing in future. If social work is to consider itself an ethically driven profession, then there is a substantial challenge in seeing through such contradictions and articulating what social work is about. An historical analysis is required.

Historical trajectory of the ethical endeavor of social work practice in the Western experience The development of professional ethics occurred during those eras known as modernity and postmodernity (from the late 19th to early 20th century, and mid-20th to early 21st century, respectively). These eras were characterized by profound social and cultural conflict; structural reorganization; competing voices; scientific, technological, and theoretical advancement; rebalancing of social power dynamics; and value-based change. During this time, social work progressed from its charitable Christian beginnings toward a profession designed to meet the stabilizing needs of changing societies, as well as the personal needs of clients (Day, 1981). Modernity was an era which birthed this profession with a mission different from other increasingly powerful social professions, in politics, medicine, and psychology. In distinguishing itself from these, social work had to clarify what it sought to achieve, and thereby how and why it existed. The task was to provide a coherent philosophical foundation for the practical mission that social work had, from its earliest days, in caring for the welfare of other human beings. Throughout the late 19th century, or early modern era, it became apparent that social helpers were driven by a desire to ensure that they and others lived according to Christian morality (Hugman, 2003). Important facets of the forming social work profession then involved articulating its values, and trying to operationalize these through ethical practice. The developing profession was influenced by modernist, and then later postmodern, thought on ethical theory (Hugman, 2003). Much of the development of ethical social work practice was defined by ethical frameworks dealing with rules and obligations about what was right and wrong (Hugman, 2003; Reamer, 1998). As social work professionalized and secularized, because of its adaptation to scientific influences, both Kantian deontology and utilitarian ethics became important (Banks, 2012; Hugman, 2003; McBeath & Webb, 2002). An ethical framework founded on deontology posits that there are universally agreed principles, rules, and duties for proper living which dictate how right or wrong any activity is. This means that some actions are wrong or bad, in and of themselves, rather than erring because they have negative consequences. Under deontology, people are deemed good or bad 59

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by how well they live according to moral absolutes when upholding rules and fulfilling duties. However, this ethic is limited in that it does not account for minority groups and people who have limited power to define these absolutist ethical rules, or to choose how to act for themselves. For example, while it is understood that children at risk need to be protected, deontological ethics failed indigenous peoples when their cultural positions defined conflicting moral rules for child-rearing, and the subsequent “ethical” removal of children detracted from the well-being and utility of that population of people (Thompson & Duthie, 2017). The basic underlying principle of utilitarianism is that people will act to maximize their pleasure, or happiness, over their pain. Good is defined according to the extent to which participants aim for what brings the greatest utility (happiness or well-being) to the greatest number of people. However, its failings pertain to how easy it is for those in minority groups, such as first-peoples and refugees, to be disregarded, so that the interests of some are persistently set against them. Hence, many have questioned the morality of a position that justifies the oppression of some groups in favor of the utility of the dominant group. In both deontology and utilitarianism, public utility is seen to benefit from mainstream liberal-­individualist judgments about “duty, obligation, reason and autonomy” (Hugman, 2003, p. 10). The spreading values of neoliberalism have recently reemphasized such liberalindividual judgments, and with this empowered a mythical form of atomistic independence. These values have strongly influenced social work theory and ethics, as manifested in such agendas as risk management and task centered practice approaches (Bauman, 2000; ­Meagher & Parton, 2004) to the detriment of nuanced judgments. By way of balance, early in postmodernity, social work’s recognition of social contexts so expanded that new emphasis was placed upon ensuring social justice and human rights based societal rules about fulfilling lives for diverse peoples. Subsequently postmodern ethics expected a just response to persons in their social and environmental context. These expectations were grounded in relational duties underpinned by values such as “attentiveness, responsibility, competence and responsiveness” (Hugman, 2003, p. 10). A related ethical theory that emerged from such ideas, and is relevant to social work practice, is that of care ethics (Hugman, 2003; McBeath & Webb, 2002; Meagher & Parton, 2004; Noddings, 1999). Care ethics seeks justice through an underlying assumption that humans are interdependent, equally inherently valuable, and therefore responsible to each other (Meagher & Parton, 2004). Care ethics is an inherently relational approach to moral action where, according to McBeath and Webb (2002, p. 1027), “the human good resides not in abstract principles…but rather in the quality of human relationships.” Qualities such as empathy, compassion, and attentiveness and responsiveness to peoples’ needs are central features of care ethics (Hugman, 2003; Meagher & Parton, 2004). However, care ethics has been co-opted by risk management, neoliberal professional culture, and rule, or consequence-based, ethical frameworks (Hugman, 2003; McBeath & Webb, 2002; Meagher & Parton, 2004) which deemphasize the quality, closeness or role of working relationships, and prioritize activities that mechanistically meet individualized needs (­Freedberg, 2009; Goldstein, Miehls, & Ringel, 2009; Meagher & Parton, 2004; Miehls, 2011). With this mechanistic approach have come pressures to continue to understand ethics as a procedural or deontological matter. Despite attempts to develop the social work profession from an ethical base, it sits in an uncertain and contentious neoliberal-­m anagerial space, riddled with contradictions about ethical practices, sociologically defined target groups, and cultural sensitivities (Campbell, Ioakimidis, & Maglajlic, 2018; Ioakimidis, 2015; ­Thompson & Reimer, 2013; Thompson & Wadley, 2016). As a consequence of such pressures, professional attempts to articulate social work ethics continue to focus upon individual 60

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ethical guidance in the form of ethical rules that apply across eventualities, that is absolutist deontological guidelines that deny nuance and the human context of decision-making (­Hugman, 2003; McBeath & Webb, 2002; Meagher & Parton, 2004). Rather than ethical theories and moral frameworks as the driver of professional activities, there has been a tendency to deploy practice routines and assume that culturally specific guidelines will prescribe ethical decision-making (Bauman, 2000; Reamer, 1998; Thompson & Wadley, 2016). For example, in cross-cultural contexts, the complexity of decision-making is sound reason for the application of consequentialist ethical approaches and the commitment to a logic that nuances rules with consideration of harm that may eventuate (Thompson & Reimer, 2013). In the main, recent social work ethics was developed on a platform of set core professional values which developed in response to both arising practice issues and subsequent guidelines for their ethical treatment (Reamer, 1998). The diversity of mistakes perpetrated by welfare agents cannot be seen as failings of “social work” per se, as social change, economic upheaval, and academic debate destabilize well-intentioned, caring (consequentialist) intentions and even well described (deontological) processes. Weak logic, cultural misunderstanding, and autocratic implementation strategies are at fault when practice is not driven by ethical innovation, but rather by reactive ethical developments following failures that are to be avoided in future practice. Social work is so focused on responding to neoliberal and managerial definitions of work roles that, by comparison, this has restrained its capacity for following philosophical guidance deployment of its philosophical foundations. The problem has been that this inadvertently exposed social work to internal conflicts and inconsistency according to its core values. Routinized practices can only in the short term protect the profession from new misdemeanors (Thompson & Duthie, 2017). Clearly, alternative ethical frameworks for social work are required. One possibility is Aristotelian virtue ethics (Banks, 2012; Hugman, 2003; McBeath & Webb, 2002; Pullen-Sansfacon, 2010). Virtue ethics requires that people actively judge what is the right or wrong way to live, and thus they build good character traits, like commitment and care rather than an unquestioning subservience to rules which others prescribe as moral guidelines (MacIntyre, 1981). Virtue ethics is holistic about each individual’s life, being focused on the complete social person and what it means to be a moral participant, rather than a slave to prescribed moral thoughts about specific situations. It is focused on people living a fulfilled and meaningful life, and it is about devotion to achieving human character traits, or virtues, which involve philosophical commitment to moral action. Virtue ethics provides for exploration of notions about what constitutes a fulfilled life, especially regarding social relations. This includes considerations about ensuring optimum conditions for human flourishing across all dimensions of a person’s life. As such, virtue ethics is not just self-focused, but is focused on what it is about the character of “me” that also creates conditions whereby others can flourish and become moral people too.

Relational practice and virtue ethics However, while virtue ethics provides guidance on how to be a person of moral character, it does not specifically prescribe the correct actions for each moral problem (Pullen-Sansfacon, 2010). This is challenging for social workers who are seeking ethical coherence that will guide practice while faced with a neoliberal policy-setting, work setting that is driven by managerialism that demands rapid response, and within a social context of persistent social change. An obvious place to start is with the idea from virtue ethics that human flourishing is made possible through hermeneutic and collective means, in relationship and dialogue 61

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with others (MacIntyre, 1981; McBeath & Webb, 2002). In social work practice, this occurs through the working relationship and, as such, draws on research about the nature of the working relationship. In particular, it emphasizes the development of important worker attributes, such as caring and reflection, which help progress the social work endeavor toward putting virtue ethics into practice. Effective working relationships have been found to involve workers being “real” in the professional role. This means having an authenticity and genuineness in the relationship with clients such that people are connecting as human to human, rather than worker to client (­Reimer, 2014). Some have found such working relationships to involve friendship-like qualities. For example, egalitarian characteristics prevail, involving humility, gentleness, shared power, care, and a sense of shared humanity (de Boer & Coady, 2003; Doel, 2010; Maluccio, 1979; Reimer, 2013, 2014; Ribner & Knei-Paz, 2002; Turney, 2012). However, while professional relational practice is similar to friendship in engaging highly personal relationships often involving mutually cultivated affection, it differs because it is driven, bounded, and s­upported by a professional context (de Boer & Coady, 2003; Doel, 2010; Reimer, 2013, 2014). Trust between workers and clients is pivotal in that it establishes the conditions for professionals to demonstrate a genuine sense of attentiveness, responsiveness, care, and authenticity in dealings with clients (de Boer & Coady, 2003; Reimer, 2013; Ribner & Knei-Paz, 2002). Trust and worker trustworthiness allow clients to honestly disclose their innermost selves to the professional and themselves, in order to be both challenged and supported to change (Barker & Thomson, 2015; Reimer, 2013, 2014). Once trust is established, effective working relationships have also been found to involve worker attributes such as openness and willingness to engage, listen, respect, accept, care, empathize, understand, and encourage the client toward hope and confidence about change (de Boer & Coady, 2003; Doel, 2010; Maluccio, 1979; Reimer, 2013; Ribner & Knei-Paz, 2002; Turney, 2012). Furthermore, such working relationships involve workers who exhibit patience, flexibility, competence through practice and lived experience, a sense of justice and fairness, and a sense of humor (de Boer & Coady, 2003; Maluccio, 1979; Reimer, 2013). They also involve workers who engage in a ­reflexive-interpretive process of critical self-awareness, and are prepared to risk actions beyond job prescriptions and work responsibilities when needed by clients (de Boer & Coady, 2003; Reimer, 2013). Effective working relationships are fundamentally about purposeful practice regarding personal change and growth, underpinned by virtue ethics for achieving a flourishing life (McBeath & Webb, 2002). In addition, these worker attributes tie in with an important dimension of virtue ethics as “the project of being human in the world…achieved through experience, reflection and circumspection” (McBeath & Webb, 2002, pp. 1020–1021). They also encompass the virtue ethics of being brave (McBeath & Webb, 2002), in terms of doing more than one’s duty. Other virtues with which these are aligned include flexibility, justice, prudence, friendliness, wisdom, and understanding, which leads to good judgment and perception (McBeath & Webb, 2002). Moreover, trust is an attribute which is both fundamental to effective working relationships (de Boer & Coady, 2003; Maluccio, 1979; Reimer, 2013) and virtue ethics (McBeath & Webb, 2002). The ethical implications of trust are profound, as Løgstrup (1997, p. 17) notes when discussing trust as an important factor in what it means to be human: Through the trust which a person either shows or asks of another person he or she surrenders something of his or her life to that person. Therefore, our existence demands of us that we protect the life of the person who has placed his or her trust in us. 62

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Through reciprocal trust, people open themselves up to others, thereby becoming mutually dependent on those others, and thereafter vulnerable to their power (Bauman, 2000; Løgstrup, 1997). This demand for vulnerability creates a challenge to care for the “other” (Bauman, 2000; Gray, 1995; Noddings, 1999). In this way, relational practice is central to ethical social work practice as practitioners must be both trusting to form relationships, and “trustworthy” if they are to be accepted. When social workers engage with people authentically, and in ways that involve mutual trust, they see that the people with whom they are working are like themselves at a fundamentally human level. Through the development of genuinely trusting relationships, and the acknowledgement of clients as fundamentally similar to themselves, it is harder for workers to dehumanize clients, or to consider them at an arm’s length, or as “other.” According to Bauman (2000), this is important because in treating someone as “other,” they are reduced to a position within which they no longer need to be respected, given voice, or cared about.

Conclusion Social work values endeavor to facilitate professional conditions that address life challenges and enhance well-being, thus enabling people to live a meaningful life. This involves striving for values such as desire for social justice, equity and inclusion, and care for human beings, in order to facilitate human dignity for workers and clients alike. However, the social work profession has a poor record when it comes to treating clients in ways that support these aims and values (Ioakimidis, 2015). Having essentially become emotionally distanced from the people with whom they work, their focus has, as a consequence of managerialism, shifted from the person to the societal problem. Thus, professionals have become less connected to people and human care. People have become a means to an end, an individual unit of a problem to be fixed before moving on to the next unit of attention. In contrast, an alternative response to social work clients comes through the development of humane working relationships that are underpinned by virtuous worker attributes, and characterized by genuine care for the people involved. As argued, a relational approach to practice gives precedence to building an emotionally close professional relationship as a precursor to attending to the needs of clients, and helping them work toward personal change. Through development of an authentic relationship, which relational practice facilitates, a situation emerges whereby workers can develop genuine care for the human being, rather than the client. Through seeing the person fundamentally like them in their humanness, workers acknowledge clients are not “other.” Rather than social workers achieving their professional agenda through tasks and intervention procedures, practitioners engaging in relational practice are morally obligated to demonstrate those ethical virtues that promote trusting relationships, and which treat clients as unique individuals, worthy of being involved meaningfully, and in a fulfilling way, in relationships with a professionally driven person. This creates a situation where workers are ethically able to balance the needs and interests of all involved in social work practice. As such, relational practice can realign social work with its core values, guided by virtue ethics.

References Banks, S. (2008). Critical commentary: Social work ethics. British Journal of Social Work, 38(6), 1238–1249. Banks, S. (2012). Ethics and values in social work. Basingstoke: Macmillan. Barker, J., & Thomson, L. (2015). Helpful relationships with service users: Linking social capital. Australian Social Work, 68(1), 130–145. Bauman, Z. (2000). Am I my brother’s keeper. European Journal of Social Work, 3(1), 5–11. British Association of Social Workers (BASW). (2014). Global definition of social work. Retrieved from https://www.basw.co.uk/resources/global-definition-social-work?id=3293 63

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Campbell, J., Ioakimidis, V., & Maglajlic, R. (2018). Social work for critical peace: A comparative approach to understanding social work and political conflict. European Journal of Social Work, 1–12. doi:10.1080/13691457.2018.1462149 Day, P. (1981). Social work and social control. London: Tavistock. de Boer, C., & Coady, N. (2003). Good helping relationships in child welfare: Co-authored stories of success. In Partnerships for children and families project. Retrieved from https://legacy.wlu.ca/­ documents/7214/Good_Helping_Relationships.pdf Doel, M. (2010). Service user perspectives on relationships. In G. Ruch, D. Turney, & A. Ward (Eds.), Relationship based social work: Getting to the heart of practice (pp. 199–213). London: Jessica Kingsley. DuBois, B., & Miley, K. (2014). Social work: An empowering profession (8th ed.). Boston, MA: Pearson. Freedberg, S. (2009). Relational theory for social work practice: A feminist perspective. New York, NY: Routledge. Goldstein, E., Miehls, D., & Ringel, S. (2009). Advanced clinical social work practice: Relational principles and techniques. New York, NY: Columbia University Press. Gray, M. (1995). The ethical implications of current theoretical developments in social work. British Journal of Social Work, 25(1), 55–70. Hugman, R. (2003). Professional ethics in social work: Living with the legacy. Australian Social Work, 56(1), 5–15. Ioakimidis, V. (2015). The two faces of Janus: Rethinking social work in the context of conflict. Social dialogue, 3(10), 6–11. Løgstrup, K. (1997). The ethical demand. Notre Dame: University of Notre Dame Press. MacIntyre, A. (1981). After virtue: A study in moral life. Notre Dame: University of Notre Dame Press. Maluccio, A. (1979). Learning from clients. New York, NY: Free Press. McBeath, G., & Webb, S. (2002). Virtue ethics and social work: Being lucky, realistic, and not doing one’s duty. British Journal of Social Work, 32(8), 1015–1036. Meagher, G., & Parton, N. (2004). Modernising social work and the ethics of care. Social Work & ­Society, 2(1), 10–27. Miehls, D. (2011). Relational theory and social work treatment. In F. Turner (Ed.), Social work treatment: Interlocking theoretical approaches (pp. 401–412). New York, NY: Oxford University Press. Noddings, N. (1999). Care, justice and equity. In M. Katz & K. Strike (Eds.), Justice and caring: The search for common ground in education (pp. 7–20). New York, NY: Teachers College Press. Pullen-Sansfacon, A. (2010). Virtue ethics for social work: A new pedagogy for practical reasoning. Social Work Education, 29(4), 402–415. Reamer, F. (1998). The evolution of social work ethics. Social Work, 43(6), 488–500. Reimer, E. (2013). Relationship-based practice with families where child neglect is an issue: Putting relationship development under the microscope. Australian Social Work, 66(3), 455–470. Reimer, E. (2014). Using friendship to build professional family work relationships where child neglect is an issue: Worker perceptions. Australian Social Work, 67(3), 315–331. Ribner, D., & Knei-Paz, C. (2002). Client’s view of a successful helping relationship. Social Work, 47(4), 379–387. Thompson, L., & Duthie, D. (2017). Cultural awareness, sensitivity and safety: Refocusing social work interventions in Indigenous affairs. Journal of Australian Indigenous Issues, 19(4), 2–15. Thompson, L., & Reimer, E. (2013). From absolutes to a relational approach when working in international development. New Community Quarterly, 1(4), 9–17. Thompson, L., & Wadley, D. (2016). Countering globalisation and managerialism: Relationist ethics in social work. International Social Work, 1–18. doi:10.1177/0020872816655867 Turney, D. (2012). A relationship-based approach to engaging involuntary clients: The contribution of recognition theory. Child & Family Social Work, 17(2), 149–159.

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10 Ethical action in challenging times Kim Strom-Gottfried

Contemporary social work practice is rife with ethical dilemmas: “two or more courses of action that are in conflict (and will potentially have both positive and negative consequences), each of which can be defended as viable and appropriate” (Weinberg, 2009, p. 144). Consider the following examples. Should a social worker: • • • • •

Advocate for the patient’s best interest or comply with the medical team’s decision to send him home? Accept a case with a limited number of approved treatment sessions even when it is clear those will be insufficient to deal with long-standing trauma issues? Discharge a resident for breaking a house rule, despite the fact that he was making progress on his recovery goals? Follow agency guidelines that systematically penalize applicants who are undocumented immigrants or “bite the hand that feeds you” by challenging organizational norms? Respect privacy laws or work in environments such as cubicles and overcrowded emergency departments where it is impossible to keep sensitive conversations confidential?

The scenarios above are not simply examples of competing goods. Each contains structural or organizational factors that conflict with the worker’s principled options or intentions. The result, for some social workers, will be moral distress. In this chapter, we examine the barriers that can prevent professionals from acting on their principles and values, the concepts related to moral distress and moral courage, and some strategies for ethical action in challenging times.

Moral distress First applied in the field of nursing, the concepts, causes, and results of moral distress are familiar to contemporary social workers ( Jameton, 1984; Weinberg, 2009). Moral distress occurs when a worker has decided on a course of action, guided by clinical, moral, and ethical considerations, but cannot pursue it due to external influences. Some conceive of moral distress as akin to a relational trauma experienced by the professional moral agent in conflict with intransigent sociopolitical impediments (Musto, Rodney, & Vahderheide, 2015). 65

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Many factors give rise to moral distress. Organizational imperatives and resource limitations conflict with complex and high stakes client needs. Staffing shortages, excessive caseloads, and burdensome regulations limit the time and attention available to weigh ethical matters. Ethical standards on client autonomy, informed consent, and privacy are in tension with professional liability, accountability metrics, and societal expectations. Resurgent waves of neoliberalism erode the social safety net and public support for social workers and the clients they serve. As a result, social service providers and their managers must often attempt to achieve unrealistic results under the microscope of public scrutiny ( Jones, 2014). At the same time as these structural barriers loom large, individual-level factors limit a practitioner’s capacity to resist or combat them. Some social workers may be oblivious to the organizational or societal impediments to ethical action due to their lack of knowledge or critical insight. Some may fail to note the systemic issues because their social construction of ethics construes dilemmas as falling only “narrowly within the dyadic relationship between worker and service user” (Weinberg, 2009, p. 143). Still other professionals may be cognizant of the structural impediments, but fail to experience dissonance. Such indifference or disregard may be the result of burnout, learned helplessness, self-interest, or “moral disengagement” (Oliver, 2013, p. 208). Social workers who are aware of the external barriers and experience the resulting distress may still acquiesce for myriad reasons. These can include the fear of being seen as imperfect (Austin, Rankel, Kagan, Bergum, & Lemermeyer, 2005), tendency to avoid conflicts (­Webster & Bayliss, 2000), futility of past actions (Wilkinson, 1987/1988), and organizational or social acculturation that rewards compliance. “Fear of losing one’s job, a lack of confidence to fight for what one believes, group pressure to behave in a particular way towards service users, battle fatigue when one’s ethical notions are at odds with others in an agency, fear of surveillance and litigation, and loyalty to one’s agency or to one’s supervisor” are also constraints. (Weinberg, 2009, p. 145) When restrictive external conditions are enduring and pervasive, staff may experience bystander effect and thus fail to act due to the diffusion of responsibility among many observers. Moral distress manifests itself in an array of physical and emotional symptoms. These may include guilt, anger, powerlessness, tearfulness, depression, loss of sleep or appetite, nausea, shame, diarrhea, or headaches (Oliver, 2013). The cumulative effects of moral distress, referred to as “moral residue,” are observable in individuals and in organizations (Webster & Bayliss, 2000). Professionals may demonstrate burnout, apathy, desensitization, and job withdrawal (working strictly to tasks or time or exploiting sick and vacation leave). Their clinical decisions will “frequently be seen as a matter of technical procedure rather than an individual moral judgement” (Oliver, 2013, p. 208). These individual reactions have a collective impact on the workplace, often resulting in reduced patient care, professional infighting, subversive or compromised employee responses, staffing shortages, and high staff turnover. As a value-based profession whose focus for change is on systems as well as individuals, social workers are uniquely positioned to experience moral distress, as well as to challenge and alleviate it.

Moral courage A common understanding of the term courage is that it refers not to the absence of fear, but to action despite fear. When asked to envision roles that require courage (activists amid 66

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repressive regimes, military and public safety officers, a Good Samaritan who intervenes in a sidewalk brawl), the implicit fear is of physical harm or death. “Moral courage” expands on that definition to include other harms that may result from taking a principled stand (Kidder, 2005): the nurse who reports negligent patient care, the welfare staff who make a nighttime visit to a remote home to remove abused children, or social workers who resist pressure to take cases for which they have insufficient resources or expertise. In these scenarios, the individuals risk disapproval, isolation, hostility, or the termination of employment, yet act anyway, demonstrating “the capacity to overcome the fear of shame and humiliation in order to admit one’s mistakes, to confess a wrong, to reject evil conformity, to renounce injustice, and also to defy immoral or imprudent orders” (Miller, 2002, p. 254). Moral courage is necessary when individuals’ principles or values are thwarted by organizational priorities or other barriers. Like physical courage, it is “that rare moment of unity between conscience, fear, and action, when something deep within us strikes the flint of love, of honor, of duty…” (McCain, 2008). It provides the role models and inspiration needed to mitigate moral distress and “a means to triumph over fear with practical action” (Lachman, 2007). The following section builds on those intentions to offer tools and strategies to take ethical action.

Ethical action One characterization of professional integrity echoes moral courage, viewing it as “maintaining and acting upon a deeply held set of values, often in a hostile climate” (Banks, 2010, p. 2170). As such, the first step in ethical action requires that practitioners understand and embrace the fundamental and interlocking principles of their professions. Internalizing and espousing these values serve three purposes: providing direction in the midst of competing choices, grounding the worker’s concerns in a canon greater than individual whims or opinions, and inspiring or fortifying the worker’s will to take action. Banks and Gallagher (2008) suggest a number of steps to help workers integrate the profession’s values and prepare to employ them in the face of ethical dilemmas. These steps include developing, debating, and owning professional values; locating those values in the profession’s history and tradition; practicing dialogue and debate in order to credibly assert the values; and working in solidarity with others such as colleagues or political networks. These steps should begin with educational programs and other early professional socialization, but they require lifelong renewal to continually situate one’s “role in the context of a broader narrative of ideals, values, character and consistency” and thus maintain the moral competence to challenge injustice and contribute to “an active ethics of resistance” (Banks & Gallagher, 2008, p. 212). Building on the foundation of firm principles, professionals must then employ communication, organizing, and problem-solving skills to translate integrity into action. In difficult conversations, social workers can use familiar communication techniques such as carefully listening to divergent positions, managing tone of voice and body posture, asking thoughtful questions (“How does this fit with our mission and values?”), and using I-statements (“I’m uncomfortable with what I just heard”). Techniques from conflict resolution, mediation, and negotiation are also useful, for example, identifying objective criteria for decision-making (“What standards can we agree on for caseload sizes?”), searching for shared procedural and substantive interests (“Our licenses and the law require us to maintain privacy. How should we respond as a staff when we cannot?”), and avoiding artificially narrow choices or precipitous decisions (“The hospital’s ethics committee can help us think through this”) (StromGottfried, 1998). 67

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The premises and steps in organizing for social change are common in social work curricula. Tackling the organizational and societal structures that give rise to moral distress is important, though perhaps overlooked opportunity for using these skills. Social workers can employ structural and tactical knowledge to build individual support systems, find allies inside and outside their organizations, and engage in political collaboration with other professions and service users “to foster fair processes and democratic ideals – locally, nationally, and internationally” to promote ethically grounded services (Rodney, 2017, p. S10). “Followership” is an important concept for organizing. Whether for improved working conditions, policies, or laws, collective action is typically directed at organizational or political leaders. The necessary corollary for leadership is, of course, followership. ­Successful, ­courageous followership encourages understanding that those in managerial or ­decision-making positions may also experience moral distress in carrying out their roles. The signs of ­courageous followership include building a network of authentic, loyal, and trusting relationships, understanding the dynamics of the organization, including external pressures, and being committed to the success of the leadership and the best interests of the organization (Chaleff, 2009). Research suggests that problem-solving skills have been helpful in prompting nurses to take positive action when confronted with ethical challenges (Goethals, Gastmans, & de Casterlé, 2010). Effective problem-solving requires critical thinking, empowerment to own and act on a decision, the ability to generate and weigh multiple options, and awareness of resources. Social workers frequently teach clients problem-solving skills and they utilize the skills themselves in daily practice. Ethical action is possible when social workers direct those abilities to the situations that give rise to moral distress rather than capitulating to hopelessness or the force of others.

Overcoming barriers to ethical action Virtue and integrity, internalization of social work values and ethics, and the skills to create change and speak truth to power are necessary but insufficient ingredients for ethical action. Moral courage also requires the will to act and it is built and sustained through self-­awareness about the personal barriers to action. Discomfort, the fear of reprisals, aversion to risk or conflict, and a sense of futility may hinder ethical action. Moral distress can lead clinicians to “internalize external constraints to such a point that their own moral values begin to shift, causing them to disengage morally, compromise their integrity, and possibly engage in harmful practice” (Rodney, 2017, p. S8); however, moral resilience, “the capacity of an individual to sustain or restore [her or his] integrity in response to moral complexity, confusion, distress, or setbacks,” can overcome these corrosive effects (Rushton, 2016, p. 111). Inspiration, support, and a fresh discourse about moral distress can build individual resilience and moral agency. The inspiration for ethical action can come from a variety of sources. Role models, both personal and iconic, can both demonstrate and motivate action (Kidder, 2005; StromGottfried, 2016). Many of us have known members of our families, communities, places of worship or employment who reveal clear principles and resolve in their daily lives and in times of adversity. Similarly, accounts of disasters, current events, and public scandals often reveal individuals who resisted co-optation, worked for change, or blew the whistle to alert others to the wrongdoing. Not all people of courage are successful at thwarting misconduct and many encounter resistance or hardship as a result; yet their reflections and advice serve as guidance for others (Lacayo & Ripley, 2002; Markopolos, 2010; McDonald & Hansen, 2009). 68

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Inspiration may also come from failure. Instances of moral cowardice, timidity, or flight can be forceful motivators for action the next time the opportunity arises (McCain, 2008). Sometimes in the face of an ethical challenge people react with flight or inaction instead of leaning in or speaking up. Those who observe an unethical act may be unsure of their responsibility if they neither committed nor were harmed by the act. The reasons for inaction are numerous, but they are commonly accompanied by regret and self-reproach as we play the scene over and consider what we could have, or should have, said. Sometimes the moment truly is past and all one can do is use the event as a chance to better prepare to respond with courage the next time around. Often, though, it is not too late. In fact, the time to reflect may bolster courage and allow consultation with others. In those instances, which still require courage, we can revisit and, perhaps, resolve the event. Last week when you asked me to sign off on the inaccurate treatment notes I was taken by surprise. The more I thought about it the more uncomfortable I became. I need to discuss it with you and decide what to do now. Strong, trusting, and enduring collegial, supervisory, and mentoring relationships are essential for managing distress and mobilizing moral courage. These supportive relationships provide the space to share ethical challenges, prompt self-reflection and growth, identify and overcome obstacles to action, and ultimately foster resilience. Role models can inspire us to be our best selves, help us practice acting with courage, and nurture self-forgiveness when we have failed. While moral distress arises from and evokes feelings of powerlessness, moral resilience suggests flipping the narrative to focus on solutions and possibilities (Rushton, 2016). Distress serves as a red flag about threats to integrity. In doing so, it can compel ethical action, reinforce moral conscientiousness, and result in feelings of strength, meaning, and accomplishment when a complex dilemma is navigated successfully. The responsibility for cultivating moral courage rests with each individual social worker, but it does not end there. Social workers in different roles, settings, and configurations can address the conditions that give rise to ethical dilemmas and moral distress.

Ethical action with coworkers In addition to the collective action strategies discussed earlier, coworkers can be alert to remedy proximal barriers to acting with courage. These barriers include problems with groupthink, culture, and communications. Groupthink is a powerful phenomenon in which the desire for unanimity or conformity inhibits honest expressions of dissent or disagreement. Many of us have had the experience of being in a meeting and harboring concerns about a decision but withholding comment because we sensed we were alone with the concern, only to find out later that others had reservations, too. Staff groups can guard against groupthink by moderating dominating speakers, soliciting minority opinions, and supporting disagreement as a constructive norm. Team members can ask for wide-ranging generation and evaluation of options and support “devil’s advocates” in the group who may help uncover flawed logic, unexamined downsides of an action, or insufficient support for the decision. Groupthink illustrates that a unit’s culture, policies, and norms shape the ways team members relate to each other. Do members arrive at meetings late and unprepared? Do people silently acquiesce or do they take an active role in decision-making? Is there are shared 69

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commitment to ethical practice? In a positive moral climate, the organization’s values align with those of the employees. Work groups have opportunities to discuss ethical challenges as a standard part of case discussions, and ethics consultation is available to promote moral resilience and serve as a resource to change efforts. Morally habitable work environments are places “where internal and external constraints on moral agency are minimized, difference is embraced, and moral well-being is promoted through shared understandings of responsibility” (Musto et al., 2015, p. 97). Team culture is often revealed through communication style and processes. How are new policies or procedures made, conflicts addressed, and dissenting views received? Ineffective communication norms in a unit can create moral distress and stifle ethical action. Destructive norms may include distorting messages unintentionally by passing them through too many layers of bureaucracy or (intentionally) by misrepresentation in the process of communication. Gossip, egos, rivalries, currying favor, and the fear of “shooting the messenger” are all norms that prevent honest discussion and problem-solving. Work groups should set mutual expectations for trust, honesty, and integrity and revisit those agreements regularly.

Ethical action by supervisors and administrators Organizations’ leaders have a particular responsibility for establishing the culture, policies, and structures that foster integrity and ethical action. Studies in health care settings have identified issues of moral courage as the keys to avoiding medical errors, enhancing retention and worker morale, improving patient outcomes, increasing productivity, strengthening adherence to workplace rules, and developing respect and support among colleagues (Maxfield, Grenny, McMillan, Patterson, & Switzler, 2005). Leaders in any organizational setting can reduce moral distress and foster courage by consistently demonstrating that they value and embody integrity. Leaders who engage in or condone unethical or illegal behaviors create conditions that give rise to moral distress and they suppress staff who are willing to stand up for what is right. Actions and communications must be congruent with values. This means acknowledging and rewarding integrity and holding accountable those who fail to live up to expected standards. The alignment of messages and actions requires transparency, to the extent that confidential processes allow, so that those working in the unit believe in the leader’s honesty and trustworthiness. The sense of futility can be a powerful deterrent to ethical action and is exacerbated by perceived or actual power differentials among employees. Therefore, staff members of all strata must be empowered to act if problematic behavior is observed. Efforts to reduce errors often include messaging that encourages all employees to accept responsibility for organizational integrity and to “say something if you see something.” Correspondingly, these changes in culture require fellow staff and administrators, regardless of rank or position, to respect and respond to earnest efforts to correct errors, regardless of who committed the error and who reported it. Consensus recommendations for addressing moral distress and building moral resilience in the field of nursing offer salient suggestions for supervisors and administrators from all disciplines (Rushton, Schoonover-Shoffner, & Kennedy, 2017). For example: • •

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Use an ethical lens in policy development to ask, “What impact will this have on the integrity of this institution and its workforce?” Use data to demonstrate the costs and effects of moral distress, including quality indicators such as client outcomes, professional errors, and staff recruitment and retention.

Ethical action in challenging times

• •

Disseminate best practices to promote communication and action around ethical dilemmas. Employ skilled facilitators or ethics consultants to create safe spaces for conversation at all phases of ethically challenging situations.

Ethical action by the profession The associations that represent the social work profession play important roles in preventing moral distress and promoting ethical action, particularly through education, advocacy, and resources. Educational competencies for students and practitioners should introduce moral distress and courage, offer cases and simulations that lead to practice and increased competence, and expand the discussion of ethics to include the structural causes and solutions to dilemmas. Professional organizations could offer research funding to study moral distress, resilience, and courage; promote media coverage of morally courageous professionals; offer robust support for social workers who have experienced retaliation for acts of integrity; and create resources similar to the Moral Distress Education Project (www. moraldistressproject.org). National and international social work organizations set the tone and agenda for the profession. Priorities for advocacy and legislative change should be derived from the systemic causes of moral distress. After decades of “death by a thousand cuts,” leading organizations can facilitate conversations about the point at which making do with insufficient resources is unethical and untenable, and they can guide their members and others in the steps for a proper collective response.

Conclusion Although understanding values and ethics is essential for effective social work practice, professionals must also have the will and capacity to act on the principles that undergird the profession. Being alert to the signs of moral distress in ourselves and in others and taking the steps to promote moral resilience and cultivate courage are crucial for professional integrity and effectiveness. Ethical action using familiar skills and knowledge can advance social work’s responsibility to fight for societal change.

References Austin, W., Rankel, M., Kagan, L., Bergum, V., & Lemermeyer, G. (2005). To stay or to go, to speak or stay silent, to act or not to act: Moral distress as experienced by psychologists. Ethics & Behavior, 15(3), 197–212. Banks, S. (2010). Ethics and values in social work. New York, NY: Red Globe Press. Banks, S. & Gallagher, A. (2008). Ethics in professional life: Virtues for health and social care. New York, NY: Red Globe Press. Chaleff, I. (2009). The courageous follower. Oakland, CA: Berrett-Koehler Publishers. Goethals, S., Gastmans, C., & de Casterlé, B. D. (2010). Nurses’ ethical reasoning and behaviour: A literature review. International Journal of Nursing Studies, 47(5), 635–650. Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall. Jones, R. (2014). The story of Baby P: Setting the record straight. Bristol: Policy Press. Kidder, R. M. (2005). Moral courage: Taking action when your values are put to the test. New York, NY: William Morrow. Lacayo, R., & Ripley, A. (2002, December 22). The whistleblowers: Cynthia Cooper, Coleen Rowley and Sherron Watkins. Time. 71

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Lachman, V. D. (2007). Moral courage: A virtue in need of development? Medsurg Nursing, 16(2), 131–133. Markopolos, H. (2010). No one would listen: A true financial thriller. Hoboken, NJ: Wiley. Maxfield, D., Grenny, J., McMillan, R., Patterson, K., & Switzler, A. (2005). Silence kills: The seven crucial conversations for healthcare. San Francisco, CA: American Association of Critical-Care Nurses. McCain, J. (2008). Why courage matters: The way to a braver life. New York, NY: Random House. McDonald, A. J., & Hansen, J. R. (2009). Truth, lies and O-rings: Inside the space shuttle challenger disaster. Gainesville, FL: University Press of Florida. Miller, W. I. (2002). The mystery of courage. Cambridge, MA: Harvard University Press. Musto, L. C., Rodney, P. A., & Vanderheide, R. (2015). Toward interventions to address moral distress: Navigating structure and agency. Nursing Ethics, 22(1), 91–102. Oliver, C. (2013). Including moral distress in the new language of social work ethics. Canadian Social Work Review, 30(2), 203–216. Rodney, P. A. (2017). What we know about moral distress. American Journal of Nursing, 117(2), S7–S10. Rushton, C. H. (2016). Moral resilience: A capacity for navigating moral distress in critical care. AACN Advanced Critical Care, 27(1), 111–119. Rushton, C. H., Schoonover-Shoffner, K., & Kennedy, M. S. (2017). A collaborative state of the science initiative: Transforming moral distress into moral resilience in nursing. AJN, American Journal of Nursing, 117(2), S2–S6. Strom-Gottfried, K. J. (1998). Applying a conflict resolution framework to disputes in managed care. Social Work. 43(5), 393–401. Webster, G., & Bayliss, F. (2000). Moral residue. In S. B. Rubin & Z. Zoloth (Eds.), Margin of error: The ethics of mistakes in the practice of medicine. Hagerstown, MD: University Publishing Group. Weinberg, M. (2009). Moral distress: A missing but relevant concept for ethics in social work. Canadian Social Work Review, 26(2), 139–169. Wilkinson, J. M. (1987/1988). Moral distress in nursing practice: Experience and effect. Nursing Forum, 23(1), 16–29.

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Section II

Visions of diverse values

11 Social work ethics and values within the context of South African social work education and practice Sue Cook

The International Federation of Social Workers (IFSW, https://www.ifsw.org/what-is-­ social-work/global-definition-of-social-work/) provides a global definition of social work that implies a unified profession aimed at the promotion of social change, empowerment, and liberation, based on principles of social justice. Social work, in reality, is taught and practiced in countries characterized by diverse historical, political, economic, and cultural landscapes, shaped by the context of the country, impacted by historical influences such as colonialism, and, in South Africa, the apartheid system. In this chapter, the South African context of social work education is explored with reference to historical and ethical issues such as colonialism and apartheid, the scars of which endure. The importance of the deconstruction and decolonization of monocultural theory, reflexivity, the ethics of self, and the development of indigenous theory relevant and appropriate to the South African context are examined. A reflexive lens may highlight progression for social work education and social work practice in South Africa.

The South African social work context Social work cannot be disentangled from the socioeconomic, political, and cultural context of the country in which it emerges. On the African continent, the profession began in the 1920s in South Africa, the first African country to educate social workers, primarily in response to the problem of White poverty, based on Eurocentric models of social welfare, influenced by Western values and ideals (Gray & Lombard, 2008). Appropriateness and relevance for the local context, coupled with the twin iniquities of colonization and apartheid which shaped law, policy, and practice, bequeathed an enduring legacy that dominated the social work arena.

Colonization and apartheid Colonization, an exercise of sovereignty by a European nation over a non-European territory (Gorelick, 1986), is rooted in oppression and racism (Smith, 2014), allowing for the “othering” of Africans as inferior, worthy only as a cheap labor force for the expansion of capitalism 75

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and the empire. Colonization laid the foundations for structural inequality with coercive policies that legitimized the exploitation of indigenous people, followed by the adoption of apartheid as official South African government policy. From these tainted foundations, social work emerged in a context of inequity, steered by White welfare demands based on monocultural discourses of reactionary reform for deserving recipients, molding social work practices to maintain the status quo (McKendrick, 1990). During the apartheid era, from 1948, social workers adhered to government policies of separate, racially categorized service provision. The apartheid agenda served to preserve White Afrikaner identity and supremacy, maintain economic privilege, and prohibit African urbanization and social advancement (Lester, in Smith, 2014). Further “advancements” to apartheid created separate race opportunities, with social work impacted by state-led directives, legislated to work as agents of social control in an unjust society that failed to uphold social justice. With little resistance evident, welfare focused on White advancement with neglect of the African people. South African universities, in alliance with the apartheid regime, created a two-tiered social work education system distinguished by “urban” (largely White) and “bush” (rural and Black) universities with presumed differential standards, perpetuating prejudice and elitism within the ranks of the profession. Division permeated every aspect of life, mirrored in the fragmentation of social work associations. The consequence for practice was a social work labor force skilled in therapeutic work for so-called first world social problems, and neglect of indigenous knowledge and skill to work with the larger population of African people (Mamphiswana & Noyoo, 2000). According to Mwansa (2011), a reliance on Eurocentric social work pedagogy remains all too evident.

Democracy, then and now The 1994 democratic elections symbolized hope for social justice, with the Truth and Reconciliation Commission promising a vehicle for healing, and the South African Constitution of 1996, seen globally as one of the most progressive constitutions (Sacco & Hoffmann, 2004). The repeal and amendment of key legislation and new laws focused on issues of democracy and human rights, as well as principles of sustainability and Ubuntu. The concept of Ubuntu, popularized by Archbishop Desmond Tutu, is a Southern African proverb referring to our connections to one another as human beings, our rights and responsibilities in the promotion of individual and social well-being. Gade (2011) suggests a contested meaning, changed over time, from a human quality and proverb, to an ethic or worldview, elevated to a philosophy of humanity, virtues, and values. Ubuntu is entrenched in South African government welfare policies, spelled out in White Paper for Social Welfare (Ministry for ­Welfare and Population Development, 1997). Although Ubuntu remains a concept of interest in relation to emancipation and periods of political transition in Southern Africa, it has, according to Suttner (https://www.dailymaverick.co.za/article/2017-09-27-op-ed-decolonising-project-what-is-the-place-of-ubuntu/), been adopted by diverse enterprises with no emancipatory aspirations, a paradox of trivialization of the concept which holds currency in its distillation of profound complexity and diversity. Democracy brought challenges for social work education, compelled to address issues of appropriateness and relevance in a changing sociopolitical and cultural environment. Amidst the need for anti-discriminatory social work practice, came stronger awareness of multisystemic interaction between micro-, meso-, and macro-environments (Bronfenbrenner, in Rosa and Tudge, 2013), with recognition that major issues in Africa are fundamentally community issues (Mwansa, 2011). 76

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The complexity of the political landscape in South Africa has shown that the 1994 enfranchisement of people has not been sufficient to transform a distributional regime of privilege amidst poverty into one that is more equitable (Seekings, 2014). Despite improvements in health and education reform, and the expansion of social grants, high-level corruption, lack of accountability, limited investment, and service failure represent some current outcomes. Hain (https://www.theguardian.com/commentisfree/2016/feb/04/mandela-rainbow-­n ationjacob-zuma-south-africa-anc) suggests that the elation of political transformation and hopes for Nelson Mandela’s rainbow nation have evaporated, the burden of expectation of social equality and economic reform in a climate of neoliberalism an almost impossible challenge to achieve. A democratic political dispensation has failed to resolve issues of diversity, heterogeneity and identity conflict (Bornman, 2010).

Neoliberalism in South Africa The global shifts in the 1980s toward neoliberalism coupled with various economic woes led to welfare system changes based on privatization and deregulation, with individualistic solutions sought for structural and social problems (Tierney, 2015). South Africa was not immune to these politico-economic shifts, developing policies that reflected global economic pressures, resulting in an exacerbation of poverty. Although radical and progressive positions were embraced by some South African social workers, essentially, neoliberalism advanced as a legacy of colonialism, with its narrative of progress and civilization concealing its true purpose of exploitation and expansion (Tierney, 2015). Both colonialism and apartheid, and their younger sibling, neoliberalism, permeate the cultural and social identity of nations and people. According to Sewpaul and Hölscher (2004), internalized, possibly idealized, notions of modernity and industrialization were seen as developmental goals, impacting on welfare transformation.

Critical consciousness and reflexivity Critical consciousness in social work is the development of a transformational awareness of social, economic, and political systems that are potentially oppressive. Oppression may be overt, subtle, structural, or personal – developing awareness can liberate both oppressor and oppressed. Goodman (2003) outlines the basic premise of Paulo Freire’s powerful message that education is fundamentally political and that pedagogy should be constructed. The process of education is more important than simply transferring knowledge, skills, and values. Through education, one is required to transform both the “self ” through critique, and society through action taken against oppression. Through the co-construction of knowledge, one becomes epistemologically curious, with appreciation of how education colludes with oppression and discrimination. Morrall (2009, p. 9) raises the notion of “provocative pedagogy” which challenges assumptions about self, values, society, encouraging critical enquiry rather than filling the mind with curricula content deficient of criticality and reflexivity. Reflexivity is the ability to understand one’s influence and role in human relationships, the consequences of one’s presence and ability to observe one’s responses, to use that knowledge to inform intervention divested of the self-deception that ethical practice is essentially neutral and value-free (­Etherington, 2004). The consequences of colonialism and apartheid remain wounding to countries subjugated by such practices, with enduring hegemonic discourses that persist in quelling critical thinking in social work education. The assumed superiority of Western 77

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discourse potentially impacts the capacity of social workers for reflexivity and critical consciousness through the internalization of power and oppression. Foucault’s (in Schirato, ­Danaher, & Webb, 2012) analysis of unseen power suggests that people understand a situation in relation to available discursive resources. If these resources purport to be the “truth,” “fact,” or “evidence,” independent, critical thought is sacrificed and cultural relevance ignored. Reflection on the impact on such discursive resources may sanction the exploration of additional or new resources that challenge the status, facilitating more culturally and contextually appropriate practice. Dascal (https://www.tau.ac.il/…/dascal/papers/Colonizinganddecolonizingminds/) explores the colonization of the mind whereby an external source impacts knowledge acquisition, values, thoughts, and beliefs that are lasting and tenacious. There exists an asymmetry of power that may be conscious or unconscious, transmitted through various social systems including the family, culture, religion, politics, media, and education. The “banking” model of education (Freire, 1972) epitomizes this mind colonization through the transmission and absorption of knowledge without critical consciousness. According to Dascal, knowledge becomes epistemic authority reinforced by assumptions of its value while devaluing other sources, resulting in conscious and unconscious discrimination and coercion. South African social work educational discourse has largely replicated and reproduced Westernized values through the process of mind colonization, at times with resultant oppressive and discriminatory practices (Hochfeld, 2010). Smith (2008, p. 376) sees “critical conscientization,” similar to the conceptualization of decolonization advanced by Friere (in Darder, 2017) as imperative for reflection on how power shapes social work practice. According to Vally (2018), the post-1994 education climate in South Africa demonstrates a paucity of radical discourse, specifically a diminished critique of the role of the State, as well as disregard for scholarly work around social justice, coupled with compliant acceptance of neoliberalism. Despite optimism and the expectation of significant change, inequality in education prevails, primarily due to the omission of social class analysis and community contribution to policy (Vally, 2018). South Africa remains a deeply divided and unequal society despite its remarkable liberation from the apartheid regime. According to Smith (2008), social work education needs to engage with the sociopolitical realities of an unequal and oppressive heritage. It is insufficient to recognize concepts such as discrimination and injustice which become normalized to the point of unconscious collusion and maintenance of the status quo. Social justice underpins social work, and consequently social work education should lead to socially just practice (Esau & Keet, 2014). This requires political distancing from purely governmental objectives of mandated social control. The development of a critical consciousness alongside the technical-rational knowledge that includes culturally relevant methods to facilitate critically responsive practice should be a pedagogical imperative.

Developmental social work Developmental social work, a social development approach relatively new in social work education globally, is an accepted model in Southern Africa, deemed contextually appropriate and relevant (Hochfeld, 2010). The impact of this approach on policy and practice, although evident in The White Paper for Social Welfare (Ministry for Welfare and Population Development, 1997), is contested. Accusations of grants used as political tools, rampant corruption, and a lack of appropriate training in development work for student social workers have challenged service delivery and participatory development (Patel, 2015). 78

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South Africa has distinctive social issues such as poverty, violence toward women, and the impact of HIV/AIDS on families and children, as well as unprecedented global migration including the mobility of social workers. Social problems cross borders in our increasingly globalized world, requiring social workers capable of working with social issues that diverge from the dominant culture and discourse of their own particular country. Hochfeld (2010) asserts that escalating social problems will not be resolved using a remedial approach to social welfare, citing Patel, who states that a developmental, community based approach is essential. Within a neoliberal business discourse however, it risks becoming a tool to maintain the current status quo (Smith, 2014). Social work education must prepare students to work within multiple cultural and international contexts. As a socially constructed profession and a product of Westernized values, social work is required to evaluate its own foundations and progression. Smith (2014) proposes a dialectical-historical perspective for social work in South Africa whereby the process of being formed (by the State) and forming the profession’s response to injustice and contemporary issues is considered through a lens of reflection, reflexivity, and, if necessary, resistance and challenge.

Postmodernism and the ethics of self Critical and radical social work requires analysis of modernist and postmodern theory, as well as contemplation of the decolonization of theory, in conjunction with reflexivity to develop critical consciousness. Spolander, Pullen-Sansfacon, Brown, and Engelbrecht (2011) perceive the tension between a global agenda to standardize and internationalize social work education, and postmodern ideals that prioritize local contexts and constructions of reality. Postmodernism, despite criticism, has fostered awareness of the social construction of knowledge and respect for multiple worldviews that interrogate and delegitimize the meta-narrative of universal explanations of the social world and what it means to be human. An exploration of Foucault’s theory of postmodernity (1980, in Hugman, 2003) posits the “ethics of self ” as central, grounded in the practice of self-scrutiny. Differing from universal, ethical laws, it is a reflexive responsibility and responsivity of the self in encounters with the social world. Ethics in the Western world have become a straitjacket of dogma with the potential for coercive practices that dictate thought and action. Disciplines that seek to manage human life, social work being one example, have to manage the relationship between care and control, knowledge and power (Foucault 1980, in Hugman, 2003). Ethics are of necessity the property of individuals, coupled with the moral element of social objectives, seeming “… at once both impossible and necessary” (Hugman, 2003, p. 1053). Integrity in ethics cannot be achieved without consideration of diversity and plurality. Postmodernism challenges positivist views on knowledge, with social work intuitively aware of the diversity of skills and knowledge needed for practice. A postmodern era in South Africa will provide opportunity to synthesize indigenous and Western knowledge, transforming social work education and practice to facilitate intervention that reflects local values and needs, within accepted global standards. Postmodernism could cultivate extreme relativism and subjectivity where knowledge is equivocal (Hugman, 2003), leaving expertise on shifting sands, with implications for social work education and practice. The response to this may be a drift to evidence-based practice with quantifiable and measurable outcomes as befits a neoliberal agenda of standardized, managed care, or a radical decolonization and indigenization of knowledge. 79

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Decolonization Decolonization is a process requiring critical thinking and reflexivity to work ethically to understand communities and social issues. The assumption that “West is Best” and movements to standardize social work based upon Western methods and approaches necessitate resistance and a call for culturally relevant social work education, research, and practice (Ibrahima & Mattaini, 2018). Western social work practice methods fail to address social problems that are specific to African countries, such as rural poverty, ethnic conflict, and migration. Ibrahima and Mattaini (2018) draw attention to the communal nature of traditional African communities, whereby the collective is valued above the individual, the latter characteristic of Western culture. Social work education programs must consider the potential outcomes of perpetuating theory and methods that focus on urban, industrialized social issues at the expense of structural issues. Urbanization remains a compelling contemporary issue and related social problems endure; however, a singular preoccupation with this arena of practice may unwittingly reinforce colonial-style discourses. Decolonization is the tool for resistance and rejection of mind colonization, the impact of which has a profound impact on thoughts, values, and behavior. Communication and dialogue in its truest sense of the word, listening, sharing, and constructing narratives that are respectful of all viewpoints may be a fitting solution. Without the capacity and will for the practice of reflexivity, however, this may mean a replication of discourses, shorn of critical reflection.

Indigenous social work Disagreement and debate characterize the “indigenization of social work,” specifically around the issue of universal standards and values against local relevance. While universalism and standardization have clear benefits, there is risk of the devaluation of alternative voices and narratives, with a value-laden, potentially oppressive set of practice norms, deficient as a nuanced and richly described professional body of knowledge that is adaptable to local conditions and the changing social landscape. Hochfeld (2010) draws attention to an emerging body of literature on “indigenous social work” in response to the inappropriateness of Eurocentric models and methods for localized issues. However, the concept of indigenousness is contested, albeit defined in relation to previous colonial discourses rather than a strengths-based view of people with a dynamic worldview that is the product of their experiences of nature and relationships with the social world, embedded in local culture (Gray & Coates, 2010; Ibrahima & Mattaini, 2018). Challenge is required of the ideological position of superiority of Western knowledge with its inclination to colonize methodology in ways which diminish indigenous knowledge and undermine self-determination (Tuhiwai Smith, in Marks, 2002). Social work research methods can validate, include legitimize, and empower, or the converse, based on hidden value judgments wherein the importance of both physical and nonphysical reality, often part of indigenous knowledge construction, is invalidated when confronted with established Western methodology. Tuhiwai Smith questions the plethora of research that has typically failed to improve the lives of the people being researched. Nicholls (2009) proposes a triad of reflexive research practice that consists of self-reflexivity, interpersonal reflexivity, and collective reflexivity, and a process of enquiry of colonial academic discourse and research to facilitate contemplation of the outcomes and consequences for the lives of people being researched. In recent years, social work scholars have identified the ways in which Western social work paradigms, research methods, and practice approaches have perpetuated ­post-colonialism (Gray, Coates, Yellow Bird, & Hetherington, 2013). This critique has become particularly 80

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relevant in social work’s quest to internationalize its curriculum and practice focus. Decolonizing social work disrupts the discourse of “othering,” the hegemony of expert social work interventions and research methodologies that privilege the Western worldview. It emphasizes the strengths, customs, and traditions of local and indigenous people (Gray et al., 2013).

A way forward? Various indigenous scholars call for the co-construction of knowledge, the validation of local voices, and, importantly, dialogue (Ibrahima & Mattaini, 2018). It is through language and dialogue that we construct meaning, providing a deeper understanding of need and how to address it. The importance of macro-practice, a community focus of intervention, must be at the forefront of developmental social work (Mwansa, 2011). Ibrahima and Mattaini (2018) suggest that failure to develop appropriate methods is, in part, a result of miscomprehension of the complexity and diversity of social issues, and the mistaken belief that generic solutions provide the answer. The process of decolonization does not exclude expertise and collaboration, but needs to be a forum for sharing knowledge, wisdom, and values. This requires of education to develop a skilled social work labor force with the ability to be reflexive, to question the construction of knowledge, to explore the nature of power and oppression, in order that intervention with diverse communities is ethical, relevant, and appropriate. It requires research to be culturally focused and locally initiated, with a commitment to a co-constructed academic community, respectful of inclusive knowledge construction and genuine dialogue between Africa and the West, resulting in the ethical transformation of curricula to encompass all voices and values.

Conclusion Can social work reassess and revise its heritage? Continued internalized and structural oppression in postcolonial and postapartheid South Africa requires of social work education, critical engagement with modernist and postmodern theory, and the development of reflexivity and a critical consciousness. Respect for the plurality of views and values enables emancipatory and indigenous theory to emerge, for practice to be informed by wider sociopolitical, economic, cultural, and environmental issues, mindful of creating unintended consequences and oppressive outcomes perpetuated through hegemonic colonial discourses. To fulfill its core value of social justice, social work must relinquish its reliance on Western frameworks, values, and models to incorporate indigenous knowledge to improve the fit between theory and the realities of practice. Social work has a significant role to play in a democratic South Africa, notwithstanding the complex challenges of remaining relevant to meet local need and contributing to developmental social welfare policy.

References Bornman, E. (2010). Emerging patterns of social identification in postapartheid South Africa. Journal of Social Issues, 66(2), 237–254. Darder, A. (2017). Reinventing Paulo Freire: A pedagogy of love. New York, NY: Taylor & Francis. Esau, M., & Keet, A. (2014). Reflective social work education in support of socially just social work practice: The experience of social work students at a university in South Africa. Social Work/Maatskaplikewerk, 50(4), 455–467. Etherington, K. (2004). Becoming a reflexive researcher: Using our selves in research. London: Jessica Kingsley. Freire, P. (1972). Pedagogy of the oppressed. New York, NY: Penguin. 81

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Gade, C. B. N. (2011). The historical development of the written discourses on Ubuntu. South African Journal of Philosophy, 30(3), 303–329. Goodman, B. (2003). Big ideas: Paulo Freire and the pedagogy of the oppressed. Nurse Education Today, 34(7), 1055–1056. Gorelick, R. E. (1986). Apartheid and colonialism. The Comparative and International Law Journal of Southern Africa, 19(1), 70–84. Gray, M., & Coates, J. (2010). “Indigenization” and knowledge development: Extending the debate. International Social Work, 53(5), 613–627. Gray, M., Coates, J., Yellow Bird, M., & Hetherington, T. (2013). Decolonizing social work. Farnham, Surrey: Ashgate. Gray, M., & Lombard, A. (2008). The post-1994 transformation of social work in South Africa. International Journal of Social Welfare, 17(1), 132–145. Hochfeld, T. (2010). Social development and minimum standards in social work education in South Africa. Social Work Education, 29(4), 356–371. Hugman, R. (2003). Professional values and ethics in social work: Reconsidering postmodernism? British Journal of Social Work, 33(8), 1025–1041. Ibrahima, B., & Mattaini, M. A. (2018). Social work in Africa: Decolonizing methodologies and approaches. International Social Work. doi:10.1177/0020872817742702 Mamphiswana, D., & Noyoo, N. (2000). Social work education in a changing socio-political and economic dispensation. International Social Work, 43(1), 21–32. Marks, D. F. (2002). Perspectives on evidence-based practice. Health development agency: Public health evidence steering group. London: City University. McKendrick, B. (1990). Introduction to social work in South Africa. Pretoria: HAUM Tertiary. Ministry for Welfare and Population Development. (1997). White paper for social welfare (Government Gazette, 8 August). Pretoria: Government Printer. Morrall, P. (2009). Provocation: Reviving thinking in universities. In T. Warne & S. McAndrew (Eds.) Creative approaches to health and social care. Knowing me. Understanding you. Basingstoke: Palgrave MacMillan. Mwansa, L. (2011). Social work education in Africa: Whence and whither? Social Work Education, 30(1), 4–16. Nicholls, D. (2009). Qualitative research: Part one–Philosophies. International Journal of Therapy and Rehabilitation, 16(10), 526–533. Patel, L. (2015). Social welfare and social development (2nd ed.). Oxford: OUP. Rosa, M., & Tudge, J. (2013). Urie Bronfenbrenner’s theory of human development: Its evolution from ecology to bioecology. Journal of Family Theory & Review, 5(4), 243–258. Sacco, T., & Hoffmann W. (2004). Seeking truth and reconciliation in South Africa: A social work contribution. International Social Work, 47(2), 157–167. Schirato, T., Danaher, G., & Webb, J. (2012). Understanding Foucault: A critical introduction. London: Sage. Seekings, J. (2014). South Africa: Democracy, poverty and inclusive growth since 1994. Johannesburg: CDE. Sewpaul, V., & Hölscher, D. (2004). Social work in times of neoliberalism: A postmodern discourse. Pretoria: Van Schaik. Smith, L. (2008). South African social work education: Critical imperatives for social change in the post-apartheid and post-colonial context. International Social Work, 51(3), 371–383. Smith, L. (2014). Historiography of South African social work: Challenging dominant discourses. Social Work/Maatskaplike Werk, 50(3), 305–331. Spolander, G., Pullen-Sansfacon, A., Brown, M., & Engelbrecht, L. (2011) Social work education in Canada, England and South Africa: A critical comparison of undergraduate progammes. International Social Work, 54(6), 816–831. Tierney, K. (2015). Resilience and the neoliberal project: Discourses, critiques, practices – and Katrina. American Behavioural Scientist, 59(10), 1327–1342. Vally, S. (2018). Missed opportunities: The rhetoric and reality of social justice in education and the elision of social class and community in South African Education Policy. KOERS – Bulletin for Christian Scholarship, 83(1), 1–14.

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12 Barriers to d ­ esigning a code of ethics for social w ­ orkers in the Arab society Fakir Al Gharaibeh

This chapter provides an analysis of the perceived barriers to the devising of a code of ethics for social workers in the Arab society. A brief overview is given of these factors: social work education, local culture, client characteristics, professional associations, professional training, and the nature of the communities where social workers operate. The chapter concludes with suggestions for how social workers in the Arab society can devise a code of ethics based upon their social and cultural context using an international framework. The Arab world is comprised of all 22 members of the League of Arab States (see ­Figure 12.1). The current population of the Arab world is about 422 million and is expected to grow by 114% to nearly 700 million in the next four decades. Although the majority of people in the region are adherents of Islam, and the religion has official status in most countries, a sizeable minority are Christian (Al Gharaibeh, 2017). The “ethics boom” is a current global concept that guides the professional conduct of practitioners of many fields, including social work. This is the result of the growing awareness of human rights and the search for solutions for the issues of inequality, poverty, war, and refugee crises in zones of conflict, along with the phenomenon of global terrorism, the rise of neoliberalism in politics, a weakness of traditionally strong welfare states, cutbacks in social services, and many other issues that demand an ethical response from social workers (Banks, 2012). The objective of a code of ethics is to propose a set of core values, principles, and standards that guide practitioners when making professional decisions (Al Gharaibeh, 2011). It is not a conventional set of final answers about what is “right” or “wrong,” but rather it assists social workers to base their actions in their professional roles on a professional framework (Spano & Koenig, 2007). In the Arab society, there are no formal professional ethical principles and standards that ensure that practitioners and the institutions that employ them work together as an integrated whole to better serve the patients in need of care. It is often the case that social workers in the region comply with in-house regulations rather than a national or international code. Codes of ethics are established through professional practice and, therefore, develop over time, in accordance with cultural norms and naturally occurring cultural changes, the development of the science upon which the profession is based, and changes in the approaches and methods of the profession, in addition to changes in priorities in the field. Unlike other 83

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Figure 12.1  Map of Arab League countries Source: University of Texas, Perry-Castañeda Library Map Collection. Note: The dashed line in Sudan separates North from South Sudan, which became an independent country in mid-2011.  The Arab League includes Comoros, which is located approximately 950 miles (1,530 kilometers) south of Mogadishu and is not pictured here.

fields, such as medicine, nursing, law, and even the media, social work in the Arab world does not have a clear professional code of ethics. Despite its importance, no serious effort has been made to develop an Arab professional code of ethics for social work that clarifies the profession’s identity as befits the specifics of the Arab culture, defines and describes the standard practice, and establishes the need for social workers, based on the needs of the beneficiaries (Al Gharaibeh, 2011). Social work plays a significant role in furthering human rights and dealing with social problems, including familial difficulties, crime, unemployment, poverty, and displacement. Social workers also deal with many marginalized groups in society. They work to help their clients solve problems within changing social systems and they develop social programs in line with the values, theories, and practice of the profession (IFSW, 2002). The Arab society needs certified social workers to meet the needs of its people, especially while the Arab society still suffers from the impact of the Arab Spring that started in 2010 and its consequences such as instability, poverty, and unemployment. The Arab region has experienced profound structural changes following the Arab Spring, a revolutionary wave of demonstrations, protest, riots, and civil wars that began on D ­ ecember 18, 2010. The onset of this movement has been attributed to the spread of corruption, economic stagnation, poor living conditions, in addition to the severe political and security restrictions imposed on individuals and the lack of electoral integrity in most Arab countries (Al Gharaibeh, 2017). For the past few decades, the priority of most governments in the region has been to provide basic services to their citizens such as medical care, education, and economic needs; meanwhile, combating other social problems has not been regarded as a crucial issue for these governments. This is evident from the low level of concern for improving the quality of social work since its inception in the area in the 1940s. 84

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Major barriers to designing a code of ethics for social workers The cultural context The Arab society places high importance on the moral and ethical conduct of individuals. Consequently, cultural and religious values, ethics, and moral principles are incorporated into the general code of practice of social workers. However, one needs to proceed with caution when attempting to explore the nature of these values. It may be right to believe that the Arab Muslim society remains closed to the cultural/religious values that differentiate it from other cultures in many respects. In general, Muslims adhere to Muslim values, and not Islamic ones. Islamic values are set out in the Quran and the life of the Prophet Mohammad. Muslim values are those that developed as a part of the culture of the different communities of the region; thus, the values may or may not be compatible with the teachings of Islam and its theology (Al Gharaibeh, 2016). Cultural competence is critical if social workers are to live up to the ideals of their profession through advancing human rights, advocating for minority groups, and promoting understanding between the social and cultural sectors. An understanding of culture and religion enables social workers to adequately comprehend psychosocial problems that are constructed and understood in culturally specific ways. The principles and values of Islam are therefore integral to resolving difficulties for Muslims (Al-Krenawi & Graham, 2003). Social workers working with Muslim clients need to have some understanding of the basic teachings of Islam and how Muslims comprehend human rights in order to promote social justice for society while encouraging pride in rich cultural and religious traditions. Muslims do not need to repudiate their faith in order to embrace principles of universal human rights, as these principles are, in fact, integral to Islam (Al Gharaibeh & Villa, 2016). However, the cultural disparity between the Muslim and Western cultures, where social work as a profession first started, has resulted in one of the thorniest issues that face social work in the Arab society. This is because most Arab scholars believe social work to be a Western colonial creation that is alien to Arab culture. Historically, Egypt, mainly following the American model, pioneered social work in the region. From there, the same model spread to other Arab Muslim countries during the period 1935–1960. However, eventually, an Arabic model appeared in the Arabian Gulf region as well as in Libya, Iraq, and Syria. Another factor that leads some to believe that social work in the Arab society is a Western product is the cultural influence experienced by Arab students overseas who come back to an Arab society to practice and teach at the end of their studies (Ragab, 1995). Another cultural barrier to the practice of social workers in the region is the social expectations regarding the nature and scope of interaction among people of different genders. An Arab male client and/or his family may find it difficult to accept a female social worker. In the case of female clients, a male social worker would be obliged to maintain even greater distance than normal and have minimal eye contact with the client (Al-Krenawi & Graham, 2000). Furthermore, a social worker would find it very awkward to discuss the sexual aspects of the relationship of a married couple receiving family intervention. A code of ethics might enable social workers to have deeper involvement with cases and encourage clients to more readily accept intervention. Meanwhile, the professionalization of social work practice in many countries, particularly Scandinavia, as well as France, Germany, Greece, Italy, and Spain, has steered it away from a religious approach to a scientific understanding of people and their problems and how to best assist them in addressing their issues (Watts, Elliott, & Mayadas, 1995). It has been posited that this trend was not a rejection of religion itself, but rather a gradual shift to a view of “the government as the provider of social services when the scope of, and demand for, services 85

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rose beyond the abilities of nongovernmental faith based providers to meet the needs of individuals, families, and communities” (Watts et al., 1995). Yet, this has not been the case in the Arab world where resistance to this trend has been entrenched due to the pivotal role that religion plays in every individual’s life there (Sloan, Bromfield, Matthews, & Rotabi, 2017). The interaction between individual and professional ethics is possibly more complex for social workers than in any other profession because social workers’ relationships with their clients are noticeably more restricted than that of doctors, nurses, accountants, or lawyers, for example (see Sinead Phillips, 2010). Cultural differences between social workers and clients can add to this complexity. This can have a strong impact on the quality of social services provided in the Arab world today, where many expatriates live and work and need to benefit from the services provided. However, cultural diversity should not be a barrier against formulating a code of ethics in the Arab society. The negative cultural perceptions of practicing social work in the Arab society should be modified. Social services should be accepted just as other professions such as medicine and nursing in which interactions between professionals and clients of different genders are customary.

Gender difference and family structure The international statement on ethics in social work (IFSW & IASSW, 2004) takes into account the cultural context and ethical standards, client/system preferences, relevant societal/individual values, and the unique aspects of the situation that has presented itself (Davies, 2000). It embodies both these senses of social work and aims to contribute to the dialogue about values, practices, and ideas across boundaries. It describes concepts such as the rights of individuals, individual privacy and confidentiality, and nondiscrimination on grounds of gender, ethnicity, ­sexual identity, and so on. However, the work that goes into developing of international s­tatements of principles and standards (which involves consultation and negotiation between representatives from different countries) and their acceptance and publication plays an important role in creating an international language in which to talk about social work and engage in debates about the relevance, meaning, and importance of key concepts and principles (such as human rights or nondiscrimination). It gives participants in the debates a chance to question the values, attitudes, and practices in their own countries, to reflect on how far to go in terms of accepting or respecting cultural and religious differences in their own and other counties, and on what issues to take a stand and hold firm, regardless of law, religion, or culture (Banks, 2012). As mentioned previously, global values guiding social services are considered universal, although these values are viewed to be based on Western ideas that may not be compatible with the local norms and mores. To illustrate, the legal codes in many Arab countries, which are based on Shari’a law, still forbid certain behavior that is otherwise condoned in the West. For example, like much of the world until recently, homosexuality is understood as forbidden according to the Qur’an (Sloan et al., 2017). On the other hand, some social practices, such as polygamy, that are allowed under Shari’a law may not be socially or legally accepted in the West. However, many of the ethical principles of social work are shared by both the Arab and Western societies. Such issues can seriously obstruct any attempt at devising a code of ethics that follows international standards and Western views on gender issues for social work in the region.

Quality of education of social workers The systemic teaching of social work as an academic field of study in the Arab world started in Egypt in the 1940s. However, it still suffers some serious drawbacks. First, many universities 86

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in the Arab world view the teaching of social work, the practice of social work, counseling, sociology, and special education as one and the same thing. Moreover, sociology lecturers, not social work specialists, frequently teach in social work departments. This weakens the practical part of teaching, particularly when exploring ethical issues related to social services, and gives more emphasis to the study of sociology rather than social work. At the same time, most social institutions rarely employ new graduates on the basis of their specialization. In fact, in most Arab countries, there is very little distinction between sociology and social work graduates. Students’ training and placement are also highly insufficient. The teaching curricula should include fieldwork training that is carried out in conjunction with social institutions. However, low levels of cooperation and communication between universities and social service agencies make the latter hesitant to welcome trainee students. What complicates matters is that some universities are unwilling to pay even symbolic fees to the host institutes for training their students. Consequently, there is shortage of professional training placement. Meanwhile, the practical component only lasts approximately 120 hours. In addition, student placement preferences are not often met which ultimately affect the outcomes of their training. Another serious issue that affects the quality of education of future social workers in the region is the lack of culture specific textbooks. For example, in a unique initiative, member states of the Gulf Cooperation Council (GCC) recruited Western social work educators to develop social work programs. Currently, there are 12 undergraduate social work programs: six in the Kingdom of Saudi Arabia (KSA), three in the UAE, and one each in Kuwait, Qatar, and Oman. There are also two graduate social work programs in the Gulf: one in KSA and the other in the UAE (Sloan et al., 2017). However, as Al Bahar (2011) points out, although some textbooks are available in Arabic, there is a lack of textbooks that are specifically designed for use in the region. Sloan et al., (2017) assert that most social work faculty and programs in the GCC depend on Western-focused textbooks; these books are mostly not appropriate to the Islamic or Arab context. Another failing is the gap between the teaching and practice of ethical issues at higher education. Leighton (1985) highlights that professional relationship between social workers and clients is focused, while a personal relationship is normally more voluntary. Therefore, Shafer, Morris, and Ketchland (2001) point out that ethics training for students has to achieve the goal of ethical principles. Designing an ethics curriculum for social work requires an understanding of students’ current level of awareness of ethics. However, although Arab students are introduced to the key principles of social work, which are similar to the code of ethics adopted by Western social work associations such as confidentiality, worth, dignity, nonjudgmental attitudes, and self-determination, gaps in the professional education ethics and practice still exist (Al Brithin & Dziegielewski, 2016).

The limited role of social work associations In Arab countries, social work graduates are not required to obtain a license or membership in a professional association to practice. Meanwhile, very few social work university departments are members of the International Federation of Social Workers (IFSW). The problem is that most social workers are employed by government organizations that regulate the performance of social workers based upon their own regulations, without referring to an independent code of ethics. Naturally, social workers hold their own personal views of the social world and the nature of human relationships. Leighton (1985) argues that these personal opinions should be shared among co-practitioners in order to design a unified code of ethics. It is necessary for social workers to join professional associations to establish professional identities and meet the agreed standard approach to addressing ethical dilemmas. 87

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This is also important to establish a network of professionals who could help in improving the ethical practice in social work (Davies, 2000). Furthermore, a code of ethics reflects the values of the profession. Surprisingly, there is no written code of ethics for social workers in the majority of Arab countries and there does not seem to be enough interest to develop one. Most practitioners in these countries, at least in theory, voluntarily refer to the International Code of Ethics for Social Workers issued in 2004 by the IFSW (Abo El Nasr & Eltaiba, 2016). Officially, the conduct of social workers is evaluated according to the general regulations of their institutions, regulations that equally apply to any other member of staff regardless of their position and duties. Internationally, there are active professional bodies, unions, and associations. These organizations publish documents outlining the nature of social work, knowledge, skills, and ethics. Most notable of these are the IFSW and International Association of Schools of Social Work, who define the scope of social work and draw the international principles for practice and a statement of ethical principles based on the tenants of human rights and social justice (Banks, 2012). However, there are no equivalent local bodies for social workers in the Arab region. Given the absence of professional bodies in these countries, it can be argued that standards of practice and professional development may be negatively affected. In contrast, in Western countries, social work practitioners are required to participate in professional training and education programs continually in order to update professional skills and meet licensing requirements (Al Brithin & Dziegielewski, 2016). The issue of licensing requirement also affects the service standards of the providers. Recently, and in response to existing demand, practice services have been permitted to extend beyond governmental organizations to such private settings as courts, family mediation, and nursing facilities. For example, there is need for private family counseling offices, childcare, elderly care, addiction treatment, autism care, and disability care centers (Abo El Nasr & Eltaiba, 2016). These facilities should be required to obtaining operating licenses as is the case with private practices. This could encourage practitioners to get approval to have their own social wok centers or clinics as in the United States, United Kingdom, Canada, and Australia.

Conclusion Social work is still a new field in Arab countries with little information on how it is conducted and whether it adheres to a similar code of ethics as outlined in developed countries. Al Gharaibeh and Villa (2016) emphasize that social work in the Arab Muslim society could be reoriented by creating a more culturally competent model. The IFSW stresses that the social work profession promotes the values of democracy, human dignity, and equality among human beings (IFSW, 2002). In Arab countries, social workers believe that social work as a profession is rooted in human rights and respect for the dignity of human beings. Al Gharaibeh and Villa (2016) suggest that an appropriate practical model of professional intervention could be adopted in the Arab Muslim society based on the principles of Islamic and Arabic culture using a framework of social legislation to safeguard women, children, prisoners, and the elderly. I suggest that social work associations should be established in every Arab country. The role of such associations would be to coordinate between institutes of higher education to design and adopt curricula that include the required knowledge, skills, and ethics for social work. They would monitor the performance of universities in teaching and share training experiences with them. Graduates of enlisted universities could then become members of the associations. 88

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I also propose that governmental and nongovernmental organizations cease to employ new graduates who have not received license to practice from such a professional association. The associations should also monitor both the work performance and adherence to the ethical standards of social workers and provide them with opportunities to develop their professional skills. Moreover, they should facilitate for the submission of client complaints in cases of infringement of their rights by social workers. Designing code of ethics is necessary, whatever the barriers are in the Arab society.

References Abo El Nasr, M., & Eltaiba, N. (2016). Social work in Egypt: Experiences and challenges. British Journal of Education, Society & Behavioural Science, 16(1), 1–11. Al Bahar, M. (2011). Social work education in the UAE: Local reality and global challenges. In S.  ­Stanley (Ed.), Social work education in countries of the East: Issues and challenges (pp. 563–578). ­Hauppauge, NY: Nova Science. Al Brithin, A., & Dziegielewski. (2016). Practicing social work ethics among hospital social workers in Saudi Arabia. Journal of Social Service Research, 42(5), 729–741. Al Gharaibeh, F. (2011). Obstacles in formulating a code of ethics for social workers in Jordanian ­institutions. Asian Social Science, 8(1), 125–133. Al Gharaibeh, F. (2016). Debating the role of custom, religion and law in ‘honour’ crimes: Implications for social work. Ethics and Social Welfare, 10(2), 122–139. Al Gharaibeh, F. (2017). Understanding the needs and rights of Arab Muslim youth: The case of ­Jordan. International Social Work, 60(5), 1169–1188. Al Gharaibeh, F., & Villa, R. (2016). Conceptualising social work and human rights from an Islamic perspective. European Journal of Social Sciences, 51(2), 183–192. Al-Krenawi, A., & Graham, J. R. (2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health Social Work, 25 (1), 9–22. Al-Krenawi, A., & Graham, J. R. (2003). Principles of social work practice in the Muslim Arab world. Arab Studies Quarterly, 25(4), 75–91. Banks, S. (2012). Global ethics for social work? A case-based approach. In S. Banks & K. Nøhr (Eds.). Practising social work ethics around the world: Cases and commentaries (pp. 1–31). Abingdon, Oxon: Routledge. Davies, M. (2000). The Blackwell encyclopedia of social work. Oxford: Wiley-Blackwell. International Federation of Social Workers (IFSW). (2014). Global definition of social work. Retrieved from https://www.ifsw.org/what-is-social-work/global-definition-of-social-work/ International Federation of Social Workers (IFSW) and International Association of Schools of ­Social Work (IASSW). (2004). Ethics in social work, statement of principles. Retrieved from https:// www.iassw-aiets.org/wp-content/uploads/2015/10/Ethics-in-Social-Work-Statement-IFSWIASSW-2004.pdf Leighton, N. (1985). Personal and professional values – marriage or divorce. In D. Watson (Ed.), A code of ethics for social work. London: Routledge. Map of Arab League country. Retrieved from https://www.safaribooksonline.com/library/view/ the-arab-world/9781118236420/9781118236420cintro.xhtml Phillips, S. (2010). A happy 18th birthday….or is it? Critical Social Thinking: Policy and Practice, 1, 189–204 Ragab, I. (1995). Middle East and Egypt. In T. D. Watts, D. Elliott, & N. Mayadas (Eds.), International handbook on social work education (pp. 281–304). Westport, CT: Greenwood. Shafer, W., Morris, R., & Ketchland. A. (2001). Effects of personal values on auditors’ ethical decisions. Accounting, Auditing and Accountability Journal, 14(3), 254–278. Sloan, L., Bromfield, N., Matthews, J., & Rotabi, K. (2017). Social work education in the Arabian Gulf: Challenges and opportunities. Journal of Religion & Spirituality in Social Work: Social Thought, 36(1–2), 199–214. Spano, R., & Koenig, T. (2007). What is sacred when personal and professional values collide? Journal of Social Work Values and Ethics, 4(3), 6–25. Watts, T. D., Elliott, D., & Mayadas, N. S. (1995). International handbook on social work education. ­Chicago, IL: Greenwood. 89

13 Disability ethics A confluence of human and distributive rights Elizabeth DePoy and Stephen Gilson

What should a viable human body do, how should it function, and how should it appear? To what resources and rights should it obtain? These questions form the foundation for understanding the typical, the norm, their contraries, and disability. The answers are not universal, summoning the need for careful analysis and response, particularly with regard to decisions about moral legitimacy for rights and resources, to those who are deemed to be members of the disability category. This chapter enters that underbelly of human rights and distribution, first by suggesting that reasoning about disability rights joins in the bodies and background valuation approaches to deciding who is worthy of what and who is not. Specific to disability, the degree to which bodies (see below for a definition) adhere to or violate acceptable standards of functioning for rights eligibility, or what we refer to as embodied rights, and accompanying resources is then differentially conferred relative to context-embedded relativist perceptions. The linguistic and theoretical bedrock of disability in itself is complex and dynamic and thus, before our discussion of ethical models, we provide definitions and a brief history for clarification.

Visiting definitions through ages and locations Language is a uniquely human gift, central to our experience of being human. Appreciating its role in constructing our mental lives brings us one step closer to understanding the very nature of humanity. (Boroditsky, 2018, para. 1) This quote from Boroditsky (2018) repositions the Miles Principle, “where you stand depends on where you sit,” from bureaucracy to the conceptual. That is to say, how a construct is definitionally and ethically seated determines where it stands, its perimeters, its substance, and its reach and scope. Looking back through time and across geographic boundaries, the construct of disability, albeit graced with diverse monikers and meanings, has a commonality no matter where it was seated. Despite some claims to the contrary, disability is about the violating body (DePoy & Gilson, 2014). So here is the first definition: body refers broadly to the container of individual experience, appearance, and behavior, including the aesthetic, 90

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sensory, physical, organic, physiological, cognitive, expressive, emotive, recreation, social, communicative, spiritual, and other elements. The violating body fails to meet contextual standards in one or more of those areas and is thus served up for moral judgment and frequent alteration, truncation, or even denial of rights on the basis of body characteristics. However, as we will see in our brief historical sojourn, violation in one context may be judged typical and acceptable in another. Keep in mind that the violation and negative valuation thereof are contextual but, once deemed to be in violation of the typical, are disabling. We now enter a brief historical overview of disability as the foundation for understanding the relationship between disability and conceptualizations of the violating body, and the importance of that association for context relative ethical decision-making and embodied rights. Note that we have supplanted the term “human rights” with “embodied rights,” given the debates about the qualifications for membership in humanness (DePoy & Gilson, 2014). Over the course of history, multiple value paths, from celebration to death, have been traversed to analyze the scope and nature of the atypical body. From ancient Greece through current time, a continuum from fascination to revulsion and even expulsion of the violator was enacted in some fashion, whether through symbolism or action. But regardless of which condition occupies the atypical seat, social acceptance and how these individuals have been approached are out of the ordinary. While a full history is beyond the scope of this chapter, the points below provide a conceptual context for the role of the atypical body in establishing markers and parameters for the acceptable to heinous violation and how this continuum has been met with full, partial, or no rights and resources. • • •

•

•

Within the defective range, while specific embodied conditions are treated somewhat differently, most are residents of the “undesirable neighborhood.” Responses to people with devalued embodied differences are diverse, across a continuum from simple curiosity and disapproving stare through marginalization and elimination. Prior to the Enlightenment and even now, deliberation about human violation formally was the purview of philosophy and theology. The violating body to a greater or lesser degree was judged on its acceptability and deemed as human, quasi-human, or not human at all (DePoy & Gilson, 2014). Thus, equivalent human rights were not given for all people. Enlightenment thinking was a major impetus for capturing the body within a “scientific” bastille, with scientists and professionals taking the lead as sentries. Although claiming objectivity, who passed through the disability portal and how those members were treated lie in the valley of morals and ethics. Industrialization further created and ensconced acceptable standards for desirable body function, size, and appearance and thus for violations, social valuation and concomitant embodied rights.

These principles can be gleaned from documentation in recorded history through current times, whether contained in visual image, illuminated manuscript, philosophical narrative, policy narrative, etc. (DePoy & Gilson, 2014). As example, a look back at the history of those who could not hear reveals marginalization until ostensibly, the construct of valued linguistic diversity replaced hearing impairment as a descriptor of the condition of deafness. But has it really? Hearing impairment is a prime target of ADA regulations, but as we will discuss further in the chapter, the ADA defines disability as an embodied deficit. Given that hearing impairment is one of the protected beneficiaries of this specialized policy instrument, a contradictory quandary is raised when claiming it as a linguistic culture. 91

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Similarly, we see numerous definitions posited for disability, each approaching disability and embodied rights from different viewpoints. However, notwithstanding the varied organizational structures, all definitions fit neatly into a tripartite taxonomy: embodied, social, and interactive. Embodied definitions, also referred to as the medical model, indict the violating corpus, including its appearance, behavior, thoughts and feelings, sensations, productions, etc. as the primary locus of disability. The violating body, one that strays from the “norm,” is the causal seat of disability, providing that the deficit is long term or permanent and results in an impairment that fits within accepted conditions considered to be disabling. In this conceptual framework, an individual “has a disability” or is someone “with a disability.” Responses to legitimate members of this category seek to move the violating body toward typical function through surveillance, ongoing evaluation, and provision of specialized services, resources, and policies. Implicit in this response is judgment that violation is not desirable nor deserving of the same rights afforded to non-violators. We address this point in more detail below. It is therefore not surprising that the social model was proposed. In opposition to the view of the violating body as disabled, and borrowing from other rights movements, proponents of the social model locate the cause of disability in the exterior environment. Rather than blaming the atypical body, the social model fingers negative social attitudes and discriminatory practices as “disabling” forces. Early social model theorists did not explicate any disabling role for the violating body, but nevertheless, the theory, literature, and responses were sought by and for those with violating corpuses. The role of the “impaired body” was reintroduced in more recently penned social model narratives. Note the term impairment here. These theorists identified oppression, discrimination, and exclusion of impaired bodies from full participation and opportunity as causal of disability. However, we propose that, in the social model, impairment is just a euphemism for embodied violation, used in large part to distinguish medical and social views. Look at this definition from the World Health Organization, “any loss or abnormality of psychological, physiological or anatomical structure or function” (WHO, 2018, para. 3). But at the end of the day, focusing on the impaired body as the object of prejudice still places the violating body as undesirable and ripe for the provision of embodied rights that do not reach equivalency with human rights afforded to the mythic typical citizen. Just consider synonyms for impairment: damage, destruction, deterioration, ruination, ruined goods, and wreckage. Within social conceptions of disability, we also bring your attention to the violating body as immoral in itself, referring to beliefs that the plight is somehow deserved either because of one’s own agency or that of the birth parents (DePoy & Gilson, 2014). Interactive models such as disjuncture theory (DePoy & Gilson, 2014) and that advanced in the UN Convention on the Rights of Persons with Disabilities (UN Disability, 2006; 2007) remarry social and medical models to recognize the violating body in context as the locus of disability. Although this approach makes most sense to us, given that the contextually embedded definition of disability slithers among diverse meanings, we have selected the medical model definition for analysis in this chapter due to its widespread acceptance, its power in shaping embodied rights responses, as well as its espousal by social work and as we will see, by diverse nations. Note that, for example, Simcock and Castle (2016) present multiple models of disability in their text on social work and disability while defaulting to violating bodies as the actors and objects of study.

Ethical meandering Because many of the works in this collection discuss ethical decision-making models, we do not reiterate details here. Rather, we just provide narrative useful for our discussion about the 92

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scope and ways in which this delicious field has been baked and sliced. First, we distinguish among ethics and morals. Ethics are codes of the “many” while morals are judgment of the one (Tasdoven, 2014). Second, there are many taxonomies each in service to different metrics to classify ethical models. One approach divides ethical models into three segments: outcome, action, and person-based. Outcome-based models render judgment on what should occur as a result of human agency while process models are concerned with the goodness of the action itself, sometimes without regard to outcomes. Person-based models guide people to be “good” in their nature and intentions. Of course, this trifurcation is a naïve oversimplification of the ethical model terrain but provides major thematic distinctions among the diverse approaches proposed by many ethicists (Tasdoven, 2014). An alternative system, one of many but the one most relevant to our work in this ­chapter, organizes ethical decision-making models into two divisions: universalist and relativist. ­Universalist models propose a unitary set of “goods, bads, shoulds and should nots,” while relativist models assert the existence and use of many ethical codes shaped by and influencing contexts in which outcomes, intentions, and actions occur. How those codes define relativism, operationalize it, and then translate it into judgment and action is diverse and creates a textured panorama for discussion and debate. Because of the articulated commitment of social work to human diversity and in service to a pluralistic analysis of disability, moral relativism (often used interchangeably with ethical relativism) is a potent, although often contested (Lukes, 2008), ethical scaffold for comparatively analyzing disability and responses to it across the globe. While there are diverse monikers, we use the term moral relativism for simplicity as well as to depict the view that decisions about goodness of intent, action, and outcome are interpreted individually even within groups that may hold ethical codes in common (Corradetti, 2009). As noted previously, the field of moral relativism is complex, precluding a full discussion within the scope of this chapter, so we consult Lukes (2008), who divides the r­ elativist ­landscape into descriptive, normative, and meta. What all three have in common is that they do not label different positions as right or wrong. Rather, each has a different scope and/or action agenda. Descriptive moral relativism does just what it says; it describes d­ ifferences among ethical/moral positions that are developed using the same knowledge base. M ­ eta-relativist ethics hold that there are major through minor disagreements on what is right, wrong, and so forth, but propose that all are valid regardless of which position is held. The normative moral relativist describes and then adds a pronouncement, prescribing tolerance even in the face of disagreement. As you can already see, there could potentially be major conceptual problems with this school of thought. First, the espousal of a relativist position seems internally contradictory since it implies a universalist ethic that all people should accept pluralism. Second, any relativist position could be seen as eviscerating a set of universal moral truths. If we espouse this criticism, we are left with an analytic void. However, there are resolutions to the crevasses left by moral relativism, and given its resonance with the social work commitment to diversity, we invite those into our discussion now. Bickenbach and Bickenbach (2009) suggest that the conflict can be resolved by seeing “progressive realisation of rights along with situational sensitivity of difference” as friends that can and must coexist to foster human rights. Schulzke (2015) halts the conceptual fisticuffs referring to a model of contingent morality. He argues that even decisions about initiating or continuing warfare, while generally morally disdained, need to be made “contingent upon immediate and changing circumstances….” (p. 95). Similarly, Corradetti (2009) suggests 93

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that models of situated authenticity and pluralistic universalism transcend the binary, thereby uniting universal and relative moral judgment. Applied to social work, Banks proposes the relevance of universalist global statements for guidance, within which social workers must use professional judgment to decide on the place-based ethics, while Healy (2007) asserts that there is no wiggle room when social work encounters discrimination. We urge the social worker to use the Miles Principle with regard to definitional grand narratives (proposed by Lyotard to describe statements that have multiple or no truth value) and, along with Corradetti (2009), regardless of the terrain, to avoid seeing ethics as constant for any circumstance. Rather we implore social workers to ethically deliberate on complex substantive, purposive, contextual, and professional factors while remaining aware of our universalist philosophical themes. Given our commitment to celebration of diversity, heaped onto myriad ways in which disability is defined and met with social response, a ­universalist-relativist dilemma calls for a relativist ethical approach supervised by the grand narratives contained within professional codes.

Illustrating the ethical landscape A short contemporary illustration is in order. Plastic straws are an ecological toxin with efforts from many groups to ban them from use. While this aim seeks to implement conservation and global sustainability, it infringes on the rights of many with impairments who without straws would experience publicly embarrassing body betrayals such as drooling to the extreme case of not being able to drink any liquids at all. Who is right in which context? Now, let’s wax macro examining the International Federation of Social Workers (2019) for its placement along the relativist-universalist continuum. Alongside many professional codes of ethics, this Statement experiences a similar oxymoronic fate to relativist ethics, in that it both mandates pluralism and monism, but one which Bickenbach and Bickenbach (2009), Schulzke (2015), and Corradetti (2009) have reconciled to our satisfaction. The following ethical principle may seem rife with inconsistencies but is it? Again, invoking the Miles Principle, social workers may differentially understand the concept “respect for diversity” through both universal and relativist ethical positions. 3.2 Respect for Diversity-Social workers work toward strengthening inclusive communities that respect the ethnic and cultural diversity of societies, taking account of individual, family, group, and community differences. (WFSW, 2018, para 12) Recognizing the patina of conflict brought by relativist ethics, and being satisfied with the philosophical solution to this (N.A., 2018), we assert that a relativist framework used critically and in service to professional universalist narratives has significant promise for social work. Moreover, descriptive relativism steers away from imposing a direction or even tolerance on disagreements, but rather provides systematic analysis of the pluralistic meanings of and response to disability to inform praxis.

The disability picture We now move to a substantive discussion of embodied rights (recall this as our term for disability rights), their polemics, and the explicit and implicit ethics contained within the texts. In essence, rights instruments, where they exist across the globe, primarily take the shape of 94

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specialized, segregated legislation for people with violating bodies. What we mean by segregated legislation is that such instruments mimic “pull-out” programs, making no change to existing rights instruments that, heretofore, have not protected diverse bodies including those in violation despite assertions that all are human. At an international level, The Declaration of Human Rights states: “human rights are universal – to be enjoyed by all people, no matter who they are or where they live.” Everyone is invited, but, absent of enforcement, this legislation does no work other than to propose a grand narrative that floats simply as utopian story without doing any work. Now look at the UN CRPD (CRPD, 2006). Often celebrated for its progressive definition of disability, the lexicon states, “disability is an evolving concept and…results from the interaction between persons with impairments and attitudinal and environmental barriers that hinder. Their full and effective participation in society on an equal basis with others.” We are not opposing such legislation but rather call analytic attention to it as a “pull-out” program not so subtly implying that “everyone” in the Declaration does not mean everyone. The “who” is thus up for interpretive grabs. Two types of endorsements by UN member nations occur, signature indicating broad agreement with no obligation, and ratification, binding the nation to uphold the Conventions’ eight rights principles still with no enforcement obligation. Accordingly, access, participation, nondiscrimination, equal opportunity for the binary classic genders, and respect and recognition are ostensibly the “goods and should” for qualifying violating bodies, but again absent clear criteria for who qualifies and how nations will proceed if at all to enforce such mandates. Both the Declaration and the CRPD are proposed as universal, but leave the door open for relativism. Similar to national legislation, in our five exemplars, if described at all, the violating body places “impairment” on the constructed stage and cloaks it in a grand narrative of what the body should do, receive, and conditions to which it should not be subjected. Further affirming contextual difference is the choice for no, some, or full endorsement. But even with ratification, interpretation of how to enact the principles, if at all, is up for grabs. Let’s look. In service to limited space, Table 13.1 provides a brief visual comparison of what we have referred to as embodied rights instruments in each of the five exemplar nations on four selected parameters: specified or implied disability definition, level of CRPD endorsement, response, and enforcement. Consistent with Bickenbach and Bickenbach’s (2009), Schulzke’s (2015) and Corradetti’s (2009) ideas, a perusal of just these five exemplar nations reveals both universals and differences. Definitionally, with the exception of Ghana, which does not detail what is meant by disability but implies impairment throughout, all nations locate the conceptual seat of disability within the violating body. Thus, the violating body in itself is the “devalue” to which responses are directed. Note also that the violating body is perceived as fiscal burden, one that needs help to contribute anything valued in the social or economic context. While articulated moral responses in each country are relative, all meet the universal cost burden with some form of “reasonable accommodation” clause that allows perceived cost to trump the right to equal access afforded to non-violators. Look at some examples. In Japan, a threshold number of employees must be met in order for businesses to be held accountable for quota hiring of violating bodies. In the United States, demonstrating “undue hardship” can excuse a business from providing accommodations for violating bodies. Of particular note is the limited or full absence of global enforcement, pardoning embodied rights instruments from doing any work. 95

Elizabeth DePoy and Stephen Gilson Table 13.1  Comparative analysis of selected global disability rights policies and practices Definition of disability

CRPD action

Response

Enforcement

Britain

Embodied violations

2009-ratification

A, D, E, N, $,

Partial

Germany

Age atypical embodied violations

2009-ratification

A, D, E, N, $, R,

Partial

Ghana

Vague

2012-ratification

Japan

Embodied violations with a focus on employment and cost of childcare

2014-ratification

A,E, N, R,

United States

Impairment of long term or permanent duration or recognized as such by others

2009-signatory

A, D, E, N,

Nonbinding Council established Quota system with penalties in employment sector Support for burden of disabled children    , $, R

Initiated by claimant

Note:  A-architectural modifications; D-dignity; E-employment/academic accommodations; N-nondiscrimination; $-income support;

-health insurance; R-reasonable accommodation.

Now to social work ethics Just this short sojourn poses moral and ethical dilemmas for social workers who encounter disability and embodied rights across the globe. The first question to be answered is what is it? If social workers define disability as deficit, the violating body begins as devalued, discriminated against, and in need of fixing. If we define disability as diversity, the rights conversation makes sense, but how do we apply a universalist ethic to responding when disability is so vastly different across the globe. Just consider a short example from Albrecht (2005), who defined a disabling condition as the death of a working elephant in a farming family in Ghana? If discrimination is the definitional seat of disability, how does the violating body differ from other bodies that are the object of this prejudice and how can professional universal ethical responses be enacted in the face of diversity? From a macro perspective, we query the extent to which legislation is even the most efficacious instrument to dictate moral responses. So, a multidimensional crossword puzzle beginning “where the client is, where the nation is, where the globe is” is served up for ethical investigation informing social work praxis. To encounter and resolve these and other ethical queries in this chapter (specific to disability but more expansive in its application), we propose moral relativism with a touch of the universal in the style of Bickenbach and Bickenbach (2009), Katiuzhinsky and Okech (2014), and Corradetti (2009) and in concert with Nuttman-Shwartz (2017) who asserts that “it is important to recognize the need for a complex professional identity that interweaves indigenous, local, global, and universalistic thinking” (p. 1). Creative application of moral relativism guides the social worker to look for context relevant approaches to establish and 96

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accomplish goals for practice related to disability. But the overarching seamless universal ethic to direct relativist thinking and action guides all social workers to integrate all bodies into rights that are meant for everyone (n.d.).

References Albrecht, G. (2005). Encyclopedia of disability. London: Sage. Bickenbach, J. E., & Bickenbach, J. E. (2009). Disability, culture and the UN convention. Disability and Rehabilitation, 13(14), 1111–1124. Boroditsky, L. (2018). how-does-our-language-shape-the-way-we-think. Retrieved from The Edge: https:// www.edge.org/conversation/lera_boroditsky Corradetti, C. (2009). Relativism and Human Rights. Dordrecht, NE: Springer. Department of Economic and Social Affairs. (2007, March). Convention on the Rights of Persons with Disabilities. Retrieved from United Nations: https://www.un.org/development/desa/disabilities/ convention-on-the-rights-of-persons-with-disabilities.html DePoy, E., & Gilson, S. (2014). Branding and designing disability. New York, NY: Routledge. Healy, L. (2007). Universalism and cultural relativism in social work ethics. International Social Work, 50(1), 11–26. International Federation of Social Workers (2019). Global Social Work Statement of Ethical Principles. Retrieved from https://www.ifsw.org/global-social-work-statement-of-ethical-principles/ Katiuzhinsky, A., & Okech, D. (2014). Human rights, cultural practices, and state policies: Implications for global social work practice and policy. International Journal of Social Welfare, 32(1), 80–88. Lukes, S. (2008). Moral relativism. New York, NY: Picador. N.A. (2018, August 16). Kobayashi Maru. Retrieved from Wikipedia: https://en.wikipedia.org/wiki/ Kobayashi_Maru Nuttman-Shwartz, O. (2017). Rethinking professional identity in a globalized world. Clinical Social Work Journal, 45(1), 1–9. Schulzke, M. (2015). The contingent morality of war: Establishing a diachronic model of jus ad ­bellum. Critical Review of International Social and Political Philosophy, 264–284. Simcock, P., & Castle, R. (2016). Social work and disability. Malden, MA: Policy. Tasdoven, H. (2014). Ethical decision making. In S. Thompson (Ed.), Encyclopedia of diversity and social justice (pp. 305–305). Lanham, MD: Rowman & Littlefield Publishers. UN Disability. (2007). Department of Economic and Social Affairs. Retrieved March 19, 2019 from https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-withdisabilities/convention-on-the-rights-of-persons-with-disabilities-2.html UN Disability. (2006). Department of Economic and Social Affairs. Convention on the Rights of Persons with Disabilities. Retrieved March 19, 2019 from: https://www.un.org/development/desa/ disabilities/convention-on-the-rights-of-persons-with-disabilities.html WHO. (2018, June 14). WHO disability assessment schedule 2.0. Retrieved from World Health Organization: http://www.who.int/classifications/icf/whodasii/en/

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Section III

Abortion

14 Self-determination and abortion access A pro-choice perspective on the International Statement of Ethical Principles Heather Witt, Erica Goldblatt Hyatt, Carly Franklin, and Maha N. Younes

Miranda and Joseph had been married for seven years. After two miscarriages, Miranda was excited to conceive again. Though anxious during the first trimester, after hitting the 12-week “safe zone” and passing early fetal diagnostic tests, Miranda finally began to relax. She and Joseph discovered they were expecting a girl and chose the name Hope. At 20 weeks’ gestation, many expecting mothers undergo a routine anatomy scan to identify abnormalities. Hope’s ultrasound revealed a severe skeletal defect, thanatophoric ­dysplasia. Her skeleton was disproportionately small, and malformations included an oversized, c­ loverleaf-shaped skull and ribcage that would not accommodate growing lungs. Two separate neonatologists confirmed that Hope’s condition was incompatible with life: she would be s­tillborn or die of respiratory failure shortly after birth, experiencing extreme pain and suffering. Miranda and Joseph were provided with three options. They could carry Hope to term and request extensive and aggressive medical intervention for her, including an emergency tracheostomy with mechanical ventilation; however, her life would still be brief. Alternatively, the couple could enlist the services of perinatal hospice immediately after birth. Hope would feel a tremendous amount of pain due to her multiple structural defects, living only for minutes in respiratory failure. There would not be enough time to palliate Hope’s symptoms before death. Their third option was to terminate the pregnancy. Miranda and Joseph consulted their pastor, loved ones, and a perinatal social worker. Miranda’s dreams for her little girl’s full, happy life were destroyed. She now had to consider bringing a child into the world to experience a brief, agonizing life and painful death. After confirming with their maternal-fetal medicine specialist, who informed them that there was no scientific evidence of pain in fetuses prior to 24 weeks, the couple chose termination.

Introduction When considering abortion, a case like Miranda and Joseph’s may not first come to mind, as their story is one of the fewer than 3% of couples who terminate pregnancies in the second trimester 101

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(Coleman, 2015). However, their story deserves attention and exploration, as throughout the world, individuals and families seek abortion care for a variety of complex reasons. Although the decision to end a pregnancy may be due to financial, employment, and educational concerns, pressures from partners or other relational issues, worry over the size of one’s current family (Broen, Moum, Bodkter, & Ekeberg, 2005; Kirkman, Rowe, Hardiman, Mallett, & R ­ osenthal, 2009), or fetal anomaly as in the case of Hope, the authors of this chapter argue that social workers must honor a pro-choice orientation when working with clients, regardless of rationale. Social workers must support individuals’ right to choose the outcome of their pregnancies. This chapter first presents a discussion of the most relevant International Ethical Principles underlying the rationale of the pro-choice argument, followed by implications on language and culture. We conclude by promoting the use of ethical decision-making models to assist social workers in working with clients.

International Statement of Ethical Principles The social work profession’s stance is straightforward related to respecting the right to self-determination, promoting social justice, and guiding professional conduct to support these aims. While we argue that all the guidelines support a pro-choice orientation, this section highlights particularly relevant guidelines from the International Federation of Social Workers’ and International Association of Schools of Social Work’s Statement of Ethical Principles (2018) that describe social workers’ responsibilities.

Promoting the right to self-determination In the International Ethical Principles, the admonition to safeguard client s­ elf-determination is clear: “Social workers respect and promote people’s rights to make their own choices and decisions, provided this does not threaten the rights and legitimate interests of others” (Principle 4). It is inappropriate for social workers to impose their own personal, moral, and/ or religious viewpoints on any individual facing the decision to end a pregnancy. In doing so, the social worker undermines the pregnant individual’s right to self-determination. Some may argue that respecting the right to self-determination of the pregnant individual by including the option of abortion access undermines the right to self-determination of the fetus. This argument hinges on the social worker’s personal, moral, and/or religious viewpoint for when life begins. Social workers must resist imposing beliefs over the individuals they serve. Any definition of human life must come from the client, not the social worker. Even if a societal consensus was reached on when a fetus becomes a human being, or a life, we must acknowledge that no individual is ethically, morally, or legally required to undergo unwanted bodily use, even if doing so keeps another life alive (Thomson, 1971). Indeed, individuals have the legal right to refuse organ donation in many countries, even if it would save another life. Pregnancy without the option of abortion forces the pregnant individual to choose the riskiest of the potential medical options, as research suggests that the risk of death associated with full-term delivery to be 14 times higher than legally obtained induced abortion (Raymond & Grimes, 2012).

Treating people as whole persons The Principles call upon social workers to …recognize the biological, psychological, social, and spiritual dimensions of people’s lives and understand and treat all people as whole persons. Such recognition is used to 102

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formulate holistic assessments and interventions with the full participation of people… with whom social workers engage. (Principle 7) Dictating a woman’s obligation to bear a child against her will overlooks that woman as a whole person, with significant detrimental impacts on all dimensions of life. While some would argue that other solutions exist, such as adoption or perinatal hospice in case like Hope, this ignores the reality that the pregnant woman may be choosing abortion to avoid continuing with risks and costs associated with the actual pregnancy itself, which are often significant. These costs are not only monetary but also psychological and emotional. ­Ignoring all of the dimensions of an individual, even if only for the duration of a pregnancy, violates this principle. In cases of physical anomalies, disallowing mothers like Miranda the right to determine the nature of their unborn children’s life and death further restricts them from acting as parents to their own children. Having all options available promotes ­self-determination while considering all dimensions of their lives.

Promoting the right to participation The right to participation hinges on the centrality of the right to self-determination, as discussed previously. The ethical principles state: “[s]ocial workers work toward building the self-esteem and capabilities of people, promoting their full involvement and participation in all aspects of decisions and actions that affect their lives” (Principle 5). Unintended pregnancy can have significant negative consequences that impact individuals’ lives and their ability to fully participate within broader society. These consequences may negatively impact pregnant women’s psychological and emotional well-being. For example, they may be forced to quit school or jobs, they may be rejected from family and/or the broader community, they may be forced into unwanted marriage, and they may become victims of domestic violence (Hardee, Eggleston, Wong, Irwanto, & Hull, 2004; Singh, Sedgh, & Hussain, 2010). Social workers should actively fight against the systemic forces that result in this type of marginalization. However, when all options, including parenting, adoption, and safe and legal abortion, are not presented to individuals, or when those options are presented coercively or incompletely, a social worker is acting in bad faith. The social worker is not only thwarting individuals’ right to self-determination but also actively abdicating the responsibility to help clients participate in their own decision-making. Because of the significant, long-term effects of unintended pregnancy or the severe multifaceted effects of fetal anomalies, abortion access is critical to help ensure clients’ self-determination and full participation. The health implications of blocking or removing access to the safe and legal option of abortion are apparent. Research on unwanted and mistimed births reinforces that these can result in increased health risks to women (Gipson, Koenig, & Hindin, 2008). According to Sedgh, Henshaw, Singh, Åhman, and Shah (2007), approximately 45% of all abortions worldwide are unsafe, and these result in about one in seven maternal deaths (Ganatra et al., 2017). In addition, approximately five million women are hospitalized each year due to complications of unsafe abortions (Singh, 2006). Blocking or removing access to safe and legal abortion also violates the principle that calls social workers “…to bring to the attention of their employers, policymakers, politicians, and the public situations in which policies and resources are inadequate or in which policies and practices are oppressive, unfair, or harmful” (Principle 3.4). 103

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Social workers should act with integrity Social workers are bound by the ethical principles to “not abus[e] their positions of power and relationships of trust with people that they engage with; they recognize the boundaries between personal and professional life…” (Principle 9.4). Imposing their own belief systems on to the client constitutes an abuse of power and of the trust that has been built in the helping relationship. Social workers must act in accordance with individuals’ rights to make their own decisions, even if the social worker would choose differently.

Language, culture, and other considerations An honest discussion of abortion and reproductive rights is incomplete without highlighting the powerful impact of language on public opinion and social policy based on moral and cultural factors that influence women’s rights to self-determination and reproduction. Terms such as “pro-choice” and “pro-life” are emotionally provocative and promote divisive and erroneous assumptions that oversimplify a most complex social issue. Suggesting that life and choice are contradictory, and implying that those who support a woman’s right to assert control over her body are against life, are just as offensive as viewing those who advocate for birth as reproductive oppressors. The question becomes whose life should be honored, and whether a woman’s self-determination and reproductive choice are protected human and civil rights? Combellick-Bidney (2017) notes that embracing reproductive rights as human rights demands courage and nonconformity as it invites discourse, requires “translation across differences,” and links understanding and perceptions between local and global spheres (p. 818). The evasiveness that emerges when discussing reproductive rights should not be divorced from oppressive cultural practices that view women as property, their bodies as vessels, their sexuality as a burdensome taboo, and gender violence as justifiable. Combellick-Bidney (2017) discusses South Africa’s 1996 legalization of abortion and emphasis on reproductive freedom for men and women. Despite progress, the practice of forced sterilization of HIV positive women is common and gender-based violence hinders their access to services and increases their exposure to HIV infections. Likewise, although abortion is legal in India, sex-selective abortions are common because dowries make raising females economically burdensome on families. Brazil’s pronationalist government and Catholic orientations criminalize all abortions except in cases of rape, and access to services is often challenging, especially for marginalized groups (Combellick-Bidney, 2017). Culture and religion intertwine to frame perspectives on reproductive rights. Take for example Middle Eastern and North African Muslim countries following Qur’anic and Shari’a (Islamic law) and prohibiting abortions after the “ensoulment” of the fetus, which is described as taking place 120 days following conception. Abortion is permitted when a woman’s life is at risk, to safeguard the interests of a breastfeeding child, and due to socioeconomic concerns (Hessini, 2007). Abortion due to fetal abnormalities that are incompatible with life is allowed prior to ensoulment, and only if the mother’s life is threatened after that (­A l-Matary & Ali, 2014). Al-Matary and Ali (2014) stress the importance of educating potential parents and health care workers of Qur’anic and Islamic principles as late diagnosis of fetal anomalies makes the termination of pregnancy following ensoulment forbidden and illegal. The intersection of culture, religion, and politics is magnified in Israel where “militarism, patriarchy, and cultural values heavily shape and influence Jewish and Arab ­Women’s access to and experience of reproductive health” (Granek & Nakash, 2017, p. 893). National 104

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and demographic insecurity due to historical trauma and ongoing political and social ­conflicts proliferate the emphasis on reproduction for the sake of ethnic survival for Jews and ­Palestinians alike. Israeli society views children and motherhood as the center of family life, considers “biological parenthood” as a “moral right,” and choosing to remain childless is seen as “pathological” (Granek & Nakash, 2017, p. 893). Half of the annual 40,000 abortions in Israel are illegal, and a committee of two doctors and a social worker, one of whom must be a woman, must approve them. The state covers the cost of legal abortions, which may be performed up to full gestation and makes Israel one of the highest performers of late-term abortions (Steinfeld, 2015). The battle for reproductive rights is no different in the United States where the law that supposedly legalized abortion, Roe v. Wade, faces perpetual attacks and has become one of the most contentious and defining ideological issues for political parties. West (2009) argued that the law provides a negative right as it does not legalize abortion but merely protects individuals from criminal charges. A more potent approach suggested is to pursue a political shift to recognizing reproductive rights rather than court imposed constitutional mandates to keep the state out of family life. However, the imposition of restrictive regulations by many state governments has also instigated the closure of many clinics, limiting access and increasing difficulty and cost for women needing services. Decreased access to legal medical services compels many women to find alternative routes to abortion without medical assistance, thus placing their well-being at higher risk. The most basic human and civil rights of women to autonomy, self-determination, dignity and self-worth, equity and justice, and equal access to resources are challenged by religious, cultural, social, and political constraints. Discussions of life and choice without recognizing the impunities that women face because of such constraints are hollow and oppressive. Valuing women and their contributions while depriving them of reproductive choice, forcing them into involuntary parenthood, is contradictory, and awareness of their implications requires honest assessment within the social work profession. Čepulionytė and Dunajevas (2016) investigated the values of social workers in Lithuania and found that 70.7% of participants held contradictory values that may lead to daily value conflicts in their work. Therefore, social work educators must promote self-awareness, value clarification, and personal assessment among aspiring social work students to minimize value impositions once in the field. Moreover, understanding the muddling power of language in distorting core values and furthering the victimization of women is essential to empowering social workers with the critical thinking necessary to serve their clients. A lifelong commitment to advancing cultural humility would illuminate the predicaments facing women related to reproductive rights and compel policy advocacy that respects their right to self-determination.

Ethical decision-making models and abortion Restrictive responses to abortion do not reflect the ethical frameworks prioritized in ­social work. Social work ethical codes emphasize micro, mezzo, and macro level interventions that are evidence-based, collaborative, client-centered, considerate of client strengths, ­holistic, and inclusive of context and lifelong impacts. The literature suggests that using ethical frameworks to guide decision-making around abortion improves the emotional coping of clients (Upadhyay, Cockrill, & Freedman, 2010). When abortion is approached in neutral, open ways, clients may ultimately receive medical care that more closely aligns with their preferences (Macks, Weeks, Wright, Block, & Prigerson, 2010) resulting in increased q­ uality-of-life, improved experiences of client’s social support network, and decreased economic strain at 105

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micro and macro levels (You, Fowler, & Heyland, 2014). Any of the models highlighted below could be used to build a conversation regarding a complex problem, but some specific aspects of ethical decision-making models are particularly useful when building solutions around abortion. Specific models for consideration include: Character-Based Decision-Making Model ( ­Josephson Institute of Ethics, 2002), Essential Steps for Ethical Problem-Solving (Reamer & Conrad, 1995), Ethical Decision-Making Process (Steinman, Richardson, & McEnroe, 1997), and Ethical Principles Screen (Dolgoff, Loewenberg, & Harrington, 2004). Often the goals of decision-making focus on achieving an accurate decision and reducing the level of effort (or stress) required to arrive at it (Tyszka, 1998). Decision-making accuracy can be defined based on client perspective. For example, a client seeking an abortion may define an accurate decision as prioritizing honesty over societally defined morality or perceived selflessness (Gilligan, 2015). In addition to ensuring informed consent to engage in the model with the client, models emphasize the importance of value clarity for both professional and client. Professionals should engage in evaluating which values they consistently rank higher than others and seek appropriate supervision and support when grappling with ethical dilemmas. Regardless of how deeply professionals feel regarding an issue, they cannot allow their personal preferences to influence the client’s decision-making process (Mattison, 2000). Otherwise, the professional is not engaging in social work but instead proselytization (Sue & Sue, 2002). Ethical decision-making models encourage professionals to explore concepts related to transpersonal development. A transpersonal approach would allow a professional to maintain their own personal beliefs, while also recognizing their client’s beliefs as equally valid ­(Cowley, 1993). In addition, practitioner-focused recommendations include the use of cultural humility over cultural competency. By emphasizing humility, the practitioner could remain open in client conversations, allowing the client to more fully share their expertise in solution-building (Fisher-Borne, Cain, & Martin, 2014). If professionals can use evidence-based strategies to engage in more ethical, balanced discussions on abortion, the divisive narrative can be shifted toward productive solutions that more effectively improve the well-being of those directly impacted by abortion, as well as satisfy the primary goals of an increased number of stakeholders.

Conclusion The authors of this chapter argue that social workers are compelled to practice from a ­value-neutral stance when working with pregnant individuals. Social workers must honor the unique cultural and social contexts influencing client decision-making – including ­supporting a client’s decision to carry to term or end a pregnancy. Imposing one’s beliefs r­ egarding abortion onto a client instead of seeking supervision, referral, and/or working to put the client’s needs first seriously violates multiple codes of ethics. Remaining ­value-neutral, social workers act in the best interests of clients by referring them to appropriate private and community organizations for assistance continuing or ending a pregnancy. The issue of abortion is complex, and is framed and impacted by language, culture, and context. While the case of Miranda and Joseph humanizes one complex circumstance, each narrative of abortion must be honored as a decision enacted of free will, without coercion. To do so would violate client self-determination and threaten the very helping relationship that social workers uphold as sacred. 106

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References Al-Matary, A., & Ali, J. (2014). Controversies and considerations regarding the termination of pregnancy for foetal anomalies in Islam. BMC Medical Ethics, 15(10), 1–10. Broen, A. N., Moum. T., Bodtker, A. S., & Ekeberg, O. (2005). Reasons for induced abortion and their relation to women’s emotional distress: A prospective, two-year follow-up study. General Hospital Psychiatry, 27(1), 36–43. Čepulionytė, D., & Dunajevas, E. (2016). The value contradictions in social work. The Journal of Social Work Values & Ethics, 13(2), 12–21. Coleman, P. K. (2015). Diagnosis of fetal anomaly and the increased maternal psychological toll associated with pregnancy termination. Issues in Law and Medicine, 30(1), 3–25. Combellick-Bidney, S. (2017). Reproductive rights as human rights: Stories from advocates in Brazil, India and South Africa. The International Journal of Human Rights, 21(7), 800–822. Cowley, A. S. (1993). Transpersonal social work: A theory for the 1990s. Social Work, 38(5), 527–534. Dolgoff, R., Loewenberg, F. M., & Harrington, D. (2004). Ethical decisions for social work practice. Boston, MA: Brooks Cole. Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2014). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34(2), 165–181. Ganatra, B., Gerdts, C., Rossier, C., Johnson Jr, B. R., Tunçalp, Ö., Assifi, A., … Alkema, L. (2017). Global, regional, and subregional classification of abortions by safety, 2010–14: Estimates from a Bayesian hierarchical model. The Lancet, 390(10110), 2372–2381. Gilligan, C. (2015). Revisiting “in a different voice.” The Harbinger, 39(1), 19–28. Gipson, J. D., Koenig, M. A., & Hindin, M. J. (2008). The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Studies in Family Planning, 39(1), 18–38. Granek, L., & Nakash, O. (2017). The impact of militarism, patriarchy, and culture on Israeli women’s reproductive health and well-being. International Journal of Behavioral Medicine, 24(6), 893–900. Hardee, K., Eggleston, E., Wong, E. L., Irwanto, & Hull, T. H. (2004). Unintended pregnancy and women’s psychological well-being in Indonesia. Journal of Biosocial Science, 36(5), 617–626. Hessini, L. (2007). Abortion and Islam: Policies and practice in the Middle East and North Africa. Reproductive Health Matters, 15(29), 75–84. International Federation of Social Workers and International Association of Schools of Social Work Statement of Ethical Principles. (2018). Statement of ethical principles. Approved at the General Meetings of IFSW and IASSW in Dublin, Ireland, July 2018. Retrieved August 7, 2018, from http:// ifsw.org/policies/statement-of-ethical-principles/ Josephson Institute of Ethics. (2002). Making sense of ethics. Playa del Rey, CA: Josephson Institute of Ethics. Kirkman, M., Rowe, H., Hardiman, A., Mallett, S., & Rosenthal, D. (2009). Reasons women give for abortion: A review of the literature. Archives of Women’s Mental Health, 12(6), 365–378. Macks, J. W., Weeks, J. C., Wright, A. A., Block, S. D., & Prigerson, H. G. (2010). End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt care consistent with preferences. Journal of Clinical Oncology, 28(7), 1203–1208. Mattison, M. (2000). Ethical decision making: The person in the process. Social Work, 45(3), 201–212. Raymond, E. G., & Grimes, D. A. (2012). The comparative safety of legal induced abortion and childbirth in the United States. Obstetrics & Gynecology, 119(2 Pt 1), 215–219. Reamer, F. G., & Conrad, Sr. A. P. (1995). Professional choices: Ethics at work [Video]. Washington, DC: NASW Press. Sedgh, G., Henshaw, S. K., Singh, S., Åhman, E., & Shah, I. H. (2007). Induced abortion: Estimated rates and trends worldwide. Lancet, 370(9,595), 1338–1345. Singh, S. (2006). Hospital admissions resulting from unsafe abortion: Estimates from 13 developing countries. Lancet, 368(9550), 1887–1892. Singh, S., Sedgh, G., & Hussain, R. (2010). Unintended pregnancy: Worldwide levels, trends, and outcomes. Studies in Family Planning, 41(4), 241–250. Steinfeld, R. (2015). Wars of the wombs: Struggles over abortion policies in Israel. Israel Studies, 20(2), 1–26. Steinman, S. O., Richardson, N. F., & McEnroe, T. (1997). The ethical decision-making manual for helping professionals. Boston, MA: Brooks Cole. Sue, D. W., & Sue, D. (2002). Counseling the culturally diverse: Theory and practice. New York, NY: Wiley. Thomson, J. J. (1971). A defense of abortion. Philosophy and Public Affairs, 1(1), 47–66. 107

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Tyszka, T. (1998). Two pairs of conflicting motives in decision making. Organizational Behavior and Human Decision, 74 (3), 189–211. Upadhyay, U. D., Cockrill, K., & Freedman, L. R. (2010). Informing abortion counseling: An examination of evidence-based practices used in emotional care for other stigmatized and sensitive health issues. Patient Education and Counseling, 81(3), 415–421. West, R. (2009). From choice to reproductive justice: De-constitutionalizing abortion rights. Yale Law Journal, 7, 1394–1432. You, J. J, Fowler, R. A., & Heyland, D. K. (2014). Just ask: Discussing goals of care with patients in hospital with serious illness. Canadian Medical Association Journal, 186(6), 425–432.

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15 Social work’s first obligation The role of social workers in protecting unborn children William C. Rainford and Bruce A. Thyer

Across the globe, the profession of social work is centrally committed to the protection of human life and dignity (International Federation of Social Work, 2014). Indeed, it is from this ethical primacy that all other social work ethics and values originate. For if the human being is not of distinctly individual inherent worth, and the dignity of that human being can be commoditized, exploited, and extinguished without protective response from social workers, then social work has no purpose. The profession, while widely agreeing on an ethos of human rights, does not have universal agreement on when life begins and, thus, when the social work obligation to protect that life arises. The medical field has established that, at the point of conception, a unique individual (termed initially a zygote, then an embryo, then a fetus) is formed, and that it is by genetic and biological definition a fully functioning ­organism – a human being (Condic, 2008). From the moment the zygote is formed, the ­human being is in a constant state of generation and growth that continues across the lifespan until death (DeMarco, 2000). This newly formed human being is unrepeatable, unique in all aspects, and identifiably separate from its mother in its genetic makeup (Miklavcic & Flaman, 2017). Because the fetus is a human being, it has inherent human rights, codified in various international declarations, treaties, and professional codes. Therefore, social workers are professionally bound and obligated to act on behalf of the human being from point of conception, enlisting social work knowledge, skills, and experience in protecting the life of the unborn human being from conception forward and facilitating its growth in dignity toward full ­human potential. Further, as in all social work practice, it is not enough to merely serve the unborn human being; the professional social worker must advocate for the end of the legality and practice of abortion as an atrocity and affront to the life and dignity of all human beings. This chapter discusses the social work ethos of human rights, examines violations of human rights presented by policies and practices of abortion, and details a model of prolife social work.

Foundations of social work’s ethos of protecting human life The profession of social work is centrally committed to protecting human beings and their inherent dignity, as is well documented through various codes and standards of social work, where nearly ubiquitous language of protecting and enhancing human well-being is used to 109

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describe social work’s chief function. The term well-being is operationalized to mean that human life is protected and nourished across the lifespan. Lost in translation is that the social work ethos of protecting life and human dignity has evolved across, not decades or even centuries, but millennia and has as its roots the earliest oral traditions and teachings of the Judaic Talmud, and was formed from the books of the New Testament of Christianity and the Koran of Islam, with their deep emphasis on charity, mercy, peace, and justice toward protecting life and upholding human dignity (Trattner, 1999). Social work continued its development across the centuries, influenced directly from a strong Judeo-Christian ethos of the sanctity of life and dignity of the human person, and in the form of direct charitable ministration through religious relief agencies, hospitals, and orphanages across Europe and in the New World. Indeed, social work would not exist as a profession were it not for religious men and women who founded such organizations. Mary Richmond, perhaps the most influential person in the formation of modern social work, was an active Christian who adamantly argued that the teachings of Christianity, chiefly the protection of life and the indomitable force of the church in delivering charity, were centrally important to the mission of social work. So, too, did Jane Addams hale from a Christian family, whose belief in the protection of life and human dignity was foundational for her later work in Hull House.

Social work and human rights The profession of social work has, from its earliest formation, been dedicated to human rights, with particular attention to the protection of life and human dignity. In the 20th ­century, social workers participated in codifying human rights, first in international treaties and declarations, then in the later part of the century, in its own various professional codes (Healy, 2008). In 1928, the first International Conference of Social Work was held in Paris. Nearly 3,000 social work delegates from 42 countries attended the conference. Its historical setting was Europe in recovery from World War I amidst a global economic boom that resulted in vast socioeconomic gaps between extreme wealth and dire deprivation. A central theme of the conference was the protection of life and dignity of human beings, with a call for a unified declaration of this commitment (Kuilema, 2016). Two more such conferences would be held in Frankfurt, Germany in 1932 and London, England in 1939, to continue building on the Paris Conference (IFSW, 2018). Three years after World War II ended, and as a direct response to the war’s tragic affront to life and human dignity, with its monstrous systematized extermination of nearly the entire population of German and Polish Jews, the United Nations General Assembly adopted the UN Declaration of Human Rights (UNDHR) (Morsink, 1993) to protect of life and worth of every individual. The UNDHR codifies the protection of life and human dignity in several concrete tenets. In its preamble, the deceleration identifies each member of the human family as holding inherent dignity and worth. Thus, all human beings, regardless of their stage of development, deserve protection. Article 3 declares all human beings have the right to life, while Article 5 prohibits torture and cruelty. Article 6 guarantees that the law will recognize all human beings as persons, while Article 7 provides equal protection of all human beings before the law (UN General Assembly, 1948). It wasn’t long before professional associations of social work began echoing the UNDHR. In 1960, the United States National Association of Social Workers codified the protection of the dignity and worth of human beings in its first code of professional ethics (NASW 110

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News, 1961). As social workers from around the globe gathered at the International Conference of Social Work in 1968, this time in Finland, Dr. Madhav Sadashiv Gore, President of the Indian Chapter of the International Association of Schools of Social Work, declared social work’s central ethos of the protection of human life and dignity directly mirrors the UNDHR (Gore, 1969). Over the next several decades, more than 21 associations across the globe would declare protection of life and human dignity as central to the profession of social work (Keeney et al., 2014). Ultimately, in 1988, the International Federation of Social Work, an organization of associations of social work from countries with such associations, declared that the profession of social work is dedicated to the protection and promotion of human rights, in keeping with the UNDHR (Healy, 2008). In 1989, recognizing that children are particularly vulnerable and subject to death, torture, abuse, and exploitation, the UN General Assembly adopted the Convention on the Rights of the Child (UNCRC). The preamble of the UNCRC declares, “The child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before, as well as after, birth” (United Nations, 1989, para. 9). Later, the convention codified the protection of the life of the child (Part I, Article 6, subsection 1), echoing the UNDHR in prohibiting torture, abuse, or cruelty of the child (Part I, Article 19, subsection 1), and protects the life of children with cognitive or physical disability (Part I, Article 23, subsection 1) (United Nations, 1989). Not surprisingly, as with the UNDHR, the International Federation of Social Workers fully embraced the UNCRC as reflecting and being reflected by the profession of social work and its commitment to human rights, particularly the protection of the lives of children (IFSW, 2002).

Being human – when does it begin? There is much debate about the exact moment when the human being comes into existence, thus becoming deserving of such protection. The question of determinant existence as a human being is not a mere matter of religion, philosophy, or ideology. It is a medical question, legal inquiry, and scientific quest for which there is truth generated from evidence. The question for science is a settled one – human beings exist at the point of fertilization of the ovum by the spermatozoon, when the zygote is formed (England, 1996). Gilbert (1938) concretely described the process by which spermatozoon and ovum unite in fertilization to become a human being, wholly individualized and separate in all identifiable ways from the mother. In Gilbert’s world in the middle of the 20th century, the idea that the unborn child wasn’t a human being was completely unheard of or scientifically argued. In the decades to come, while proponents of medical abortion would argue the zygote is not a human being, and thus not deserving protection, the science of human embryology, genetics, and biology would grow far beyond the knowledge available to Gilbert (1938), providing irrefutable evidence the fetus is a human organism that is uniquely identifiable (Moore & Persaud, 1998), with its own completed genetic code that is unrepeatable (at least by natural processes), and biologically functioning, driven by its own internal chemistry, cellular systems, and emerging organs (Condic, 2008; Yeung, 2005). The zygote metabolizes, develops, responds to stimuli in its environment, and reproduces cells into organs – the four criteria science uses to identify living organisms (Ruiz-Mirazo & Moreno, 2011). There is clear evidence that the human fetus is capable of learning (Krueger & Garvan, 2015), another proof of their humanity. Astonishingly, the microscopic zygote formed at fertilization begins to immediately affect influence on its mother, in which it orchestrates its own developmental process toward birth (Moore & Persaud, 1998). If uninterrupted by external forces, this process 111

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of becoming the human being will continue across the lifespan until death. Concretely, then, the zygote-embryo-fetus is a human being because it: (1) contains a complete, individual genetic code; (2) generates its own drive to actualize across the lifespan; (3) functions separately from its mother in its becoming; and (4) has a finality in becoming at its beginning – the zygote doesn’t become a human being at some later stage and in some other form (DeMarco, 2000; Moore & Persaud, 1998). Still, there is other evidence that the fetus is alive. The considerable body of medical research done on aborted fetuses which dispassionately examine their movements, squirming, and in response to being poked, and even grasping things, before finally expiring because they were incapable of surviving outside the womb. In 1975, the US government produced a report titled Research on the Fetus, which contained the following statement: “Under the ban imposed by P.L. 93–348, research on the living human fetus, before or after induced abortion, is not supported by NIH unless such research is done with the intention of assisting the survival of the fetus” (National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research, 1975, p. 50). Notice the phrase “living human fetus” and recognition that the fetus is alive while in the uterus, but when is delivered intact via abortion, remain alive for some time postabortion (and potentially being the subject of research). Moreover, this document deals with protecting human subjects. Not amorphous “tissue,” but a real person. To this day, the federal regulations governing research on human beings include the human fetus as a protected or vulnerable population.

The pain-capable fetus It is widely accepted by the medical profession, based on empirical evidence, that the fetus experiences pain in the 20th week of gestation and may likely do so much earlier (­Derbyshire, 2010). By week 14, the fetus has developed sensory receptors throughout the entire body (Myers, Bulich, Hess, & Miller, 2004). The receptors then are connected to the brain by the 20th week, thereby completing the network of nerves, spinal cord, and brain necessary for pain conductivity throughout the nervous system (Van Scheltema, Bakker, Vandenbussche, & Oepkes, 2008). Given the newly developed neurosensory system, the pain experienced by the fetus is not inconsequential, and may be more severe than that experienced by the newborn child, as the epidermis is thin and nerve fibers are closer to the surface than in older children and adults. Since surgical abortion by its very nature involves subjecting the fetus to extreme stress and pain, invasive procedures, and corporal dismemberment, it is cruel, torturous, and abusive. Prior to 14 weeks gestation, abortions are usually induced pharmaceutically and do not typically involve invasive procedures. After 14 weeks’ gestation, however, abortions are usually conducted through dilation and evacuation. Once the mother’s cervix is dilated, the fetus is extracted through a combination of suction and dismemberment. The process takes approximately 15 minutes. While death of the fetus is nearly immediate at the beginning of the procedure, the procedure is not free of pain for the fetus. When the fetus is more fully developed, dilation and extraction are necessary. In this procedure, the fetus is removed from the uterus through the cervix until the cranium is exposed. In order to remove the fetus, the head is collapsed through cranial puncture with a surgical instrument (Gordon, Sherk, Am, & Lerner, 2013). Videos depicting the fetus attempting to escape the physician’s tools are particularly compelling. The 28-minute film The Silent Scream illustrates this tragedy (see https://www.bing.com/videos/search?q=fetus+escaping+from+abortion+tool&&view= detail&mid=0D468161F36E47D944750D468161F36E47D94475&&FORM=VRDGAR). 112

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Genocide and population control through abortion Some governments and societies use abortion as a method of eugenic population control, where gender, ability, and race are all characteristics that societies and governments have sought to selectively diminish or exterminate. In China, abortion is used for gender selectivity. In Denmark, in 2014, 98% of mothers of unborn children with Down syndrome aborted their child (Ferrold, 2015). In the United States, abortion rates are far higher among urban African Americans than any other group; in 2014, in the United States, the rate of African American abortions is nearly five times that of the rate of White abortions ( Jones & Jerman, 2017).

China’s one-child policy and aborting female babies In 1979, China, seeking to reduce its burgeoning population and control its economy, instituted its infamous “one child” policy; a high rate of abortions resulted. Since families could only birth one child, and, culturally, Chinese families desire male children for their income earning, the overwhelming number of abortions was and remains of females (Zhang, 2017), resulting in an abnormally high male-to-female birth rate (Festini & de Martino, 2004). As a result of the policy, nearly 15 million children are aborted each year, according to the Chinese Ministry of Health (Moore, 2013). Due to gender selective abortions, there were 33 million more males than females under the age of 20 in the 2005 Chinese national intercensus survey (Zhu, Lu, & Hesketh, 2009).

Denmark’s eugenic abortion practices While the heartbreak, crisis, and lifelong challenges of parenting children with Down’s syndrome cannot be overstated, children with this and other disabilities still retain their right to life and dignity under the UNDHR and UNCRC. Importantly, many children with Down’s syndrome are able to live functional, productive, and meaningful lives with supportive and loving relationships by caregivers (Skotko, Levine, & Goldstein, 2011; ­Thulberry & Thyer. 2014). In 2006, Denmark initiated uniform prescreening of pregnant women for Down’s ­syndrome in the fetus. What resulted was a nearly 100% rate of abortion of children with Down’s syndrome (Ferrold, 2015). Tragically, Europe as a whole has a high abortion rate of children with Down’s syndrome, where nearly 90% of pregnancies were terminated when Down’s syndrome was identified (Boyd et al., 2008). Meanwhile, the United States has a rate of abortion of children with Down’s syndrome, of nearly 70% (Natoli, Ackerman, ­McDermott, & Edwards, 2012).

Genocide in the United States – African American abortions Although African-Americans make up approximately 13% of the population of the United States (US Census Bureau, 2016), they are disproportionally represented in comparative rates of abortion. More than 36% of all abortions performed in the United States were of ­A frican-American babies. In Alabama, Georgia, Michigan, and the District of Columbia, the abortion rate for African-Americans accounts for more than 50% of all abortions (USCDC, 2017). There were nearly 260,000 African-American abortions in 2014 ( Jerman, Jones & Onda, 2016), making abortion the leading cause of death for African-American children (Kochanek, Murphy, Xu, & Tejada-Vera, 2016). Combined with other sociocultural factors 113

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and social policies, the aggressive abortion rates of African-American children have created a population scenario in which the drop in the fertility rate between 2008 and 2016, from 2.15 births to 1.89 births per African-American woman, has created a deficit of expected births of nearly 10% – nearly 700,000 African-American children weren’t born (Stone, 2018). This matters as a concern of human rights for African-Americans. It also matters as a concern of economic justice. The organization Black Genocide is one advocacy group protesting the disproportionate negative impact US abortion policy has on African Americans, with almost 16 million Black babies having been aborted since Roe v. Wade. An African-American social worker, Erma Clardy Craven, claimed that “Several years ago, when 17,000 aborted babies were found in a dumpster outside a pathology laboratory in Los Angeles, California, some 12–15,000 were observed to be black” (c.f. www.Blackgenocide.org). Another writer on this website, Michael Novak, states Since the number of current living Blacks (in the U.S.) is 36 million, the missing 16 ­m illion represents an enormous loss, for without abortion, America’s Black community would now number 52 million persons. It would be 36% larger than it is. Abortion has swept through the Black community like a scythe, cutting down every fourth member. Working toward reducing the number of elective abortions would be a concrete way in which social workers can act to reduce the horrific impact liberal abortion policies have had in the American Black community.

Conclusion The human being is formed when spermatozoon and ovum combine to create the zygote. From that point, the human being has equal rights to all other humans. Given the profession of social work’s commitment to the protection of life and human dignity arising from its ethos of human rights, the unborn human being needs and deserves the same protections and supports the profession affords all born humans. Currently, the profession does not declaratively assert commitment to the unborn human being. On the contrary, in some concrete ways, the profession acts in hostility to the unborn human being. For instance, the National Association of Social Work in the United States doesn’t merely guide its social work members to support abortion. It mandates that social workers must support abortion, including advocating for laws expanding abortion, and opposing laws that prohibit it (NASW, 2017). Most social workers, including the authors of this chapter, do not belong to the NASW and are not bound by its diktats. Indeed, some social workers are employed in crisis pregnancy centers that support women with unwanted pregnancies who chose to give birth, others provide therapy for those afflicted by postabortion grief, and others promote local community organizing to reduce abortions (e.g., Thyer, 2018). The profession of social work needs to adopt a holistic practice approach that recognizes the human rights of the unborn human, from the point of conception.

References Boyd, P., DeVigan, C., Khoshnood, B., Loane, M., Garne, E., & Dolk, H. (2008). Survey of prenatal screening policies in Europe for structural malformations and chromosome anomalies, and their impact on detection and termination rates for neural tube defects and Down’s syndrome. BJOG International Journal of Obstetrics and Gynecology, 115, 689–696. 114

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Condic, M. L. (2008). When does human life begin? A scientific perspective. National Catholic Bioethics Quarterly, 9, 127–208. DeMarco, D. (2000). The zygote and personhood. Human Life Review, 26, 91–98. Derbyshire, S. (2010). Fetal pain? Best Practice & Research Clinical Obstetrics and Gynecology, 24, 647–655. England, M. (1996). Life before birth. London, England: Mosby-Wolfe. Ferrold, H. (2015, October 20). Down syndrome heading for extinction in Denmark. Copenhagen Post. Retrieved from http://cphpost.dk/news/down-syndrome-heading-for-extinction-in-denmark.html Festini, F., & de Martino, M. (2004). Twenty five years of the one child family policy in China. Journal of Epidemiology and Community Health, 58, 358–360. Gilbert, M. S. (1938). Biography of the unborn. Philadelphia, PA: Williams & Wilkins. Gordon, D., Sherk, S., Am, T., & Lerner, B. (2013). Abortion. In B. Narins (Ed.), The Gale encyclopedia of nursing and allied health (3rd ed., Vol. 1, pp. 16–21). Detroit. MI: Gale. Gore, M. S. (1969). Social work and its human rights aspects, in Social Welfare and Human Rights, Proceedings of the Fourteenth International Conference on Social Welfare (August 1968, Helsinki, Finland, pp. 56–68). New York, NY: Columbia University Press. Healy, L. (2008). Exploring the history of social work as a human rights profession. International Social Work, 51, 735–748. International Federation of Social Work (2002). Retrieved from http://cdn.ifsw.org/assets/ifsw_ 124952-4.pdf International Federation of Social Work. (2014). Global definition of social work. Retrieved from http:// ifsw.org/ policies/definition-of-social-work/ International Federation of Social Work. (2018). Draft constitution of the International Conferences of Social Work, 1947. Retrieved from https://www.ifsw.org/wp-content/uploads/ifsw-cdn/assets/ ifsw_13038-6.pdf Jerman, J., Jones, R., & Onda, T. (2016) Characteristics of US abortion patients in 2014 and changes since 2008. New York, NY: Guttmacher Institute. Jones, R., & Jerman, J. (2017). Population group abortion rates and lifetime incidence of abortion; United States, 2008–2014. American Journal of Public Health, 107, 1904–1909. Keeney, A., Smar, A., Richards, R., Harrison, S., Carrillo, M., & Valentine, D. (2014). Human rights and social work codes of ethics: An international analysis. Journal of Social Welfare and Human Rights, 2(2), 1–16. Kochanek, K., Murphy, S., Xu, J., & Tejada-Vera, B. (2016). Deaths: Final data for 2014. National Vital Statistics Reports, 65(4). Hyattsville, MD: National Center for Health Statistics. Krueger, C., & Garvan, C. (2015). Emergence and retention of learning in early fetal development. Infant Behavior and Development, 37, 162–173. doi:10.1016/j.inf beh.2013.12.007 Kuilema, J. (2016). Lessons from the first international conference on social work. International Social Work, 59, 709–721. Miklavcic, J., & Flaman, P. (2017). Personhood status of the human zygote, embryo, fetus. The Linacre Quarterly, 84, 130–144. Moore, M. (2013, March 15). 336 million abortions under China’s one-child policy. The Telegraph. Retrieved from https://www.telegraph.co.uk/news/worldnews/asia/china/9933468/336-millionabortions-under-Chinas-one-child-policy.html Moore, K., & Persaud, T. (1998). The developing human: Clinically oriented embryology. Philadelphia, PA: WB Saunders. Morsink, J. (1993). World War Two and the Universal Declaration. Human Rights Quarterly, 15, 357–405. Myers, L., Bulich, L., Hess, P., & Miller, N. (2004). Fetal endoscopic surgery: Indications and anesthetic management. Best Practice & Research Clinical Anaesthesiology, 18, 231–258. NASW. (2017). Social work speaks: National association of social workers policy statements 2018–2020 (11th ed.). Washington, DC: NASW Press. NASW News. (1961). NASW code of ethics. Retrieved online from https://www.socialworkers.org/ About/Ethics/Code-of-Ethics/g/LinkClick.aspx?fileticket=lPpjxmAsCTs%3d&portalid=0 National Commission for the Protection of Human Subjects in Biomedical and Behavioral Research. (1975). Research on the fetus. Washington, DC: U.S. Department of Health, Education, and Welfare (DHEW Publication No. (OS) 76–127). Natoli, J., Ackerman, D., McDermott, S., & Edwards, J. (2012). Prenatal diagnosis of Down syndrome: A systematic review of termination rates (1995–2011). Prenatal Diagnosis, 32, 142–153. 115

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Ruiz-Mirazo, K., & Moreno, A. (2011). The need for a universal definition of life in twenty-first century biology. In R. Arp & G. Terzis (Eds.) Information and living systems: Philosophical and scientific perspectives (pp. 1–52). Cambridge MA: Bradford. Skotko, B., Levine, S., & Goldstein, R. (2011). Self-perceptions from people with Down syndrome. American Journal of Medical Genetics, 155A, 2360–2369. Stone, L. (2018). Baby bust: Fertility is declining the most among minority women. Institute for Family Studies. Retrieved from https://ifstudies.org/blog/baby-bust-fertility-is-declining-the-most-amongminority-women The United Nations. (1989). Convention on the Rights of the Child. Treaty Series, 1577, 3. Thulberry, S. C., & Thyer, B. A. (2014). The L’Arche program for persons with disabilities. Journal of Human Behavior in the Social Environment, 24, 348–357. Thyer, B. A. (2018). Aborting abortions: How you can reduce abortions in your community. Journal of Social Work Values and Ethics, 15(2), 93–96. Trattner, W. (1999). From poor law to welfare state: A history of social welfare in America (6th ed.). New York, NY: The Free Press. United Nations General Assembly. (1948). Universal Declaration of Human Rights. Retrieved from http://www.un.org/en/universal-declaration-human-rights/index.html US Census Bureau. (2016). An overview of Black of African American population statistics. Retrieved from https://www.census.gov/content/dam/Census/data/training-workshops/recorded-webinars/ black-pop11-16-16.pdf US Center for Disease Control and Prevention. (2017). Abortion surveillance – United States, 2014. Surveillance Summaries, 66(24), 1–48. Van Scheltema, P., Bakker, S., Vandenbussche, F., & Oepkes, D. (2008). Fetal pain. Fetal Pain and Maternal Medicine Review, 19, 311–324. Yeung, P., Jr. (2005). When does human life begin? Ethics & Medicine, 21(2), 69–71. Zhang, J. (2017). The evolution of China’s one-child policy and its effects on family outcomes. Journal of Economic Perspectives, 31, 141–160. Zhu, W., Lu, L., & Hesketh, T. (2009). China’s excess males, sex selective abortion, and one child policy: Analysis of data from 2005 national intercensus survey. British Medical Journal, 338. https:// www.bmj.com/content/bmj/338/bmj.b1211.full.pdf

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16 Mercy or murder Social work and ambivalence over abortion Mary S. Sheridan

As a medical social worker, for some years I worked with high-risk, usually premature, newborns and their families. I know what a very premature infant, one just beyond the legal limits for abortion, looks like and thus, what it would look like if still in utero. There is no question that it is a human being, and that it is trying to live. In the neonatal intensive care unit, no effort or expense was spared to help these tiny babies to survive. And yet, when an 11-year-old girl was admitted for management of her pregnancy, my immediate thought was that she should have an abortion. Just to complicate things, I am a practicing Catholic. And I oppose the death penalty. For people worldwide, abortion is a problem that doesn’t seem to go away. Countries in which it is illegal debate and vote over whether to make it legal. But once it is legal, those who oppose its legality press for a return to the previous law. Perhaps this is because abortion embodies, with human life and (for some) eternal life at stake, key questions. What does it really mean to be human, and when does human life truly begin? Who has the right to decide about the life or death of another? Should we prioritize the already-born over the potentially born, or vice versa? Does our decision depend on the cause of the pregnancy (e.g. rape or incest) or the harm that the pregnancy may pose to the mother? (Is a threat to her mental health enough? Her physical health? Her life? How can these be evaluated honestly and fairly?) Does it depend on the integrity or genetics of the fetus? Should we accept the events of life as they come as gifts from God or are our lives blank canvases that we can design for ourselves? What is the proper role of law in society, and what happens when people refuse to obey it? And, certainly pertinent to the discussion of abortion, may a “good” woman choose her own life and welfare over that of her child? These are the profound questions that underlie at least part of today’s “culture wars.” In addition to these theoretical, philosophical, and theological questions, the arguments for and against legalized abortion are not straightforward either. Those who oppose abortion argue that a human exists from the moment of conception, and thus should be accorded the rights of any human. From a religious perspective, they may say that it is “ensouled,” although the debate on ensoulment and when it occurs has gone back and forth over the centuries. Physiologically, the organism is actively growing and differentiating. Yet Wills (2000)

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states that up to 50% of conceptions end in miscarriage, often before the woman knows that she is pregnant. He concludes that, Those who talk about abortion as a ‘holocaust’ of unborn babies should consider the ‘holocaust’ of all those fertilized ova perishing in the natural process. What happens to those souls? No one can baptize them, even if they wanted to. (p. 223) Referring to the former Catholic doctrine that the unbaptized cannot enter heaven, but remain in a pleasant afterlife though deprived of unity with God, he asks, “Is God himself sending them by the millions to Limbo, never to enjoy the beatific vision?” (p. 225). Wills (2000) also points out that our laws and language distinguish between the born and the unborn. Although illegal abortion may be punished, it is not usually prosecuted as murder. Even infanticide has often been distinguished from murder under the law. Tissue from miscarriages is not baptized, given a funeral, or buried. The commonly held view that abortion should be allowed for cases of incest and rape is not consistent with the belief that abortion is murder of an innocent human. We don’t like it when pregnant women smoke, drink, or use drugs, but we seldom treat them as child abusers. Wills (2000) states, All these occurrences suggest how difficult it is even for the people most opposed to abortion to think honestly and consistently of the fetus as a human person, on a par with the persons we all admit have rights to life, liberty, and the pursuit of happiness. On the other hand, it is impossible to treat the fetus as some merely disposable appendage to the pregnant woman”. (p. 223) The problem of unwanted, sometimes disastrous, pregnancies is not a new one. “Abortion has been performed for thousands of years, and in every society that has been studied,” states the National Abortion Federation (https://prochoice.org/education-and-advocacy/ about-abortion/history-of-abortion/). It is only in relatively recent years that societies have tried to limit it. Does this represent an advance in the evolution of morals, or an aberration? Is it, like America’s prohibition of alcohol in the 1920s, a “noble experiment” that pushes too far beyond what people want, even if they ought not to want it? Given these difficult and unresolved questions, it is no wonder that opinions vary across a wide spectrum usually divided inflexibly into “pro-life” or “pro-choice.” The arguments around each of these positions have been ably presented in other chapters of this book. ­Perhaps you found yourself agreeing with portions of each. I would guess that many people, like me, have mixed feelings, or can see both sides of at least some arguments. If forced, we might place ourselves in one “camp” or the other. But never easily, never without at least a mental “but.”

Social work and ethical controversies Social work ethics, which ought to provide a solution to the issues abortion raises, do not provide clear guidance. The Ethical Principles of the IFSW (International Federation of Social Workers, 2012; Matteson, 2000) include self-determination, a basic value of the profession. Section 4.1.1 states, “Social workers should respect and promote people’s right to make their own choices and decisions, irrespective of their values and life choices, provided this does not 118

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threaten the rights and legitimate interests of others.” But in the case of abortion, the freedom of a woman to choose threatens the very life of the unborn child. For the social worker, it raises questions that are both legal and moral: who is my client – The woman? The fetus? Society? All of these? Matteson (2000) grounds ethical decisions in the familiar “person in situation” context, and states, “Although social workers will agree that core values such as client self-determination and the primacy of client interests are ones to be actualized in practice, translating social workers’ values into behavioral acts becomes less certain” (p. 202). Protection of the vulnerable is also a social work value. But both woman and fetus may be vulnerable. Principle 5.2 of Ethical Principles states, “Social workers should not allow their skills to be used for inhumane purposes.” Is abortion inhumane? There are certainly some who think so. Is denial of a medically provided abortion, perhaps leading a desperate person to illegal acts or an unwanted child, likewise inhumane? Decision-making methods for ethical conflicts often advocate prioritizing one value over another. While this approach can be helpful, in the arena of abortion I believe that, if only one value is the desired outcome, it can oversimplify. Ethical decision-making requires consideration of positive and negative outcomes, rights, duties, fairness, the common good, ­oppressed groups, cultural factors, religious teachings, and personal motivations (­Department of Science and Technology Studies, 2018). Conflicts lurk in and among all of these. In my opinion, perhaps the most resonant of the International Ethical Principles is 5.3, “Social workers should act with integrity.” Of course, it also has its dangers; it is so easy to lie to oneself. But for many of us who find ourselves between pro-life and pro-choice, practicing with integrity means dealing with ambivalence.

The ambivalent social worker As social workers, we call mixed feelings, pressures both for and against, “ambivalence.” In the applied mental health literature, I have found ambivalence most often presented as a client problem that the worker must help the client resolve. I was surprised that worker ambivalence was seldom discussed, much less the benefits that might come from the worker’s living in the tension of unresolved feelings. The potential downsides of ambivalence are obvious, including the anxiety of an unresolved issue leading to inaction, and the danger of rationalizing a self-serving solution (Weisbrode, 2012). Especially for those who value consistency, it is uncomfortable to hold both positive and negative feelings toward a single issue (Schneider & Schwartz, 2017). It can appear weak or illogical – wanting to have one’s cake and eat it too. F. Scott Fitzgerald stated: “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.” But this may be thin comfort. What might be the benefits of ambivalence? In this chapter, I would like to suggest that there are several and that they advance ethical practice. Further, I believe that there are some approaches and actions that are consistent with worker ambivalence.

Benefits of ambivalence In contrast to the negative view of ambivalence, some authors believe that it is a normal human experience (Rothman, Pratt, Rees, & Vogus, 2017). They suggest that one’s openness to new learning and behavior makes the difference between its being a problem and a challenge. I believe that those who can accept it as a challenge put much more thought and multifactorial examination into their consideration of an issue. They examine themselves, the reasons 119

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for their beliefs and conflicts, and approach the issue more contextually than those who reach a quicker and more settled decision (Guarana, 2015). I would like to suggest that ambivalence benefits the social worker/client interaction in the following ways. 1 I believe that ambivalent social workers are less likely to influence (albeit unconsciously) their clients’ decisions (Allanson & Astbury, 1995). Social workers believe in the self-­ determination of their clients and do their best to follow that principle. However, it is hard to imagine that a worker’s deeply held feelings would not leak into a discussion about whether a client should or should not have an abortion. Allanson and Astbury (1995) state that women who feel coerced into an abortion (by anyone) are among the minority who experience emotional distress following the procedure. So, it is doubly important that the social worker’s role is a neutral one of helping the client decide, then helping facilitate that decision, whatever it is. I believe this can best be done by a worker who understands and has wrestled with both sides of the abortion debate. This is also true of agency settings. Workers in some settings are expected to advocate for “pro-life” solutions and may feel a duty to prevent a “murder.” To them, the fetus is a vulnerable client whose welfare takes precedence. Other settings are aggressively “prochoice,” and workers who are convinced of the value of abortion may have difficulty not presenting that point of view. Either kind of agency may be appropriate for a client who has made up her mind and needs supportive services. But I believe that neither setting offers ambivalent clients the best opportunity to think through their decision in a neutral environment. The IFSW Ethical Principles Preamble recognizes this by noting as problematic “The fact that the loyalty of social workers is often in the middle of conflicting interests [and] The fact that social workers function as both helpers and controllers.” The principles of informed consent would seem to mandate that prospective clients know the value positions of the agency and/or worker at intake. 2 I believe that ambivalent social workers can empathize more therapeutically with ambivalent clients. This does not mean the “blind leading the blind,” but rather two people sharing the experience of contradictory facts and feelings, and the difficulty of resolving them. Social workers for whom abortion is not a settled issue are, I think, most likely to resonate with clients for whom it is not a settled issue either. In doing so, I believe that ambivalent social workers can model a way of dealing with life’s complex challenges and recognizing that sometimes there is no perfect solution. 3 I believe that ambivalent social workers may be able to help their clients recognize a wider range of potential solutions. Workers who have embraced abortion as a solution, and for whom it does not pose moral and ethical issues, and those who have ruled it out entirely because it does pose moral and ethical issues are less likely to think creatively about all of the possible resolutions of a given situation.

Actions for ambivalent social workers If abortion is only a topic of interest, but not at the center of one’s concerns, then the most basic recommended action for ambivalent workers is to choose a field of service in which this kind of conflict is likely to be rare. The breadth of the profession of social work makes this relatively easy. There is no reason to stay in a field in which one will face frequent ethical tensions. However, client situations that include unwelcomed pregnancies are so common that this strategy cannot insulate workers completely. Except in single-worker settings, social workers may be able to ask supervisors or colleagues to help. If social workers must deal 120

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with such a case because there is no one else available, then I believe that IFSW Principle 5.5 applies: “Social workers should not subordinate the needs or interests of people who use their services to their own needs or interests.” From a professional standpoint, the needs of the client must come first. One of the problems with ambivalence is that it can lead to a person’s being “stuck.” ­Unable to make a firm decision, social workers may feel incapable of taking any action at all, since it appears that there is no middle ground. Although it might seem that one must resolve the dilemma by choosing either one side or the other, I believe that there are middle grounds that allow professional action with integrity. One can be pro-life but also proabortion, the position into which many ambivalent social workers likely fall, wanting abortion to be legal, but also wanting it to occur as seldom as possible. A perspective that some people find useful is that of the “consistent ethic.” Understood fully by those who are pro-life, it means that one is concerned with a variety of issues that promote the fullness of life from conception through natural death. In addition to abortion, pro-life issues can include opposition to the death penalty, euthanasia, assisted suicide, and infant mortality. Advocating for gun control and improved conditions for women and children are other examples. The point is that one takes a life-affirming and life-conditions-­ affirming position consistently on these issues, where one can. Although few people embrace all parts of the consistent ethic (Burge, 2017), workers might find in this sort of pro-life orientation a cause or causes with which they can identify. I have also found it useful to think that, on certain areas of policy and ethics, reasonable people may differ. To me, this means that some issues are so multifaceted, involving both facts and values, that people of goodwill can evaluate them and come to different conclusions than mine. Philosophers debate this (Siegal, 2013) and question whether it is desirable or even possible, but I take comfort from it.

Actions at the micro/mezzo levels Ambivalent social workers can help model dealing with ambivalence and making decisions in situations of uncertainty. Allanson and Astbury (1995) suggest using a “balance sheet” for decision-making in problem pregnancy and, in a pilot study, found the one that they developed to be useful. Teaching clients the skill of evaluating their own pros and cons for seeking an abortion, and using this assessment as a part of the decision-making process, is a useful life skill. When working with individuals and their families, or small groups, many of the principles of motivational interviewing (MI) can be helpful. MI was designed to deal with ambivalence about harmful behaviors, such as drug and alcohol use, and helps clients to discover and strengthen their own motivations and methods for behavioral change. It begins with the evidence-based finding that lectures by a counselor are not as effective as reasons put forth by the client and proceeds to elicit and evaluate motivations both for and against change. This helps to assure that the decision that is reached truly comes from the client.

Actions at the macro level At the macro level, I believe that harm reduction provides the most useful theory base for ambivalent social workers. Harm reduction methods begin with the belief that, rightly or wrongly, legally or illegally, desperate people are going to engage in certain behaviors, as they have for centuries. They are going to drink to excess, use drugs, and want an ill-timed pregnancy to just go away. 121

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Once this insight is accepted, the next step is to look at the damage that the behavior may cause. In the case of illicit drug abuse, for example, that damage includes impairment of the brain and body, transmission of bloodborne diseases, and encounters with the law enforcement system. When the sources of harm are identified, then the focus is on how to mitigate them. Notice again that the focus is not to eliminate the behavior, because harm reduction believes that it is not going to go away, but rather to mitigate the potential for harm that is related to the behavior. For example, injection drug users are at high risk for diseases such as hepatitis and HIV, because they commonly share needles and syringes. If they have access to an ample supply of sterile needles/syringes, the rates of disease transmission go down. So, people and organizations have established needle exchange programs that allow users to trade used needles and syringes for new ones, refer injection drug users to treatment, and provide other social and medical services. Such programs have demonstrably reduced the transmission of disease as well as saved millions of dollars in costs to the health care system (Centers for Disease Control and Prevention, 2018). In areas where it is illegal to buy n ­ eedles/syringes without a prescription, working toward a change in the law would be a useful and life-­ affirming action. Regarding abortion, a harm reduction approach was implicitly described by A ­ lvargonzalez (2015): The absence of agreement on the ethical legitimacy of abortion does not entail the impossibility of finding a consensus…. [N]obody doubts that… contraception is better than abortion, abortion is better than infanticide, and abortion is worse the later and the less safe it is performed. Because the complete elimination of abortion is not possible, the most relevant realistic political objectives… are reducing the abortion rate, reducing the gestational age of abortions, and making the remaining abortions safer. (E39) Unwanted pregnancy, of course, doesn’t occur in a vacuum. As social workers have long recognized, the personal is social and the social is personal. Modifiable social factors that are associated with abortions include poverty, male unemployment, ignorance, the availability of contraception and health insurance to cover it, and the availability of abortion providers (Nulty, 2012). Dealing with those modifiable factors is antiabortion work perhaps better than demonstrating in front of a clinic or working to get a law changed, although each person hears the call to action differently. The law may never be changed and, in this era of abortifacient drugs, a changed law might be impossible to enforce (Oberman, 2018); however, as Nulty (2012) points out, work to change the modifiable social factors has already demonstrated success.

Conclusion Ambivalence among social workers is seldom discussed, and ambivalence, in general, is viewed negatively. But social workers are people too, and people may not be able to embrace either a pro-life or pro-choice policy position without reservations. However, one need not hold a firm position to work productively with clients or client groups or at the macro level. Taking a middle position is a reasonable approach to complex topics and may bring benefits. To be true to one’s conscience, even in the face of uncertainty, is in keeping with social workers’ integrity.

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References Allanson, S. A. & Astbury, J. (1995). The abortion decision: Reasons and ambivalence. Journal of Psychosomatic Obstetrics and Gynecology, 16(3), 123–136 Alvargonzalez, D. (2015). Towards a non-ethics-based consensual public policy on abortion. International Journal of Health Planning and Management, 32, E39–E46. Burge, R. (2017). Almost no one in the US believes in a consistent ethic of life. Christianity Today International. Retrieved from https://christianitytoday.com/ct/2017/september-web-only/­consistentethic-life-abortion-euthanasia-death-penalty-gss.html Centers for Disease Control and Prevention. (2018, July 19). Improving access to prevent the spread of HIV and HCV. Retrieved from https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html Department of Science and Technology Studies. (2018). Making choices: A framework for making ethical decisions. Retrieved from www.brown.edu/academics/science-and-technology-studies/ framework-making-ethical-decisions Guarana, C. L. O. (2015). An examination of ambivalence: When cognitive conflicts can help (Doctoral dissertation). Retrieved from: https://digital.lib.washington.edu/researchworks/bitstream/­handle/ 1773/33634/Guarana_washington_0250E_14354.pdf?sequence=1 International Federation of Social Workers. (2012). Statement of ethical principles. Retrieved from https:// www.ifsw.org/statement-of-ethical-principles/ Matteson, M. (2000). Ethical decision making: The person in the process. Social Work, 45(3), 201–212. National Abortion Federation. (2018, June 13). History of abortion. Retrieved from https://prochoice. org/education-and-advocacy/about-abortion/history-of-abortion/ Nulty, M. (2012). Back to basics: Beyond the polarity. SEJ&P: Social and Economic Justice and Peace Section Connection, 2(Winter), 8–9. Oberman, M. (2018, May 31). Opinion: What happens when abortion is banned? New York Times. Retrieved from https://www.nytimes.com/2018/05/31/opinion/sunday/abortion-banned-­latinamerica.html Rothman, N. B., Pratt, M. G., Rees, L., & Vogus, T.J. (2017). Understanding the dual nature of ambivalence: When ambivalence leads to good and bad outcomes. Academy of Management Annals, 11(1), 33–72. Schneider, I. K., & Schwartz, N. (2017). Mixed feelings: The case of ambivalence. Current Opinion in Behavioral Sciences, 15( June), 39–45. Siegal, H. (2013). Argumentation and the epistemology of disagreement. In D. Mohammed & M. Lewiński (Eds.), Virtues of argumentation. Proceedings of the 10th International Conference of the Ontario Society for the Study of Argumentation (OSSA) (1–22). Windsor, ON: OSSA. Weisbrode, K. (2012). On ambivalence: The problems and pleasures of having it both ways. Cambridge, MA: MIT Press. Wills, G. (2000). Papal sin: Stuctures of deceit. New York, NY: Doubleday.

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Section IV

Relationship and gender issues

17 Advocating for self-­determination, arriving at safety How social workers can address ethical dilemmas in intimate partner violence Amber Sutton and Catherine Carlson

Defining intimate partner violence Social workers have long been essential frontline advocates in addressing domestic violence (DV). In 1975, the National Association of Social Workers (NASW) mandated the National Committee on Women’s Issues, bringing gender-related disparities to the forefront. According to the CDC (2015), 20 people are victims of intimate partner violence every minute of every day. Intimate partner violence (IPV) affects all communities, with communities of color experiencing higher rates than majority White communities. Individuals affected seek services in a variety of settings where social workers practice, making it all but inevitable that most social workers will work with this population, regardless of their specialty area of practice. We define IPV as a pattern of harmful and fear-inducing behaviors used to maintain power and control an intimate partner. For the purposes of this chapter, we will specifically discuss the violence that occurs between intimate partners rather than with other familial relationships.

The relationship between self-determination and safety IPV is complex and complicated, fraught with compounding variables that leave practitioners in a state of confusion about how to address clients’ presenting needs. Ethical dilemmas can arise when there is tension between advocating for clients’ rights to self-determination and the desire to help clients achieve safety. In addition to upholding clients’ rights to self-­ determination and following ethical principles, other issues can include mandatory reporting, children witnessing IPV, honoring cultural values, and the duty to warn. Social workers and clients can hold opposing views of critical issues, including self-determination. There is the potential for conflict between empathetically and nonjudgmentally allowing clients self-determination while still advocating for their immediate safety.

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What is safety? The definition of safety needs to be defined as it relates to DV and IPV. What all does safety encompass? Physical? Emotional? Psychological? In fact, all of these need to be considered because safety is broader and more complicated than just physical well-being. Because absolute safety is not always possible, social workers may need to focus their work on progress toward safer conditions. These cases require close examination and consideration and, as a result, ethical decision-making can be challenging and devoid of simple answers. The role and mission of social workers are to practice in alignment with their governing codes of ethics, including empowering those who are vulnerable, even if that empowerment means supporting the client’s right to make risky decisions.

The importance of inter-agency collaboration According to the NASW Code of Ethics (2017), “[s]ocial workers respect and promote the rights of clients to self-determination and assist clients in their efforts to identify and clarify their goals” (p. 7). There are times when legal obligations will override clients’ rights. It is necessary to advise clients when these situations arise. Such occasions include the mandated reporting of child abuse, elder abuse, and the threat of harm to self or others. C ­ ommunication with clients is crucial, particularly regarding the systems they may encounter once the required reports are filed. Leading clients through the processes affords social workers the opportunity to maintain a collaborative relationship, which can aid in healing. Poor communication and ineffective collaboration between organizations have taught us some hard but valuable lessons. Not fully understanding the issues and making baseless judgments cause harm to everyone involved in IPV cases, as illustrated in Nicholson v. Williams 1999 (USA). This case highlighted that, due to gender bias, battered mothers are frequently blamed for any and all harm that their children suffer due to gender bias. The brief further argued that the Family Court Act (USA) should be interpreted to require assessment of the non-abusive parent’s individual responsibility for any harm to adequately protect their due process rights. In addition, removing children from their homes on the mere presumption of responsibility violates those rights. The Appeals Court agreed that a mother’s inability to protect a child from witnessing abuse does not constitute neglect and cannot be the sole basis for removal. Furthermore, the Court held that any decision to remove a child must be weighed against the potential psychological harm created by that removal and should include judicial approval.

Barriers to upholding self-determination in IPV cases According to Reamer (2005), “Social workers are drawn to the profession because of their deep-seated wish to help vulnerable people” (p. 1) and social workers who practice in the field of DV are not exceptions. Many social workers either have experienced IPV personally or know someone who has. This can cause difficulty when clients reject offers of assistance and choose to remain in dangerous situations. Social workers who are survivors can be ­effective advocates if they have healed from their experiences. Otherwise, they risk becoming paternalistic due to an internalized duty to prevent others from experiencing what they themselves have experienced. Social workers can find themselves in conflict between upholding ethical principles and protecting clients, particularly when clients’ decisions place them at risk. 128

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Client-centered versus service-centered approaches There is a fundamental difference in understanding the code of ethics on an intellectual level and being able to formulate professional responses that are mindful of the practical realities of clients’ lives. For example, Moon and Rice (2012) write: Each of us, from time to time, will come to question what she or he is doing or just did. Many of these questions can be placed into one of two categories. ‘Is what I am doing sufficiently client-centered?’ or ‘Is what I am doing too client-centered? (p. 295) When assisting clients, social workers make a professional commitment to honor and recognize the importance of human relationships. This is the fundamental difference between being person-centered and being service-centered. Clients are more than data points. Merely providing a list of numbers and resources does not get to the heart of serving those who are affected by IPV. Social workers must practice and strengthen the art of dialogue. Not every client’s primary concern is safety; therefore, it is crucial that social workers understand the totality of each client’s situation before suggesting resources. Positive change can be dependent on the alliance between social workers and their clients.

Complexities of IPV Trauma, mental health, substance abuse, child abuse, poverty, and immigration are just some of the factors that may need to be considered when creating effective response strategies for victims of IPV. Social workers need to thoroughly understand the systems that IPV victims may encounter and their potential impact so that their clients can make informed decisions. For example, many court systems enact “no-drop” policies when prosecuting cases. As described by Danis (2003), “no-drop policies create challenges for social workers in reconciling social work values regarding client self-determination and the criminal justice system’s value on gaining convictions” (p. 243). No-drop policies deny victims the option of dropping a case once formal charges have been filed. Historically, cases were dismissed if the victim chose not to participate in the prosecution. Different systems have different goals and it is crucial to consider clients’ desired outcomes as part of the decision-making process. There are no simple answers in eliminating abusive behavior; therefore, social workers need to remain practical in how progress is measured. Practitioners walk a fine line on infringing on self-determination when they create treatment plans that are incongruent with the goals of the client.

The feminist framework and how it applies to IPV An important facet of IPV work is the intersection with the feminist/political framework. This sets the foundation for extensive advocacy work and compliments the empowerment model that threads through effective social work practice and infuses various codes of ethics. Researchers and programmers have long highlighted how patriarchy has shaped societal expectations in order to maintain male superiority over women. Part of being an effective advocate is understanding the realization that we cannot keep individuals and families safe without changing the existing patriarchal structures. Practicing from this framework also illustrates that safety and self-determination can be complicated by other identities such as race, sexual orientation, and gender. Due to implicit bias, prejudices, stigmatization, and common misconceptions about IPV, self-determination might be more limited for minorities. 129

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Social workers are enlighteners and enhance clients’ information rather than acting as a victimizer and taking control of their lives. Applying a feminist perspective to further understanding IPV allows for guiding frameworks such as intersectionality to be examined and incorporated into understanding existing power structures. The Matrix of Domination, first introduced by Collins (1990), demonstrates how some people have greater access to social power and privilege based on their social identities, a major contributing factor to IPV. ­Advocates can use this tool to help guide their practice when working with survivors. Out of a feminist analysis come feminist social work skills that emphasize the female perspective and how sexual inequality impacts women. It is increasingly necessary that social workers recognize that IPV is a form of sex discrimination and a violation of human rights. This is absolutely essential for challenging traditional gender roles and helping move survivors from surviving to thriving. By using a feminist analysis of IPV, practitioners acknowledge that patterns of dominance and subordination affect survivors’ daily lives and should be addressed via interventions that strive toward empowerment and self-determination. A feminist framework encourages use of a survivor-centered approach that requires a survivor’s choice to be a main principle in practice along with empowerment. This leads to an attitude of power with the client, not over the client. Survivors are not a monolithic group and, by using a feminist analysis, social workers can avoid the universalization of survivors’ experiences, thus honoring the complexity of each human being. As applicable as this model is, it has not been without criticisms, mainly from those who are not involved in the IPV movement. Some of the criticism toward the framework surround the portrayal that all IPV is heterosexual and that it does not address same-sex relationships; however, as described by McPhail, Busch, Kulkarni, and Rice (2007), “the feminist perspective on domestic violence acknowledges the importance of looking at the intersections between gender and other systems of oppression such as race, class, national origin, sexual orientation, age and disability” (p. 819). Extending from feminist theory, intersectionality exemplifies that patterns of inequality serve as the foundation for developing multiple systems of domination and impact access to power, privileges, and relationships.

Recommendations & practical applications Anticipating and preparing for every dilemma that might arise in the course of IPV work are impossible. Mattison (2003) states that “by its very nature, an ethical dilemma is a situation for which no one solution is right or correct” (p. 2). Each clients’ situation includes unique barriers and considerations for the best and most ethical course of practice. Fortunately, there are practical strategies for learning how to logically and rationally arrive at solutions. Individually, practitioners must begin with self-awareness by addressing their own biases and privileges because ethical decisions can be intertwined with our own perceptions and judgments. These are critical components of ethical decision-making. Pawlukewicz and Ondrus (2013) affirm that “decisions that are made based on a practitioner’s own emotional need can be considered a form of abusive clinical power that is exploitative in nature and therefore harmful to the client” (p. 3). Systemically, change also needs to occur from an educational standpoint, utilizing a curriculum and teaching materials that incorporate ethical practice examples and scenarios to develop the use of applied practice approaches. Not enough classes are offered on IPV and how to respond effectively when faced with ethical dilemmas. Increased education could help social work students to challenge their own misconceptions and to view IPV as a systemic problem rather than an individual issue. Novice practitioners may feel unprepared to address these situations confidently, thus limiting possible solutions for survivors. Experience managing 130

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situational anxiety in order not to become emotionally reactive allows for person-centered approaches to become more commonplace when dealing with ethical challenges. It is unethical to practice outside areas of competence; therefore, it is crucial that social workers receive appropriate training in assessment, screening, safety planning, and best practices surrounding IPV. Reamer (2002) published an excellent guide to ethical decision-making. The first step is to identify conflicting ethical social work issues and values, along with the stakeholders that may be affected, then define all potential resolutions assessing risks and benefits for each. ­Social workers should then review pros and cons of each option, then consult with colleagues and experts. Finally, they should confirm their decisions and document the process according to agency guidelines. Also note that all decisions can benefit from periodic evaluation. The National Coalition Against Domestic Violence and various state coalitions are resources that can be helpful for accessing current DV laws, local organizations, and best practices. Using the concept of a nondirective attitude, it is understood that it is not the role of social workers to set goals for their clients, but rather to collaborate with clients as they develop their own goals. Social workers need to remain aware of consciously or unconsciously pushing their personal agendas because it is unethical to exercise power over the client. At times, practitioners may become self-invested in a client’s healing process and be at risk of taking on responsibility for a client’s decisions and outcomes. Using an ecological model to assess IPV and implementation of trauma-informed practices can inform social workers’ understanding of how clients arrive at decisions and can also help social workers come to a resolution when their goals for their clients are different than their clients’ goals for themselves. It is important for social workers to remember that, because their clients have managed their situations before, they (social workers) should avoid creating a dynamic of power and control. Self-determination is the priority when working with clients as they move toward safer lives. Research suggests that adopting and adhering to motivational interviewing (MI) techniques help to elicit information that is needed to be both effective in working with survivors of IPV as well as skilled in solving ethical dilemmas. The paradigm of trauma-informed care recognizes the importance of understanding how violence holistically impacts clients’ lives and how behaviors that are often seen as maladaptive can actually be survival strategies that clients have developed in response to traumatic experiences. Within an MI framework, social workers are forced to confront their own need for complex and righting reflex. The foundation of MI encourages that social workers do not attempt to fix their clients’ situations before being granted permission to do so or before the client has asked for assistance. This technique directly aligns with self-determination because it allows social workers to demonstrate belief in their clients’ autonomy and self-empowerment. Mattison (2003) provides practical and sequential guidelines for solving ethical dilemmas. She writes: Resolving the dilemma calls for the social worker to have a firm grip on the standards of practice that constitute sound practice behavior, have a working familiarity and understanding of the principles in the NASW Code of Ethics, make use of peer/supervisory consultation, understand applicable agency polices and legal mandates and be open to examining the ways in which one’s own values/preferences influence the ultimate choice of action. (p. 2) In addition to understanding mandatory reporting laws regarding children, vulnerable adults, self-harm, and threats to others, social workers need to be well-informed that some 131

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states require physicians to report DV injuries of adults. Furthermore, there are duty to warn laws, HIPAA practices, agencywide policies, and the Violence Against Women Act (VAWA) protections that affect service delivery. It is crucial that social workers familiarize themselves with laws applying to their own state and country. Being a good consumer of information ­a llows practitioners to critically examine the positive, negative, and unintended consequences of these policies. It is best practice that social workers familiarize themselves with state and agency policies and use this information to guide ethical dilemmas. It is also important to know when to intervene, according to the NASW (2018) “[s]ocial workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others” (p. 8). The landmark case of Tarasoff v. Regents of the University of California 1976 provides guidance for reporting: there is evidence of a threat of violence, there is good reason to believe that a client is likely to act violently, a violent act is imminent and you are able to identify a probable victim. If it is a law, the legal mandates supersede ethical obligations. To be fully informed, social workers should elicit more information from their clients, use supervision, consult relevant ethical guidelines, and make mandated reports to law enforcement when necessary. Research suggests that overreporting or underreporting from certain ethnic groups does exist, due in large part to the fact that we all make decisions based upon our own experiences, perceptions, and biases. Some potential solutions, even when benign, might actually cause further harm and disruption. There is rarely ever just one barrier in IPV cases because individuals are caught in a maze of everyday interactions and decisions.

Safety planning A key component of IPV practice is developing confidence about safety planning. Plans need to be individualized for each client. There are many safety planning templates from which social workers can choose. One example of a comprehensive tool is the VIGOR safety plan. This strengths-based plan allows for victims to create a personalized approach and a detailed assessment of all risks involved. Hamby (2015) concludes that “(86%) found the VIGOR more helpful than other safety planning. Further, 9 out of 10 participants reported they thought the VIGOR would be helpful to most victims” (p. 1). The safety plan aids in identifying relevant resources based on the type of abuse including life-threatening violence and can be used for victims, children, pets, and other concerns and covers a wide-range of abuses as well as coping strategies.

Danger assessments As is the case with safety plans, there are various danger assessment (DA) instruments. The DA by Campbell (2003) was designed to be used by advocates, police officers, and health care professionals. The DA questions may give survivors insight into their situation and the level of severity of abuse they are experiencing. Survivors of IPV and DV tend to underestimate their own risk of danger, but rarely do they overestimate it.

Case study vignette Hannah (name changed to protect the confidentiality of the client) is a 20-year old Latina college student who has been dating her partner for one year. She came to a social worker initially because her mother called the social worker on Hannah’s behalf, even though Hannah 132

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made it clear that she was not interested in seeking services and did not identify her relationship as “abusive.” Hannah’s mother brought her to the social workers’ office. Hannah begrudgingly agreed to meet with the social worker if her mother would wait in the waiting area without entering the interview room. Hannah shared her experiences with the social worker. Using techniques from MI, the social worker was able to elicit information from Hannah. Hannah’s story included instances of drinking as a coping mechanism in response to the treatment by her partner. The social worker and the client discussed how drinking impaired her ability to remain safe physically, sexually, and emotionally; further, together they discussed potential harm reduction techniques. Additional conversation uncovered that Hannah previously reported abuse to the police and that the outcome was that her partner became even more abusive. Hannah was in a state of fear, but was nonetheless resistant to intervention; meanwhile, her mother was terrified that she might be seriously injured or killed. The social worker’s responsibility was to her client, not to her client’s mother. The social worker assessed her client’s risk utilizing the DA and helped her to create a safety plan. The social worker also consulted with her own supervisor about confidentiality issues regarding Hannah’s situation and specifically what could be shared with Hannah’s mother. It was imperative for the social worker to build rapport with Hannah quickly in order to minimize her resistance. She also had to demonstrate loyalty to Hannah instead of her mother. It was important for the social worker to match the language of her client and to learn about her individually before introducing the topic of abuse. The social worker then educated Hannah about the legal definition of DV and illustrated how her experience was, in fact, a crime. The social worker then validated Hannah’s right to self-determination and confirmed that she was protected by her right to confidentiality. The social worker and Hannah discussed options, including enacting a protective order, participating in counseling, and connecting with other local services. When leaving, the social worker confirmed that the information Hannah provided would remain confidential. Even though she was hesitant in the beginning, Hannah did admit that she felt better after discussing her issues. She was provided with information on support groups, but ultimately decided that she was not ready to participate in a group setting. Hannah reported that she still wanted to give the relationship another try, blaming her partner’s actions on her troubled childhood, and was not yet ready to leave, even though the people in her support systems were adamant that she should. Hannah still believed that there were options for repairing the relationship, particularly referencing couples counseling. The social worker and Hannah discussed the root causes of IPV, along with some of the possible limitations of couples counseling. The social worker presented ways for Hannah to stay safe while engaging in this option, including taking separate vehicles when traveling, staying with a friend, and participating in separate, individual counseling concurrent with couples counseling. Members of Hannah’s support system called social worker with inquires, but the social worker did not confirm nor deny that Hannah was even a client, knowing that information of this type could not be released without the client’s consent or a court order due to ethical codes, agency policies, and VAWA confidentiality provisions (because the agency was a recipient of VAWA funding).

Conclusion This chapter has provided some insight into the complex nature of DV and IPV and the importance of responding ethically. Solving ethical dilemmas in IPV cases can be difficult and simple solutions may not be available; however, having a foundational framework 133

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from which to make decisions can assist social workers by ensuring that safety and self-­ determination work in conjunction with one another rather than in opposition. Remember, it is the responsibility of social workers to adapt to meet the specialized needs of their clients.

References Campbell, J. (2003). Danger assessment. Retrieved from https://www.dangerassessment.org/ CDC. (2015). Retrieved from https://www.cdc.gov/injury/wisqars/overview/key_data.html Collins, P. H. (1990). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. Boston, MA: Unwin Hyman. Danis, F. S. (2003). The criminalization of domestic violence: What social workers need to know. Social Work, 48(2), 237–246. Hamby, S. (2015). The VIGOR safety plan for victims of domestic violence|Sherry Hamby. Retrieved from http://www.thevigor.org/the-vigor/#.W23iNPZFxyw Mattison, M. (2003). Ethical decision making meets the real world of field work. The New Social Worker. Retrieved August 5, 2018, from http://www.socialworker.com/feature-articles/ethics-articles/ Ethical_Decision_Making_Meets_the_Real_World_of_Field_Work/ McPhail, B. A., Busch, N., Kulkarni, S., & Rice, G. (2007). An integrative feminist model: The evolving feminist perspective on intimate partner violence. Violence Against Women, 13(8), 817–841. Moon, K. A., & Rice, B. (2012). The nondirective attitude in client-centered practice: A few questions. Person-Centered & Experiential Psychotherapies, 11(4), 289–303. NASW. (2018). National Association of Social Workers’ Code of Ethics. Washington, DC: NASW. Pawlukewicz, J., & Ondrus, S. (2013). Ethical dilemmas: The use of applied scenarios in the helping professions. Journal of Social Work Values and Ethics, 10(1), 1–12. Reamer, F. G. (2002). Eyes on ethics: Making difficult decisions. Social Work Today. Retrieved from http://www.socialworktoday.com/news/eoe_101402.shtml Reamer, F. G. (2005, January/February). Eyes on ethics: The challenge of paternalism in social work. Social Work Today. Retrieved from http://www.socialworktoday.com/news/eoe_0105.shtml

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18 Social work clinical practice and intimate partner violence A system approach to help reverse the macro and individual effects of violence Maria E. Taylor

Intimate partner violence (IPV) is a pervasive issue that has monetary, psychological, and emotional repercussions for individuals who experience violence, use violence, the family system aware of IPV, and society. The cost of IPV is emotionally, psychologically, and monetarily staggering, which makes appropriate detection, response, and treatment paramount in addressing and ameliorating the issue. Using systems theory, social workers intrinsically ­explore the systems in which IPV is present and are capable of responding in reactive and proactive manners. Through collaboration, the contributions of social work practice to include advocacy, education, prevention, intervention, and case management enhance community response to IPV and improve outcomes for those affected by violence. It is important to treat and support those who experience violence, but also for the individuals who use violence to be fully assessed, with discoveries informing the methods chosen to treat these individuals. Traditionally, the terms victim and perpetrator are used to define people who experience or use IPV. These terms inform both policy and practice and their narrowed view inhibits opportunities to examine the complexities of the issue. Terminology chosen in this document will reflect a recovery oriented perspective. IPV user and IPV experiencer are the nomenclature that we adopted, rather than perpetrator, batterer, abuser, victim, or abused. Conceptually, it would be difficult to treat a perpetrator or a victim and expect either to cease being the label; the propensity for recovery enhances when stigma is removed and the individual is viewed as using or experiencing behaviors rather than the individual being defined and labeled. Service providers or people served in this arena must not lose sight of the fact that everyone has potential for recovery. Identifying the dramatic toll IPV takes on the emotional and psychological, as well as micro and macro fiscal systems in the United States begs for a review of current processes to ensure that issues are appropriately addressed. IPV is experienced by people from various races, ethnicities, religions, sexual orientation, and socioeconomic backgrounds. Recent statistics reveal that one in three females and one in four men amongst the general population of the United States have been raped, experienced physical violence, or have been stalked by an intimate partner in their lifetime (National Intimate Partner Violence and Sexual Violence 135

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Survey Report Executive, 2010). Statistics from the Department of Justice show roughly 1,500 instances of homicide and manslaughter between intimate partners annually in the United States, with more than 1,200 of these involving women as victims (Bureau of Justice Statistics, 2013). IPV can result in death, serious physical injury, and chronic medical and/or mental health issues for the IPV experiencer. The cost of IPV is more than “$5.8 billion each year, nearly $4.1 billion of which is for direct medical and mental health care services” (Department of Health and Human Services, 2003, p. 2). IPV has been affiliated with increased short- and long-term medical and mental health costs for people who experience violence due to injuries stemming from the incident. In the United States, overall health care costs are at least 19% higher in women with a history of domestic violence (Rivara, 2007). Approximately, 80% of those hurt by IPV went to emergency departments after the date of the documented incident (Karin & Rhodes, 2011). Long-term effects of IPV manifest in physical health conditions, psychological conditions, and social impairments. Health conditions associated with IPV include asthma, ­bladder and kidney infections, cardiovascular disease, fibromyalgia, irritable bowel syndrome, chronic pain syndromes, central nervous system disorders, gastrointestinal disorders, joint disease, migraines and headaches, gynecological disorders, pelvic inflammatory disease, sexual dysfunction, sexually transmitted infections, included HIV/AIDS, delayed prenatal care, preterm delivery, pregnancy difficulties like low birth weight babies and perinatal deaths, and unintended pregnancy (Center for Disease Control and Prevention, 2017). Long-term costs for those who experience violence have been estimated to persist for as long as 15 years after the abuse has ceased (Rivara, 2007). Psychological diagnoses often found in people who experience IPV include anxiety, depression, PTSD, antisocial behavior, suicidal behavior, low self-esteem, substance use, inability to trust others, fear of intimacy, emotional detachment, and sleep disturbances. Social consequences of experiencing ­v iolence include restricted access to services, strained relationships with health providers and employers, isolation for social networks, and homelessness (Center for Disease Control and Prevention, 2017). Socially, women who experience violence are isolated by their partners and are often not allowed to work, go to school, or develop identities outside of the home. Children of women who experience violence are frequently threatened, furthering the need for women to take protective measures by staying on guard and not tending to normal activities such as work or social interactions. These factors can contribute to the higher than normal rates of unemployment and need for public assistance (Lloyd & Nina, 1999). Those women who do work are affected by the violence and lose productivity, often taking time off to tend to their injuries. In 2003, the Center for Disease Control and Prevention estimated the annual cost of lost productivity due to IPV to be $727.8 million, with over 7.9 million paid workdays lost per year (Center for Disease Control and Prevention, 2014). US businesses lose an estimated $3–$5 billion per year in lost time and productivity due to IPV (Bureau of National Affairs, 1990). Those who experience IPV lose a total of nearly 8.0 million days of paid work, equal to more than 32,000 full-time jobs (Department of Health and Human Services, 2003). ­A lthough difficult to quantify, there is a significant impact on IPV users, to include lost days at work, criminal charges, costs of court mandated treatment, as well as strained relations, loss of family, loss of social supports, loss of employment, and having a criminal record. Multiple factors place individuals at higher risk for experiencing or using IPV, including low self-esteem, low income, low academic achievement, young age, aggressive/delinquent behavior as a youth, heavy alcohol and drug use, depression, anger/hostility, antisocial or 136

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borderline personality traits, history of physical and/or psychological abuse, isolation, unemployment, emotional dependence and insecurity, patriarchal view of society, desire for control in relationships, and psychological aggression (CDC, 2017). It is imperative for social workers to be adept at using effective screening, assessment, education, advocacy, and intervention. Since IPV is an experience and not a diagnosable condition, it is important for social workers take a nonjudgmental and non-pathologizing stance. When working IPV experiencers, social workers must focus on ensuring interventions such as education, safety planning, exploration of resources, treatment for stressors, and assist in learning how to build safe and stable relationships. In balance with client autonomy, social workers must be cognizant of the laws where they practice, understanding when a report is mandated. Not all physical violence warrants a report; if the client has no intention of leaving the relationship, and the type of violence falls outside of the mandatory reporting guidelines defined by law, reporting violence against the client’s wishes can often result in an increase of violence as the potential for retribution is high. In addition, decreased trust and diminished rapport may follow if the client attributes the report to the provider (Futures Without Violence, 2018). Clinicians often try to fix situations and can become disenfranchised if the client chooses to stay in a violent relationship. Social workers must respect the client’s autonomy and use appropriate methods to aid the client with safety planning as well as helping the individual to recover. Therapeutic interventions for those who stay in these relationships include dialectical behavior therapy (Iverson, 2009), acceptance and commitment therapy (Follette, 2016), or problem-solving (Warshaw & Brashler, 2009). There is no single reason why people use violence in a relationship. People who use IPV with endorsed adverse childhood experiences have a prevalence of experiencing a number of stressors, including adult financial, legal/criminal, and relationship stresses. According to Roberts, McLaughlin, Conron, and Koenen (2011) for men with “high-level childhood adversity, past year stressors were associated with an 8.8 percentage point increased risk of perpetrating” (p. 1) when compared to men with low-level childhood adversity. A study that compared IPV users with and without a history of childhood family violence (CHV) found that a history of CHV was a marker for severe behavioral and attitudinal problems (Rosalyn, Mikel, Walters, & Basile, 2013). In respect of biological processes and neuropsychological functioning for IPV users, one study found that participants in a hospital-based program for IPV had a 61% incidence of head injuries (Rosenbaum, 1989). Psychopathy has received attention as a correlate to DV/IPV, with prevalence ranging from 15% to 30% in different studies (Langhinrichsen-Rohling, 2000). These are just a few considerations when contemplating why one might use IPV. Despite multiple reasons why people might use IPV, most IPV users are referred to treatment born of one model. A grassroots effort arose in 1981, termed the Domestic Abuse ­Intervention Program of Duluth, Minnesota (Novak & Galaway, 1983). The Duluth program emanated from concerns with the failed legal and police interactions with battered women, viewing advocacy as a key component to bring forth change (Shepard & Pence, 1999). The Duluth program included interventions targeting the issues identified as causing IPV whose format included groups for IPV users as an alternative to incarceration and since has been recognized as the Duluth model. The Duluth model’s group approach seeks to educate participants about feminist theory and the potential legal consequences of IPV. Members are taught that violence against their partners originates from a patriarchal need for power, control, and dominance. Group members are encouraged to replace these needs and resulting behaviors with appropriate beliefs 137

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about and actions toward their spouses. These philosophical underpinnings, which are related to male privilege and how it informs behavior, state that patterns of behavior are driven by perceptions of the right to control or dominate, rather than by singular episodes of abuse or explosive behavior that are the result of constricted emotions or concerns. The Duluth model is not considered a therapy, but rather an intervention that targets the aforementioned beliefs. The Power and Control Wheel (Shepard & Pence, 1999) is used as a means of providing psychoeducation about the tenets of the model as well as guidance on the expected beliefs and behaviors that result from participation in this intervention. Courts in many states mandate that batterer intervention programs (BIPs) use the Duluth model. The Duluth model has been influential, as evidenced by the programs and policies that exist not only in the United States, but also in other countries, including Scotland, England, New Zealand, and Germany (Shepard & Pence, 1999). Criticisms of the model exist, with assertions that the model generalizes all behaviors to the larger issue of aggression in relationships, without applying rigor to evaluate the model (Dutton, 2006). Despite the fact that the Duluth model is the most commonly used IPV treatment, studies have suggested that the model is not effective at reducing recidivism rates (Barner & Carney, 2011). Studies of BIPs in Florida using the Duluth model found that recidivism was not reduced and that IPV attitudes remained unchanged. A study by Ashcroft, Daniels, and Hart (2003) suggests that BIPs based on the Duluth model “do not change batterer’s attitudes and may only have minor effects on behavior” (p. ii). Another study suggested that group treatments for IPV batterers have small impact on the cycle of violence, with most studies having minimal to no impact above arrest alone (Stover, Meadows, & Kaufman, 2009). Assessments of court involved IPV users are not consistent; less than half of those in domestic violence courts are assessed; those who are assessed are done so by staff in the prosecutor’s office, BIP providers, or probation staff (Labriola, Bradley, O’Sullivan, Rempel, & Moore, 2010). The lack of consistent assessments for court involved IPV users by an unbiased, trained clinician affects the intervention assignment. If people are generally referred to BIPs for the Duluth intervention, rather than to evidence-based treatment for comorbid conditions, then one cannot expect the intervention to succeed, the problem to abate, or financial resources expended to have positive impact. Domestic Violence Court personnel perceptions suggest that nearly four-fifths of court respondents (79%) rated holding the offenders accountable for illegal behavior as extremely important, accomplished thorough offender supervision, BIPs, and efforts to increase offender compliance with protective orders. Also, only 53% of respondents deemed rehabilitation to be extremely important (Labriola et al., 2010). Court staff actions and recorded perceptions of what is important suggest that investment in punishing IPV users rather than prescribing evidence-based treatments could reduce recidivism. If IPV users have comorbid conditions and those conditions are not treated, then the BIP intervention will likely not prevent future occurrences of IPV as the individual is not being treated appropriately. IPV frequency in general population as compared to those who are engaged in SUD treatment programs vastly differ. Overall, IPV occurs in about 30% of all relationships; when considering men who are engaged in substance abuse treatment, the incidence increases to 85% (Freeman, Schumacher, & Coffey, 2015). Despite the pervasiveness of clients who have comorbid SUD and IPV served by social workers and others, there is scant evidence of knowledge by practitioners regarding these issues. There are many clients who are involved with both issues; the area of practice at times determines the goals identified and corresponding treatments. It can be inferred from Timko et al. that barriers to treatment could emanate from lack of agency policy, funding, screening, monitoring of clients, refusing to serve 138

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clients with IPV, and lack of programming to meet the needs of IPV users. Approximately, one third of clients who were suspended or terminated from treatment were engaging in violence. In addition, staff were not equipped to screen or treat for this issue, it was not part of the mission of the agencies studied, and there was no funding to reimburse for expenditures in treatment of this issue (Timko et al., 2012). Early research on the effectiveness of concurrent IPV and SUD treatment indicates the need for greater screening and treatment in order to ensure successful treatment outcomes. SAMSHA issued a Treatment Improvement Protocol (TIP). Within the TIP, it was strongly recommended that the providers in SUD screen and appropriately refer for treatment of IPV; it was also indicated for the legal community to interact and collaborate on treatment, rather than to continue referring for IPV treatment or SUD treatment only (Substance Abuse and Mental Health Services Administration, 1997). Post-traumatic stress disorder (PTSD) should also be considered when reviewing this issue. If social information processing is affected as part of having PTSD, then it could stand to reason that those affected by PTSD may interpret their surroundings in a more hostile manner and, in return, respond in a manner that may be aggressive (Black et al., 2010). ­General population IPV users participating in BIPs and who met the diagnostic criteria for PTSD self-reported to engage in higher aggressive behaviors and significantly higher rates of IPV use when compared to general population IPV users who did not meet the diagnostic criteria of PTSD (Rosenbaum & Leisring, 2003). IPV rates within a college campus male population and discovered similar findings – males who endorsed symptoms suggestive of PTSD used higher rates of IPV, had greater trait and internal anger, as well as hostility compared to men who did not have these symptoms ( Jakupcak & Tull, 2005). Despite often detecting violence in the assessments, IPV is not targeted in the traditional treatments of PTSD. Social workers serving this population have clinical and ethical obligations to provide holistic care ensuring services rendered are commensurate with needs. Motivational enhancement therapy (MET) is employed in the SUD arena, showing promise when SUD is concurrent with IPV. MET is not confrontational in comparison to typical IPV interventions. Increasing motivation and eliciting change talk vest the IPV user with wanting to change behavior. People who use IPV are motivated to change behaviors when they are able to recognize the behavior negatively affects something cared about such as children, jobs, relationship status, etc. Of note is a small pilot study of a 90-minute MET intervention addressing IPV in alcohol treatment seeking men. Feedback elicited from participants indicated that the intervention was liked, behavior change intentions were reported, and the participants found the feedback meaningful. Men receiving MET reported seeking more types of assistance and spent more time help seeking. At three- and six-month follow-ups, reductions in IPV and anger were detected (­Schumacher & Coffey, 2011). Walker et al. (2010) evaluated how this questionnaire was interpreted by those who took it. The questionnaire elicits perceived internal and external consequences that IPV users experience. An association with IPV, readiness to change, and treatment seeking were affiliated with internal and external motivations and that these motivations to change were rooted in consequences for the behaviors emitted. Helping the IPV users define the consequences and his/her feelings about the consequences by using MET is a viable method of vesting the user with wanting to change the behaviors. The study also noted that physical and injurious violence is affiliated with higher consequences and indicated that often little or no consequences exist for psychological/emotional abuse or sexual assault affiliated with IPV. Eliciting change talk from IPV users in these circumstances is valuable as external motivation does not always 139

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appear in all modes of IPV (Walker et al., 2010). In addition, Walker et al. (2010) commonly reported internal consequences include feeling down, feeling bad about the way they treated their partner, being distracted at work, losing respect for themselves, and frightening their partner… worrying about what their abuse was doing to their children, concern about their partner leaving…feeling crazy and scared…a source of anxiety, emotional stress…negatively impacting their abilities at work and relationships. (p. 6) The idea that IPV users need to have proper motivation to change their behaviors is echoed in Sobell’s work from 2000, which indicates that people are motivated to change behaviors when they weigh personal consequences, rather than how their behavior impacts others (­Sobell, Ellingstad, & Sobell, 2009). The Strength at Home (SAH) program is a therapeutic intervention at the National ­Center for PTSD. Treatment is geared to assist in the recovery of US veterans who use physical or psychological violence in the context of an intimate partner relationship. The goal of the treatment is simply to ameliorate that violence. With theoretical underpinnings based in social processing theory, survival mode, and MET, SAH is emerging as a strong clinical practice. SAH has demonstrated in a randomized clinical trial decreases in physical and psychological abuse better than enhanced treatment as usual (Taft, Macdonald, Creech, & Murphy, 2016). Emerging trends are to treat IPV users as people who have conditions requiring treatment steeped in evidence-based practices that are empirically proven to be effective at reducing IPV, rather than to treat them as criminals. Punishment or universal treatment for IPV users is not effective. Likewise, a recovery approach needs to be taken with IPV experiencers. A thorough evaluation of each individual must be accomplished to appropriately match the treatment to the needs of the individual. Effective treatment matching could reduce IPV and the inordinate costs to individuals, family systems, and society in general. Ongoing research should be conducted to aid in identifying proper screening methods, treatment approaches, and reintegration methods. Social workers must incorporate the knowledge and skills into their practice in order to aid the individuals, family systems, and society at large with improving this health care epidemic.

References Ashcroft, J., Daniels, D. J., & Hart, S. V. (2003). Batterer intervention programs: Where do we go from here? Washington, DC. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/195079.pdf Barner, J. R., & Carney, M. M. (2011). Interventions for intimate partner violence: A historical review. Journal of Family Violence, 26(3), 235–244. Black, M. C. Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M.T., … Stevens, M. R. (2010, January). National Intimate Partner and Sexual Violence Survey. Retrieved from Center for Disease Control: https://www.cdc.gov/violenceprevention/pdf/NISVS_Executive_Summary-a.pdf Bureau of Justice Statistics. (2013, November 21). Office of Justice Programs, BJS. Retrieved from Intimate Partner Violence: Attributes of Victimization 1993–2011: https://www.bjs.gov/index. cfm?ty=pbdetail&iid=4801 Bureau of National Affairs. (1990). Violence and stress: The work/family connection. Washington, DC: Bureau of National Affairs. Center for Disease Control and Prevention. (2014, January 9). Intimate partner violence. Retrieved from https://www.cdc.gov/violenceprevention/pub/IPV_cost.html

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Center for Disease Control and Prevention. (2017, August 22). Intimate partner violence: Risk and protective factors. Retrieved from https://www.cdc.gov/violenceprevention/intimatepartnerviolence/ consequences.html Department of Health and Human Services. (2003, March). Cost of intimate partner violence against women in the United States. Retrieved from CDC: https://www.cdc.gov/violenceprevention/pdf/ IPVBook-a.pdf Dutton, D. G. (2006). Transforming a flawed policy: A call to revive psychology and science in domestic violence research and practice. Aggression and Violent Behavior, 11(5), 458–483. Follette, C. M. (2016). Acceptance and commitment therapy as a non-pathologizing intervention approach for survivors of trauma. Journal of Trauma & Dissociation, 11(5), 138–150. Freeman, A. J., Schumacher, J. A., & Coffey, S. F. (2015). Social desirability and partner agreement of men’s reporting of intimate partner violence in substance abuse treatment settings. Journal of Interpersonal Violence, 30(4), 565–579. Futures Without Violence. (2018). Mandatory reporting of domestic violence to law enforcement by health care providers: A guide for advocates working in response to or amend reporting laws related to domestic violence. Retrieved from https://www.futureswithoutviolence.org/userfiles/Mandatory_Reporting_of_ DV_to_Law%20Enforcement_by_HCP.pdf Iverson, K. S. (2009). Dialectical behavior therapy for women victims of domestic abuse: A pilot study. Professional Psychology: Research and Practice, 40(3), 242–248. Jakupcak, M., & Tull, M. (2005). Effects of trauma exposure on anger, aggression, and violence in a nonclinical sample of men. Violence Victims, 20(5), 589–598. Karin, V., & Rhodes, C. L. (2011). Intimate partner violence identification and response time for a change in strategy. Journal of General Internal Medicine, 26(8), 894–899. Labriola, M., Bradley, S., O’Sullivan, C., Rempel, M., & Moore, S. (2010). A national portrait of domestic violence courts. Washington, DC: US Department of Justice. Langhinrichsen-Rohling, J. H. (2000). The clinical utility of batterer typologies. Journal of Family Violence, 15(1), 37–53. Lloyd, S., & Nina, T. (1999). The effects of male violence of female employment. Violence Against Women, 5(4), 370–392. National Intimate Partner Violence and Sexual Violence Survey Report Executive. (2010). CDC. Retrieved from https://stacks.cdc.gov/view/cdc/11637 Novak, S., & Galaway, B. (1983). Domestic abuse intervention project final report. Duluth, MN: Domestic Abuse Intervention Project. Rivara, F. (2007). Healthcare utilization and costs for women with a history of IPV. American Journal of Preventative Medicine, 32(2), 89–96. Roberts A. L., McLaughlin, K. A., Conron, K. J., & Koenen, K. C. (2011). Adulthood stressors, h ­ istory of childhood adversity, and risk of perpetration of IPV. American Journal of Preventative Medicine, 40(2), 128–138. Rosalyn, D. L., Mikel, L. Walters, J. E., & Basile, K. C. (2013). Behavioral and attitudinal factors differentiating male intimate partner violence perpetrators with and without a history of childhood family violence. Journal of Family Violence, 28(1), 85–94. Rosenbaum, A. A. (1989). Head injury and marital aggression. American Journal of Psychiatry, 146(8), 1048–1051. Rosenbaum, A., & Leisring, P. A. (2003). Beyond power and control: Towards and understanding of partner abusive men. Journal of Comparative Family Studies, 34(1), 7–22. Schumacher, J., & Coffey, S. (2011). Development of a brief motivational enhancement intervention for intimate partner violence in alcohol treatment settings. Journal of Aggression and Maltreatment Trauma, 20(2), 103–127. Shepard, M., & Pence, E. L. (1999). Coordinating community responses to domestic violence: Lessons from Duluth and beyond. Thousand Oaks, CA: Sage. Sobell, L., Ellingstad, T., & Sobell, M. (2009). Natural recovery from alcohol and drug problems: Methodological review of the research with suggestions for future directions. Addiction, 95(5), 749–764. Stover, C., Meadows, A. L., & Kaufman, J. (2009). Interventions for intimate partner violence: Review and implications for evidence-based practice. Professional Psychology, Research, and Practice, 40(3), 223–233.

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Substance Abuse and Mental Health Services Administration. (1997). Substance abuse treatment and domestic violence. Rockville, MD: Author. Taft, C., Macdonald, A., Creech, S. M., & Murphy, C. (2016). A randomized control clinical trial of the strength at home men’s program for partner violence in military veterans. Journal of Clinical Psychiatry, 77(9), 1168–1175. Timko, C., Valenstein, H., Lin, P., Moos, R., Stuart, G., & Ronkite, R. (2012). Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs. Substance Abuse Treatment Prevention and Policy, 7(37). Retrieved from https://substanceabusepolicy. biomedcentral.com/articles/10.1186/1747-597X-7-37 Walker, D., Neighbors, C., Lyungai, M. O., Zegree, J., Roffman, R., & Edleson, J. (2010). Evaluating the impact of intimate partner violence on the perpetrator: The perceived consequences of domestic violence questionnaire. Journal of Interpersonal Violence, 25(9), 1684–1698. Warshaw, C., & Brashler, B. (2009). Mental health treatment for survivors of intimate partner violence. Retrieved from http://www.nationalcenterdvtraumamh.org/wp-content/uploads/2015/10/MitchellChapter-24.pdf

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19 The legal and ethical ­consequences of human trafficking Michelle Sunkel

It is imperative to understand humanitarian law and human rights as we discuss the impact of human trafficking. Humanitarian law focuses on the protection of life, the dignity and worth of individuals, and the prohibition of inhumane treatment, while human rights focus on freedoms, justice, and peace. These entities work with vulnerable populations and are intended to reduce suffering, without exception. Despite efforts by the United Nations, ­European Union, United States, and many other entities to combat human trafficking, it remains one of the fastest growing industries in the world (Ngwe & Elechi, 2012). It is estimated that up to 40 million people are trafficked each year, resulting in $150 billion dollars of profit (­International Labor Organization and Walk Free Foundation, 2017; Fish, 2017). English (2017) defined human trafficking as the exploitation of basic rights that includes the “recruitment, transportation, transfer, harboring, or receipt of a person by means of threat, coercion, abduction, fraud, or deception” (p. 54). Levett (2013) acknowledged the expanded definition of modern-day slavery as “forced labor, forced marriage, organ trafficking, and harboring a victim illegally” (p. 20). As we continue to update and change the definition of human trafficking, we continue to increase the number of people who fit the description of having been trafficked. Identifying those who have been trafficked is challenging, because not all victims identify as victims and not all cultures define human rights in the same way. This creates challenges as we attempt to address international human rights issues. In countries that implement human rights laws, professionals have often lacked the training that is necessary to recognize victims; thus, they have been unable to intervene effectively.

Vulnerable populations at risk of being trafficked People who are at risk of being exploited to traffickers include children, those living in poverty, runaways, homeless people, sexual minorities, unemployed or underemployed people, people who have previously been victimized, and anyone with mental or physical health problems (Greenbaum, Yun, & Todres, 2018). Traffickers tend to identify vulnerabilities quickly and use coercion, charisma, and opportunities to engage with potential victims. Recruitment tactics include false job advertisements, promises of a better life or legal status, intimate partner opportunities, and personal connections. Once traffickers establish control 143

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over their victims, they use various methods to maintain obedience. These methods of control include economic abuse, withholding basic needs, forced drug use, assault, isolation, manipulation, and threats. Once someone is trafficked, it is very difficult for them to regain their freedom. In addition, people who live in countries with extreme poverty, gender inequality, corruption, and war and/or conflict have increased likelihood of being trafficked (Macy & Johns, 2011). According to the International Labor Organization and Walk Free Foundation (2017), 20.1 million (81%) people have been trafficked for labor (state imposed and forced) and 4.8 million (19%) have been sexually exploited. In the United States, race is another vulnerability, as 95% of labor trafficking victims identified as Black, Hispanic, or Asian, while 74% of sex trafficking victims identified as Black, Hispanic, or Asian (Fish, 2017). Mostly women and children are trafficking into the sex trade, with the average age of child recruitment at 12 (Ngwe & Elechi, 2012). This means that American women and children of color are at high risk of being trafficked.

International interventions Human trafficking, also known as modern-day slavery, is considered to be a human rights violation and public health issue. Combating human trafficking is difficult, with low numbers of prosecutions and convictions obtained worldwide. It is frequently challenging for survivors to come forward and assist in the prosecution of their traffickers. Approximately, 60 international organizations have joined forces to combat human trafficking by changing policies, implementing new laws, defining victims, offering trainings and education, and by ­d irectly intervening. Global Centurion Foundation, The Council of Europe, ­European Union, United Nations, ACT Alberta, Maiti Nepal, Polaris Project, Reaching Out R ­ omania, etc. are all working to abolish slavery and trafficking (Cokar, Ulman, & Bakirci, 2016); however, we continue to see only limited success in prevention. In the United States, the Child Abuse Prevention and Treatment Act 2015 expanded treatment options until the age of 24 to children of human trafficking (English, 2017). Again, as prevention has been mostly unsuccessful, transitioning and changing intervention protocols to support survivors are necessary. Currently, only 32 out of 195 countries worldwide prosecute for sex tourism crimes, suggesting the need for more global justice and understanding of human trafficking violations (Cokar et al., 2016). Ethically, social workers must understand the complexity of human trafficking, identify the high risk factors, and use evidenced base interventions to provide safety, support, and treatment to victims as quickly as possible.

Ethics of human trafficking Human trafficking is considered to be one of the most severe forms of human rights violations. It disrupts human dignity, autonomy, integrity, justice, quality of life, and beneficence. Trafficking is associated with extreme violence and includes physical, sexual, and mental anguish (Oram, Zimmerman, Adams, & Busza, 2011). Victims of human trafficking are at risk of developing post-traumatic stress disorder, major depression, suicidal ideation, and are at high risk of infectious diseases such as syphilis, herpes, and HIV/AIDS (Macy & Johns, 2011). Survivors may use substances to assist them with coping or managing their victimization. Therefore, ethically identifying where to start and what to ask can be overwhelming; further, any mistake by a social work has the potential to be harmful. Autonomy is considered to be one of the most important ethical values from the American perspective, while 144

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utilitarianism is highly valued from the European perspective. Balancing your own personal ethical values, the cultural values of the client, and expectations of human rights can be very confounding. These competing values may unintentionally cause professionals to not ask certain questions, overlook harm (physical and psychological), or mistake coercion for approval when working with clients.

Identification of those being trafficked To assess someone who is actively being trafficked, it is important to know the physical signs as well as the psychological effects. Common traumas experienced by survivors include burns, bites, lacerations, scarring, and mutilation to the anus or vagina (Casey, 2017). Psychologically, those that have been trafficked may be despondent, with a flat affect or actively in crisis (yelling, shaking, crying, etc.). Some individuals will present as anxious, avoid eye contact, and be fearful. Their mood, energy, and behavior will be dependent at least partially upon their feelings of safety. Most survivors identify intense feelings of shame, fear, and intimidation (Cheshire, 2017). If the trafficker is in the room, the survivor will usually defer to the trafficker for all answers. The survivor may appear fearful or nonreactive, depending on his or her own capacity and feelings of safety in that moment. Social workers must identify the power differential and request meeting with the survivor alone for an adequate assessment. Other indicators of human trafficking include the lack of access to legal documents, isolation, and the inability to speak the dominant language of the given country. In light of the Western perspective of the importance of personal autonomy, professionals may shy away from asking questions about familial relationships. However, if we disrupt the ethics of autonomy to inquire further, we may create opportunities to engage in the ethics of beneficence, non-maleficence, and least harm. Violating the most comfortable ethical value may result in the most ethical outcome for clients. For other countries that favor collectivism and utilitarianism, this means evaluating the ethics of act and rule to determine if a violation of human rights has occurred. We must always act in the beneficence of our clients, protect human life, and support quality of life. Those who are being trafficking are not able to live a fulfilled life and we must intervene ethically and legally.

Prostitution – denial of human trafficking Another ethical complication is when survivors deny coercion or having been trafficked. Those who are coerced into prostitution may psychologically reject their victimization and instead exert control over their experiences and identify as a working girl (indicating their choice), instead of being a victim (Harding & Hamilton, 2009). This means that they may not want to talk to or work with social workers, whom they may identify as threats, thinking that they might call the police or another organization of authority. Social workers must be cognizant of their own biases, because prostitution may conflict with their own values and interfere with ethical interventions. This can create a conflict of interest and result in unintentional harm to people in this population. Hacker (2017) found that most girls seek love, security, and affection, which can be psychologically and spiritually compromised due to the exploitation that is sex trafficking. To add to the confusion of coercion versus choice for these young women (more women are trafficked statistically than men), they may be fearful of obtaining criminal charges for engaging in sex acts (Albright & D’Adamo, 2017). This means that they may not come forward and seek assistance from authorities and, instead, may protect their traffickers. Social workers 145

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must act to change laws and policies such that they are more supportive of those who have been trafficked in prostitution, regardless of how these victims identify themselves. We must minimize harm to this vulnerable population and be empathic, as victims of sexual exploitation usually have histories of childhood sexual abuse or have experienced domestic violence, verbal abuse, or emotional abuse (Harding & Hamilton, 2009). Victims of abuse tend to have lower self-esteem and lack self-confidence; therefore, opportunities for their autonomy to be taken away are increased, human dignity is denied, and quality of life is gravely affected. Social workers assessing situations like these should recognize the complexity of trauma and should empower their clients and act on behalf of the beneficence of the person. The intricacy of these relationships, coercive factors, and self-identity are all critical factors for respecting the dignity of victims. Social workers may need to engage in the ethics of caring and operate from a humanistic perspective in order to appropriately intervene, being careful not to impose their own values and goals onto survivors.

Social work interventions Human trafficking occurs across the globe; therefore, national and international interventions, services, and supports must be implemented. The Palermo Protocol has been ratified by 166 countries, deeming human trafficking illegal and criminal ( Jones & Winterdyk, 2018); however, there are still approximately 20 million unidentified victims who are currently being trafficked (Chuang, 2014). Once survivors are identified and taken into safety, social workers must meet their immediate needs with medical care, housing, and language interpretation (Macy & Johns, 2011). Social workers must be aware of cultural needs, expectations, and healing norms in order to prevent causing additional trauma. Family reunification may be essential in the recovery process for some survivors, as well as legal protection (Greenbaum et al., 2018). Trauma informed care is of the utmost importance during crisis intervention. Ongoing needs for each survivor will need to be independently identified via a thorough needs assessment. During this time, autonomy and human dignity must be established. Physical and mental health evaluation must be completed and must be appropriate to victims’ cultural contexts. ­Long-term needs may include life skills, job skills, housing, and legal status (Macy & Johns, 2011). Global policies should be addressed in order to support immediate and long-term needs of human trafficking victims; in addition, ongoing education about sex trafficking for all health and human service providers, law enforcement, educators, and legal providers is an important factor in our society’s ability to recognize and assist victims. Our understanding of human trafficking is incomplete; nonetheless, our interventions should start now.

References Albright, E., & D’Adamo, K. (2017). Decreasing human trafficking through sex work decriminalization. AMA Journal of Ethics, 19(2), 122–126. Casey, D. (2017). Identifying and advocating for human trafficking victims. American Nurse Today, 12(12), 37–38. Cheshire, W. J. (2017). Groupthink: How should clinicians respond to human trafficking? AMA Journal of Ethics, 19(1), 91–97. Chuang, J. (2014). Exploitation creep and the unmaking of the human trafficking law. American Journal of International Law, 4, 609–649. Cokar, M., Ulman, Y. I., & Bakirci, N. (2016). Breaking the silence of the lambs: Integrating medical staff in prevention of human trafficking. Acta Bioéthica, 22(1), 101–110.

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English, A. (2017). Mandatory reporting of human trafficking: Potential benefits and risks of harm. AMA Journal of Ethics, 19(2), 54–62. Fish, C. (2017). Extraterritorial human trafficking prosecutions: Eliminating zones of impunity within the limits of international law and due process. St. John’s Law Review, 91(2), 529–557. Greenbaum, V. J., Yun, K., & Todres, J. (2018). Child trafficking: Issues for policy and practice. Journal of Law, Medicine & Ethics, 46(1), 159–163. Hacker, P. M. S. (2017). The passions: A study of human nature. Hoboken, NJ: John Wiley & Sons. Harding, R., & Hamilton, P. (2009). Working girls: Abuse or choice in street-level sex work? A study of homeless women in Nottingham. The British Journal of Social Work, 39(6), 1118–1137. International Labour Organization and Walk Free Foundation. (2017). Global estimates of modern slavery: Forced labour and forced marriage. Retrieved from https://www.ilo.org/wcmsp5/groups/public/@ dgreports/@dcomm/documents/publication/wcms_575479.pdf Jones, J., & Winterdyk, J. (2018). Introduction to human trafficking: Challenges and opportunities for the 21st century. Onati Socio-Legal Series, 8(1), 1–10. Retrieved from http://opo.iisj.net/index.php/ osls/article/view/919 Levett, C. (2013). Modern day slavery. Australian Nursing Journal ( July 1993), 21(2), 48. Macy, R. J., & Johns, N. (2011). Aftercare services for international sex trafficking survivors: Informing U.S. service and program development in an emerging practice area. Trauma, Violence & Abuse, 12(2), 87–98. Ngwe, J. E., & Elechi, O. O. (2012). Human trafficking: The modern day slavery of the 21st century. African Journal of Criminology & Justice Studies, 6(1/2), 103–119. Oram, S., Zimmerman, C., Adams, B., & Busza, J. (2011). International law, national policymaking, and the health of trafficked people in the UK. Health and Human Rights, 2, 3–16.

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Section V

Micro practice settings

20 Social work ethics and v ­ alues Global issues in ­criminal justice practice Kathi R. Trawver, Kelli E. Canada, and Stacey Barrenger

Since the beginning of the profession in 1904, social workers have provided services to justice-involved individuals who face immense injustices and vulnerabilities (Springer & ­Roberts, 2017; Wilson, 2010). Social workers serve clients in a variety of criminal justice settings, including law enforcement, state and federal correctional facilities, city and county jails, probation and parole, courts, juvenile justice, faith- and community-based programs serving returning citizens, and/or health and behavioral health settings (Wilson, 2010). At any given time, there are over 10 million individuals in prisons worldwide, with over 30 million entering and exiting institutions (Fazel, Hayes, Bartellas, Clerici, & Trestman, 2016). Currently, the United States houses more than two million people in jails and prisons. Although this number is extraordinary, it does not include the 6.7 million people on community supervision (i.e. probation, parole) and the many others who remain in their communities while awaiting prosecution for their charges (Kaeble & Glaze, 2016). Although incarceration rates are highest in the United States (i.e. 698 per 100,000 people), other countries such as El Salvador, Turkmenistan, and Cuba also have incarceration rates of over 500 people per 100,000 (Wagner & Sawyer, 2018); however, rates in Europe, Canada, Australia, and New Zealand are much lower. Finally, significant racial, disability, and economic disparities found within the criminal justice system require social workers to navigate discrimination and implement change. In 2016, of the 2.2 million incarcerated individuals in the United States, 27% were African American, representing more than twice their share of the nation’s population (Sentencing Project, 2018). Worldwide, there is also an overrepresentation of prisoners who experience behavioral health disorders ( Jack et al., 2018). For example, nearly 90% of UK prisoners have at least one mental health or substance use disorder (Hayton & Boyington, 2006). More specifically, a recent meta-analysis including over 30,000 prisoners in 24 countries found that almost 4% of prisoners experienced psychosis and that over 10% had major depression (Fazel & Seewald, 2012). Substance abuse disorders are also overrepresented in worldwide criminal j­ustice populations. A recent ten-country study found that, on average, 24% of prisoners had an alcohol use disorder (16–51% of males and 10–30% of females), while 30% of males and 51% of ­females had a drug use disorder (Fazel, Yoon, & Hayes, 2017). Finally, justice-involved persons also have high rates of childhood and adult trauma. A study of 21,099 prisoners from 151

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20 countries found reported post-traumatic stress disorder prevalence rates of 6.2% among males and 21.1% among females (Barnayi, Cassidy, Fazel, Priebe, & Mundt, 2018). People who live in poverty are disproportionately at risk of incarceration. Economic disparities are highly visible among prison populations. Loony and Turner (2018) found that boys born into low-income families are 20 times more likely to be incarcerated than those who are born into high-income families. Also, at least in the United States, criminalizing homelessness by arresting individuals for life-sustaining activities, such as sleeping in public, is increasing (National Coalition for the Homeless, 2018). Given the financial, physical, psychological, and social devastation criminal justice involvement has on individuals and their families (Binswanger et al., 2007), social workers across the world are called upon to reform these systems and support the people affected by them in an effort to enhance social justice, uphold the dignity and worth of people, and ­facilitate human connections and relationships. When working with clients who are involved with the criminal justice system, social workers must balance the importance of public safety and the needs of the criminal justice system with the unique and complex needs of the individuals involved in the system, all while facing a number of ethical challenges.

Global social work values and ethics The International Federation of Social Workers (IFSW, www.ifsw.org) is the international organizing group for the profession of social work. This organization, along with the International Association of Schools of Social Work (IASSW; www.iassw.org), produced a global definition of the social work profession that informs international ethics in social work practice settings (https://www.ifsw.org/what-is-social-work/global-definition-of-social-work/). The definition highlights the overarching principles of social justice, human rights, collective responsibility, and respect for diversity as being core to social work practice and delineates IASSW’s Global Standards and Statement of Ethical Principles (https://www.ifsw. org/­g lobal-social-work-statement-of-ethical-principles/). These principles are: (1) recognition of the inherent dignity of humanity; (2) promoting human rights; (3) promoting social justice (­challenging discrimination and institutional oppression, respect for diversity, access to equitable resources, building solidarity); (4) promoting the right to self-determination; (5) promoting the right to participation; (6) respect for confidentiality and privacy; (7) treating people as whole persons; (8) ethical use of technology and social media; and (9) professional integrity. Many national social work organizations (particularly those in Canada, Australia, Great Britain, and Aotearoa/New Zealand) recognize that their ethics statements are informed by the IFSW’s ethical principles. Some also embrace a broad human rights orientation or specifically mention their commitment to first peoples or indigenous individuals in their respective countries. Ethical statements are often organized into underlying values that guide specific principles or practices. For example, the Australian Association of Social Workers identifies three core values that inform six practice responsibilities (www.socialworkers.org/ About/Ethics/Code-of-Ethics/Code-of-Ethics-English). Codes of ethics from other countries, like the United States (National Association of Social Workers Code of Ethics), Great Britain (British Association of Social Workers), and Canada (Canadian Association of Social Workers Code of Ethics), are a mix of values and practice components. The three core values shared in ethics statements are: (1) respect for persons and their inherent worth and dignity; (2) social justice; and (3) professional integrity. Additional values identified include (a) service to humanity; (b) competence in practice; (c) importance of human relationships; and (d) confidentiality in professional practice. Although some countries identify these as values, some 152

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countries choose to subsume these values into practice statements. For example, some people might decide that the value of confidentiality is subsumed under professional integrity. In the United States, the National Organization of Forensic Social Workers (NOFSW) has provided a Code of Ethics for its members since 1987. Among its identified canons, the NOFSW Code includes guidance on social work responsibility to the organization, employers and colleagues, society, and clients. Outside of indigenous or first peoples, ethics and values statements do not generally refer to specific groups of persons, like those imprisoned or formerly incarcerated. Because of this, as social workers move between different practice settings and work with people from different populations, it is incumbent upon them to make ethical interpretations for given situations and people. These decisions can be particularly challenging for social workers who work within the criminal justice system where different values, such as public safety, are the stated priorities. Likewise, ethical principles and concepts from other professions, such as law and law enforcement dominant criminal justice system, differ from the principles and concepts of social work.

Values and ethics in criminal justice practice Upholding social work ethical standards and honoring social work values can be challenging when working within the criminal justice system. Justice systems across the world are often influenced by biases and inequities. When working on interdisciplinary teams, such as in problem-solving courts or within prisons, collaboration with other professionals can challenge, shape, and expand the social work lens. Maintaining social work values and ethics while working within teams and complicated systems is essential. Regardless of place, context, team members, or specific system of practice, social workers lead with ethics and values (International Federation of Social Workers, 2012; Maschi & Leibowitz, 2018).

Human rights Social work interventions within the criminal justice system can target individuals, groups, policies, and systems. When promoting human rights, social workers must recognize the problems stemming from systemic issues, rather than solely focusing on individuals (Maschi & Leibowitz, 2018). That is to say, micro-level interventions (e.g. treatment) are essential for some clients, but change is also needed among people working within the criminal justice system, in communities (e.g. stable housing), and at the policy level (Barrenger & Canada, 2014). Classical schools of thought regarding why crimes occur argue that the desires to exercise free will, coupled with poor ethics and morals, drive crime (Albanese, 2016). Alternatively, the structural view of crime identifies the roles of power, injustice, and oppression in the creation of laws, how they are enforced, and how those who violate them are punished. These perspectives dictate action. If social workers perceive a person to be immoral, they may only advocate for treatment or rehabilitation. If social workers view crime from a structural perspective, their interventions will be aimed at redistributing power and wealth, making systemic changes (Albanese, 2016).

Dignity and worth of people Taking a human rights stance and honoring the dignity and worth of people suggest social workers must recognize the need for multisystemic intervention. They must acknowledge the 153

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historical contexts of how decisions are made about what to criminalize and what not to criminalize, what actions should be more serious or less serious charges, and how punishment varies based upon choices that people with power make. These decisions have historically been shaped by racism and bias (Albanese, 2016). System reform is pivotal in promoting human rights, and social workers are well positioned to champion these reforms. The generation of ideas for reform and intervention requires partnerships with people who have had contact with the system (Maschi & Leibowitz, 2018). Although systems reform is essential, people within the criminal justice system also require intervention. Inherent in the criminal justice system is labeling people as criminals, felons, or offenders. Despite the challenges of separating people from their behaviors, social workers have the opportunity to advocate for person first-language and action.

Self-determination and empowerment Providing services within the criminal justice system is no different from providing care outside this system. Even if a person is mandated to treatment, social workers maintain clients’ rights to self-determination. Collaboration with clients to identify what goals they want to work on, intentionally giving maximum choice, and acknowledge the boundaries of confidentiality through the informed consent process are critical.

Confidentiality Clients may be hesitant to build rapport and disclose when social workers work within criminal justice systems (e.g. within a prison) for fear that their problems or concerns may be shared. Regardless of context, social work ethics apply. Clients have the right to know the limits of confidentiality and access to private and confidential treatment. Social workers may have to advocate for this and educate other professionals about the limits of sharing private information. Even when a release of information is signed by clients, social workers should only share information that is relevant to providing quality care.

Cultural awareness and social diversity Given the disproportionate contact that members of minority groups have with all facets of the criminal justice system (see Nellis, 2016; Tubex, 2017), social workers working within these systems face the need for ongoing education and training on cultural awareness. Specific interventions and strategies must be appropriate for diverse populations and appropriate outcomes should be measured to ensure that practice strategies are meeting clients’ goals for recovery and rehabilitation. When clients lack the capacity to make decisions, the integration of families and guardians is essential for making decisions about treatment and rehabilitation. Social workers must also ensure that services are appropriate for clients who lack ­decision-making capacity and must advocate for their rights when justice systems encroach on their rights to self-determination with specific directives.

Interruption of services Finally, sectors of the criminal justice system are often disjoined. That is, within many systems, there are disconnects between the police, courts, community supervision, jails, and prisons. Social workers play an essential function in reducing risks of service interruption. For example, if a client is receiving services in the community, efforts should be made to 154

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continue services if that client enters jail or prison. Social workers can bridge this transition by connecting with the jail and prison to promote cohesion in care. From a systems perspective, social workers may also advocate for communities to include more wraparound or transitional services to promote a continuation in care.

Summary Worldwide, criminal justice social work practice is a broad and ethically complex area of professional practice. Justice-involved clients have experienced some of the greatest levels of trauma, racism, oppression, discrimination, poverty, mental illness, and other disabling conditions, as well as higher than average levels of addiction. Social workers are required to balance sometimes conflicting mix of laws and professional ethics in criminal justice practice. Furthermore, the use of incarceration to solve social problems prompts advocacy related to social work values of human rights and addressing social injustice. Criminal justice social work practice requires professionals to have a highly specialized knowledge base and strong practice abilities, but also the capacity to navigate and balance a variety of complex ethical tensions and conflicts. Codes of ethics from across the globe help guide social workers effectively serve justice-involved clients and criminal justice organizations.

References Albanese, J. S. (2016). Professional ethics in criminal justice: Being ethical when no one is looking. Boston, MA: Pearson. Australian Association of Social Workers. (2010). Code of ethics 2010. Retrieved from https://www. aasw.asn.au/document/item/1201 Barnayi, G., Cassidy, M., Fazel, S., Priebe, S., & Mundt, A. P. (2018). Prevalence of posttraumatic stress disorder in prisoners. Epidemiologic Reviews, 40(1), 134–145. Barrenger, S., & Canada, K. E. (2014). Mental illness along the criminal justice continuum. Journal of Forensic Social Work, 4(2), 123–149. Binswanger, I. A. Stern, M. F., Deyo, R. A., Cheadle, A., Elmore, J. G., & Koepsell, E. D. (2007). Release from prison: A high risk of death for former inmates. The New England Journal of Medicine, 366, 157–165. British Association of Social Workers. (2014). Code of ethics. Retrieved from https://www.basw.co.uk/ about-basw/code-ethics Canadian Association of Social Workers. (2005). Code of ethics. Retrieved from https://www.casw-acts. ca/sites/default/files/attachements/casw_code_of_ethics.pdf Fazel, S., Hayes, A., Bartellas, K, Clerici, M., & Trestman, R. (2016). The mental health of prisoners: A review of prevalence, adverse outcomes and interventions. Lancet Psychiatry, 3(3), 871–881. Fazel, S., & Seewald, K. (2012). Severe mental illness in 33,588 prisoners worldwide: Systematic review and meta-regression analysis. British Journal of Psychiatry, 200(5), 364–373. Fazel, S., Yoon, I. A., & Hayes, A. J. (2017). Substance use disorders in prisoners: An updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction, 112(10), 1725–1739. Hayton, P., & Boyington, J. (2006). Prisons and health reforms in England and Wales. American Journal of Public Health, 96, 1730–1733. International Association of Schools of Social Work. (2018). Global social work statement of ethical principles. Retrieved from https://www.ifsw.org/global-social-work-statement-of-ethical-principles/ International Federation of Social Workers. (2012). Statement of ethical principles. Retrieved from https:// www.ifsw.org/statement-of-ethical-principles/ Jack, H. E., Gricchione, G., Chibanda, D., Thronicroft, G., Machando, D., & Kidia, K. (2018). Mental health of incarcerated people: A global call to action. Lancet Psychiatry, 5(5), 391–392. Kaeble, D., & Glaze, L. (2016). Correctional populations in the United States, 2015. Washington, DC: Bureau of Justice Statistics. 155

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Loony, A., & Turner, N. (2018). Work and opportunity before and after incarceration. Washington, DC: The Brookings Institution. Retrieved from https://www.brookings.edu/wp-content/uploads/2018/03/ es_20180314_looneyincarceration_final.pdf Maschi, T., & Leibowitz, G. S. (2018). Forensic social work: Psychosocial and legal issues in diverse practice settings (2nd ed.). New York, NY: Springer. National Association of Social Workers. (2017). Code of ethics. Retrieved from https://www.socialworkers. org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English National Coalition for the Homeless. (2018). Criminalization of homelessness. Retrieved from https:// nationalhomeless.org/issues/civil-rights/ National Organization of Forensic Social Workers. (2012). Code of ethics. Retrieved from http://nofsw. org/wp-content/uploads/2014/03/NOSFW-Code-of-Ethics-Changes-2-16-12.pdf Nellis, A. (2016). The color of justice: Racial and ethnic disparity in state prisons. The sentencing project. Retrieved from https://www.sentencingproject.org/publications/color-of-justice-racial-and-ethnicdisparity-in-state-prisons/ Sentencing Project. (2018). Report to the United Nations on racial disparities in the U.S. criminal justice system. Retrieved from https://www.sentencingproject.org/publications/un-report-on-racial-disparities/ Springer, D. W., & Roberts, A. R. (Eds.). (2017). Social work in juvenile and criminal justice systems. Springfield, IL: Charles C. Thomas. Tubex, H. (2017). Political economy of punishment in Australia. In D. Melossi, M. Sozzo, & J. A. Brandariz Garcia (Eds.), The political economy of punishment today (pp. 137–159). New York, NY: Routledge. Wagner, P., & Sawyer, W. (2018). States of incarnation: The global context 2018. Retrieved from https:// www.prisonpolicy.org/global/2018.html Wilson, M. (2010). Criminal justice social work in the United States: Adapting to new challenges. Washington, DC. NASW Center for Workforce Studies. Retrieved from https://www.socialworkers.org/LinkClick. aspx?fileticket=n8L3HaALWb8%3D&portalid=0

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21 Boundary issues and dual ­relationships in social work A global perspective Frederic G. Reamer

Social workers – including clinicians, community organizers, policy makers, supervisors, researchers, administrators, students, and educators – often encounter circumstances that pose actual or potential boundary issues. Boundary issues occur when social workers face possible conflicts of interest in the form of what have become known as dual or multiple relationships (Congress, 1996; Kagle & Giebelhausen, 1994; Lazarus & Zur, 2002; Reamer, 2012; StromGottfried, 1999; Zur, 2017). Dual or multiple relationships occur when professionals engage with clients or colleagues in more than one relationship, whether social, sexual, religious, or business (St. Germaine, 1993, 1996). Dual or multiple relationships can occur in the context of face-to-face and online relationships. Norms pertaining to boundary issues vary significantly across the globe; in addition to international differences, there is noteworthy variation within nations based on ethnic, cultural, religious, and geographic differences, among others. Dual relationships occur primarily between social workers and their current or former clients and between social workers and their colleagues (including supervisees and students). Most discussions of boundary issues have focused on dual relationships that are exploitive in nature such as social workers’ sexual involvement with clients. Certainly, these are important and compelling issues. However, many boundary and dual relationship issues in social work are subtler than these egregious forms of ethical misconduct. Examples include the appropriateness of behaviors such as developing friendships and Facebook relationships with former clients, participating in social activities with clients when they and their social workers live in remote rural communities, hiring former clients, serving on community boards with clients, providing clients with one’s personal mobile telephone number, accepting goods and services from clients instead of money, accepting clients’ gifts and social invitations; and discussing one’s religious beliefs with clients (Borys & Pope, 1989; Brownlee, 1996; Gutheil & Gabbard, 1993; Pope, Tabachnick, & Keith-Spiegel, 1988; Reamer, 2012; Smith, 1999; Smith & Fitzpatrick, 1995; Strom-Gottfried, 1999; Zur, 2017). It is important for social workers to distinguish between boundary violations and boundary crossings (Gutheil & Gabbard, 1993; Smith & Fitzpatrick, 1995; Zur, 2017). A boundary violation occurs when a social worker engages in a dual relationship with a client or colleague that is exploitive, manipulative, deceptive, or coercive. Examples include social workers who become sexually involved with current clients or exchange text messages with 157

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sexual content, recruit and collude with clients to bill insurance companies fraudulently, borrow money from clients, or influence terminally ill clients to include social workers in clients’ wills. Boundary violations are inherently unethical and are generally recognized internationally. One key feature of boundary violations is a conflict of interest that harms clients or colleagues (Epstein, 1994; Gifis, 1991; Kitchener, 1988; Pope, 1988, 1991; Reamer, 2012; Zur, 2017). Some conflicts of interest involve what lawyers call undue influence. Undue influence occurs when a social worker inappropriately pressures or exercises authority over a susceptible client in a manner that benefits the social worker and may not be in the client’s best interest. In contrast, a boundary crossing occurs when a social worker is involved in a dual relationship with a client or colleague in a manner that is not intentionally exploitive, manipulative, deceptive, or coercive. Boundary crossings are not inherently unethical and their meaning varies considerably in different cultural contexts; what is considered ethically permissible in one cultural context (for example, accepting a client’s gift or invitation to a lifecycle event) may be unacceptable in another. In principle, the consequences of boundary crossings may be harmful, salutary, or neutral (Gutheil & Gabbard, 1993; Reamer, 2012; Zur, 2017). Boundary crossings are harmful when the dual relationship has negative consequences for the social worker’s client or colleague and, possibly, for the social worker as well. For example, a clinical social worker who discloses to a client on Facebook personal, intimate details about his or her own life, ostensibly to be helpful to the client, ultimately may confuse the client and compromise the client’s mental health because of complicated transference issues produced by the social worker’s self-disclosure. A social work educator who accepts a student’s dinner invitation may inadvertently harm the student by confusing the student about the nature of the social work educator’s relationship. A social work administrator whose family vacations with an employee and his or her family may have difficulty managing future personnel problems involving that employee. Alternatively, some boundary crossings may be helpful to clients and colleagues. Some social workers argue that, handled judiciously, a clinical social worker’s modest self-disclosure or decision to accept an invitation to attend a client’s wedding may prove, in some special circumstances, to be therapeutically useful to a client (Anderson & Mandell, 1989; ­Chapman, 1997; Reamer, 2012, 2018; Zur, 2017). In some cultures, social workers would be expected to accept certain social invitations (Reamer & Nimmagadda, 2017). A social worker at a community mental health center who worships, coincidentally, at the same church or mosque a client attends may help the client “normalize” the professional-client relationship. A social work educator who hires a student to serve as a research assistant may boost the student’s self-confidence in a way that greatly enriches the student’s educational experience. Yet, other boundary crossings produce mixed results. A social worker’s self-disclosure about personal challenges may be both helpful and harmful to the same client – helpful in that the client feels more “connected” to the social worker and harmful in that the self-­ disclosure undermines the client’s confidence in the social worker. The social work administrator of a residential substance abuse treatment program who hires a former client may initially elevate the former client’s self-confidence and create boundary problems when the former client subsequently wants to resume the status of an active client following a relapse. It is important for social workers to have access to a conceptual framework to help them identify and manage the dual relationships they encounter. What follows is a typology of boundary issues in social work, based on several data sources: insurance industry statistics summarizing malpractice and negligence claims; empirical surveys of social workers and other professionals about boundary issues; legal literature and court opinions in litigation 158

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involving boundaries; and the author’s extensive experience as chair of a social work association’s ethics committee, ethics consultant, and expert witness in a large number of legal and licensing board cases involving boundary issues (Reamer, 2012, 2015, 2019). Boundary issues in social work can be placed into conceptual categories revolving around five central themes involving practitioners’ (1) intimate relationships, (2) pursuit of personal benefit, (3) emotional and dependency needs, (4) altruistic gestures, and (5) responses to unanticipated and unavoidable circumstances.

Intimacy Many dual relationships in social work involve some form of intimacy. Often these relationships entail a sexual relationship or physical contact, although they may also entail other intimate gestures such as gift giving, friendship, and affectionate communication. A significant portion of intimate dual relationships entered into by social workers involves sexual contact. Most, but certainly not all, of these relationships involve male practitioners and female clients (Akamatsu, 1988; Bouhoutsos, 1985; Bouhoutsos, Kolroyd, Lerman, ­Foster, & Greenberg, 1983; Celenza, 2007; Coleman & Schaefer, 1986; Feldman-Summers & Jones, 1984; Gabbard, 1989; Gechtman, 1989; Pope, 1990; Pope & Bouhoutsos, 1986; Reamer, 1992, 2015; Sell, Gottlieb, & Schoenfeld, 1986; Simon, 1999; Syme, 2003). Not all physical contact between social workers and clients is sexual in nature. Physical contact may be nonsexual and appropriate in a number of circumstances, for example, a brief hug at the termination of long-term treatment or placing one’s arm around a distraught client in a residential program who just received bad family news. In many, but not all cultural contexts, such brief, limited physical contact is not likely to be harmful; many clients would find such physical contact comforting and “therapeutic.” Physical contact may be culturally appropriate and encouraged in some ethnic or social communities, although prohibited in others (Reamer, 2012; Smith & Fitzpatrick, 1995; Stake & Oliver, 1991). In contrast are situations involving physical touch that have more potential for psychological harm. In clinical relationships, physical touch may exacerbate a client’s transference in destructive ways and may suggest that the social worker is interested in more than a professional relationship. Providing services to someone with whom a social worker was once intimately, romantically, or sexually involved also constitutes a dual relationship. The relationship history is likely to make it difficult for the social worker and client to interact with each other solely as professional and client; inevitably, the dynamics of the prior relationship will influence the professional-client relationship – how the parties view and respond to each other possibly in ways that are detrimental to the client’s best interests. Boundary issues can also emerge when social workers and clients or colleagues engage in other intimate gestures such as gift giving and expressions of friendship (including sending affectionate text messages and written notes). It is not unusual for clients to give social workers a modest gift, especially in some cultures. In many instances, a client’s gift represents nothing more than an appreciative gesture. In other instances, however, a client’s gift may carry great meaning. For example, the gift may reflect the client’s fantasies about a friendship or more intimate relationship with the social worker. There is consensus among social workers that in-person and online friendships with current clients constitute an inappropriate dual relationship. There is less clarity, however, about friendships and online contact between social workers and former clients. Although social workers generally understand the risk involved in befriending a former client – due 159

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to the possibility of confused boundaries – some social workers argue that friendships with former clients are not inherently unethical and reflect a more egalitarian, nonhierarchical approach to practice that is valued in some cultural contexts. These social workers typically claim that emotionally mature social workers and former clients are quite capable of entering into new kinds of relationships, including online relationships, following termination of the ­professional-client relationship and that such new relationships often are, in fact, evidence of the former client’s substantial therapeutic progress. Social workers involved in nonclinical ­relationships – such as social work researchers or community organizers – may argue that strict prohibition of relationships with former clients should not automatically apply to them.

Personal benefit Beyond these various manifestations of intimacy, social workers can become involved in dual relationships that produce other forms of personal benefit. The personal benefit to the social worker may take the form of monetary gain, goods, services, or useful information. In some situations, social workers stand to benefit financially because of a dual relationship (Bonosky, 1995). Examples include instances when a client in a hospice program includes her social worker in her will and when a former client offers his social worker an opportunity to invest in the client’s new business venture. On occasion social workers receive goods or services – rather than money – as payment for their professional services communities (Schank & Skovholt, 1997; Woody, 1998). In some cultures, barter is an accepted practice. For example, a client who specializes in home repair might offer to perform work at the social worker’s home in exchange for services. A risk is that the client’s interests could be undermined should some problem emerge with the work that would require some remedy or negotiation. Another example involves a social worker in a remote, rural community whose clients “pay” the social worker with a farm animal or portions of a crop. Social workers occasionally have an opportunity to benefit from clients’ unique knowledge. A social worker with a complex health problem may be tempted to consult a client who is a physician and who happens to specialize in the area relevant to the social worker’s illness. A social worker who is interested in adopting a child, and whose client is an obstetrics/gynecology nurse, may be tempted to talk to her client about adoption opportunities through the client’s hospital. A social worker who faces an expensive automobile repair may be tempted to consult a client who is a skilled mechanic. In these situations, there is the potential for an inappropriate dual relationship, where a social worker engages with the client in a self-serving manner and where a social worker’s judgment and services may be shaped and influenced by his or her access to a client’s specialized knowledge. Conversely, relatively brief, casual, and nonexploitive conversations with clients concerning topics on which clients are expert may empower clients, facilitate therapeutic progress and the delivery of both clinical and nonclinical services, and challenge traditionally hierarchical relationships between social workers and clients.

Emotional and dependency needs A number of boundary issues arise out of social workers’ efforts to address their own emotional needs. Many of these issues are subtle in nature and some are more glaring and egregious. Examples include practitioners who develop friendships or intimate relationships with clients because of their loneliness, disclose detailed personal information to clients in an effort to gain emotional support, recruit clients to convert to the social worker’s faith, and 160

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perform favors for clients outside of the professional relationship in order to feel useful and helpful. These are generally recognized internationally as unethical. In contrast, some boundary issues are subtler and subject to cultural differences. Examples include social workers whose clients invite them to attend important lifecycle events (such as clients’ weddings or graduations, or key religious ceremonies), social workers who conduct home visits and whose clients invite them to sit-down meals being served at the time of the visits, and social workers who themselves are in recovery and encounter clients or supervisees at 12-step meetings. In these situations, social workers sometimes disagree about the most appropriate way to handle boundary issues (Doyle, 1997; Zur, 2017). For example, some social workers are adamantly opposed to attending clients’ lifecycle events because of potential boundary problems (for example, the possibility that a client might interpret the gesture as an indication of the social worker’s interest in a social relationship or friendship); others, however, believe that attending such events can be ethically appropriate and, in fact, therapeutically helpful as long as the clinical dynamics are handled skillfully. For instance, some social workers believe that practitioners in recovery should never attend or participate in 12-step meetings where clients or colleagues are present, because of the difficulty clients and colleagues may have reconciling social workers’ professional roles and personal lives. Others, however, argue that recovering social workers have a right to meet their own needs and can serve as compelling role models to clients and colleagues in recovery. What is considered a boundary breach in one nation or cultural context might be considered ethical in another (Reamer & Nimmagadda, 2017).

Altruistic gestures Some boundary issues and dual relationships arise out of social workers’ genuine efforts to be helpful. Unlike social workers’ involvement in dual relationships that are intentionally self-serving, altruistic gestures are benevolently motivated. Although these dual relationships are not necessarily unethical, they do require careful management and consideration of pertinent cultural norms. Examples include social workers who provide informal assistance to friends and relatives outside of a formal professional-client relationship, accept gifts or social invitations from clients to avoid insulting them or hurting their feelings, performing favors for vulnerable clients (such as providing transportation, clothing, or temporary housing), and sharing personal information in response to clients’ questions about social workers’ lives.

Unanticipated circumstances Some boundary issues involve situations that social workers do not anticipate and over which they have little or no initial control. The challenge for social workers in these circumstances is to manage boundary issues in ways that minimize possible harm to clients and colleagues. Examples include social workers who live in remote rural communities and cannot avoid social encounters with clients, social workers whose close relative is dating a client or a client’s coworker, social workers’ inadvertent encounters with a client on an online dating site, and social workers’ encounters with clients in the local gym’s shower room.

Managing dual relationships To manage boundary issues effectively, social workers must develop a clear understanding of what distinguishes ethical and unethical dual relationships. A dual relationship is unethical 161

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when it has several characteristics (Corey & Herlihy, 1997; Epstein, 1994; NASW, 2017; Reamer, 2012), such as that the relationship is likely to • • • •

interfere with the social worker’s exercise of professional discretion interfere with the social worker’s exercise of impartial judgment exploit clients, colleagues, or third parties to further the social worker’s personal interests harm clients, colleagues, or third parties.

Social workers must be especially careful to consider how cultural and ethnic norms are relevant to boundary issues and how dual relationships are interpreted. To protect clients and minimize possible harm – and to minimize the possibility of ethics complaints and lawsuits that allege misconduct or professional negligence – social workers should establish clear “risk management” policies and procedures. A sound risk management protocol to deal with boundary issues should contain several major elements: 1 Be alert to potential or actual conflicts of interest. 2 Be cognizant of “red flags” that may signal a boundary problem. 3 Inform clients and colleagues about potential or actual conflicts of interest; explore reasonable remedies. 4 Consult colleagues and supervisors, and relevant professional literature, regulations, policies, practice standards, and ethical standards (codes of ethics) to identify pertinent boundary issues and constructive options. 5 Take into consideration pertinent social, cultural, ethnic, religious, and geographic norms related to boundaries. 6 Design a plan of action that addresses the boundary issues and protects the parties involved to the greatest extent possible. 7 Document all discussions, consultation, supervision, and other steps taken to address boundary issues.

Conclusion In recent years, social workers have developed a richer, more nuanced understanding of boundary issues in the profession, particularly with regard to variation in norms across and within cultures. To further enhance this understanding, social workers must examine dual relationships that are exploitive in nature and those that are more ambiguous, distinguishing especially between boundary violations and boundary crossings. Most important, skillful management of boundary issues enhances social work’s ethical integrity, one of the key hallmarks of a profession.

References Akamatsu, T. J. (1988). Intimate relationships with former clients: National survey of attitudes and behavior among practitioners. Professional Psychology: Research and Practice, 19, 454–458. Anderson, S., & Mandell, D. (1989). The use of self-disclosure by professional social workers. Social Casework, 70, 259–267. Bonosky, N. (1995). Boundary violations in social work supervision: Clinical, educational and legal implications. Clinical Supervisor, 13, 79–95. Borys, D. S., & Pope, K. S. (1989). Dual relationships between therapists and clients: National study of psychologists, psychiatrists and social workers. Professional Psychology: Research and Practice, 20, 283–293. 162

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Bouhoutsos, J. (1985). Therapist-client sexual involvement: A challenge for mental health professionals. American Journal of Orthopsychiatry, 55, 177–182. Bouhoutsos, J., Kolroyd, J., Lerman, H., Foster, B. R., & Greenberg, M. (1983). Sexual intimacy between psychotherapists and patients. Professional Psychology: Research and Practice, 14, 185–196. Brownlee, K. (1996). The ethics of non-sexual dual relationships: A dilemma for the rural mental health professional. Community Mental Health Journal, 32, 497–503. Celenza, A. (2007). Sexual boundary violations: Therapeutic, supervisory, and academic contexts. Lanham, MD: Jason Aronson. Chapman, C. (1997). Dual relationships in substance abuse treatment. Alcohol Treatment Quarterly, 15, 73–79. Coleman, E., & Schaefer, S. (1986). Boundaries of sex and intimacy between client and counselor. Journal of Counseling and Development, 64, 341–344. Congress, E. P. (1996). Dual relationships in academia: Dilemmas for social work educators. Journal of Social Work Education, 32, 329–338. Corey, G., & Herlihy, B. (1997). Dual/multiple relationships: Toward a consensus of thinking. In Hatherleigh Editorial Board (Ed.), The Hatherleigh guide to ethics in therapy (pp. 183–194). New York, NY: Hatherleigh Press. Doyle, K. (1997). Substance abuse counselors in recovery: Implications for the ethical issue of dual relationships. Journal of Counseling and Development, 75, 428–432. Epstein, R. (1994). Keeping boundaries: Maintaining safety and integrity in the psychotherapeutic process. Washington, DC: American Psychiatric Press. Feldman-Summers, S., & Jones, G. (1984). Psychological impacts of sexual contact between therapists or other health care practitioners and their clients. Journal of Consulting and Clinical Psychology, 52, 1054–1061. Gabbard, G. (Ed.). (1989). Sexual exploitation in professional relationships. Washington, DC: American Psychiatric Press. Gechtman, L. (1989). Sexual contact between social workers and their clients. In G. Gabbard (Ed.), Sexual exploitation in professional relationships (pp. 27–38). Washington, DC: American Psychiatric Press. Gifis, S. H. (Ed.). (1991). Law dictionary (3rd ed.). Happauge, NY: Barron. Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. American Journal of Psychiatry, 150, 188–196. Kagle, J. D., & Giebelhausen, P. N. (1994). Dual relationships and professional boundaries. Social Work, 39, 213–220. Kitchener, K. S. (1988). Dual role relationships: What makes them so problematic? Journal of Counseling and Development, 67, 217–221. Lazarus, A. A., & Zur, O. (Eds.). (2002). Dual relationships and psychotherapy. New York, NY: Springer. National Association of Social Workers. (2017). Code of ethics of the National Association of Social Workers. Washington, DC: Author. Pope, K. S. (1988). Dual relationships: A source of ethical, legal and chemical problems. Independent Practitioner, 8, 17–25. Pope, K. S. (1990). Abuse of psychotherapy: Psychotherapist-patient intimacy. Psychotherapy and Psychosomatics, 53, 191–198. Pope, K. S. (1991). Dual relationships in psychotherapy. Ethics and Behavior, 1, 21–34. Pope, K., & Bouhoutsos, J. (1986). Sexual intimacy between therapists and patients. New York, NY: Praeger. Pope, K., Tabachnick, B., & Keith-Spiegel, P. (1988). Good and bad practice in psychotherapy: National survey of beliefs of psychologists. Professional Psychology, 19, 547–552. Reamer, F. G. (1992). The impaired social worker. Social Work, 37, 165–170. Reamer, F. G. (2012). Boundary issues and dual relationships in the human services. New York, NY: Columbia University Press. Reamer, F. G. (2015). Risk management in social work: Preventing professional malpractice, liability, and disciplinary action. New York, NY: Columbia University Press. Reamer, F. G. (2018). Ethical standards in social work: A review of the NASW Code of Ethics (3rd ed.). Washington, DC: NASW Press. Reamer, F. G. (2019). Social work values and ethics (5th ed.). New York, NY: Columbia University Press. Reamer, F. G., & Nimmagadda, J. (2017). Social work ethics in India: A call for development of indigenized ethical standards. International Social Work, 60, 182–195. 163

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Schank, J. A., & Skovholt, T. M. (1997). Dual relationship dilemmas of rural and small-community psychologists. Professional Psychology: Research and Practice, 28, 44–49. Sell, J., Gottlieb, M., & Schoenfeld, L. (1986). Ethical considerations of social/romantic relationships with present and former clients. Professional Psychology: Research and Practice, 17, 504–508. Simon, R. I. (1999). Therapist-patient sex: From boundary violations to sexual misconduct. Forensic Psychiatry, 22, 31–47. Smith, D., & Fitzpatrick, M. (1995). Patient-therapist boundary issues: An integrative review of theory and research. Professional Psychology: Research and Practice, 26, 499–506. Smith, J. (1999). Holding the dance: A flexible approach to boundaries in general practice. In J. Lees (Ed.), Clinical counseling in primary care (pp. 43–60). New York, NY: Routledge. Stake, J. E., & Oliver, J. (1991). Sexual contact and touching between therapist and client: A survey of psychologists’’ attitudes and behavior. Professional Psychology: Research and Practice, 22, 297–307. St. Germaine, J. (1993). Dual relationships: What’s wrong with them? American Counselor, 2, 25–30. St. Germaine, J. (1996). Dual relationships and certified alcohol and drug counselors: A national study of ethical beliefs and behaviors. Alcoholism Treatment Quarterly, 14, 29–44. Strom-Gottfried, K. (1999). Professional boundaries: An analysis of violations by social workers. Families in Society, 80, 439–449. Syme, G. (2003). Dual relationships in counselling and psychotherapy. London: Sage. Woody, R. H. (1998). Bartering for psychological services. Professional Psychology: Research and Practice, 29, 174–178. Zur, O. (2017). Multiple relationships in psychotherapy and counseling. New York: Routledge.

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22 Social workers’ dilemma in ­patients’ rights on end-of-life care and decision-making ­under the new act in South Korea Sooyoun K. Han This work was supported by the National Research Foundation of Korea (NRF-2016S1A3A2925399)

The new legislation on end-of-life care and decision in South Korea The “Act on Decision on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life” (hereafter referred to as Act) [Enforcement Date 04 Aug, 2017] [Act No. 14013, 03 Feb, 2018. New Enactment] is a special law, and it was partially revised [Enforcement Date 28 Mar, 2019] [Act No. 15542, 27 Mar, 2018. Amendment] (Korea Ministry of Government Legislation; KMGL, 2018). Article 1 (purpose) of the Act defines the purpose is to prescribe matters necessary for life-sustaining treatment and determination to terminate, etc., life-sustaining treatment for patients in a hospice, receiving palliative care, and at the end of life, and the implementation thereof, and thereby to protect the dignity and value of human beings by assuring the best interests of the patients and by respecting their self-determination. The Act guarantees patients’ advance decisions on end-of-life (EOL) care to patients aged at least 19 years old. With the Act, the range of diagnoses for comfort care was extended to acquired immune deficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), and chronic liver cirrhosis and cancer. The Ministry of Health and Welfare (MHW) has performed several hospice pilot projects to develop the model of services according to Article 21 (Hospice Projects), paragraph 1 of the Act to assist in implementing programs and services (MHW, 2018a, 2018b, 2018c). Care expenses incurred for hospice institutions through ­A rticle 25 (Designation, etc., of Institutions Specialized in Hospice Care), paragraph 3 fully or partially, were reimbursed. Therefore, the Act is called the “well-dying act” and it serves to promote a person’s autonomy and provide institutional support for hospice and palliative care to the public, becoming a turning point for building the new death culture in South Korea. However, debate points are unavoidable, corresponding with some conflicts based on the Act. In the process of legislation, two individually proposed bills and seven related bills were 165

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submitted as one bill in the final stage of the law’s evaluation. After the bill’s deliberation, because of the different perspectives that led to multiple directions for the range and the application by the significant stakeholders, the Act embeds four distinct conflicts from its several underlying issues (Choi, 2016; Kim & Song, 2018; Lee, 2016; Suh, 2016). To be specific, first, the Act applies implementing stage into two different processes of the dying patient and the terminal patient, rarely understanding those stages without a professional medical knowledge and/or a legal assistance. Second, the Act restricts the range of patients’ terminal diseases, intentionally neglecting certain concerns of age groups related to end stages of dementia. Third, the Act deprives patients’ rights to designate a health care proxy as a surrogate for their decision-making in advance, not corresponding to patients’ preferences on EOL care decision. And finally, the Act limits patients’ rights to choose only four options of the life-sustaining treatments, firmly implementing only for cardiopulmonary resuscitation, hemodialysis, the administration of anticancer drugs, and respiration. For such reasons, the right to autonomy for some groups who have been disabled in making decisions can lead to serious deficits in implementing the legislation such as children without biological parents, elderly patients at the end stages of dementia, person with mental illnesses, and person with no family or legally approved relatives for their surrogate decision-making.

Social and cultural movement toward “good death” Korean society has not openly discussed death culture as it has shifted from traditional burial rituals to hospital-based cremation rituals since the “Act on Funeral Services, ETC” [No. 6158, January 12. Full Amendment], [Enforcement January 13, 2001] (KMGL, 2001). The whole society could not try to integrate of the meaning of a “good death” to enlarge the type and procedure of burial. They responded only to social needs to developed cities and regions. In a result, it imposed on Korean society to distract from personal graves with a legally formulated new death rituals. In the past 20 years, it has led to an unexpected final scene of the death ritual. The cremation ratio was about 82% in 2016, an increase of 60% compared to 1994 (Korea Funeral Culture & Policy Institute, 2017). It unifies more people to end their lives in a hospital emergency room affiliated with a luxury funeral home instead of a personal home. The definition of a “good death” is not simply to imply the scope of individual experience throughout the death of a significant other or the personal dying process. It has also been transformed from the experience of whole groups who have engaged in the process of dying within their socially approved perceptions (Kwon, 2015). By analyzing the themes of a “good death,” 11 main themes were classified to explain the perception (Meier et al., 2016): 1 preference for a special EOL care decision process, 2 freedom from pain, 3 fulfilling religion and spirituality, 4 emotional peace, 5 completion of life, 6 preference for treatments, 7 dignity, 8 family, 9 quality of life, 10 relationships with medical personnel, and 11 other. 166

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Bennett and Proudfoot (2016) found that the conversation among patients, their families, and their medical teams played an important part in the “good death” that patients perceived. According to the Korean national survey of the meaning of “good death,” they perceived the themes of a “good death” as mostly (1) being with family members and/or significant others in the end stages of life, (2) being less burdensome to family, (3) having a well-­ completed life, (4) ending life that was planned, (5) dying pain free, and (6) fulfilling religiously and spiritually (Yun et al., 2018). Interestingly, they did not endorse the themes of a “good death” as preference for a special EOL care, or a relationship with medical personnel.

International human rights instruments supporting patients’ right to self-determination in the EOL care and decisions International Bill of Human Rights for patients on the EOL care and decision The International Bill of Human Rights comprises three documents. A universal Declaration of Human Rights, an aspirational document, a nonbinding in its format, was adopted by General Assembly Resolution 217 A (III) on December 10, 1948 (United Nations; UN, 1996). Article 1 states, all human beings are born free and equal in dignity and rights. This is the basic assumption, that the right to liberty and equality are humanity’s birthright and cannot be taken away. The UN developed two formal drafts, legally binding treaties that impose obligations on those States. Both international instruments of human rights – the ­International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social and Cultural Rights (ICESCR) – contain measures of implementation in the field of human rights. Related to patients’ right to EOL care and decisions, ICCPR, Article 7 states that human beings shall have the right to prohibit torture, inhumane or degrading treatment, or punishment. Article 19, paragraph 2 states that everyone shall have the right to freedom of expression, including freedom to seek, receive, and impart information and ideas of all kinds. Thus, if a state party confers a particular benefit of any kind on a person or group of persons, it must be accorded in a nondiscriminatory fashion. That is, distinctions drawn by law must be based on reasonable and objective grounds, these being criteria the Committee may assess, to be consistent with this provision (UN, 2005). The UN Special Rapporteur on Torture and on Health have stated that the denial of access to pain relief, if it causes severe pain and suffering, may amount to cruel, inhumane, or degrading treatment or punishment (UN, 2010). ICESCR, Article 12 defines the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, which suggests availability, accessibility, acceptability, and quality of care as important elements (UN, 2000). The Human Rights Committee reported three core obligations to take steps to realize the rights to exercising health on the basis of nondiscrimination. First, the obligation to respect requires states to refrain from interfering directly or indirectly with the right to health. Second, the obligation to protect requires states to prevent third parties from interfering with the right to health. And finally, the obligation to fulfill requires states to adopt appropriate legislative, administrative, budgetary, judicial, promotional, and other measures to fully realize the right to health.

The rights for children on EOL care and decisions In the Convention on the Rights of the Child (CRC), Article 13 specifies that children shall have the right to freedom of expression including the freedom to seek, receive, and 167

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impart information and ideas of all kinds. In addition, the CRC stipulates children’s rights to receive accurate information about their illness, symptoms, and palliative care including that information must be available, accessible, acceptable, and of good quality to children by governments (UN, 1989).

The rights for persons with disabilities on EOL care and decisions In the Convention on the Rights of Persons with Disabilities (CRPD), Article 3, “Respect for inherent dignity, individual autonomy,” Article 12, “Equal Recognition Before the Law,” and Article 21, “Freedom of Expression and Opinion, and Access to Information,” state that all appropriate measures shall be taken to ensure that persons with disabilities can exercise the right to freedom of expression and opinion, including the freedom to seek, receive, and impart information and ideas on an equal basis with others and through all forms of communication of their choice. Article 25 states that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability (UN, 2006).

The rights for elderly on EOL care decisions The elderly’s rights principle 14 defines that they should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care, or treatment facility, including full respect for their dignity, beliefs, needs, and privacy, and that they should have the right to make decisions about their care and the quality of their lives (UN, 1991). The Madrid International Plan of Action on Ageing (UN, 2002) has been a guideline for the responsibilities of its member states providing for (1) older persons and development, (2) advancing health and well-being into old age, and (3) ensuring enabling and supportive environments.

National health care insurance system on EOL care and decisions The Korean health insurance system has covered the entire population of the country by the universal health care plan since 1988. Insurance benefits are provided for the insured or their dependents’ injuries, childbirth, health promotions, rehabilitations, or preventions of diseases (National Health Insurance Service; NHIS, 2015). It also covers long-term acute care for the geriatric hospital, to provide medical and nursing care in case of diseases, injuries, rehabilitation, and nursing for elderly patients. And it covers the long-term care (LTC) benefit plan to provide support for physical activity and nursing care of elderly patients residing in LTC residential institutions (NHIS, 2015). It offers full coverage of services with only less than 20% co-payment regardless of insured’s income and property. With the Act, MHW is operating 81 inpatient institutions, 25 home institutions, 20 counsel institutions, and 11 inpatient institutions at geriatric hospitals (National Hospice Center, 2018). An inpatient institution provides care by a doctor, nurse, and social worker as compulsory staff and offers nonmedical services by therapists, volunteers, clergy, and health aids (MHW, 2018a). A home institution provides care in the patient’s home, with exclusive nurse service for 24/7 through phone consult as well as with physical visit (MHW, 2018b). The counsel institution is a hospital team that cooperates with the doctor in charge and offers discharge services to link inside and outside institutions in the network (MHW, 2018c). Article 38 (medical professionals quota), Paragraph 2 of the enforcement regulations of the Medical Act (enforced 01/01/2018) (Decree of the Ministry of Health and 168

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Welfare, No. 485, Partially Amended 03/7/2017) requires that there be only one person in charge of consultation and guidance out of those who are qualified social workers in a general hospital. They recently became compulsory hospice staff; however, unlike medical staff, they have very limited work conditions such as only one social worker in place, a nonregistered position, and a lack of supervision (Shim, 2017). Their knowledge did not meet the level to educate and inform about EOL care and decisions in LTC facilities (Han, 2016a). The education level of those who have worked in a geriatric hospital and LTC facilities can also effect on their intention for EOL care (Han, 2016b; Kwon, Park, & Song, 2014).

Social workers’ dilemma based on the ethical standards Patients with delayed decisions Article 10 (Drafting/Registering a Plan for Medical Care for Life Prolongation), Paragraph 1 of the Act stipulates that the primary physicians provide information on the plan for life-­ sustaining treatment and hospice care for terminally ill patients. However, due to the culture of Korean society that is against death and a lack of a medical system that can support primary physicians in advance care planning (Shim et al., 2016), the patient or their family cannot expect to receive sufficient consultation. Children or elderly patients who are unable to fill out the form showing their intent for advance directives must rely on the decision made by their family regardless of their preferences. If their family actively seeks treatment, then the decision for hospice care will be delayed.

Patients whose intentions are difficult to verify Article 17 (verifying patient intent), Paragraph 1, Subparagraph 3 of the Act stipulates if a patient who is 19 years of age or older is in a medical state that renders them unable to express their intent, the patient’s intent must be confirmed through the unanimous statement of at least two or more family members (Those who are 19 years of age or older). The scope of a family member is spouse, direct descendant, direct ascendant, brother or sister if none of the other three qualifies. The patient’s decision must first be based on autonomy, but an ­authorized representative must be prepared in case of a situation where the patient is unable to make a decision (Baker, 2016). However, the Act states that rather than designating an authorized representative, the family’s decision takes the place of the patient’s intent, and the primary physician can decide on the patient’s life-sustaining treatments or hospice care based on the legally verified statement of family members. Therefore, patients who cannot declare their intent due to psychiatric disorders or medical condition, particularly the ones who do not have family members or have differing family statements, have no ­decision-maker available.

Patients who are only given limited options Article 2 (definitions), Paragraph 6 of the Act refers to “hospice patients” as patients who received a terminal diagnosis for any of the following clauses (A. cancer, B. congenital immune deficiency syndrome, C. chronic occlusive respiratory disease, D. chronic liver cirrhosis, E. other disease as determined by the Decree of the MHW) or patients who are in the process of death. Moreover, Article 14 (establishment and management of an institutional review 169

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board), Paragraph 1 of the Act says that the medical institution that will be making the decision for life-sustaining treatment or implementing tasks related to the execution must set up an Institutional Review Board (hereafter “IRB”) at the medical institution. Article 19 (executing the decision for life-sustaining treatment), Paragraph 2 of the Act stipulates that even if the patient wishes to end aggressive medical care, simple provisions, such as nutrient supply, water, and oxygen, must continue to be given. And the scope of the decision for medical care for life prolongation and hospice care may differ depending on the patient’s disease or whether or not the hospital has an IRB. For example, terminal dementia patients have difficulty getting hospice services, and nutrients must still be supplied even if a terminally ill patient does not want medical care for life prolongation. Patients at geriatric hospitals or hospice institutions must be transferred to a hospital with an IRB if they wish to make the decision for implementing their decision for life-sustaining treatment.

Social worker’s ethical standard and dilemma on patients’ EOL care and decision Social workers must work with people who are in a vulnerable or difficult state and represent their standpoint and must consider whether or not they are performing their tasks based on the ethical values and standards as a professional (National Association of Social Workers, 2018). Therefore, social workers in a health care setting may experience dilemmas regarding the rights of vulnerable patients and the quality of life at the EOL; hence, the following practices will be discussed according to ethical standards. First, from the perspective of social justice, all patients must be able to participate in the process of deciding on the care they receive at the end of their life in a fair and meaningful way, and there must not be any differentiation in the scope or content of their choice (Elwyn & Edwards, 2016). Social workers must take part in various civil liberty activities such as developing a medical system that supports doctor consultations so that patients can be part of advance care planning with the doctor from the beginning of their diagnosis, expanding the range of those who are eligible for hospice care, including terminal dementia patients and other various terminally ill patients, partaking in policies that enforce the requirement of an IRB in all geriatric hospitals and hospice institutions, and amending laws. Second, from the perspective of dignity and worth, all patients must be able to receive support so that they can solve the various conflicts that occur from the values they pursue and institutional issues during the process of EOL care and decision (Baker, 2016). Social workers must provide training and consultation so that patients can take the initiative in filling out a form showing their intent for advance directives and an informed consent form, and must expand on promotion projects and death training projects that inform the patient, family members, medical professionals, and the general public about every patient’s right to make their own decisions. Consultation must be provided for the family of patients who are unable to declare their intent. Third, from the perspective of the social worker’s competence, the patient and their family must be able to ask for professional and continual assistance during the process of EOL care and decision ( Joynt et al., 2015). Social workers must have professional knowledge regarding medical care for life prolongation and improve their practice so that they can participate in EOL care planning, and must continuously provide services through training and supervision. 170

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References Baker, I. (2016). Ethics at the end of life. Medicine, 44(10), 598–601. Bennett, R., & Proudfoot, J. (2016). What does the staff think? Factors association with clinical staff perceptions of what constitutes high-quality dying and death at a tertiary pediatric hospital. Journal of Hospice & Palliative Nurse, 18(5), 470–476. Choi, K. (2016). Legal and ethical issues regarding end-of-life care in Korea. Development and Society, 45(1), 151–164. Elwyn, G., & Edwards, A. (2016). Shared decision making: A path to customized rather than commercialized health care. In G. Elwyn., R. Thompson., & A. Edwards. (Eds.), Shared decision making in health care. New York, NY: Oxford University Press. Han, S. (2016a). The effects of South Korean social workers’ professional resources on their understanding of a patient’s rights to end of life care decision in long term care facilities. Asian Social Work & Policy Review, 10, 200–209. Han, S. (2016b). Social work perspective: Comparing Korean social workers’ education and knowledge of advance directives. Development and Society, 45(2), 255–274. Joynt, G. M., Lipman J., Hartog, C., Guidet B., Paruk, F., Feldman, C., … Sprung, C. L. (2015). The Durban world congress ethic round table IV: Health care professional end-of-life decision making. Journal of Clinical Care, 30(2), 224–230. Kim, H., & Song, M. K. (2018). Medical decision-making for adults who lacks decision-making capacity and a surrogate: Stage of the science. American Journal of Hospice & Palliative Medicine, 35(7), 456–463. Korea Ministry of Government Legislation. (2001). Act on funeral services, ETC. Retrieved from http://­ korealaw.go.kr/lsInfoP.do?lsiSeq=8163&ancYd=20000112&ancNo=06158&ef Yd=20010113&nwJo YnInfo=N&efGubun=Y&chrClsCd=010202#0000 Korea Ministry of Government Legislation. (2018). Act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life. Retrieved from http://www.law.go.kr/lsSc.do?tabMenuId=tab18&p1=&subMenu=1&nwYn=1§ion=&tabNo=&query=%EC%9D%98%EB%A3 %8C%EB%B2%95#undefined Korea Funeral Culture, & Policy Institute. (2017). Funeral statistics 2016.12. Retrieved from http:// www.kfcpi.or.kr/infoMadang/funeral_stat_view.do#eyJzZXJ2aWNlZGl2aWQiOiJCMDAwMD AwMDA3IiwiY3VzdHNlcSI6NTk3MH0= Korea Ministry of Health and Welfare. (2018a). In-Patient hospice institution hospice service guideline. Retrieved from http://hospice.cancer.go.kr/hospice/front/boardView.do?keykind=&keyword=&page_now&returl=/hospice/front/boardList.do&listurl=/hospice/front/boardList. do&brd_mgrno=181&menu_no=442&brd_no=88907 Korea Ministry of Health and Welfare. (2018b). Guideline for home hospice pilot service. Retrieved from http://hospice.cancer.go.kr/hospice/front/boardView.do?keykind=&keyword=&page_now& returl=/hospice/front/boardList.do&listurl=/hospice/front/boardList.do&brd _ mgrno= 181&menu_no=442&brd_no=88905 Korea Ministry of Health and Welfare. (2018c). Guideline for counsel hospice pilot service. Retrieved from http://hospice.cancer.go.kr/hospice/front/boardView.do?keykind=&keyword=&page_ now&returl=/hospice/front/boardList.do&listurl=/hospice/front/boardList.do&brd_mgrno= 181&menu_no=442&brd_no=88906 Korea National Health Insurance Service. (2015). National health insurance program: Insurance benefit. Retrieved from https://www.nhis.or.kr/static/html/wbd/g/a/wbdga0405.html Korea National Hospice Center. (2018). The status and statistic of Korean hospice palliative service. Retrieved from http://hospice.cancer.go.kr/home/contentsInfo.do?menu_no=443&brd_mgrno=Kwon, S. A., Park, Y. S., & Song, J. Y. (2014). A study on impact of end of life care intention of geriatric social worker. Health and Social Welfare Review, 34(2), 187–218. Kwon, S. H. (2015). From biological death to human death. Social and Philosophy, 30, 199–223. Lee, J. (2016). A critical review on the hospice, palliative care, and life-sustaining treatment ­d ecision-making act. Study of Law, 16(4), 219–245. Meier, E. A., Gallegos, J. V., Thomas, L. P., Depp, C. A., Irwin, S. A., & Jeste, D. V. (2016). Defining a good death (successful dying): Literature review and a call for research and public dialogue. American Journal of Geriatric Psychiatry, 24(4), 261–271. National Association of Social Workers. (2018). Code of ethics of the National Association of Social Workers. Washington, DC: Author. 171

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Shim, S. H. (2017). Factors influencing turnover intention of hospice social worker (Unpublished doctoral dissertation). Korea University, Seoul. Shim, H., Chang, Y. J., Kwak, K., Mai, T. T. X., Choi, J. Y., Ahn, E. M., Jho, H. J., & Park, S. (2016). Do Korean doctors think a palliative consultation team would be helpful to their terminal cancer patients? Cancer Research and Treatment, 49(2), 437–445. Suh, Y. J. (2016). End-of-life and hospice issues in Korean aging society. Development and Society, 45(2), 213–230. United Nations. (1989). Convention on the rights of the child. Retrieved from http://www.ohchr.org/EN/ ProfessionalInterest/Pages/CRC.aspx United Nations. (1991). Principles for older persons. Retrieved from http://www.ohchr.org/EN/ ProfessionalInterest/Pages/OlderPersons.aspx United Nations. (1996). Fact sheet No. 2 (Rev. 1): The international bill of human rights. Retrieved from http://www.ohchr.org/Documents/Publications/FactSheet2Rev.1en.pdf United Nations. (2000). General comment No. 14: The right to the highest attainable standard of health (Art. 12) (Contained in Document E/C.12/2000/4). Retrieved from http://www.refworld.org/ pdfid/4538838d0.pdf United Nations. (2002). Political declaration and Madrid international plan of action on ageing. Retrieved from https://www.un.org/development/desa/ageing/madrid-plan-of-action-and-its-implementation. html United Nations. (2005). Civil and political rights: The human rights committee fact sheet 15 human rights. Retrieved from http://www.ohchr.org/Documents/Publications/FactSheet15rev.1en.pdf United Nations. (2006). The convention on the rights of persons with disabilities and its optional protocol [A/RES/61/106]. Retrieved from http://www.un-documents.net/a61r106.htm United Nations. (2010). Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. Retrieved from https://www.ohchr.org/en/issues/torture/srtorture/ pages/srtortureindex.aspx Yun, Y. H., Kim, K. N., Sim, J. A., Kang, E., Lee, J., Choo, J., … Jung, K. H. (2018). Priorities of a “good death” according to cancer patients, their family caregivers, physician, and the general population: A national survey. Support Cancer Care, 26(10), 3479–3488.

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23 An effective theoretical ­approach to ethical problem-solving in cross-cultural social work Valerie Bryan, Laura Kaplan, Scott Sanders, Stephen Young, and Paul Mwangosi

As social problems resulting from global migration and interdependence of countries around the world have increased, the need for additional attention regarding ethical cross-cultural social work is needed (Barner & Okech, 2013). However, little guidance from social work curriculum standards in the United States (CSWE, 2015) is provided to educators to help familiarize social work students with these rising international issues (Barner & Okech, 2013) such as global inequalities, Western cultural hegemony, and differential access to resources, including technology. Social work curricula need to address positive and negative consequences and strategies in globalization and prepare graduates to address and understand their related challenges. These discussions are pertinent to cross-national practice and cross-national efforts to define professional values and multicultural changes within nations. When encountering cross-cultural practice, social workers continually face a series of questions. Are there any universal truths in cross-cultural social work practice? Are ethical standards of helping professions always dependent on cultural application, or are some principles universally accepted across all societies? Competing schools of thought in ethics differ in the extent to which ethical rules are viewed as fixed or contextual. These points of view are at the heart of debates in the human rights arena, where they are often labeled the universalist and cultural relativist positions (Dolgoff, Harrington, & Loewenberg, 2005). The deontological position, first proposed by Immanuel Kant, is universal, in applying duties to all rational agents (Dolgoff et al., 2005). The universalist’s view is that all humanity shares the same inalienable rights and duties, diminishing the role of culture (Donnelly, 1984). The utilitarian position (see Bentham, Mill) conversely holds that ethical principles are contingent upon expected outcomes, promoting the greatest good for the greatest number, which would take into account cultural context, and can be considered relativistic (Bryan, Sanders, & Kaplan, 2016; Dolgoff et al., 2005). Examples of the universalism/relativism debate can be seen in how health providers navigate complex health decisions across the globe. Since the development of strict confidentiality regulations such as HIPAA in the United States, social workers are extremely concerned with protecting client confidentiality (Reamer, 2013). With rare exceptions (e.g. duty to warn cases), social workers cannot share confidential information about clients with 173

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their family members without consent. However, in other cultures, the family unit is considered primary, so much so that social workers are expected to share client information with the family; even in the absence of the client’s consent, individual’s privacy interests are secondary (Reamer, 2013). Indeed, in some cultures, the concept of informed consent is not widely recognized (Njhawan et al., 2013). Furthermore, in other cultures, family members are inclined to share confidential information about the client with the social worker, fully expecting that the social worker will not tell this information to the client (e.g. concerning the client’s poor health prognosis) (Mobeireek et al., 2008). Social workers may find their positions on the universalism/relativism continuum are not static but change depending upon the particular situation. Clearly, social workers must be careful to avoid assuming that their professional ethical standards translate equally well to other nations’ cultures. Thus, the key purpose of this chapter is to introduce an ethical framework that balances the extremes of universalism and relativism by accounting for cultural differences while recognizing the common, universal harms all rational people wish to avoid, known as common morality.

Common morality Gert (2006) conceptualized and published his common morality framework in 1970. Gert and colleagues published Bioethics: A Return to Fundamentals (Gert, Culver, & Clouser, 1997) to introduce this framework to the bioethics and philosophy fields. Common morality has been presented to other disciplines, most recently social work, as a framework for ethical decision-making (Bryan, 2006; Bryan et al., 2016). Rather than attempting to create an ideal moral system, Gert’s moral theory assumes an underlying universal moral system exists and understanding its explication will aid ethical decision-making. Common morality is comprised of moral rules (prohibitions avoiding harm) and ideals (actions that prevent harm) that guide rational persons in avoiding harms (Kaplan & Bryan, 2009). The framework also clarifies how one might justify moral rules violations. It is not possible for any moral system to guarantee unique “right” answers to every problem. The moral system exists and is evident in the widespread consensus on most moral matters. For example, people agree that killing is wrong although many will likely differ about what (if anything) justifies killing. Such disagreements may be attributed to variance in cultural, religious, and personal beliefs or values. Gert considers these cultural differences in the description of morally relevant features, the questions used to consider exceptions to the moral rules.

Nature of common morality The common moral system is: (1) an informal public system; (2) agreed upon by all rational individuals; (3) is characterized by impartiality; and (4) consists of both moral rules and ideals. As an informal public system, common morality is inclusive of all educational levels and cultural or socioeconomic identities, and it applies to and is agreed upon by all rational agents. Rationality is defined by its obverse, irrationality, that is, any action that increases risk of harm to self or others with no corresponding benefit or adequate reason is irrational (Gert et al., 1997). The moral system comprises rationally required and rationally acceptable beliefs. Rationally required beliefs hold that all persons are vulnerable and wish to avoid 174

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certain harms such as death, pain, disability, and loss of freedom or pleasure. Rationally acceptable beliefs are not morally required in a civil society. Belief in a single omniscient deity, for example, is not rationally required for all persons to cooperate and avoid harms; it is, however, rationally acceptable for persons to hold divergent views about the nature or existence of deities.

Rules and ideals Common moral rules (rationally required) must be applied impartially to all rational persons. Both the concepts of rationality and impartiality underscore the universal nature of the common moral system: rationality in that all rational persons want to avoid harms, impartiality because the moral rules inherent in the moral system apply to all rational persons. Moral rules delineate the harms that all rational persons want to avoid, including: 1 Do not kill. 2 Do not cause pain. 3 Do not disable. 4 Do not deprive of freedom. 5 Do not deprive of pleasure. 6 Do not deceive. 7 Do not cheat. 8 Keep your promise. 9 Obey the law. 10 Do your duty. Moral ideals are not required; they are morally encouraged to prevent or reduce the risk of encountering harms. They involve action one may choose to take but they are not a requirement for one to act morally. An ideal may become a moral rule if that ideal is explicitly articulated as professional’s duty. Therefore, one may be required to act based upon a moral ideal because it is required by their profession.

Violating moral rules In everyday life moral rules are violated. Gert’s explication of the moral system accounts for how these violations are justified or not. An ethical dilemma occurs in any situation that results in the violation of a moral rule. For example, social workers, in fulfilling their duty, will make decisions that cause pain. When faced with such decisions, we are obligated to ensure that the decision is morally justifiable. Justifying the violation of a moral rule is a two-step process involving the consideration of both the morally relevant features pertinent to the situation and the rationality and impartiality of publicly allowing the violation. Identify the morally relevant features of the case. Herein, we separate morally relevant facts from those not morally relevant. Gert (2006) provides ten questions to determine whether or not a fact or circumstance is morally relevant to the case: 1 Which moral rule is being violated? 2 What harms are: a caused by the violation; 175

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b avoided by the violation; c prevented by the violation? 3 What are the desires and beliefs of the person toward whom the rule is being violated? 4 Is the nature of the relationship between the person violating the rule and the person toward whom the rule is being violated such that the former may have a duty to violate certain moral rules with regard to the latter without their consent? 5 What goods are being promoted by the violation? 6 Is the rule being violated toward a person in order to prevent her from violating a moral rule when her violation would be (a) unjustified or (b) weakly justified? 7 Is the rule being violated toward a person because he has violated a moral rule (a) unjustifiably or (b) with a weak justification? 8 Are there any alternative actions or policies that would be morally preferable? 9 Is the violation being done intentionally or only knowingly? 10 Is the situation an emergency such that people are not likely to plan to be in that kind of situation? Estimate the consequences of everyone knowing that the violation is publicly allowed. What might be the long-term effects of publicly allowing a moral violation? Consider the willingness to falsify information on behalf of a client who needs services. In the moment, there may be moral considerations that make doing so seem rational and reasonable. Being known and allowed by the public means the violation would be justifiable for all needy clients and that all professionals would be allowed to do the same thing in similar situations with similar clients in an impartial fashion. It would likely also require a violation of the moral rule to obey the law, placing clients, the professional, and the profession at greater risk for harm. It cannot pass the rationality test, because allowing all social workers to lie about all clients needing services raises the level of harm spread into society by an immeasurable amount without a corresponding benefit of the same magnitude.

General moral rules made culturally specific In two identifiable ways, common morality accounts for cultural variation: first, in the morally relevant features review, Question 3 asks about the relevant beliefs/desires of the person who would experience rules violations. Obviously, this includes cultural values and beliefs. Second, the approach offers a simple formula to make any general moral rule or ideal culturally specific: general moral rule + cultural practice or institution = culturally specific moral rule. For instance, consider a society with rigid moral standards about nudity with plenty of beaches. Here, the general moral rule is made specific to this society in the following manner: Do not cause pain (of embarrassment) + rigid moral codes about nudity and beaches = culturally specific moral rule not allowing nudity at public beaches. This may or may not be reflected in the law (though it is implemented in the United States in many places); it may be merely socially controlled by the community. The same formula applies to ideals. Because the social work professional community is required to provide informed consent, it can be argued that social workers have an obligation to provide ideal informed consent or risk placing clients in gravely harmful circumstances (see prior discussion on ideals; Bryan et al., 2016).

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Cross-cultural case application Box 23.1 The Lukala family The Lukala family’s matriarch, Amidah, is a 78-year-old great-grandmother whose health has suffered a steep decline in recent months following heart failure. This Tanzanian immigrant’s doctor is Dr. Brown at Everytown Hospital, United States. Dr. Brown, increasingly concerned about her health and several complicating factors, including multiple urinary tract infections and frequent falls, strongly advises the Lukala family to work with you, the medical social worker, to find an appropriate long-term care facility staffed with medical professionals who can meet Amidah’s medical needs. The horrified looks on the family’s faces indicate resistance to the idea. In whispered tones, the family discusses the option as Amidah weeps inconsolably. Her granddaughter addresses Dr. Brown, stating, “Doctor, we cannot do this. Grandma has a family she can live with. We will care for all of her needs. She needs her family around her as she transitions to the last phase of life.” Dr. Brown, apparently aggravated by this resistance, tells the family,

Look. Are any of you doctors? I’m telling you, you won’t be able to meet her needs. Her situation is highly complex and to treat her requires advanced medical knowledge. To not allow her access to this type of facility may constitute medical neglect,

stating the last sentence in a stern, somewhat threatening tone. More gently, he says, “Please, go with Ms. X (you), and discuss your options more fully. I am sure you will feel more comfortable with the idea after you have met with her.” The family stares at you warily. Should you support Dr. Brown’s strongly worded advice to the Lukalas, and push the option of long-term institutional care?

Analysis First and foremost, it should be obvious to the reader that the person with the most ethical responsibility to act morally is Dr. Brown. This, however, does not exculpate Ms. X from moral judgment. Much like social workers in the 1950s who facilitated the return of often-unjustifiably lobotomized patients to their family homes, Ms. X is complicit in any harms suffered by the Lukala family if she supports and advocates the doctor’s position and it is deemed morally unjustifiable (Margolin, 1997). It is obvious that the family objects strongly to institutional placement over staying with the family. This is in fact a revered tradition in Tanzanian culture, to care for and deeply respect the elders in the family and clan, because elderly people are the custodians of customs and traditions and placing them in an institution indicates failure for the family. This is a cultural consideration that many Tanzanian families simply would not ever entertain (Crispin & Katzenstein, 2006). Thus, we begin the two-step analytic process to determine first, if any

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rules violations occur if Ms. X advocates for the doctor’s suggestion of a long-term care institution, and then second, determine if the action is morally justifiable.

Morally relevant features and moral rules The framework does not require an answer to every question of the ten. It is under the discretion of the analyst to determine if a question applies. However, it is clear that certain questions are commonly asked across cases. The first, “What moral rules would be violated?” is in reference to the social worker advocating for the doctor’s position. It would clearly cause the family great pain, and deprive the family of freedom and pleasure. The social worker may not be fulfilling her duty. Question 2 requires us to place the findings from Question 1 into the case context. The reason why those rules would be violated is because it is out of step culturally to place Tanzanian elders in institutions when old and ill (Crispin & Katzenstein, 2006). It would deprive the family of freedom to make their own decision about the care of their great-­g randmother, as well as the pleasure of maintaining a close familial relationship in her waning years. Arguably, the social worker may not be doing her duty if she does this, as it reflects cultural incompetence. What harms is the doctor trying to prevent? Obviously, he wants to prevent unnecessarily early death from serious, but treatable conditions. It is unknown how long her life can be prolonged, however, or what quality of life she would experience if confined to an institution. This is of limited value in the analysis. Harms avoided really don’t exist, as the length of her survival is merely a matter of probabilities and not certain. Question 3 illustrates the way the framework can embrace cultural differences, asking what the client’s relevant beliefs and desire might be about the current situation. As a great-grandmother from a traditional Tanzanian household, her expectation was and remains that she will die of old age in the comfort of her home surrounded by loved ones. She likely also expects that her wish will be respected and not challenged. The family’s considerations should be included as well, as Tanzanian culture is much more communitarian than Westernized notions of family. They likely expect to be able to fulfill their family obligations by caring for Amidah and removing her from their care robs them from their ability to do so, a strong sign of disrespect for tradition and for the elders in their community. Question 4 is not applicable as it is primarily of concern when someone has a designated legal representative to make decisions on one’s behalf. Doctors sometimes do have this relationship, but only in cases of incompetence. There is no indication that Amidah is incompetent to make this decision. Question 5, goods promoted by the violation (s) is essentially question 2 in reverse. The doctor hopes to prolong her life and health by pushing for institutional care. The same concerns about probabilities and quality of life temper the value of this answer here as well. Questions 6 and 7 do not apply as they are limited to situations of legitimate punishment and prevention of crime and/or delinquency or other inappropriate social behavior. Question 8 forces us to consider alternative actions. In this case, there may be several: A deeper exploration of Tanzanian culture to better educate the medical staff about cultural differences in end-of-life issues could significantly help. An exploration of the practices and policies of available institutions would help the family know what to expect if they considered that option. The doctor and social worker can, in tandem, explain what Amidah would likely experience with home care over institutional care. Essentially, anything that can help the family make a fully informed decision could be viewed as a mitigating alternative action. The harms caused by this would occur only knowingly and not intentionally, as the doctor and social worker are not seeking to inflict harm for harm’s sake, but because they want to 178

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provide the best care possible (Question 9). Last, this is not an emergent situation; it is routine, yet personally challenging for families (Question 10).

Justification We must ask, is it rational for the doctor to push this idea on recalcitrant clients? It is due to the doctor’s desire to extend her life. Could all doctors and social workers forcefully advocate for long-term care in facilities against strong objections by families? The answer is a gray-area response. Some may believe that, yes, they could in fact do this in every case. Other rational and reasonable people would say no, that in many cases this reveals cultural ignorance and disrespect, and would cause too much pain across the population of elderly patients, especially those with backgrounds and traditions outside of Western norms, to even be rational. What brings the analysis into sharp relief is the consideration of public allowance. Would this still be okay if everyone knew that doctors would advocate breaking up families that violate their cultural traditions at the end of life, and for social workers to facilitate such separation? What are the long-term consequences of this? The fear that this could cause across multicultural populations is immense and very important to consider. People may shy away from ongoing medical maintenance checkups due to fear of the consequences. Practices could suffer and fail to be sustainable due to a lack of patients. Overall access to health care for everyone could decline. For these reasons, we believe this to be an unjustified violation of moral rules and should not be allowed.

Conclusion To conclude, we have shown that common morality, the approach to ethics that makes what is implicitly known about morality explicit and systematic in its application, is neither purely deontological nor utilitarian (or relativistic) in nature. It recognizes that while general moral rules are universal, social and cultural forces shape those universal rules into culturally specific formulations, sometimes but not always codified in community laws. This allowance makes the use of common morality a particularly useful aid in working cross-culturally. Common morality takes the best of “what works” from the idealistic frameworks of deontology (universalism) and utilitarianism (relativism) and melds them into a decision-making system that puts clients’ best interests first, and from their perspective. It helps protect against unjustified and ethnocentric paternalism, a common rules violation in helping and health professions. It focuses on the violation of universal moral rules, prompting the worker to evaluate potential outcomes (utilitarian in nature) and other morally relevant features. Justifying rules violations also requires a deontological evaluation of cases based in universalizability through questions pertaining to impartiality and public allowance of choices. This is simply an articulation of an intuitive process working through moral problems. By making implicit moral understanding explicit, we believe common morality can foster the development of a more mature, culturally sensitive approach to ethics that is sorely needed in work with diverse populations who need assistance.

References Barner, J. R., & Okech, D. (2013). Teaching globalization to social work students: In and out of the classroom. Social Work Education, 32(8), 1061–1074. Bryan, V. (2006). Moving from professionally specific ideals to the common morality: Essential content in social work ethics education. Journal of Teaching in Social Work, 26(3–4), 1–17. 179

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Bryan, V., Sanders, S., & Kaplan, L. (2016). The helping professional’s guide to ethics: A new perspective. New York, NY: Oxford University Press. Crispin, B., & Katzenstein, J. (2006). The effect of cultural diversity on the design of a telemedicine system in Tanzania. International Journal of Diversity in Organisations, Communities, and Nations, 5(4), 21–28. CSWE (2015). Educational Policy and Accreditation Standards. Retrieved from https://www.cswe. org/Accreditation/Standards-and-Policies/2015-EPAS Dolgoff, R., Harrington, D., & Loewenberg, F. M. (2005). Ethical decisions for social work practice. ­Belmont, CA: Brooks/Cole. Donnelly, J. (1984). Cultural relativism and universal human rights. Human Rights Quarterly, 6, 400–419. Gert, B. (2006). Morality: Its nature and justification. New York, NY: Oxford University Press. Gert, B., Culver, C. M., & Clouser, K. D. (1997). Bioethics: A return to fundamentals. New York, NY: Oxford University Press. Kaplan, L., & Bryan, V. (2009). A conceptual framework for considering informed consent. Journal of Social Work Values and Ethics, 6(3). Retrieved from http://www.socialworker.com/jswve/ Margolin, L. (1997). Under the cover of kindness: The invention of social work. Charlottesville, VA: The University Press of Virginia. Mobeireek, A. F., Al-Kassimi, F., Al-Zahrani, K., Al-Shimemeri, A., al-Damegh, S., Al-Amoudi, O., … Gamal-Eldin, M. (2008). Information disclosure and decision-making: The Middle East versus the Far East and the West. Journal of Medical Ethics, 34(4), 225–229. Njhawan, L. P., Janodia, M. D., Muddukrishna, B. S., Bhat, K. M., Bairy, K. L., Udupa, N., & ­Musmade, P. B. (2013). Informed consent: Issues and challenges. Journal of Advanced Pharmaceutical Technology and Research, 4(3), 134–140. Reamer, F. G. (2013). Social work in a digital age: Ethical and risk management challenges. Social Work, 58(2), 163–172.

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Section VI

Mezzo practice settings

24 Ethics and values in ­social group work Mark Doel

What is social group work? In order to consider the place of ethics and values in social group work, an understanding of group work is necessary. The term covers a broad spectrum of practice within social work and beyond, from clinical practice in groups that are created by the groupworker (Gitterman & Salmon, 2009), to self-directed groups in which members join together to provide their own mutual aid (Fleming & Ward, 2013), to community action groups in which the focus is radical societal transformation rather than personal change (Kronenberg, Pollard, & S­ akellariou, 2010). The question of when is a group a group? (and when is it not a group?) is complex, but wherever there are three or more people gathered for a mutual purpose we can speak of there being, at the least, a group-in-waiting (Doel, 2006, 2012). The active use of group process is needed to transform a collection of individuals into a group; and group work is the collection of skills that transform a gathering of individuals into a system of mutual aid and, often, collective action (Mullender, Ward, & Fleming, 2013; Steinberg, 2004). The notion of “Flash groups” allows for the possibility of spontaneous group work, in contrast to created groups, often in situations of adversity (Doel, 2007). Group process is ethically neutral; it can be used for the common good or harnessed to manipulate others. Several infamous social experiments have demonstrated the potential negative power of group process, in particular the dangers of groupthink, where peer pressure produces a false consensus in a group of people determined to become like-minded even when truths self-evidently point in another direction (Turner & Pratkanis, 1998). A more subtly unethical practice arises when the potential for group work is squandered. For instance, when service users are gathered in a group but are treated as individuals-in-a-group with a failure to use the potential for group process. This fails the ethical test of good practice by default.

Group work values Group work is practiced in a variety of situations with diverse purposes and practice methods. In individualistic cultures, group work is valued because it brings people together to experience mutuality, whilst in more collectivist societies the group can be a place where 183

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individuals are able to find their own separate voices (Cohen et al., 2012). Two universal values of social group work are interdependence and participation. The group will likely make demands of its members to join in and to find common linkages to create interdependence. Group leaders demonstrate their value for the agency of group members by empowering them to shape the group in order to develop a sense of belonging and ownership. There are always challenges to this ideal, ones that require the group leaders’ abilities to work with them. In tandem with the collectivism of group work is the respect for individuals and the diversity of their biographies, belief systems, and life experiences. The group might be meeting for a common purpose – to campaign for better housing, to prepare for transition to foster care, to remedy earlier life traumas, to avoid a custodial sentence – but an ethical group allows individual journeys and solutions to emerge. Group members ought to experience the power of giving as well as receiving, of being part of others’ solutions as they help each other. The recognition of difference and similarity, and valuing them, is key to successful group work. The values of group work are made explicit in the internationally recognized Standards for Social Work Practice with Groups (IASWG, 2010).

Epic and everyday ethics Moral philosophy is inclined to draw on epic dilemmas thrown up by Big Questions – ­nuclear weaponry, euthanasia, capital punishment, wartime killings, and the like. However, social groupworkers face more nuanced ethical decisions, at times so fine-tuned that they can pass unnoticed. Later we will examine these singularities (Doel, 2016) and consider the everyday relevance of ethical theories, as well as the benefit that group members can derive from participation in moral discourse. For now, let us briefly explore how the ethical world has been mapped by Western philosophy. The ethical framework that speaks most closely to the moral universe of the people who experience social work is virtue ethics. Research from client studies suggests that it is the personal qualities of social workers that service users value: warmth, respect, and trustworthiness guide their judgment of the worth of the social worker (Ruch, Turney, & Ward, 2010). Virtue ethics, in which personal qualities are of paramount importance, arise from ­A ristotle’s ­Nicomachean Ethics. However, determining these virtuous characteristics is problematic. A ­ sking the group how it thinks a “good” group ought to behave can open up the notion of virtue. Consequences figure strongly in ethical theory. In consequentialism, good and bad are defined by outcomes and, in utilitarianism, ends justify means if good actions bring the greatest sum of happiness for the greatest number of people (Mill, 1863). In the context of group work, would the exclusion of one member from the group be right if it brought greater happiness for the rest of the group? What if the consequence for that person was that they committed suicide? Taking each situation case by case, weighing different factors in our moral scales is referred to as casuism or situational ethics. There is some evidence that social workers operate mainly from a moral position of casuism in which context weighs heavily (Doel et al., 2010). In deontological ethics, good actions are those arising from a sense of duty: a good act is one that is performed without regard to consequence but from a sense of “ought” (Kant, 1797/1991). Group participants who have been given the options of group attendance or imprisonment have not made a moral decision to join the group, though they might nevertheless benefit from it. Duty-based ethics stand in opposition to actions taken as a “convenience to self ” ( Joseph & Fernandes, 2006, p. 30), but how are these duties and obligations to be determined? 184

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In the search for an everyday ethics for social groupworkers, the new ethics – the ethics of care (Held, 2006; Meagher & Parton, 2004; Parton, 2003) and relational ethics (Banks, 2012) – might prove well suited. The ethics of care focus on interpersonal relationships rather than the individual’s rights or virtues, or calculations of utility. Relational ethics better reflect the collective nature of group work, unlike most Western ethical frameworks that place the individual at the center of their moral universe; however, as Hugman (2005, 2013) has noted, people need to feel sufficiently connected to one another to care about values in the first place. Perhaps a society that demonstrates its care for its people through the development of strong systems of collective health care, universal welfare, and social security is more likely to produce individual citizens who care about rights and values? Can a population that is treated carelessly be expected to concern itself with values, over and above keeping themselves safe or giving themselves a competitive edge? Social group work has been employed in quite explicit ways to develop civic society: best known is the creation of the conditions for a democratic society in post-Nazi Germany by using social group work at a grassroots level (Kalcher, 2004). Learning to work well in a group is good practice for learning to participate as an active citizen. Another ethical framework suited for group work is a non-Western paradigm known as surrender ethics (Rif kin, 2009). Surrender, the ability to let go, is central to holistic cultures such as First Nation American and Australian Aboriginal. Value conflicts are subsumed into an empathic solidarity in which the collective experience is most valued. “Letting go” requires high levels of empathy and interdependence, at the human level and also with the animal and natural worlds – not dissimilar to the land ethic (ecological) of Leopold (1949).

The “wise groupworkers” Social work practice is continually faced with ethical issues, many of which surface as dilemmas (Banks, 2012; Banks & Nøhr, 2012) – choices between different routes that have ethical implications. I have elsewhere developed the notion of the “wise professionals” in which social workers discover and nurture their inner moral philosopher (Doel, 2016). This is true for group work. The wise groupworkers can be people whose group work practice you admire and would like to emulate, or imagined, idealized groupworkers that you aspire to become. They are groupworkers, plural, in recognition of the fact that different value judgments can be equally valued and equally “right.” The wise groupworkers are an expression of philosophic skepticism, too, a notion that the best actions and decisions arise from Socratic dialogue, even if this discourse is only with yourself. My own position as a social groupworker is that moral issues cannot be resolved in a prescriptive manner, not by lists of dos and don’ts, and that situations need to be approached from a position of philosophical skepticism, which means being open to different possible meanings – doubt, in the philosophic sense. Moral discourse only occurs when we are genuinely interested in exploring “right” and “wrong” and not when we seek only to win our argument or assert our will. Groupworkers can help group members to do this if they are able to reason this way themselves. Facilitating group members to achieve precision in moral reasoning, to find their inner moral philosophers, is one of the greatest gifts the group can give.

Different values within the group Conflicting values in the group can be interpreted by group facilitators as an obstacle in the journey to mutual aid; yet these value conflicts are the grist to provoke the change that is frequently a primary purpose of the group. 185

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Let us consider an example. Ruth and Kyle are leading a group for parents with children at risk of being taken into public care. One couple, Sherrine and Shad, believe in strong discipline in the form of rules and punishment, and they find themselves in conflict with Jessica and Justin who emphasize children’s self-expression and are dismissive of routine. The rest of the group find themselves siding with one or other camp. Inexperienced groupworkers could try to mediate, seeking some middle-ground compromise. However, Ruth and Kyle use their understanding of group process and ethical frameworks to help the group understand the different values that underpin the diverse beliefs, and they do this in a value-free manner: in other words, they do not give weight to one set of values over the other, even if they feel more connection to one of them. Rather than make compromising statements (“whichever approach you’re taking to managing your child’s behavior, everyone has the best interests of their child at heart”) or seek the middle ground (“perhaps we can create some structure for the child whilst allowing some flexibility”), the ethically minded groupworker asks questions of the group that help members to verbalize the values behind their beliefs: “When Sherrine says that she sent her son to his room because he was late back from his after-school club, what are the values that are supporting that action?” The group understands the question because Ruth and Kyle have introduced the notion of values from the first session, so the group is versed in this way of thinking. Notice, too, how the whole group is asked about the values behind Sherrine’s behavior; it becomes a group effort rather than spotlighting one person. Even those in the “other camp” are asked to put themselves in Sherrine’s shoes. Likewise, the whole group is asked: “When Justin says that he let his daughter stomp out of the house and throw her toys around the garden with no consequences, what values support that action?” Groupworkers Ruth and Kyle are modeling moral reasoning used in a value-free, nonjudgmental framework. They give no moral commentary on the rights and wrongs of the various parents’ actions and they involve the whole group in a search for ethical understanding. Of course, during the discussions some values might emerge as more or less caring or effective in their consequences, and the groupworkers might help the group reflect on this; but the differences are respected and it is the group that develops its own understanding of these differences, guided by the groupworkers. There are times when the value base of a group member contravenes a higher principle such as respect for others. For instance, Donald says that he hates Muslims and if they came to live next door he would build a big wall so he didn’t have anything to do with them. The inexperienced groupworker sees “racist” and decides to shut the discussion down: “That’s a completely unacceptable statement and I have to be clear that we won’t allow racist comments in the group.” However, an ethically alert groupworker recognizes an opportunity to open a discussion based on values; admittedly, Donald is unlikely to experience a Damascene conversion, but at least he and the rest of the group will find a better understanding of the values that lead him to this belief. Also, group members learn that taboo topics can be introduced without fear they will be trampled. Having introduced the notion of values from the first session, the groupworker can ask, “Donald, I’m interested in what the values are that lead you to make that statement?” The groupworker speaks of the values, not your values, as a way of objectifying them, bringing them into the center of the group for inspection, rather than locating them “in” Donald. In this case, the groupworker asked Donald to explore the values rather than opening it to the group because on this occasion it is important for Donald to start this particular journey into a better understanding of the values behind Islamophobia. In reality, it can take many of these kinds of discussion for any shifts to develop – and they might not become apparent until long after the group has finished. 186

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Value differences between coworkers Groups with more than one leader have the potential for value conflicts between the coworkers (Doel, 2006). Again, let us view this conflict as an opportunity rather than a challenging obstacle. What better way to understand how value conflicts ought to be addressed than a demonstration by the groupworkers themselves? Taking the earlier example of Donald, what if Kyle shuts the discussion down whilst Ruth pursues a line of questioning to explore Donald’s values? Kyle points to the ground rules already agreed by the group, about respect and anti-racism. Ruth reminds the group of the importance of reflecting on their own values. This is an opportunity for the coworkers to model how conflicting values can be subject to moral reasoning; for instance, to discuss the difference between rule-governed ethics and the ethics of care. Kyle and Ruth can discuss with the group “watching in attendance,” or they can involve the group – not in taking sides but in engaging in moral reasoning. Indeed, if they wanted to have some fun with it, they could agree to take each other’s positions – Kyle arguing Ruth’s case for an exploration of values and Ruth arguing Kyle’s for closing the discussion.

Singularities Earlier I considered the need for an everyday ethics to match the moment-to-moment decisions in group work, the singularities that are junctures where a choice determines the direction of the group (Doel, 2016, pp. 101–111). Often, we are unaware of their s­ ignificance – who knows what might otherwise have been? Let us explore a singularity, using different ethical frameworks. Sam and Winston are coleading a group in a drug rehabilitation center. It is a drop-in group with a core of seven regular members, all young men who use the day facilities. The purpose of the group is to provide mutual aid and support to keep free of drug use. Toward the end of the session, Ritchie is accused by another group member, Stan, of some “weird sh*t behavior” the previous day and, before he can censor himself, Ritchie blurts out, “yeah, well, I was high wasn’t I?” The group leaders have a dilemma: what to do with this information? They stand at the crossroads of various choices, all of which have ethical dimensions. Sam’s ethical stance is deontological, or rule-based, and the set of rules agreed at the beginning of each session states that illegal behavior is unacceptable and will be reported. But group member Danny reminds Sam that they also have a rule that what’s said within the group stays within the group. Sam retorts that it is a matter of principles and that the illegality principle is higher than the confidentiality one. Danny replies that the confidentiality ­principle is about trust and that without trust people won’t be honest. Danny is taking a utilitarian line – the greater good is achieved by respecting honesty and that honesty is a consequence of confidentiality (Clark, 2006). Majid joins the discussion by declaring Ritchie to be a good person, one that he admires for his qualities of honesty and caring about people. Majid is arguing from virtue ethics – good character and personal qualities matter most. Carlos counters by saying that it’s unfair if Ritchie “gets away with it” just because Majid likes him: “Ritchie should get the same treatment as Marlon, even though everyone knows Marlon is as sh*t!” Carlos is arguing from a Kantian ethical position in which equal respect for people is paramount, no matter what they have done or what their character. Danny comes back and pleads for empathy with Ritchie’s position, telling how he knows Ritchie was dumped by his girlfriend a couple of days ago (“sorry, Ritchie, but I think they 187

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should know”) and that this excuses his uncharacteristic lapse. Danny is arguing from both an ethics of care – empathic compassion should be what guides us– and casuism – each case ought to be judged according to its own circumstances. Listening to all this is Darren who is thinking, “Well, I got a fix yesterday, too, but I had the good sense not to mention it – but is it right that I should benefit from my own dishonesty?” The group has been undertaking a journey through ethical theory using everyday moral reasoning, even if the jargon to describe these theories is off-putting – deontological, etc. The group leaders now need to help the group reflect on the process and, indeed, to praise it for the quality of the reasoning. Whatever decision is taken, the most significant learning for the group is that it arises from sustained and careful moral reasoning. Moreover, the initial moral (duty-based) position taken by one of the leaders, Sam, might be overturned by the dialectical power of the group. If this were the case, it should not be seen as a climb-down, but as the logical conclusion of a reasoned discussion, in which the equal worth of all members, including leaders, has been respected.

Consent and evaluation Alongside the issue of confidentiality raised in the previous section, an area of particular ethical concern in group work is that of consent, in particular, the degree to which participants in groups have given informed consent to be there. Have involuntary group members – those who attend instead of a custodial sentence, for instance – given consent under duress and, in that case, is it ethically acceptable? In considering this question we need to step back and ask to what extent most members of social work groups are there because they “consent” or want to be? Most people would prefer not to be a woman with severe and enduring mental health problems, a person with alcohol addiction, a person suffering dementia and memory loss – just as most would not wish themselves to be in the position of choosing between prison and a compulsory course of group treatment. The extent of each person’s free will is another kind of philosophical question, but with a bearing on ethical considerations (Sartre, 1946). To what extent ought we to be held responsible for our life choices? It is in the area of consent and disobedience that moral and political philosophy shade into one another (Plamenatz, 1938; Singer, 1973). We do not have space to explore this in detail, but the question of whether it is ever right to break the law and, if so, in what circumstances is of immediate relevance to social action groups such as animal rights activists and national liberation movements. The groupworker has a practice dilemma, if not a specifically ethical one, when leading a group with involuntary members: how to make a group work well when its members have not freely chosen to take part? The evidence suggests that these groups can be very successful (Rooney, 2009). This would satisfy a utilitarian perspective, where ends justify means. Perhaps the group members’ evaluation of the group once they had experienced it (compared to what might have been had they been imprisoned) ought to be weighed in the ethical scales? There is an ethical imperative for groupworkers to evaluate groups and, in the spirit of the core value of empowerment in group work, to do so in ways that are member-led. At this point in the chapter, I hope readers are able to construct their own lines of moral reasoning for the process of group evaluation. In what ways can the “worth” of the group be evaluated? Invariably, sponsors of groups (such as the agency employing the groupworker) take a largely consequentialist approach to these evaluations – in terms of the outcomes for individual members of the group. Referring back to the other ethical paradigms that have been explored, what other value might be attached to a group and, therefore, what different qualities might 188

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be evaluated? For instance, in a group that follows a prescribed curriculum (“a manualized group”), a duty-based ethical evaluation might focus on the extent to which the program had been carefully followed. In this chapter, we have explored the significance of different ethical frameworks to the practice of social group work. The importance of values has been emphasized, as has the opportunity that groups offer to learn and teach about moral reasoning via group process. Far from being an esoteric branch of philosophy, ethics is central to the lives of all who participate in groups, whether as leaders or members.

References Banks, S. (2012). Ethics and values in social work (4th ed.). Basingstoke: Palgrave Macmillan. Banks, S., & Nøhr, K. (Eds.). (2012). Practising social work ethics around the world. Abingdon: Routledge. Clark, C. (2006). Against confidentiality? Privacy, safety and the public good in professional communications. Journal of Social Work, 6(2), 117–136. Cohen, C., Doel, M., Wilson, M., Quirke, D., Ring, K., & Abbas, S.A. (2012). Global group work: Honouring processes and outcomes. In A. M. Bergart, S. R. Simon, & M. Doel (Eds.), Group work: Honoring our roots, nurturing our growth (pp. 107–127). London: Whiting and Birch. Doel, M. (2006). Using groupwork. London: Routledge/Community Care. Doel, M. (2007). Flash groups. Groupwork, 17(3), 3–7. Doel, M. (2012). When is a group not a group. In G. J. Tully, K. Sweeney, & S. Palombo (Eds.) ­G ateways to growth (pp. 129–138). London: Whiting and Birch. Doel, M. (2016). Rights and wrongs in social work: Ethical and practice dilemmas. London: Palgrave. Doel, M., Allmark, P., Conway, P., Cowburn, M., Flynn, M., Nelson, P., & Tod, A. (2010). Professional boundaries: Crossing a line or entering the shadows. British Journal of Social Work, 40(6), 1866–1889. Fleming, J., & Ward, D. (2013). Facilitation and groupwork tasks in self-directed groupwork. Groupwork, 23(2), 48–66. Gitterman, A., & Salmon, R. (Eds.) (2009). Encyclopaedia of social work with groups. New York, NY: Routledge. Held, V. (2006). The ethics of care. Oxford: Oxford University Press. Hugman, R. (2005). New approaches in ethics for the caring professions. Basingstoke: Palgrave. Hugman, R. (2013). Ethics. In M. Davies (Ed.), The Blackwell companion to social work (pp. 379–386). Chichester: Wiley-Blackwell. IASWG. (2010). Standards for social work practice with groups (2nd ed.). Alexandria, VA: Author. Retrieved from www.iaswg.org Joseph, J., & Fernandes, G. (Eds.). (2006). An enquiry into ethical dilemmas in social work. Mumbai: ­College of Social Work. Kalcher, J. (2004). Social group work in Germany: An American import and its historical development. In C. Carson, A. Fritz, E. Lewis, J. Ramey, & D. Sugiuchi (Eds.), Growth and development through group work (pp. 51–72). New York, NY: Haworth Press. Kant, I. (1797/1991). The metaphysics of morals (M. J. Gregor, Trans.). Cambridge: Cambridge University Press. Kronenberg, F., Pollard, N., & Sakellariou, D. (Eds.). (2010). Occupational therapies without borders – ­Volume 2: Towards an ecology of occupation-based practices. London: Elsevier. Leopold, A. (1949). A sand county almanac. Oxford: Oxford University Press. Meagher, G., & Parton, N. (2004). Modernising social work and the ethics of care. Social Work and Society, 2(1). Retrieved from http://www.gptsw.net/wp-content/uploads/MeagarParton.pdf Mill, J. S. (1863). Utilitarianism. London: Parker, Son and Bourn. Mullender, A., Ward, D., & Fleming, J. (2013). Empowerment in action: Self-directed groupwork. London: Palgrave. Parton, N. (2003). Rethinking professional practice: The contributions of social constructionism and the feminist “ethics of care”. British Journal of Social Work, 33(1), 1–16. Plamenatz, J. (1938). Consent, freedom and political obligation. Oxford: Oxford University Press. 2nd edition published 1968. 189

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Rif kin, J. (2009). The empathic civilization: The race to global consciousness in a world in crisis. New York, NY: J.P. Tarcher/Penguin. Rooney, R. (2009). Strategies for work with involuntary clients (2nd ed.). New York, NY: Columbia ­University Press. Ruch, G., Turney, D., & Ward, A. (Eds.). (2010). Relationship-based social work. London: Jessica Kingsley. Sartre, J-P. (1946). Existentialism and humanism. Paris: Les Editions Nagel. Singer, P. (1973). Democracy and disobedience. Oxford: Oxford University Press. Steinberg, D. M. (2004). The mutual-aid approach to working with groups: Helping people help one another (2nd ed.). New York, NY: Haworth Press. Turner, M., & Pratkanis, A. (1998). Twenty five years of groupthink research. Organizational Behavior and Human Decision Processes, 73(2), 105–115.

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25 Ethical challenges in group work Potential perils and preventive practices Mary Banach and Roshini Pillay

Groups have been a staple method of social work intervention since the beginning of the profession’s origin. Throughout the life cycle, individuals encounter various groups; thus, group work is an important intervention for social workers. Social work pioneers utilized groups to facilitate socialization, help manage difficult life transitions, and further advocacy efforts. Mutual aid, one of group work’s primary principles, coincides with the social work value of the importance of human relationships. The power of group work has regularly been recognized for its healing and empowerment potential in work with various clients (Breton, 2000; Drower, 1993; Gitterman & Knight, 2016; Gutiérrez & Ortega, 1991; ­Williams, 2000). Globally, there are many social conditions that have found the power of groups to be beneficial such as crime, poverty, violence, HIV and AIDS, substance use, and sexual abuse (Shisana et al., 2013). As with any intervention modality, social workers need to be aware of potential ethical challenges that can arise in practice. Social work as a practicing profession requires ethical conduct (Lee, 2018; Teater, 2011). It is envisaged that this chapter will increase awareness of some of the ethical dilemmas social workers conducting groups may experience and point out proactive measures that can be taken to reduce these ethical quandaries. Groups traditionally have been used in a variety of settings. Fields of practice including mental health, child welfare, elderly and adult services, and addiction treatment have regularly included group work in service offerings. Currently, additional fields of practice in which groups are regularly utilized include adventure and wilderness therapy (Gillen & Balkin, 2006; Williams, 2000; Davis-Berman & Berman, 1994), immigration and refugee services (Breton, 2000), and hospital settings (Foreman, Willis, & Goodenough, 2005; Keast, 2012). As group work moves into the future, the use of technology and the development of online groups will increase and new ethical dilemmas will challenge practitioners and group members. Consideration regarding how data will be used and who accesses the data will need to be implemented. In addition, fake identities may emerge in online platforms presenting challenges to the practitioner and the group. Technology is ubiquitous and has positive and negative impacts (Bendini, 1993). The benefits include online groups that can reach members who are not mobile or live in hard to reach geographical areas (Meier, 2000). The use of text-based communication can allow members to be more reflective about their posts. 191

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However, use of technology that is available 24/7 can result in an invasion of privacy and disrupts work/life balance. Several client populations use groups as a treatment mainstay. Clients struggling with ­a lcohol and substance addiction are regularly involved in groups as a part of both inpatient and outpatient services (Anderson, 1982; Engle & Macgowan, 2009). Practitioners refer ­clients to 12- step programs and peer run groups. Various child welfare programs employ groups for work with children (Coholic, Oystrick, Posteraro, & Lougheed, 2016), parents (Knight, 2017), and families (Wong, Ma, & Chan, 2015). Groups are also a regular service offering for clients who are struggling with domestic abuse. (Fuchsel & Hysjulien, 2013; Black, Weisz, Mengo & Lucero, 2015). One issue emerging from the literature points to training gaps in learning and remaining proficient in group work skills. Gumpert and Black (2006) note a reduction in robust group work content in many social work educational programs. Training gaps become more apparent considering the advent of online groups (Holmes & Kozlowski, 2015), the need for sensitivity to intersectionality (Crenshaw, 1989), and the impact of globalization (Freeman, 1987). Groups offer many opportunities for healing and are a regular component of social work practice. There are some ethical challenges that are distinctive to group work, while other challenges can arise in all methods of practice. The following paragraphs detail the ethical challenges that can develop in group work practice. Dual relationships, seen as a social worker having a connection with a client outside the professional role, can be a challenge in both individual work and group work. The possibility of dual relationships has higher probability in rural areas and in group work with clients struggling with addiction (Doyle, 1997). In work with clients struggling with addition, professionals in recovery themselves may attend the same 12-step meetings as former/ current clients. Dual relationships can lead to oversharing of personal information if caution is not used. The most important consideration regarding dual relationships is “availability” (Herlihy & Corey, 1992). Social workers need to consider the way their activities may create situations in which dual relationships can arise (Haas & Malouf, 1989). One ethical challenge, relevant to all modes of practice, that can be particularly difficult in group work is the issue of informed consent. Various concerns are connected within informed consent. Within group practice, for members to provide consent freely, the purpose of the group must be clear and language about the group adapted to meet the needs of participants (Palmer & Kaufman, 2003). Group work services for clients struggling with addiction are faced with questions about the potential of intoxication at the time of consent (McCrady & Bux, 1999). Mandates or coercion into treatment also present challenges to informed consent for group participants. This is true both in groups serving clients struggling with addiction (Chiauzzi & Liljegren, 1993) and groups for adolescents in wilderness therapy programs (Koocher, 2003). Client confidentiality also has several potential ethical concerns. Within group work, social work facilitators are bound to preserve client confidentiality. Within different countries, confidentiality is mandated by laws overseeing licensing for professionals, federal or regional laws protecting health information (Becker, 2010), and federal laws protecting clients struggling with addiction (Legal Action Center of the City of New York, 1995). Challenges to confidentiality in group work can also arise due to issues related to specific client problems, settings, and group facilitator training. Clients can be stigmatized because of the struggle with issues they face. This can occur, for example, with clients having addiction problems and clients infected or affected by HIV and AIDS. Confidentiality for these clients therefore needs to be carefully safeguarded (Cottone & Robine, 1998; Scott, 2000) 192

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Challenges can occur when clients are mandated to treatment and group work facilitators are required to produce reports regarding attendance and participation. In groups working with people infected and affected by HIV and AIDS, boundaries must be respected and members need to be in control of the amount of information they wish to share (Drower, 2005). The setting in which a group takes place can likewise present ethical challenges for facilitators. In less formal settings, such as wilderness therapy or community centers, practitioners may feel less bound by ethical and legal aspects of confidentiality (Becker, 2010; Russell, 2001; Cavalier, 1987). The location in which the group takes place needs to consider the special needs of members such as members who are wheelchair bound. Location is an important factor in groups for clients with disabilities. Issues of access, privacy, and anonymity are concerns particularly if representatives or interpreters are present (Dodds, Yarbrough, & Quick, 2018). Group facilitator training can additionally be a factor in challenges to confidentiality. Should groups be facilitated by social workers or personnel that have not been given adequate information on the legal parameters of confidentiality, risks for breaches of privacy are present. Breaches in confidentiality constitute negligent and unethical treatment regardless of the setting or facilitator (Becker, 2010). Related to challenges connected to confidentiality are concerns about maintaining ethically sound boundaries in practice. Boundaries are patterns of behavior defining who or what are included in systems (Boyle, Hull, Mather, Smith, & Farley, 2009). Boundaries point to appropriateness of role behavior. In group work, maintaining clear and appropriate boundaries can be challenging within different situations. Practitioners must always be particularly mindful of professional and personal boundaries and the potential to cause harm to both an individual client and the entire group (Becker, 2010; Mama & Ward, 2010). Concern about boundary violations has intensified because of fears connected to malpractice claims (Lazarus, 1994). Although arguments have been made for potential therapeutic benefits of relaxed boundaries (Williams, 1997), the current trend is toward more clearly delineated boundaries (Lazarus, 1994; Williams, 1997). Group work with culturally diverse clients has potential ethical challenges for practitioners. As noted, one of the issues confronting social workers generally is the increased global context for work with clients. Within this context, power and control are essential issues to consider in ethically sound group work (Rittner & Nakanishi, 1993). Ethical aspects include the degree to which group members are part of the design, implementation, and evaluation of the process. Anti-oppressive practice requires that issues of power and oppression are foregrounded (Lindsay & Orton, 2014; Delgado & Humm-Delgado, 1982). Factors that require consideration include: communication with minority group members; the use of language; role of race, color, gender, and language of the group facilitator; the capacity of the group leader to recognize issues of power especially professional power; the ability of the group leader to be open to introspection; and recognition of decolonizing pedagogy. The function of pedagogy is important to look at biases present in literature. Steinberg and Salmon (2009) concur that sharing knowledge and views on group work addresses one of the big crises in group work. The increase of groups as an intervention is hindered by a “lack of education courses and material on the subject” (Steinberg & Salmon, 2009, p. 174). For example, in South Africa, the only apparent recent book produced by educators and practitioners from within that country is by Becker (2005). This book was authored by mainly White people, thus marginalizing the views of Black people in South Africa. Ethical challenges can ensue when group facilitators do not recognize cultural diversity or the route/context of members to the group. As an example, unique to South Africa is the 193

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cultural value of Ubuntu “umuntu ngumuntu ngabantu” (Mokgoro, 1998) roughly translated means “I am because we are.” The value of Ubuntu examines how ones identity is shaped by the community, the collective culture, and society (Steinberg & Salmon, 2009). In group work, Ubuntu can be used to embrace the concept of mutual aid and how group members support each other and resolve ethical concerns. Several issues and challenges face group facilitators working with immigrants and refugees. Ethical breaches can emerge without sufficient consideration by social workers. Timberlake and Cook (1984) emphasize the need to recognize multiple losses and trauma. Immigrants and refugees face the loss of social networks, a way of life, employment, and their national/ territorial identity amongst others. Connected with these losses can be a sense of cultural dissonance (Portes & Rumbaut, 1990; Potocky, 1996) and social isolation (Seward & M ­ cDade, 1988). As noted earlier, when reflecting on power and control, language barriers are a major issue for group work facilitators to address (Giles, 1988; Padilla, 1997). Confidentiality and privacy concerns emerge with immigrants and refugees who face problems of domestic violence (Holt, Kirwan & Ngo, 2015; Lovell, Thuango, & Nguyen, 1987; Nah, 1993). Group work facilitators, regardless of setting or client population, are required to attend to the needs of their clients. When organizational obstacles interfere with the needs of the group or group members, social workers encounter an ethical challenge. Ethical obligations require advocating within the organization or system to overcome the obstacle which may limit group work activity (Goodman, 2006 Hoefer, 2000). Wood and Middleman (1989) point to the need for social workers to attain insight into organizational function. If this insight is deficient, the possibility of ethical challenges increases. Group work is multifaceted and complex. The years of experience does contribute to what is crudely described as developing a “gut feel,” but as you begin to develop competence and capability, here are some suggestions that can help along the way for making ethical decisions. In reality, there is no set method that can be suggested for all situations when you encounter an ethical quagmire in group work as each situation is unique. The beginning stages of a group require in-depth screening and contracting which can be formal and outline the codes of conduct and the limits of confidentiality such as child abuse, harm of others, member protection, and referrals should the needs of the member not suit the group (­Toseland & Rivas, 2009). Developing a good understanding of the laws of the country, the constitution, the international and national codes or standards that govern both social work and group work is essential. Group workers should keep abreast with current trends through examination of new literature and research. For example, when working with groups on HIV and AIDS or drug dependency, there is a requirement to understand current treatments and resources for these clients. Masson, Jacobs, Harvill, and Schimmel (2012) agree that insight, training, and education serve to counter the “most frequent group unethical practice in group counselling [which] occurs when untrained or inexperienced leaders conduct groups” (p. 36). In addition, supervision offers a sounding board to put things into perspective and helps a group worker to better understand the medical or legal dilemmas that may arise. An experienced supervisor would be a good resource and offer a wealth of knowledge about how to prevent ethical challenges. Moreover, the supervisor should have a comprehensive understanding of agency policy and procedure. Awareness of personal blind spots and biases will provide an understanding of the way a group leader behaves in groups and understands diversity. Being reflective and keeping a diary will help the group leader make sense of the group process. Lindsay and Orton (2009) suggest a novel but sensible approach. This involves recognizing when there is something 194

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difficult in a group, which could include an ethical dilemma, and to do nothing immediately, but wait a while before doing something. Within a session, this might entail pausing before carefully considering a response. After a group session, doing nothing immediately suggests a waiting period allowing for greater clarity of thinking so that sound minds prevail. Conducting a SWOT analysis (strengths, weaknesses, opportunities, and threats) is another option to better understand the ethical dilemma in the group. Dhai and McQuiod-Mason (2011) offer the following five steps to analyze an ethical issue taken from the World Medical Association. First, formulate the problem, then gather information, next consult authoritative sources, consider the different options, and finally make a moral assessment. While these steps are used in medicine, they have value for a social worker overcoming an ethical dilemma when working with groups. Finally, understand the power that is attributed to the group worker especially coercive power and expert power. These types of power can be useful or destructive. Thus, the group worker needs to share power and encourage mutual aid in the group (Toseland & Rivas, 2009). Whilst ethical practice in group work is an iterative process and will evolve based on context and time, the need for research and revision will keep the power of groups alive.

References Anderson, S. C. (1982). Group therapy with alcoholic clients: A review. Advances in Alcohol & Substance Abuse, 2(2), 23–40. Becker, L. (2005). Working with groups. Cape Town: Oxford University Press Southern Africa. Becker, S. P. (2010). Wilderness therapy: Ethical considerations for mental health professionals. Child & Youth Care Forum, 39(1), 47–61. Bedini, L. (1993). Technology and people with disabilities: Ethical considerations. Palaestra, 9(4), 25–28/30. Black, B. M., Weisz, A. N., Mengo, C. W. & Lucero, J. L. (2015). Accountability and risk assessment: Members’ and leaders’ perspectives about Psychoeducational Batterers’ Group. Social Work with Groups, 38(2), 136–151. Boyle, S., Hull, G., Mather, J., Smith, L., & Farley, O. W. (2009). Direct practice in social work (2nd ed.). Boston, MA: Allyn and Bacon. Breton, M. (2000). The relevance of the structural approach to group work with immigrant and refugee women. Social Work with Groups, 22(2–3), 11–29. Cavalier, A. (1987). The application of technology in the classroom and work place: Unvoiced premises and ethical issues. In A. Gartner & T. Joe (Eds.), Images of the disabled, disabling images (pp. 129–142). New York: Praeger. Chiauzzi, E. J., & Liljegren, S. (1993). Taboo topics in addiction treatment: An empirical review of clinical folklore. Journal of Substance Abuse Treatment, 1, 303–316. Coholic, D. A., Oystrick, V., Posteraro, J., & Lougheed, S. (2016). Facilitating arts-based mindfulness group activities with vulnerable children: An example of nondeliberative social group work practice. Social Work with Groups, 39(2–3), 155–169. Cottone, R. R., & Robine, S. (1998). Addictions and ex-offender counseling. In R. R. Cottone & V. M. Tarvydas (Eds.), Ethical and professional issues in counseling. Columbus, OH: Merrill. Crenshaw, K. (1989). Denationalizing the intersection of race and sex: A black feminist critique of non­ orum, discrimination doctrine, feminist politics and anti-racist politics. University of Chicago Legal F 139, 139–167. Davis-Berman, J., & Berman, D. S. (1994). Wilderness therapy: Foundations, theory, and research. Dubuque, IA: Kendall/Hunt. Delgado, M., & Humm-Delgado., D. (1982). Natural support systems: Source of strengths in Hispanic communities. Social Work, 27(1), 83–89. Dhai, A., & McQuiod-Mason, D. (2011). Bioethics, human rights and health law: Principles and practice. Cape Town: Juta. Dodds, R. L., Yarbrough, D. V., & Quick, N. (2018). Lessons learned: Providing peer support to culturally diverse families of children with disabilities or special health care needs. Social Work, 63(3), 261–264. 195

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Drower, S. J. (2005). Groupwork to facilitate empowerment in the context of HIV /AIDS. In L. Becker (Ed.), Working with groups (pp. 100–119). Cape Town: Oxford Southern Africa.  Doyle, K. (1997). Substance abuse counselors in recovery: Implications for the ethical issue of dual relationships. Journal of Counseling & Development, 75(6), 428–432. Drower, S. (1993). The contribution of group work in a changing South Africa. Social Work with Groups, 16(3), 5–22. Drower, S. J. (2005). Groupwork to facilitate empowerment in the context of HIV /AIDS. In L. Becker (Ed.), Working with groups (pp. 100–119). Cape Town: Oxford Southern Africa.  Engle, B., & Macgowan, M. (2009). A critical review of adolescent substance abuse treatments. Journal of Evidence-Based Social Work, 6(3), 217–243. Foreman, T., Willis, L., & Goodenough, B. (2005). Hospital-based support groups for parents of seriously unwell children: An example from pediatric oncology. Social Work with Groups, 28(2), 3–21. Freeman, E. M. (1987). Consultation for improving group services to alcoholic clients. Social Work with Groups, 10(3), 99–116. Giles, W. (1988). Language rights are women’s rights: Discrimination against immigrant women in Canadian language training policies. Resources for Feminist Research, 17(3), 129–132. Gillen, M. C., & Balkin, R. S. (2006). Adventure counseling as an adjunct to group counseling in hospital and clinical settings. The Journal for Specialists in Group Work, 31(2), 153–164. Gitterman, A., & Knight, C. (2016). Empowering clients to have an impact on their environment: Social work practice with groups. Families in Society: The Journal of Contemporary Social Services, 97(4), 271–273. Goodman, H. (2006). Organizational insight and the education of advanced group work practitioners. Social Work with Groups, 29(2–3), 91–104. Gumpert, J., & Black, P. N. (2006). Ethical issues in group work: What are they? How are they managed? Social Work with Groups, 29(4), 61–74. Gutiérrez, M. L., & Ortega, R. (1991). Developing methods to empower Latinos: The importance of groups. Social Work with Groups, 14(2), 23–43. Haas, L. J., & Malouf, J. L. (1989). Keeping up the good work: A practitioner’s guide to mental health ethics. Sarasota, FL: Professional Resource Exchange. Herlihy, B., & Corey, G. (1992). Dual relationships in counseling. Alexandria, VA: American Association for Counseling and Development. Hoefer, R. (2000). Human service interest groups in four states: Lessons for effective advocacy. Journal of Community Practice, 7(4), 77–94. Holmes, C. M., & Kozlowski, K. A. (2015). A preliminary comparison of online and face-to-face process groups. Journal of Technology in Human Services, 33(3), 241–262. Holt, S., Kirwan, G., & Ngo, J. (2015). Groupwork interventions for women and children experiencing domestic abuse: Do they work and do they last? Groupwork, 25(1), 8–33. Keast, K. (2012). A toolkit for single-session groups in acute care settings. Social Work in Health Care, 51(8), 710–724. Knight, C. (2017). Group work with homeless mothers: Promoting resilience through mutual aid. Social Work, 62(3), 235–242. Koocher, G. P. (2003). Ethical issues in psychotherapy with adolescents. Journal of Clinical Psychology: In Session, 59(11), 1247–1256. Lazarus, A. A. (1994). How certain boundaries and ethics diminish therapeutic effectiveness. Ethics and Behavior, 4(3), 255–261. Lee, C. (2018). Social work with groups; practice ethics and standards: Student confidence and competence. Research on Social Work Practice, 28(4), 475–481. Legal Action Center of the City of New York, Inc. (1995). Confidentiality: A guide to the federal laws and regulations. New York: Author. Lindsay, T., & Orton, S. (2014). Groupwork practice in social work (3rd ed.). London: Sage. Lindsay, T., & Orton, S. (2009). Groupwork practice in social work. Exeter, UK: TJ International. Lovell, M. C., Thuango, J., & Nguyen, C. D. (1987). Refugee women: Lives in transition. International Social Work, 30(4), 317–325. Mama, R. S., & Ward, K. (2010). Breaking out of the box: Adventure-based field instruction (2nd ed.). ­Chicago, IL: Lyceum Books. Masson, R., Jacobs, E., Harvill, R., & Schimmel, C. (2012). Group counseling interventions and techniques (7th ed.). Belmont, CA: Brooks/Cole. 196

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McCrady, B. S., & Bux, D. J. (1999). Ethical issues in informed consent with substance abusers. Journal of Consulting and Clinical Psychology, 67(2), 186–193. Meier, A. (2000). Offering social support via the internet: A case study of an online support group for social workers. Journal of Technology in Human Services, 17(2–3), 237–266. Mokgoro, J. Y. (1998). Ubuntu and the law in South Africa. Potchefstroom Electronic Law Journal/ Potchefstroomse Elektroniese Regsblad, 1(1). Nah, K. (1993). Perceived problems and services delivery for Korean immigrants. Social Work, 38(3), 289–296. Padilla, Y. C. (1997). Immigrant policy: Issues for social work practice. Social Work, 42(6), 595–616. Palmer, N., & Kaufman, M. (2003). The ethics of informed consent: Implications for multicultural practice. Journal of Ethnic & Cultural Diversity in Social Work, 12(1), 1–26. Portes, A., & Rumbaut, R. G. (1990). Immigrant America. Berkeley: University of California Press. Potocky, M. (1996). Refugee children: How are they faring economically as adults? Social Work, 4(4), 364–373. Rittner, B., & Nakanishi, M. (1993). Challenging stereotypes and cultural biases through small group process. Social Work with Groups, 16(4), 5–23. Russell, K. (2001). What is wilderness therapy? The Journal of Experiential Education, 24(2), 70–79. Scott, C. G. (2000). Ethical issues in addiction counseling. Rehabilitation Counseling Bulletin, 43(4), 209–214. Seward, S. B., & McDade, K. (1988). Immigrant women in Canada: A policy perspective. Ottawa, ON: Canadian Advisory Council on the Status of Women. Shisana, O., Rehle, T., Simbayi, L., Zuma, K., Jooste, S., & Zungu, N. (2013). South African national HIV prevalence, incidence and behaviour survey, 2012. Cape Town: HSRC Press. Steinberg, D., & Salmon, R. (2009). Communicating the values of social work with groups by talking in the idiom of the other. Paper presented at the Group work: Honoring our roots, nurturing our growth, Chicago, IL. Teater, B. (2011). Maximizing student learning: A case example of applying teaching and learning theory in social work education. Social Work Education, 1, 1–15. Timberlake, E. M., & Cook, K. O. (1984). Social work and the Vietnamese refugee. Social Work, 29(2), 108–113. Toseland, R., & Rivas, R. (2009). An introduction to group work practice. Boston, MA: Pearson Education, Inc. Williams, B. (2000). The treatment of adolescent populations: An institutional vs. a wilderness setting. Journal of Child and Adolescent Group Therapy, 10(1), 47–56. Williams, M. H. (1997). Boundary violations: Do some contended standards of care fail to encompass commonplace procedures of humanistic, behavioral, and eclectic psychotherapies? Psychotherapy, 34(3), 238–249. Wong, M. M. C., Ma, J. L. C., & Chan, L. C. L. (2015). Multiple family group therapy for families with children placed in out-of-home care in a Chinese context. Social Work with Groups, 38(2), 106–121. Wood, G., & Middleman, R. (1989). The structural approach to direct practice in social work. New York, NY: Columbia University Press.

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Section VII

Macro practice settings

26 The ethical ­geography of macro practice Human rights to utilitarianism Ogden Rogers

While the relatively individualistic context of micro social work practice has rich values and ethics literature from which to draw, moving into the wide contexts and variety of community practice has less philosophical and practice wisdom to elaborate the values and ethical behavior directions that macro practitioners might require (Hardcastle, Wenocur, & Powers, 1997). Micro context assumes a very small system, perhaps a dyad of “worker-client,” where rights and obligations are vested in the individuals. These behaviors are at best modified by those few ethical principles that invoke “social responsibility” (Reisch & Lowe, 2000). Depending on the type of community practice with which one might be involved, it is difficult to figure out what values and ethics might be influencing one’s practice. Trying to navigate such a diverse landscape requires some sense of direction. This chapter seeks to posit at least a rudimentary conceptual “geography” of the different macro practice types and the philosophies that shape their practitioners’ behavior. The community practice environments (or the “countries” on our “map”) are derived by describing constructs using a Weberian “Ideal Type” method (Shils & Finch, 1997). While there can be understandable criticisms of this approach such as the reality of very diverse behaviors of practitioners of any particular practice within a group, the risks of portraying a “culture” for the purposes of seeking moral direction in a type of community practice outweigh the costs of possible stereotypy. An Ideal-Type “Scientist” will value the pursuit of understanding empirically reproducible phenomenon with an aim toward prediction. An Ideal-Type “Sculptor” will value expression of some aesthetic principle in three-dimensional media such as stone, clay, or bronze. To this end, we can imagine a community practice “landscape” that extends from one end, with practices that might value top-down, rational, technocratic ideas and techniques, to community practices that value tactics that might value grassroots, conflict oriented, “ends-justify-the-means” tactics at the other end. As we look at the various macro practitioners, there are common questions that must be addressed by each of these various practitioners: (1) To whom do they owe their primary allegiance? A client or clients? Who are those clients – some agency (nonprofit or governmental) an ideal? (2) What sort of role do they play in the macro change environment? Are they a facilitator, a leader, an advocate, a member? (3) What is the nature of truth, truth-telling, and honesty in their practice? (4) Why is their value orientation toward personal and individual 201

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liberties and responsibilities and/or toward collective and class consciousness? (5) What is the focus of their change efforts? Are they seeking to improve change for individuals, groups, whole societies, or are they advancing some cause or idea? Our survey begins in the most rational extreme of the proposed continuum, The C ­ ommunity Planner.

The Community Planner Community planners often concern themselves with the use of physical resources used in social contexts: land, housing, industry, transport, water, energy, and public health. The use of land for housing, industry, agriculture and commerce was largely either under control of propertied elites or laissez-faire prior to the 20th century. With increasing urbanization of the modern period, the plights of the poor living in dangerous conditions in swelling and often polluted neighborhoods became the focus of increased movements of social liberalism and progressivist attempts of social reform. While some of these efforts had origins in grassroots empowerment processes, others were promoted by elites influenced by scientific principles. Governments began efforts to change “blighted” neighborhoods with the use of rational and scientifically informed goals and engineering influenced technologies. The professions of Public Health, Urban Planning, and Community Planning have their beginnings in this paradigm (Weber & Crane, 2012). The Community/Urban Planner sees themselves as a “Good Government” era professional who values principles that are built often on rational constructs that might be considered normative (meaning ideal, desired future states) rather than real. The values of architecture and efficiency, driven by top-down “public good” concepts – “complete, compact, connected, complex, and convivial describes everything that you want a neighborhood to be” (Blackson, 2017), are enforced by zoning laws, community plans, and, ultimately, bulldozers. Most community planners are employees of governments, therefore susceptible to pressures from their employers when planning processes may be perceived to have controversial or costly ramifications. While an American association of professional community planners posits a code of ethics that includes an initial principle of “Overall Responsibility to the Public,” the “public” tends not to be defined, and the remaining principles in their code outline responsibility to employers, colleagues, and profession, with the bulk of their “Rules of ­Conduct” oriented toward behavior of the latter groups (American Planning Association, 2016). It is not unusual to see public participation as included in a community planning document, often in a vague and not clearly documented way, while membership in planning committees is usually well described members of political and commercial power elites, technocrats, and health and safety leaders. The ethical concept of truth-telling is reflected in the Planner’s code, but in practice, when plans are being developed that include purchasing lands for development, pressures may exist to be circumspect to keep prices from rising in speculation. The ethical concept of truth-telling is reflected in the Planner’s code, but in practice, when plans are being developed that include purchasing lands for development, pressures may exist to keep public information circumspect to keep prices from rising in speculation. As planning places emphasis on elite norms and conceptualizations of elite desired future states, the products produced may fall as fashions change. Post-WWII America witnessed displacement of many poor persons by “urban-renewal” efforts in “blighted” neighborhoods who were relocated to “model high-rise projects,” only to see these same housing models torn down thirty years later, when development goals changed. 202

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The Community Developer Community development as a practice probably sits somewhat left of the realm of Community Planning. Community developers address social, environmental, and economic issues in the environments of their focus. They have a long history of engaging economic development to help people build community capacity, develop sustainable communities, enhance local economy, and infrastructure. As such, they live a similar life to community planners, but tend to have a more community based, egalitarian, “problem-solving” orientation that recognizes a greater emphasis on citizen participation. The Developer’s ethics might tend to lean toward situational or consequentialist approaches (Fletcher, 1966). The Community Developer may be a governmental or private agency employee, facing again the issues of allegiance to the goals of who sign their paycheck versus the expressions of will that arise from members of the “stake-holder” audience. The Developer’s perspective on transparency may be somewhat more open as they may have a more balanced perspective as to who constitutes the stakeholder context. In some ways, they may demonstrate a similar culture to the “Collaborative Post-Alinsky” Community Organizer (below), but as with the Planner remain influenced by seeking improvements in physical or economic environments. Unlike the Community Planner, the career of the Community Developer may be more precarious as they are not as aligned with technocratic and rational ideals such as architecture, and more placed in the middle of messy human situations of negotiating or mediating between and amongst multiple constituencies seeking different ends (Lotz, 1982).

The Community Organizer As with all the models in this geography, the Community Organizer’s values and behavior are shaped by the continuum of the organization model in which they live. Perhaps the most classic development of this continuum are two of the perspectives of Rothman and Tropman (1987) who located aspects of the present continuum, as practices of “Locality Development,” and “Social Action.” Locality development could be viewed as a broad collaboration model that begins from a conflict free basis, and is based on the assumption that a wide variety of community stakeholders should be involved in planning, implementation, and evaluation of desired community goals. This model has sometimes been called a “horizontal” or “Post-Alinsky” perspective. The locality development organizers sees all “sides” of developing issues and attempts to get all “sides” to contribute and listen to each other to expand consciousness and see how all members of a community are part of desired change processes. This type of organizers sees the entire community as their client and values voluntary cooperation, self-help, development of local leadership, and the support democratic mechanisms of decision-making and leadership. Truth-telling is valued by the organizer in this model, with a respect for the possibility of multiple truths. In more recent years, this perspective has evolved with what has been called a “social justice-citizenship” perspective as the rational set of values that drives the practitioners’ behavior. In this model, the degree of community participation may vary, but a problem is derived from the community base that can be argued via legal means. The organizer in this perspective sees the rights and obligations of the Human Rights framework as the fulcrum for community discussion and problem-solving. They may work community members to assert needs to a larger power structure, often making use of existing or developing laws ­implemented in legislatures and enforced by courts or law enforcement mechanisms. 203

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Social action practitioners (in the Alinsky mold) in this perspective assume a conflict oriented environment where a disadvantaged segment of the population needs to be organized to be able to make demands on the larger community for increased resources or improved treatment. This is a “haves” versus the “have nots” vertical perspective where the organizer has the disadvantaged communities goals as paramount and supports the development of local leadership, but may also take a leadership role themselves. The organizer may borrow from a Marxist perspective when it comes to the means of engaging a conflict. In such a “social war” perspective, it is perfectly acceptable to agree to “rules of engagement” publicly, but engage in whatever deceptive or instrumental means necessary to accomplish the mission of the goal. The ends will justify the means (Alinsky, 1971).

Social movement organizers Possibly the most far-flung array of macro practice would be those who commit themselves to a goal of structural changes in societies via consciousness raising and direct action. Social movements build from diverse collections of individual activists; advocacy organizations; local, national, or international organizations; multiple spokespersons; and, at best, are held together by relatively common aims of the social change ideal. Like the entire community practice landscape itself, the social movement practitioner will be informed by values and ethics from the movement in which they seek to promote. This could range from non-conflict oriented consciousness raising via educational or media methods to conflict oriented, ranging from nonviolent and pacifist (e.g. Mohandas Gandhi, Martin Luther King) approaches to radical, militant revolutionary approaches (e.g. Marxist-Leninist) which may see violence as a means of struggle (Reisch & Andrews, 2002). The social movement organizer may begin from a structural approach like the Alinsky oriented Social Action Community Organizer, or from a Mass Protest perspective. In the former, efforts begin in one-on-one relationships that coalesce into community goals and political action. In Mass Protest orientation, the Social Movement Organizer works to bring together established autonomous groups to organize around creating polarizing events that can rally hundreds to thousands of unaffiliated people to take to the streets around symbolic, popular social concerns. If an employee, the Social Movement Organizer faces pressures from the foundational sources that financially back their efforts. These sources, which range from wealthy private individuals, nonprofits, and even governments, may influence the ethical stance of the practitioner. In the extreme radical orientation, morality from a Marxist perspective is a fluid concept determined by the Marxist dialectic that everything in society is in a state of evolutionary change. Society is evolutionary and moving toward a state without social and economic class distinctions. The dialectical view of evolutionary history argues the conflict between a proletariat and the bourgeoisie defines the present morality narrative. Marxists argue the morality of the capitalist class exploits the working class. As class consciousness arises and workers win their struggle, old moral codes will be abandoned and new ones will be established that reflect classless society (Bax, 1887). In either context, non-conflict or conflict oriented, the Social Movement Organizer has the movement ideology as their highest value. In a sense, people are the means to the social movement goal, and such goals may precede the consciousness of individual persons. As it is the material circumstances that primarily shape people’s lives, not their morality, truth-­ telling is based on the ideology of the movement. Deception may or may not become a tactic depending on the ideology. 204

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References Alinsky, S. D. (1971). Rules for radicals: A practical primer for realistic radicals. New York, NY: Vintage Books. American Planning Association. (2016). AICP code of ethics and professional conduct. Retrieved from https://www.planning.org/ethics/ethicscode/ Bax, E. (1887, April 23). Concerning “Justice”. Commonweal, pp. 132–133. Blackson, H. (2017, October 19). The 5 ‘Cs’ of community planning. Public Square a CNU Journal. Retrieved from https://www.cnu.org/publicsquare/2017/10/19/5-cs-community-planning Fletcher, J. F. (1966). Situation ethics: The new morality. Louisville, KY: Westminster John Knox Press. Hardcastle, D., Wenocur, S., & Powers, P. (1997). Community practice: Theories and skills for social workers. New York, NY: Oxford University Press. Lotz, J. (1982). The moral and ethical basis of community development: Reflections on the Canadian experience. Community Development Journal, 55(1), 27–31. Reisch, M., & Andrews, J. (2002). The road not taken: A history of radical social work in the United States. New York, NY: Brunner-Routledge. Reisch, M., & Lowe, J. I. (2000). Of means and ends revisited: Teaching ethical community organizing in an unethical society. Journal of Community Practice, 7(1), 19–38. Rothman, J., & Tropman, J. E. (1987). Models of community organizing and macro practice perspectives: Their mixing and phasing. In F. M. Cox, J. L. Erlich, J. Rothman, & J. E. Tropman (Eds.), Strategies of community organization: Macro practice (pp. 3–25). Itasca, IL: Peacock. Shils, E. A., & Finch, H. A. (1997). The methodology of the social sciences. New York, NY: Free Press. Weber, R., & Crane, R. (Eds). (2012). The Oxford handbook of urban planning. New York, NY: Oxford University Press.

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27 Ethical dilemmas when w ­ orking with extreme right-winged youth cultures in Germany Stefan Borrmann

Extreme right-winged youth cultures are not a new phenomenon in Germany nor in the Western world in general. The roots of these groups have their origin in the White power skinhead movement, a result of a split of the skinhead and punk youth cultures at the end of the 1970s/beginning of the 1980s in England (Clarke, Hall, Jefferson, & Roberts, 1997). In Germany, these groups evolved in style, music, organizational forms, and localization in youth and subcultures, but they have always been a constant phenomenon. Currently, rightwinged youth cultures are not solely part of the skinhead culture but can also be found as subgroups in the gothic, metal, techno, and hip-hop scenes (Dornbusch & Killguss, 2005). Research about violent and political extremist youth cultures shows that mainly four characteristics can be attributed to these groups: (1) Members have strong undemocratic attitudes based on the right-wing ideology of inequality among human beings, (2) there is a general acceptance of violence, (3) they see themselves as part of a youth culture with specific styles that can be seen as markers, and (4) a great amount of conformity is expected by and of the members of the group and they tend to have informal, but clearly visible, hierarchical structures (Borrmann, 2006). Since the early nineties, right-wing extremism has developed into a serious problem in Germany. Since the German reunion in 1990, at least 193 people have died as a result of neoNazi attacks, many more were injured (see https://www.mut-gegen-rechte-gewalt.de/news/ chronik-der-gewalt/todesopfer-rechtsextremer-und-rassistischer-gewalt-seit-1990). After a reduction in the mid-nineties, the number of cases began to rise again and has now stabilized at a very high level. Not every crime was committed by members of extreme right-winged youth cultures but a very high percentage of these crimes were affiliated in some way to these adolescents. Research suggests that 75% of the culprits are members of right-wing youth groups that are not part of the organized radical right (like parties or neo-Nazis), and that 90% are younger than 24 years old, 91% of which are male (Wahl, 2001). The rise of right-winged extremism and populism is currently a worldwide phenomenon (Greven, 2017). Especially the connection between the current Trump administration in the United States to the socalled “alt-right-movement,” the demonstration in Charlottesville in 2017, and the current rise of right-winged populist parties in Europe have intensified the international discussion 206

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about these groups. But these political “movements” cannot be analyzed nor explained in this chapter. This chapter is referring to groups commonly known as peer groups, in which the members associate themselves with right-wing youth cultures. For these groups, social work in Germany offers special programs and the federal government has been financing these since the mid-1990s.

Freedom of speech versus hate speech To fully understand the German discussion about ethical dilemmas when working with these groups and conflicting goals of this work, one has to explain the German perspective about the contradiction between the constitutional right of freedom of speech and the constitutional right for nondiscrimination which is challenged through hate speech. In Germany, as in almost all Western countries, the freedom of speech is a constitutional right. Restrictions to this right have to be limited to very few cases such as individual defamation, treason, or infringement of intellectual property rights. In contrast to the United States, many European countries and especially Germany see the enactment of a ban to hate speech as a legitimate reason to restrict the freedom of speech. In the German criminal code (§130), there are several acts mentioned that put hate speech, the public denial of the Holocaust, right-winged propaganda, and other forms of discrimination under punishment. For social work in the field of right-winged youth cultures, this poses a challenge. When working with these groups directly, a social worker is most likely to witness some form of xenophobic or neo-Nazi propaganda. This directly raises the question of how to react to such forms of discrimination without being guilty to complicity. Social workers in this field have to be able to tolerate a lot of their talk – as discriminatory, offensive, or inhumane as it might be. However, when this talk turns into organized political propaganda with the aim of distributing political ideology, a line is crossed (Borrmann, 2005).

Social work in this field Social work and right-winged extremism When working in the field of right-winged extremism and youth cultures as a social worker, one has to define what the goals of the work actually are. As mentioned in the introduction of this chapter, one can identify four dimensions defining these groups. So questions arise around the dimensions on which social work should concentrate. Is it enough to reach the point where these groups no longer show violent behavior, or should the actual goal be that the right-winged attitudes are no longer persistent? And with regard to the latter how can one justify this goal of changing political beliefs in the light of the discussion around freedom of speech.

Different approaches to combat right-winged extremism 1 Political education From the early eighties to the mid-nineties, the political education of young adolescents through social workers in professional youth work has been the main approach to tackle the problem of right-winged attitudes. The work was seen as part of a set of preventive measures and took place in youth centers, in schools and in the context of specialized 207

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programs. This work referred mainly to the experiences and atrocities of the national socialism and the basic idea was that if the adolescents realize what happened during that time in Germany they will almost “automatically” no longer follow the extreme-right positions. Since the mid-nineties these approaches changed to a more spatial orientated approach, and specific forms of community organizing concepts of building and supporting NGOs of the civil society were developed. For example, teams of social workers were advising local stakeholders in municipalities how to organize and react against acts of political violence and a strong presence of right-winged activist (Wilking & Kohlstruck, 2016). 2 Supporting anti-racist groups In addition to this educational approach, social work was actively supporting anti-­ racist youth movements. These self-organized groups were in the late eighties and early nineties an integral part of the youth cultures in Germany and many of the youth centers were meeting points for these peer groups. Social workers actively encouraged adolescents to self-organize concerts, panel discussions, and other cultural events as a form of offering other young people alternative youth cultures to choose from. 3 Working with the victims As mentioned previously, the far-right youth groups have been posing a serious threat against people of color, foreigners, asylum seeker, and political opponents. During the nineties, supporting victims of hate crimes was seen as an important task for social work. But this work was never more than a supplement to other approaches. The financial support of the victims and of social work in this field was never on the same level as the other approaches mentioned and the unbalanced financial support of these activities to support victims has ever since been a constant issue of public critiques. 4 Working directly with right-winged extremist youth cultures Social workers in Germany have worked with right-winged adolescents in direct practice for approximately 30 years. The first concepts of how to work with clients like these were developed in a city called Bremen and were derived from local experiences of social workers in a suburb with a very active right-winged extremist scene (Krafeld, 1992). These approaches in direct practice provoked an outcry in the social work field of professional youth work and were criticized for actively supporting right-winged extremism with the means of social work. The opponents of social work with right-wing youth groups put forth the following arguments: • Social work addresses these clients because they are members of a right-wing youth group and not despite the fact that they are. This sends the wrong signal to other young people who might believe that this is the way to get attention. • The goal of social work with these special clients is to integrate them into mainstream society. However, social work in this field does not reflect the political attitude of mainstream culture since it believes that this is not its concern. So social work in that field can be criticized for a lack of political involvement. This argument has learned much more attention recently with the rise of right-winged populist parties in ­Europe. Critical social workers are questioning the goal of social work to reintegrate extreme right-winged adolescents when the mainstream society must also be seen as xenophobic. • Successful social work stabilizes the right-wing youth groups. As a consequence, other groups of young people get elbowed aside and have to struggle harder to get the attention of professional youth workers. 208

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The supporters of social work with right-wing youth groups however put forth these arguments: • Social work has the obligation to help everybody who needs help. There is a difference between the problems young people have and the problems they make. • Social work with right-wing young people does not imply that political attitudes of these people are accepted. Far from it, it contributes significantly to a change in their inhumane and undemocratic orientation. Such a change is only possible if the daily routines of the young persons are no longer filled with problems and conflicts. Only then can there be a chance to alter their attitudes. • The supporters also argue that in most cases the right-wing attitude of the young clients does not stem from deep conviction but is a form of protest. • Based on these arguments, several elaborate concepts for social work with rightwing youth groups were developed (Borrmann, 2006; Krafeld, 1992; Krafeld, Lutzebaeck, Schaar, Storm, & Welp, 1996). They are established mainly on the understanding that an intensive interpersonal contact is the ground upon which social work is able to point out inconsistencies and help young people reflect on their attitudes. And this – when all goes well – will also change the violent b­ ehavior as a secondary effect. 5 A new phenomena: right-wing activist as social workers Recently, there is a new phenomenon arising in the field of social work with adolescents in Germany. Some right-winged activists studied social work at universities with the goal to become a professional social worker and to work in the field of professional youth work (which in Germany is part of social work). There are few examples where these graduates try to find social work agencies and offer professional youth work financed by the municipalities mainly in rural areas. This relatively new development is questioning the normative role of social work and is challenging the profession in a new dimension.

Ethical dilemmas in this field The discussion around different approaches of how to work in this field of action has shown that there are challenging questions involved. 1 Who gets the resources, the potential victims or the potential culprits? Resources in social work are not always sufficient. In these cases, social workers and/or the stakeholders financing this work have to decide on how to prioritize the work. If a right-winged youth group in a small city or a rural area is active and has a very public profile due to their behavior, a social worker might try to work with this group with the means of preventing further violent behavior. In a municipality in Germany, there are usually no specialized programs to work with these groups. But professional youth work financed through the municipality is mandatory for each commune. Usually, this is carried out through work in a youth center or through mobile youth work (streetwork). The social worker will try to gain the trust of the group through his or her work and will see this as a part of a preventative approach. At the same time, this would mean that other adolescents will not benefit from the work of the social worker. 209

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2 Can one work with the culprits and ignore their political beliefs? As mentioned in the introduction of this chapter, the extreme right-winged youth groups can be defined by four dimensions. Social workers in direct practice usually argue that they try to see beyond these dimensions and try to get through to the individual person. By building a relationship of trust, they might be able to reach the young person and influence him or her in a positive way. The problem with this concept is that a social worker has to ignore the political beliefs and provocative arguments of the adolescents at least in the beginning of the work. By challenging a racist or sexist comment right from the beginning, a social worker might not get to the point where he or she actually can have an influence on the right-winged adolescent. However, the question must be asked if a social worker should actually assume that the right-winged and provocative statements are merely a provocation. They just might stem from a firm belief. By ignoring this, social work comes very close to collaboration. 3 What is the goal: changing behavior or changing beliefs as well? As a normative profession we aim our work at changing situations from “not good” to “better.” So the question arises what the goal of social work should be when working with these right-winged groups. As mentioned previously, beliefs and attitudes, as discriminatory they may be, will not harm anybody as long there is no violent behavior that follows. So should social work focus on violent or discriminating behavior or should social work focus on the belief system behind this behavior? 4 How is the goal changing if society is as judgmental as the adolescents? The question of changing right-winged beliefs should be a goal of social work in that field of action is getting even more contested when one takes the values and norms of mainstream society into account. For a long time, the young right-winged adolescents could be seen as extremist whose belief system is in contrast to mainstream society. But in many European countries, including Germany, right-winged populist positions are currently on the rise. Research is showing that 20% of the population in Germany tend to agree to statements in political surveys which can clearly be categorized as right-winged statements (Decker, Kiess & Brähler, 2016). But when the young adolescents have almost the same belief system as mainstream society, how can social work problematize these beliefs? In this case, we as social workers have to explain very carefully how the social work values and norms are more humane and better in an ethical sense than the societal norms. 5 How to deal with provocation? Young adolescents in peer groups tend to provoke the people around them. For rightwinged youth cultures, there is no better way to irritate than to use the right-winged belief system and say provocative things in public and in front of a social worker. For many reasons, this might only be seen as a test on how the social worker will react. Is he or she really on the young people’s side, is there a layer of trust and is the social worker really taking the adolescents seriously? These might be the questions that are behind these provocations. But how far can a social worker go in ignoring these provocations? 6 Right-winged social workers? And finally, questions arise around the new phenomenon of right-winged activist as social worker. As mentioned previously, there are only a few cases documented in Germany until now but still this is challenging social work practice and education. If a social worker is openly confessing that he or she is a right-winged activist and is behaving and arguing in a discriminating way, the case is relatively simple. In these cases, one can argue that the person is acting not in accordance with social work values and norms as stated in (international) ethical standards. But what if a student of social work or a 210

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graduate is not acting openly in a discriminating way, and he or she is meeting all the professional standards of social work practice or all the requirements in study courses? And still it has become apparent through their work that he or she is a right-winged activist working with adolescents and supporting them in their right-winged beliefs.

Working with right-winged youth cultures with the aim of harm reduction The concept in a classical sense Harm reduction is a concept originally developed as an alternative approach to criminal, disease, or moral models in public health policy, especially in the field of drug abuse (for a short summary of the origin of the concept, see Karoll, 2010, pp. 267–269). According to Riley et al. (1999), harm reduction puts the consequences of a behavior in the center of an intervention. The primary goal is to reduce harmful consequences of a client’s behavior but not to focus on the complete change of the behavioral choices themselves (MacMaster, 2004). Two principles of harm reduction in social work can be derived from the discussion that illustrate the underpinnings of the concept. First, harm reduction shifts focus away from the deviant behavior itself and its legal or moral consequences to the effects or consequences of these choices (Weingardt & Marlatt, 1998, p. 347). This can be seen as a truly utilitarian approach. The second principle refers to a more realistic goal in social work intervention. Rather than trying to change deviant behavior completely, it focuses on small steps. This means acknowledgment of the fact that to reduce harm is in many ways better than trying to end harm and to possibly fail in this completely. It becomes clear that harm reduction in this narrow sense is a concept that focuses on the individual perspective and problem of the client. It only takes actions of the social worker into account that reduce the harm for particular clients. Harm reduction does usually not focus on the environment of the client and doesn´t consider “alternative clients” for social work.

A wider approach: harm reduction When seen in this classical sense, harm reduction as a concept doesn´t work well in the field of social work with right-winged extremist youth cultures. With regard to the possible ethical dilemmas of social work in this field, it becomes clear that many – or actually all – of the dilemmas mentioned previously are so that a social worker has to consider the results of his or her action for third parties as well. An individualized approach in the work with these groups is just not adequate. And there are several reasons for this and all of them are a result of the description and the definition of these groups. As mentioned previously, these groups are defined through four dimensions. One can find explanatory models and theories that can define the development of the dimensions. If a social worker would focus his or her work on just one of the dimensions, he or she would not be able to work successfully with these groups. The reason for that is that these dimensions have emergent properties that overlap with each other. Harm for the right-winged adolescents themselves is most likely only to occur as a result of the fourth dimension – the expectancy of a great amount of conformity. If someone in these groups does not meet this expectancy, other group members might punish him or her. But other than that the defining dimensions of the right-winged youth groups are not holding any harm for the group members themselves. Thus, harm reduction in a classical sense seen from the perspective of the 211

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clients, in this case the right-winged adolescents, would not be “necessary” because there are only limited possibilities for harm for these adolescents themselves. But while being part of a youth culture might not pose any problem at all, the possible harm resulting from actions in accordance with the strong undemocratic attitudes based on the right-wing ideology will do harm to other persons who are most likely not part of the group. So, the basic question behind this discussion is: whose harm do we have to consider as a social worker in this field? It becomes very clear that a social worker in that field has to consider the possible harm inflicted on victims, as well as the possible harm they are subject to themselves. •

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The right-winged adolescents who are causing societal and individual problems for others means most likely have individual problems which are the reasons for the great appeal of these groups to them. These individual problems are the explanation for the attraction of these groups. These groups provide a feeling of security and acceptance, recognition and acknowledgment for these adolescents that they do not find at home, in school, or any other place in their daily lives (Borrmann, 2016). The right-winged peer groups are a solution for their problems – not a problem itself for the youth. Trying to disconnect the individual from these groups through social work intervention will cause more harm to these young people rather than reduce their individual problems (Böhnisch, 2012). So every approach to work with these groups with the means to reduce the meaning of the groups for the individual member has to provide alternative sources of recognition and acknowledgment (VAJA, 2007) These approaches developed in social work in the last decades are referring to harm reduction as a concept in the sense that they work with the groups as group. But while doing this, try to shift the focus away from violent to morally accepted behavior. If this means that the adolescents have still undemocratic and discriminatory attitudes, it will be accepted as a necessary evil on the way to a less harmful behavior of these young extremists. For the possible victims of the groups, however, the picture is different. Almost all of the four dimensions of the right-winged youth groups pose a threat to possible victims of the behavior of these groups (Borrmann, 2005). With regard to the first dimension, right-wing extremism defines a person in terms of his or her race and ethnicity. Rightwing ideology asserts that mankind is divided into groups of persons of different worth. Based on that ideology, right-wing adolescents justify the discriminatory and offensive actions against people whom they view as inferior. With regard to the second dimension, it is obvious that violence essentially opposes the value of life. The fact that violent actions threaten the physical integrity of human beings indicates that social work has an obligation to act against those behaviors. And as for the third and fourth dimensions that define the gender roles and the group structures within these youth groups, it becomes clear that the young men in these groups discriminate against young women due to their beliefs in the inequality between the sexes. Aggressive and violent actions are another integral part of their male gender role. These actions are typically performed within territorial conflicts with other male dominated peer groups (Kohlstruck, 1999). Harm reduction for the possible victims of right-winged youth groups would mean that social work should act solely on the basis of reducing the possible risk through these groups. This could mean to organize a support network for the possible victims, to organize NGOs in a municipality for preventive reasons, or to work with non-right-winged adolescents to prevent them from getting attracted to these kinds of groups. Stabilizing these groups because they have an important function for the group members definitely cannot be of any interest for the possible victims.

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Conclusion At the beginning of this chapter, the question was put forth of whose harm has to be considered when working with these kind of right-winged youth groups and what will be the consequences that follow. When one considers that all the ethical dilemmas in this field of action for social work are due to the possible contradiction that working and supporting the right-winged adolescents could mean a possible threat for their opponents, the consequence for social work is obvious. In the end, it is a question of the achievement in mind. What is the goal of my work? Social work has an ethical obligation to reduce harm for the clients, their environment, and society. And if there is a problem like right-winged extremism with a societal dimension, then social work should not reduce its action to an individual approach. Harm reduction has to take the environment and secondary effects into account. Losing this focus would mean to empower right-winged extremist in an increasingly right-winged society. So social work with right-winged youth groups has to work with the concept of harm reduction in a wider sense. In this field, it is a necessity to extent the definition of who is my client to who is the (possible) victim of my client. If this view is dismissed, social work is in danger to become an accomplice to the inhuman and discriminatory practice of their clients.

References Böhnisch, L. (2012). Sozialpädagogik der Lebensalter. Eine Einführung. Weinheim: Juventa. Borrmann, S. (2005). Ethical dilemmas in social work with right-wing youth groups. Solutions based on the document Ethics in Social Work, Statement of Principles by the International Federation of Social Workers (IFSW). Journal of Social Work Values and Ethics, 1(2). Retrieved from http://jswve.org/ download/2005-1/JSWVE-Spring-2005-Complete.pdf Borrmann, S. (2006). Soziale Arbeit mit rechten Jugendcliquen. Grundlagen der Konzeptentwicklung. ­Wiesbaden: Springer VS. Borrmann, S. (2016). Jugendarbeit mit rechten Jugendcliquen. Menschenrechtsorientierung und Bedürfniserfüllung. Soziale Arbeit, 65(5), 162–167. Clarke, J., Hall, S., Jefferson, T., & Roberts, B. (1997). Subcultures, cultures and class. In K. Gelder & S. Thornton (Ed.), The subcultures reader (pp. 100–111). London/New York, NY: Psychology Press. Decker, O., Kiess, J., & Brähler, E. (2016). Die enthemmte Mitte. Autoritäre und rechtsextreme Einstellung in Deutschland/Die Leipziger Mitte Studie. Gießen: Psychosozial Verlag. Dornbusch, C., & Killguss, H.-P. (2005). Unheilige Allianzen. Black Metal zwischen Satanismus, Heidentum und Neonazismus. Münster: Unrast Verlag. Greven, T. (2017). Right-wing populism and authoritarian nationalism in the U.S. and Europe. Retrieved July 8, 2018, from http://library.fes.de/pdf-files/id/13395.pdf Karoll, B. R. (2010). Applying social work approaches, harm reduction, and practice wisdom to better serve those with alcohol and drug use disorders. Journal of Social Work, 10(3), 263–281. Kohlstruck, M. (1999). Spiele und Terror. Fremdenfeindliche Gewalttätigkeiten und maskuline ­Jugendkulturen. In P. Widmann, R. Erb, & W. Benz (Eds.), Gewalt ohne Ausweg? Strategien gegen Rechtsextremismus und Jugendgewalt in Berlin und Brandenburg (pp. 223–258). Berlin: Metropol. Krafeld, F. (1992). Akzeptierende Jugendarbeit mit rechten Jugendcliquen. Bremen: Steintor Verlag. Krafeld, F., Lutzebaeck, E., Schaar, G., Storm, C., & Welp, W. (1996). Die Praxis Akzeptierender ­Jugendarbeit. Konzepte – Erfahrungen – Analysen aus der Arbeit mit rechten Jugendcliquen. Opladen: ­Leske & Budrich. MacMaster, S. A. (2004). Harm reduction: A new perspective on substance abuse services. Social Work, 49(3), 356–363. Riley, D., Sawka, E., Conley, P., Hewitt, D., Mitic, W., Poulin, C., … Topp, J. (1999). Harm reduction: Concepts and practice. A policy discussion paper. Substance Use & Misuse, 34(1), 9–22. VAJA. (2017). Distanz(-ierung) durch Integration. Aufsuchende Arbeit mit rechtsextrem und menschenfeindlich orientierten Jugendlichen. Konzept, Praxis, Evaluation. Retrieved March 3, 2016, from http://vaja-bremen.de/wp-content/uploads/2015/03/distanzierung_durch_­integration-konzept_ praxis_evaluation-2007.pdf 213

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Wahl, K. (2001). Fremdenfeindlichkeit, Antisemitismus, Rechtsextremismus. Drei Studien zu Tatverdächtigen und Tätern. Berlin: Bundesministerium des Inneren. Weingardt, K. R., & Marlatt, G. A. (1998). Sustaining change. Helping those who are still using. In W.R. Miller & N. Heather (Eds.), Treating addictive behaviors (pp. 327–351). New York, NY: Plenum Press. Wilking, D., & Kohlstruck, M. (2016). Einblicke V. Ein Werkstattbuch. Potsdam: Eigenverlag.

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28 Toward response-able social work Diffracting care through justice Vivienne Bozalek

This chapter uses a diffractive method to put into conversation with each other the political ethics of care and feminist new materialist ethics, in order to reconceptualize response-able social work policies, practices, pedagogies, and scholarship. Both care ethics and feminist new materialist ethics are predicated on relational ontologies that propose that individuals or entities do not preexist relationships, but rather that identities, or entities, come into being through relationships. A relational ethico-onto-epistemological position also starts from the premise that it is impossible to separate ethics, ontology, and epistemology (Barad, 2007). The chapter describes how political ethics of care and feminist new materialist theorists conceptualize their relational ontological positions. It examines their notions of flourishing, of living and dying well in relation to social work practices, policies, pedagogies, and scholarship. Diffracting a political ethic of care and feminist new materialist ethics entails a close and detailed reading of texts of these approaches, and an attempt to do justice to the ideas emanating from both approaches. Diffraction as a methodology does not entail juxtaposing one approach or theorist (the political ethics of care in this case) against another (feminist new materialist ethics), or contrasting them as preexisting theories or approaches but rather as a care-full, attentive, detailed, and responsive reading of one through the other without foregrounding one or the other, and coming to new or creative insights through the interference of diffractive patterns. In this chapter, the work of theorists who have considered relational ethics deeply is diffracted through each other to come to new insights into ethical concepts or moral elements – these ethical concepts or moral elements are drawn from Tronto’s (1993, 2013) political ethics of care and Barad’s (2007, 2010, 2012a, 2012b), Haraway’s (2008, 2016), and Despret’s (2004, 2016) feminist new materialist ethics, which are also referred to as posthuman ethics. The chapter will focus on certain ethical concepts that are important in their work and which I consider to be fruitful for envisaging a normative framework for evaluating social work practices, policies, pedagogies, and scholarship. In particular, the chapter focuses on attentiveness, responsibility, competence, rendering each other capable, and trust. These concepts are derived from a superposition or diffraction of these theorists’ work. ­Superposition or diffraction is a quantum physics concept, which refers to what happens when two waves merge or cross each other and is the combination of the disturbances or interferences created by each of the waves. Diffraction patterns are the result of superpositions (Barad, 2007). 215

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I  will  argue that a diffraction of Tronto’s (1993, 2013) political ethics of care and Barad’s (2007, 2010, 2012a, 2012b), Haraway’s (2008, 2016), and Despret’s (2004, 2016) posthuman or feminist new materialist concepts can be used collectively to build up the notion of response-able social work – that is, a social work which has the ability to respond to current social contexts and needs. The chapter considers what each of the concepts attentiveness, responsibility, competence, rendering each other capable, and trust may mean for practicing ethical and response-able practices, policies, pedagogies, and scholarship in social work. The chapter addresses the question: how might elements such as attentiveness, responsibility, rendering each other capable, and trust help us to develop an ethico-onto-epistemology which would make us rethink practices, policies, pedagogy, and scholarship in social work as a profession?

The political ethics of care and feminist new materialisms – relational ontologies A relational ontology is predicated on the assumption that humans or entities do not exist before or outside of relationships (Barad, 2007), and that agency can only be considered as an enactment within a relationship which occur between human/nonhuman animals/matter/ the material world. Thus, the notion of the bounded, independent, rational, and atomistic individual, which is taken for granted in neoliberal thought, is not considered to be a useful concept, as relationships are the primary means through which entities come into being. Barad distinguishes interaction from intra-action (a neologism), arguing that intra-action does not assume preexisting, independent entities (or relata). Rather it is through intra-action, or the “mutual constitution of entangled agencies” that entities and “subjects and objects come into being” (Barad, 2007). In her eschewing the possibility of preexisting subjects and objects, Barad (2007) writes about phenomena which she refers to as “the ontological inseparability of agentially intra-acting components” (p. 33). This has far-reaching consequences for how the world is perceived, as it proposes, for example, that entities as part of the world are entangled with each other across both space and time. Matter is ontologically indeterminate and lacking in inherent characteristics or in identity according to Barad (2007), who uses quantum physics to show that electrons can be either a particle or a wave, depending on the apparatus which is used to measure it. This challenges the notion of essentialized identities and willful or intentional humans acting on passive objects. Consequently, agency is not seen to reside in human beings but rather occurs in enactments. The work of political ethics of care writer Tronto (1993, 2013, 2015) and posthumanist or feminist new materialist theorists such as Barad (2007, 2010, 2012a, 2012b), Haraway (1997, 2008, 2016) and Despret (2004, 2015a, 2015b, 2016) is all predicated on these notions which underpin relational ontologies, which understand the world as entangled and inseparable rather than having discrete boundaries. These theorists also all refer to flourishing – ways of living (and dying) as well as possible in the world. Fisher and Tronto, for example, define care as: a species activity that includes everything that we do to maintain, continue and repair our world so that we can live in it as well as possible. This world includes our bodies, ourselves and our environment, all of which we seek to interweave in a complex, life-sustaining web. (Tronto, 1993, p. 105) This definition is different from other more humanly oriented and dyadic-centered care ethicists, who focus on the mother-child dyad (a caregiver and a dependent care receiver) 216

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and locate caring practices within the family (see for example Gilligan (1982) and Noddings (2002)).1 Most importantly, in this definition of care, “our world” and “the environment” are included, thus foregrounding flourishing of the more-than-human as well as the human. Haraway (2008, 2016) refers to the ethics of worlding, involving the richness and responsiveness, that comes from species interdependence and she proposes that we should enable flourishing now and in times to come by learning “to stay with the trouble of living and dying in response-ability on a damaged earth” (Haraway, 2016, p. 2). Similarly, Barad (2007) suggests that intra-acting “responsibly as part of the world means taking account of the entangled phenomena that are intrinsic to the world’s vitality and being responsive to the possibilities that might help us and it flourish” (p. 396). Despret sees flourishing as being possible through multispecies bonds and relationships (Despret & Meuret, 2016). Political ethics of care and posthumanist/feminist new materialist theorists such as Tronto (1993), Haraway (2008, 2016), Barad (2007), and Despret (2016) all regard flourishing as being significant when considering ethical enactments. Moreover, their concerns about flourishing are not only directed to humans but are extended to the damaged earth (Tsing, Swanson, Gan, & Bubandt, 2017) and how to flourish as best as possible, given the current state of the world. Pertinent to all of these relational ontologies is the emphasis on processes and practices, rather than essentialisms or identities, a rejection of individualism and rule-based or principle ethics, the assumption that we are part of the world – implicated in everything and entangled in a web of relationships with living beings and entities. The importance of staying with the trouble which would mean living (and dying) as well as possible in the world is stressed by these theorists. The reality that we are living on a damaged planet (Tsing et al., 2017) would require us to “make trouble, stir up potent response to devastating events, as well as to settle troubled waters and rebuild quiet places” (Haraway, 2016, p. 1). It is important for social work as a profession to take note of this, and of the fact that we are now living on a damaged planet and need to devise ways of responding to the devastation of climate change by including courses on the Anthropocene in social work curricula, and by including the nonhuman and more-than-human in ethics courses. The next part of the chapter will focus on four concepts that are central to the political ethics of care and posthumanist/feminist new materialist theorists – namely attentiveness, responsibility, rendering each other capable, and trust, and describes ways in which they can be put to use in social work practice.

Attentiveness Attentiveness is the first element of care in Tronto’s (1993, 2013) political ethics of care and arises from recognition or noticing that a need exists. Attentiveness requires “staying with” and being “truly present” (Haraway, 2016), as well as being open to another’s embodied difference. For Haraway (2016) and Despret (2016), attentiveness – which they see as polite or curious regard – leads to ways of learning and changing together, co-constituting or becoming-with each other across heterogeneity, being affected by and affecting others – in other words, it is a multidirectional process with humans and animals discovering each other’s needs by paying close and courteous attention to the other. Despret and Meuret (2016) describe the process as learning to hold possibilities open, learning attentiveness to the infinite ways of being affected and of affecting, where no one may know ahead of time the affects one is capable of or the kinds of forces and entities that will constitute landscapes and worlds with us. (p. 36) 217

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How would attentiveness translate into social work policies, practice, pedagogy, and scholarship? Barad (2007) alerts us to the attentiveness that is necessary for a close reading the fine details of one text/oeuvre/approach/theory through another in a diffractive method, to create something new through inventive provocations. Attentiveness in reading requires one to read, return to the text, and reread anew (Boulous Walker, 2016). Reading, writing, reviewing, as forms of attentive activities, are ethical practices, as Barad (2007) suggests, “the practice of writing is an iterative and mutually constitutive working out, and reworking of ‘book’ and ‘author’” (p. x). Scholarly practices in social work can be seen as ethical practices of affecting and being affected, of becoming-with each other as readerly writers and writerly readers (Bozalek, 2017). Social work practice requires activating the “sensibility of all our embodied faculties” (Lenz Taguchi, 2012, p. 272), so that we can perceive and apprehend complex histories of entanglement. Perceiving and listening with discernment both to what is and is not being expressed is a finely attuned attentiveness which is fundamental to ethical practice in social work. Attentiveness is not only specific to a dyadic relationship between a social worker and client, but rather a public/private, political and relational practice that involves multiple human, nonhuman and more-than-human others, including texts and policies. Such an attentive social work is centrally concerned with social justice both as a focus of and a way of doing policy, practice, pedagogy, and scholarship.

Responsibility Once a need has been noticed in the first phase of care through attentiveness, a second phase of care involves responsibility for taking action to meet the need that has been recognized. Tronto (1993) differentiates responsibility, which she sees as a response to recognizing the need for care from obligation, which refers to a formal or legal sense of duty. Barad (2007) also regards responsibility as the ability to respond which involves “the ongoing practice of being open and alive to each meeting … to breathe life into ever new possibilities for living justly” (p. x). Thus, she foregrounds openness and justice in her notion of responsibility. Barad proposes that responsibility or accountability precedes intentionality or consciousness as it is never ours alone, but involves integral entanglements between self and other (not necessarily human) across spaces and times. For Barad (2007), responsibility is about what matters and what is excluded from mattering, and not necessarily a conscious choice or a human one. Her ideas about responsibility make social workers reconsider their positions vis-à-vis their clients as separate beings, by recognizing their dependence on the other and their entanglements with the other. Barad (2007) expresses it this way: What would it mean to acknowledge that the “able-bodied” depend on the “disabled” for their very existence? What would it mean to take on that responsibility? What would it mean to deny one’s responsibility to the other once there is a recognition that one’s very embodiment is integrally entangled with the other? (p. 158) Like Barad, Haraway (2008, 2016) equates responsibility with accountability, which she sees as ongoing and being located in multidirectional relationships involving asymmetrical non-innocent relationships between humans and other species. This asymmetry needs to be borne in mind with regard to responsibility in social work relationships, and the power differentials that occur between social workers and those with whom they intra-act. Taking 218

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responsibility means an acknowledgment of non-innocence in our intra-actions with others – no one is “pure” or can escape complicity (Shotwell, 2016). This means that because we are all entangled and part of the world rather than separate from it, we are deeply implicated in what happens both then and now, here and there, far and near. This is important for social work, as it means that we are all complicit in the problems of the world, as we cannot extricate ourselves from our entanglement with them and see ourselves as separate; we are part of the world in its ongoing intra-actions. For social work then, responsibility would depend on how we are entangled through enactments of scholarship, practice, policy, and pedagogy. It would be important to be cognizant of asymmetrical power relations existing in embodied, entangled, and multidirectional relationships across space and time. Responsibility and accountability to the other mean we are mutually committed and actively engaged together to contribute to social work processes. Responsible social work involves ongoing commitments to contribute to flourishing in the world which we have inherited and being open to the indeterminacy of what is to come (Barad, 2007). In a responsible social work, all are implicated and affected in focusing on what matters in policy, practice, education, and research in social work.

Being rendered capable Being rendered capable combines phases three and four of Tronto’s care ethics – the hands-on process of caregiving (Phase 3) which involves the moral element of competence and the responsiveness of the care-receiver to the care that has been given (Phase 4) (Tronto, 1993, 2013). Rendering each other capable is a process of enhancing the capacity or competence of all involved, as it is based on the premise that we are co-constituted through each other. Despret (2004, 2015a, 2015b, 2016) is the main theorist who has contributed the notion of rendering the other capable or being rendered capable, largely by observing how humans and nonhuman animals affect and are affected by each other. As Haraway (2016) observes Despret’s kind of thinking enlarges, even invents, the competencies of all the players, including herself, such that the domain of ways of being and knowing dilates, expands, adds both ontological and epistemological possibilities, proposes and enacts what was not there before. That is her worlding practice (pp. 126–127) This quote is an apt one for reconceptualizing an expansive social work practice in which all are rendered competent and capable – social workers and service users – and where the very categories of social worker and service user/client are queered in their entanglements with each other. In this way too, it is possible for the supervisor of a social worker to be rendered capable through the process of supervising in the same way that the reviewer of a scholarly article is capacitated in the same way as recipient of the review is (Bozalek, Zembylas, & Shefer, forthcoming). We need to cultivate imaginative ways of rendering each other capable in social work, particularly in the harsh contexts of neoliberal imperatives operating currently in the field and the damaged planet in which we now reside.

Trust Thus far I have discussed attentiveness, responsibility, and being rendered capable which speak to Tronto’s (1993) first four phases of care and their associated ethical elements – caring 219

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about (attentiveness), caring for (responsibility), caregiving (competence), and care-receiving (responsiveness), the latter two which I equated with Despret’s (2004, 2016) and Haraway’s (2016) notions of being mutually rendered capable. Tronto’s (2013) fifth phase of care, which she added relatively recently to her four phases, is caring with – which refers to the reiterative process of care. The moral qualities of trust and solidarity are developed through the realization or understanding that it is possible to rely on others for care. Trust was originally identified by Sevenhuijsen (1998, 2003) as being an intrinsic part of caring practices, although Tronto did not initially buy into the significance of this for the phases of care. It refers to the duration of care and what Haraway (2016) has referred to as learning how to “stay with the trouble” (p. 2). Caring through and across time and space is where the ethical dimensions of trust and solidarity are made possible through the establishment of reiterative patterns of care. Trust assumes an attunement with the other and a willingness to be vulnerable, with the expectation that the other will perform actions on a continuing basis which are important for flourishing to happen (Bozalek et al., 2014). Trust does involve an element of risk, as one assumes that one will not be harmed by the actions of the other, but that the actions will be conducive to flourishing. Sevenhuijsen (2003) uses the work of the American philosopher Baier to define trust as the willingness to let someone look after something which one values. In this way, trust involves “reliance on another’s competence and willingness to look after, rather than harm things one cares about which are entrusted to the caregiver” (Baier, 1994, p. 128 as cited in Sevenhuijsen, 2003, p. 185). In social work practice, it would be important to show that one is trustworthy toward those with whom one is working, whether they be colleagues, students, clients, or nonhuman animals. This means that as a social worker you would have to be regarded as reliable and someone who will not abuse the trust of those with whom you are working or let them down. It would also mean a willingness on the part of the social worker to place trust in self and other. Despret (2004) refers to the importance of gaining trust in getting to know each other in human-animal relationships which she refers to as polite inquiry. As Haraway (2016) puts it: Despret’s sort of politeness does the energetic work of holding open the possibility that surprises are in store, that something interesting is about to happen, but only if one cultivates the virtue of letting those one visits intra-actively shape what occurs. They are not who/what we expected to visit, and we are not who/what were anticipated either. (p. 127) Thus, through intra-actions, new identities and new ways of becoming-with are made possible for social workers and those with whom they intra-act, transforming them all through trust which links them together (Despret, 2004). Here trust as the belief in the other, “not in terms of ‘what they are’, but of ‘what they make’” (Despret, 2004, p. 122), which creates possibilities for articulating differently. In social work, it is also necessary to take cognizance of the fact that trust requires a consciousness of differential power relations and the effects that these would have on relationships. As Sevenhuijsen (1998) puts it, trust is complicated by a “situation of hierarchy or asymmetry in power relations” (p. 11). As well as careful attentiveness to the vulnerability of others, trust also requires an acknowledgment of the other in the self (Barad, 2012b; ­Sevenhuijsen & Svab, 2003).

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A response-able social work All four of these ethical elements discussed in this paper – attentiveness, responsibility, rendering each other capable, as well as trust when diffracted through each other – create generative provocations for a response-able social work. A response-able social work would be cognizant of and attentive to what is needed in the social work profession for those involved to flourish in their endeavors. Cultivating collective responsibility and accountability and the ability to respond to entangled heterogeneous partners are important, so that we may be able change with each other. A response-able social work, in which all parties are being rendered capable about what matters in the world, is a way of expanding and opening up what it means to creatively become-with each other. A response-able social work is one which makes a contribution to justice and care through rendering each other capable to both act on and stay with the troubles of our current concerns in the social work profession.

Note 1 For a more detailed discussion of how this definition differs from more human-centered and dyadic ones, see Bozalek et al. (2014)

References Barad, K. (2007). Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham & London: Duke University Press. Barad, K. (2010). Quantum entanglements and hauntological relations of inheritance: Dis/continuities, spacetime enfoldings, and justice-to-come. Derrida Today, 3(2), 240–268. Barad, K. (2012a). Nature’s queer performativity. Kvinder, Køn & Forskning, 1–2, 25–53. Barad, K. (2012b). On touching – the inhuman that therefore I am. Differences: A Journal of Feminist Cultural Studies, 23(3), 207. Boulous Walker, M. (2016). Slow philosophy: Reading against the institution. London: Bloomsbury. Bozalek, V. (2017). Slow scholarship in writing retreats: A diffractive methodology for response-able pedagogies. South African Journal of Higher Education, 31(2), 40–57. Bozalek, V., Mcmillan, W., Marshall, D., November, M., Daniels, A., & Sylvester, T. (2014). Analysing the professional development of teaching and learning at UWC from a political ethics of care perspective. Teaching in Higher Education, 19(5), 447–458. Bozalek, V., Zembylas, M., & Shefer, T. (forthcoming). Response-able (peer) reviewing matters in higher education. In C. A. Taylor and A. Bayley (eds.), Posthumanism and Higher Education: Reimagining Pedagogy, Practice and Research. London: Palgrave MacMillan. Despret, V. (2004). The body we care for: Figures of anthropo-zoo-genesis. Body and Society, 10, 111–134. Despret, V. (2015a). We are not so stupid…animals neither. Angelaki, 20(2), 153–161. Despret, V. (2015b). Who made Clever Hans stupid?’ Angelaki, 20(2), 77–85. Despret, V. (2016). What would animals say if we asked the right questions. Minneapolis: University of Minnesota Press. Despret, V., & Meuret, M. (2016). Cosmoecological sheep and the arts of living on a damaged planet. Environmental Humanities, 8(1), 24–36. Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press. Haraway, D. (1997). Modest_Witness@Second_Millenium: Female Man_Meets_OncoMouse: Feminism and technoscience. New York: Routledge. Haraway, D. (2008). When species meet. Minneapolis: University of Minnesota Press. Haraway, D. (2016). Staying with the trouble: Making kin in the Chthulucene. Durham, NC and London: Duke University Press. Lenz Taguchi, H. (2012). A diffractive and Deleuzian approach to analysing interview data. Feminist Theory, 13(3), 265–281.

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Noddings, N. (2002). Educating moral people. Berkeley: University of California Press. Sevenhuijsen, S. (1998). Too good to be true?: Feminist considerations about trust and social cohesion. Institute for Human Studies. IWM Working Paper No. 3/1998, Vienna. Sevenhuijsen, S. (2003). The place of care: The relevance of the feminist ethic of care for social policy. Feminist Theory, 4(2), 179–197. Sevenhuijsen, S., & Svab. A. (2003). Labyrinths of care: The relevance of the ethics of care perspective for social policy. Ljubljana: Mirovni Institute. Shotwell, A. (2016). Against purity: Living ethically in compromised times. Minneapolis: University of ­M innesota Press. Tsing, A., Swanson, H., Gan, E., & Bubandt, N. (2017). Arts of living on a damaged planet: Ghosts and monsters of the Anthropocene. Minneapolis: University of Minnesota Press. Tronto, J. (1993). Moral boundaries: A political argument for an ethic of care. New York: Routledge. Tronto, J. (2013). Caring democracy markets, equality, and justice. New York: New York University Press. Tronto, J. (2015). Who cares? How to reshape a democratic politics. Ithaca, NY: Cornell University Press.

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Social work education

29 Moral courage and moral distress in social work ­education and practice A literature review Eleni Papouli

Introduction The concepts of “moral courage” and “moral distress” play key roles in social workers’ professional well-being and performance. In today’s professional environments, social workers often have to confront ethical conflicts and dilemmas that can be complex and daunting. Addressing the many conflicts and dilemmas facing social workers will certainly require decision-making that is based on moral courage. Research has shown that unresolved ethical challenges and dilemmas often result in value conflicts which, in turn, can lead social workers to feelings of moral distress. Given their importance, this chapter provides a synoptic review of the literature on these two key concepts – “moral courage” and “moral distress” – in social work education and practice. The chapter comes in three parts, the first two parts follow the same structure: they look at the historical background of the two concepts and then examine the leading definitions and search for different types. They also examine the relationship between the two concepts and the social work profession, as well as possible causes and effects on social workers and students. Finally, the third part of the chapter briefly discusses specific strategies for acting with moral courage and dealing with moral distress in social work practice. In order to present a clear and complete view of the two concepts, we look for relevant literature in other fields (e.g. philosophy, medicine, nursing, psychology) that use the concepts of moral courage and moral distress more fully.

What is courage? – definition and types Courage as a moral virtue has been closely bound to the mission of social work as an ­ethical-based profession and is essential for making tough decisions and life changes at ­personal, professional, or social level. Courage is an ancient concept, which is still held as essential and idealized; it comes from the Latin “cor” that means heart and in ancient Greece, it was synonymous with “tharros” (boldness). Courage has been approached from a v­ ariety of sociocultural and psychological perspectives, which have enriched its definition with 225

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different nuances. That which all approaches are likely to agree with is that courage is a learned ability (or capacity) to face fears or anxieties and take risks with determination and confidence. In the history of ethics, courage is considered to be a core human virtue. In ancient Greece, the philosopher Aristotle named courage as the greatest of all virtues because it is the virtue which guarantees all the others (Papouli, 2018). In modern times, courage is seen as a universal virtue because it appears to have diachronic significance and universal character. According to Peterson and Seligman (2004), courage is among the six ubiquitous virtues (courage, justice, humanity, temperance, wisdom, and transcendence) and is made up of four character strengths such as bravery, persistence, integrity, and vitality, which are “the psychological ingredients – processes or mechanisms – that define the virtues” (p. 13). Scholars from the fields of philosophy and psychology agree that there are many different types of courage in human life. However, the most commonly mentioned types of courage are: physical courage, psychological (Putman, 2010) or vital courage (Lopez, O’Byrne, & Peterson, 2003), and moral courage. These are not mutually exclusive and may often overlap in practice, though each has some specific features and characteristics. Below, we briefly describe the three main types of courage and then we shift our focus to moral courage and discuss in more detail its importance in social work education and practice.

Physical courage It is the courage that people need to make the decision to be brave in the face of death or threat of death, physical harm, or hardship. Physical courage is associated with physical acts (Crigger & Godfrey, 2011).

Psychological courage Psychological courage (also known as vital courage) is defined as a form of human virtue that involves the strength to acknowledge and face irrational fears (e.g. phobias) and personal weaknesses, disruptive habits, or threats to one’s own psychological ability (Putman, 2010).

Moral courage Moral courage has been defined in different ways by different scholars. For example, some scholars (Osswald, Greitemeyer, Fischer, & Frey, 2010) define moral courage as “a prosocial behavior with high social costs and no (or rare) direct rewards for the actor” (p. 150). Others (Lopez et al., 2003) describe it as “the expression of personal views and values in the face of dissension and rejection” (p. 187). In the field of philosophy, Putman (2010) describes moral courage as “overcoming fear of social ostracism or rejection in order to maintain ethical integrity” (p. 9).

From courage to moral courage in social work As indicated previously, moral courage is a substantive virtue for social workers because it is intertwined with the nature of the social work profession. According to Banks (2012), moral courage is the most referred virtue in the literature that is needed for social workers to overcome the barriers to practice ethically in the workplace. Yet, in spite of its obvious importance, the concept of moral courage has still not received adequate attention in the 226

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theoretical and research literature. Nevertheless, moral courage is so linked to the social work profession that scholars, like Cooper (2015), describe social work as an act of courage, especially in the critical times in which we live; today more than ever, social workers have to practice daily acts of courage to overcome challenges of neoliberal policies and managerial practices applying to almost every part of the world. Like life’s challenges, challenges in social work practice can be daunting and require courage. However, not all acts of courage have the same significance or moral worthiness. Some courageous acts may take a less dramatic form, but no less significant, such as to overcome practicalities of the job, to ask for a promotion, or to speak to your manager about a raise, while others require high levels of moral bravery to pursue and achieve your professional goals. For example, to stand up for the rights of vulnerable and disadvantaged clients (individuals, families, groups) when you encounter frightening or difficult situations or to speak out and fight against inadequate resources and policies that often restrict clients from meeting their real needs. It is, of course, not only social workers who need moral courage to overcome conflicts and frustrations and take necessary actions. The same holds true for students who might have to take courageous steps – big or small – to address unpleasant and difficult situations effectively, such as to overcome a bad practice placement, to accuse their practicum supervisors or academic teachers of abusive power or even having to report them for inappropriate teaching practices (Oliver, et al., 2017). Clearly, all the abovementioned examples require moral courage to uphold professional ethics and values in the face of opposition and possible harm to oneself and others. Hence, moral courage involves the preservation of oneself and/or others from unjust acts or unethical behaviors. In the helping professions like social work, it is well known that practitioners often need moral courage to put values and ethics into action and be able to fight for social justice and the well-being of clients. It is in this view that moral courage as a human virtue is inextricably linked to the social justice and common good. Barsky (2010) summarizes beautifully why social workers need to use moral courage in their everyday practice: “We use moral courage to correct a wrong, to pre-empt or mitigate harm, to safeguard vulnerable populations, or to hold people accountable for unethical or harmful actions” (para. 7). According to Banks (2012), moral courage is a “complex” virtue because it might require social workers and students to make the difficult decision to do the right thing even if it may work to their disadvantage. But due to its complexity, it must become clear that the concept of moral courage is neither associated with the lack of fear of making ethical decisions nor with some form of self-destructive behavior as explained by Barsky (2010). In other words, being a courageous social worker does not mean you don’t fear or you are not afraid of taking risks. Instead, moral courage requires risk-taking and fear, as indeed every act of courage involves taking risks and defying a fear. Indeed, Aristotle was the first to suggest that morally courageous individuals do not ignore fear, but are trying to overcome it in order to accomplish their goals (Papouli, 2018). As already mentioned, moral courage is a “complex” professional virtue that is required to ­ ristotle make ethical judgments and take action on ethically difficult situations. In addition, A reminds us that moral courage is content and context-dependent, though it is a universal virtue (Papouli, 2018). Moreover, in recent years, social workers have often been accused of being techno-bureaucratic and lacking the moral courage needed to stand up to the opposition and do what is right. In light of the above, it appears actually quite complicated and not ­a lways easy for social workers or students to articulate moral courage into their daily practices. But why is it so complicated to be courageous and do the right thing at work? ­Ethics experts from different disciplines discern two primary inhibitors to morally 227

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courageous behavior: the fear of consequences or reprisals and the fear of ostracism. Barsky (2009, para 1) gives the following examples of questions related to the social worker’s fear to demonstrate moral courage at work: What if I raise the issue and my superiors get angry? What if I can’t prove the wrongdoing and people accuse me of being insubordinate, traitorous, or disloyal? Am I willing to risk scorn, humiliation, alienation, or even the loss of my job? Looking at the barriers to moral courage in social work, Strom-Gottfried (2006) identified those more commonly associated with the failure of social workers to show moral courage and behave courageously in the workplace. These barriers include: the discomfort of standing alone against others, the presumption of futility, the social workers’ socialization, the bystander effect or diffusion theory, and personal cost. Finally, Kidder (2005) also examines and explores the possible barriers to moral courage at work and draws similar conclusions. He suggests the following seven barriers to moral courage at work, which are related to both individual and organizational factors. 1 Organizational cultures that stifle discussion regarding unethical behaviors and tolerate unethical acts; 2 Willingness to compromise personal and professional standards in order to avoid social isolation from peers or to secure a promotion/favoritism within the organization; 3 Unwillingness to face the tough challenge of addressing unethical behaviors; 4 Indifference to ethical values; 5 Apathy of bystanders who lack the moral courage to take action; 6 Group thinking that supports a united decision to turn the other way when unethical behaviors are taking place; and 7 Tendency to redefine unethical behaviors as acceptable.

What is distress? – definition and types It is known that social workers are confronted daily with stressful situations that may affect their physical and mental health and may directly or indirectly impact their job performance. In their effort to benefit clients and be truly effective, they come across with disputes and problems at work such as insufficient resources, function conflicts and problems with coworkers that make them feel overwhelmed and stressed out. Similarly, students face various stressful academic situations that can negatively impact their performance. Stress can affect how we feel physically, emotionally, mentally, and also how we perceive our role in different areas of life including personal and professional lives. But, feeling stressed isn’t always a negative situation; under normal circumstances, stress can motivate us to do better at jobs we care about and makes us take responsibility for our actions. For example, social workers and students may feel stressed when they move onto a new job or field placement or when there are too many projects going on. In addition, they may feel stressed at work due to factors such as excessive job demands or placement requirements. Yet, the problem arises when the stress becomes too much for the individual to cope with and thereby leads to distress, which is a negative reaction to stressful situations. The reviewed literature suggests that distress has many definitions, but there is no one definition that is more adequate than the other. Moreover, the literature acknowledges 228

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different types of distress that may find social workers, students, or even clients. The four types of distress listed below are the most common in the relevant literature and require different levels of management. We briefly describe each of them before turning our attention to the specific type of moral distress and its relation to the social work profession.

Physical distress (or somatic distress) It refers to somatic symptoms of distress such as pain, insomnia, headaches, tiredness, or fatigue that disrupt the individual’s daily life and lead to undesirable changes in behavior; it is viewed as an expression of psychological distress through physical symptoms.

Psychological distress (or mental distress) It is often described as a state of emotional suffering characterized by symptoms of depression (e.g. lost interest; sadness; hopelessness) and anxiety (e.g. restlessness; feeling tense) (Mirowsky & Ross, 2002).

Spiritual distress It is associated with concerns about the meaning of life and death, questions the meaning of suffering or of his or her own existence, verbalizes inner conflict about beliefs, expresses anger toward God or other Supreme Being, or actively seeks spiritual assistance (Miller-Keane & O’Toole, 2005).

Moral distress (ethical distress or ethical stress) It is triggered by the individual’s inability to judge or manage ethical conflicts-dilemmas related to external or internal constraints. Fenton (2015) uses the term “ethical stress” to describe the inability of social workers to base their practice on professional ethics and values.

From distress to moral distress in social work Moral distress is a crucial concept for understanding and theorizing about ethics within the complexities of practice (Weinberg, 2009). But, despite its importance, moral distress is a relatively new concept in social work literature. As yet, there is still limited evidence to provide a comprehensive understanding of this moral phenomenon. Therefore, much of our knowledge on this concrete phenomenon has been based principally on nursing and allied health literature including psychology literature (Weinberg, 2009). The concept of moral distress was popularized by Jameton’s (1984, 1993) work in nursing literature, but over the last couple of decades, the concept is increasing and spreading to other fields. Generally speaking, moral distress can be understood as a moral phenomenon in which social workers know the proper ethical action to take, but are constrained from taking it because of external or/and internal constraints. Moral distress comes in two stages which are both important for understanding what a social worker is thinking and feeling at different phases of moral distress: initial moral distress and reactive moral distress ( Jameton, 1993). Initial moral distress includes feelings of frustration, anger, and anxiety that social workers experience when faced with institutional/structural or organizational obstacles and conflicts 229

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with others about values. On the other hand, reactive moral distress – also known as moral residue – is the distress that social workers feel when they do not act upon their initial distress.

Causes and effects of moral distress Evidently, moral distress impedes the practitioners’ ability to perform professional duties and services from an ethical perspective. This is particularly true for social workers, who are committed to the professional ethics and at the same time, they find themselves being challenged by difficult ethical conflicts-dilemmas, as mentioned earlier. Literature reviews have shown that moral distress causes painful feelings and/or psychological disequilibrium and can have short- and long-term effects on the professional’s well-being (especially ongoing moral distress) such as loss of empathy and compassion, increased sick leave, helplessness and hopelessness, job dissatisfaction, demoralization, leaving job, burnout (Fronek et al., 2017; Oliver, 2013). Moral distress can also affect the well-being of students causing physical and mental health problems such as anger, feelings of guilt and frustration, loss of self-esteem, depression, and anxiety (Lynch & Forde, 2016; Sasso, Bagnasco, Bianchi, Bressan, & C ­ arnevale, 2016). But moral distress that is diagnosed at an early stage may have positive effects on the individual’s well-being as it might help to improve learning, personal and professional growth, self-awareness, and moral resilience (McCarthy & Gastmans, 2015). In a review of the nursing ethics literature, McCarthy and Gastmans (2015) identified four key contributory features to moral distress: (1) clinical situations (e.g. unnecessary/futile treatment, lack of treatment, incompetent or inadequate care, inadequate informed consent); (2) difficult working conditions and limited resources (e.g. lack of policies and guidelines, poor staffing, cost cuts, economic efficiencies, and increased workloads; (3) structural conditions (e.g. power hierarchies, devaluation, poor team work and team support, professional and interprofessional conflicts, social and health care inequalities, and discrimination); and (4) moral sources (e.g. lack of courage and self-doubt or fear, value conflicts). Interestingly, very few studies dealing with moral distress in social work (mostly carried out in health settings) have showed similar results to the nursing studies. For example, moral sources related to moral distress in social work may include a fear of speaking up, being perceived as imperfect, fear of conflict, lack of courage, fear of job loss, and self-doubt (Oliver, 2013, p. 206). Moreover, work and structural constraints or institutional constraints are associated with poor working conditions, ineffective policies, increased workload and stress, lack of resources and support in social work contexts, especially in times of crisis (Fantus et al., 2017; Mänttäri-van der Kuip, 2016). It is important to note here, though, that moral conflicts in social work result more often from a clash between professional ethics and organizational demands and/or institutional policies rather than from choices between practice interventions as happens with nursing interventions (Fronek et al., 2017; Weinberg, 2009). For this reason, some scholars suggest that the concept of moral distress in social work should be viewed as a containing political dimension and should be included in the ethics codes for social workers (Oliver, 2013; Weinberg, 2009).

Strategies for addressing moral courage and moral distress The literature indicates that coping with moral distress includes cultivating moral courage as a human quality. Hence, social workers and students should be able to identify the characteristics of both concepts in order for them to have a more informed view of the risks that come with them, as well as to make better and more informed ethical decisions in practice. 230

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To do so, they need to develop and use specific strategies that build courage and resistance and decrease moral distress. Such strategies tend to include the convergence of three commitments: education, training, and practice. Education is the backbone to developing moral courage and learning to respond to morally distressing situations. Thus, educators should include both concepts into their instruction. In addition, high-quality ongoing training opportunities for social workers are of paramount importance to address moral courage and moral distress within their everyday practice. Moreover, role modeling by real-life exemplars (e.g. supervisors, teachers, managers) is a powerful method that provides the kinds of strategies that support moral courage of social workers. Furthermore, mentoring of ethics and support networks are further examples of effective strategies for encouraging social workers and students to stay committed to their professional ethics. Last but not least, social service providers and policy makers need to strengthen an ethical work environment that supports the use of open dialogue approaches on ethical issues and cultivates ethical leadership within the organization. With these strategies, social workers and students will feel safe and supported, especially in these challenging times, to share their ethical concerns and deal with their dilemmas in practice.

Conclusion This chapter highlighted the central role that moral courage and moral distress play in the ethical practice of social workers, though they are opposite concepts; the concept of moral courage is often considered as the antidote to prevent moral distress in social work, while moral distress is seen as a threat to ethical practice. Given their importance, social workers and students need to be aware of both concepts in order to understand how these affect them and others in delivering quality social welfare services. Notwithstanding their roles in social work as an ­ethical-based profession, the two concepts have not been widely examined in the theoretical and research literature, as already discussed. The research gaps identified highlight the need to improve knowledge about the two key concepts in social work settings from various perspectives. Not only will such research help social workers and students better understand how different aspects of the concepts relate to one another, it will also help them improve strategies for developing moral courage and appearing resilient to moral distress in their professional practice.

References Banks, S. (2012). Ethics and values in social work (4th ed.). Basingstoke: Palgrave Macmillan. Barsky, A. (2009). When right is not easy: Social work and moral courage. Retrieved from http://blog.oup. com/2009/12/social-work-moral-courage/ Barsky, A. (2010). Ethics and values in social work. London, UK: Oxford University Press. Cooper, J. (2015). Social work is an act of courage. Retrieved from http://www.communitycare.co.uk/2015/ 03/18/socialwork-act-courage/ Crigger, N., & Godfrey, N. (2011). Of courage and leaving safe harbors. Advances in Nursing Science, 34(4), 13–22. Fantus. S., Souleymanov, R., Souleymanov. N. J., Lachowsky, N. J., Brennan, D. J. (2017). The emergence of ethical issues in the provision of online sexual health outreach for gay, bisexual, two-spirit and other men who have sex with men: Perspectives of online outreach workers. Medical Ethics, 18(1), 1–12. Fenton, J. (2015). An analysis of ‘ethical stress’ in criminal justice social work in Scotland: The place of values. British Journal of Social Work, 45, 1415–1432. Fronek, P., Briggs, L., Kim, M. H., Han, H. B., Val, Q., Kim, S., & McAuliffe, D. (2017). Moral distress as experienced by hospital social workers in South Korea and Australia. Social Work in Health Care, 56(8), 667–685. 231

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Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice-Hall. Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONN’s Clinical Issues in Perinatal Women’s Health Nursing, 4(4), 542–551. Kidder, R. M. (2005). Moral courage: Taking action when your values are put to the test. New York, NY: William Morrow. Lopez, S. J., O’Byrne, K. K., & Peterson, S. (2003). Profiling courage. In S. J. Lopez & C. R. Snyder (Eds.), Positive psychological assessment: A handbook of models and measures (pp. 185–197). Washington, DC: American Psychological Association. Lynch, D., & Forde, C. (2016). Moral distress and the beginning practitioner: Preparing social work students for ethical and moral challenges in contemporary contexts. Ethics and Social Welfare, 10(2), 94–107. Mänttäri-van der Kuip, M. (2016). Moral distress among social workers: The role of insufficient resources. International Journal of Social Welfare, 25(1), 86–97. McCarthy, J. & Gastmans, C. (2015). Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131–152. Miller-Keane, B. F., & O’Toole, M. T. (2005). Encyclopedia and dictionary of medicine, nursing and allied health (7th ed.). Philadelphia, PA: Saunders. Mirowsky, J., & Ross, C. E. (2002). Selecting outcomes for the sociology of mental health: Issues of measurement and dimensionality. Journal of Health and Social Behavior, 3(43), 152–170. Oliver, C. (2013). Including moral distress in the new language of social work ethics. Canadian Social Work Review, 30(2), 203–216. Oliver, C., Jones, E., Rayner, A., Penner, J., & Jamieson, A. (2017). Teaching social work students to speak up. Social Work Education, 36(6), 702–714. Osswald, S., Greitemeyer, T., Fischer, P., & Frey, D. (2010). What is moral courage? Definition, explication, and classification of a complex construct. In C. L. S. Pury & S. J. Lopez (Eds.), The psychology of courage (pp. 149–164). Washington, DC: American Psychological Association. Papouli, E. (2018). Aristotle’s virtue ethics as a conceptual framework for the study and practice of social work in modern times. European Journal of Social Work Education. Advance online publication. Peterson, C., & Seligman, M. E. P. (2004). Character strengths and virtues: A handbook and classification. New York, NY: Oxford University Press. Putman, D. (2010). Philosophical roots of the concept of courage. In C. L. S. Pury & S. J. Lopez (Eds.), The psychology of courage: Modern research on an ancient virtue (pp. 9–22). Washington, DC: American Psychological Association. Sasso, L., Bagnasco, A., Bianchi, M., Bressan, V., & Carnevale, F. (2016). Moral distress in undergraduate nursing students: A systematic review. Nursing Ethics, 23(5), 523–534. Strom-Gottfried, K. (2006). Ethical actions in challenging times. Retrieved from https://ssw.unc.edu/ files/EthicsLectureBooklet.pdf Weinberg, M. (2009). Moral distress: A missing but relevant concept for ethics in social work. Canadian Social Work Review/Revue Canadienne de Service Social, 26(2), 139–151.

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30 Disagreement about ­ethics and values in practice Using vignettes to study social work Morten Ejrnæs and Merete Monrad

Introduction In this chapter, we present research results about disagreement among social workers. These results challenge the idea that common values are influential in social work practice and that general ethical guidelines are helpful for social workers handling ethical dilemmas in practice. We review empirical research that shows widespread disagreement among social workers about judgments and attitudes regarding concrete situations and ethical dilemmas. Empirical studies show that social workers are often unaware of the existing disagreements within their profession. Hence, controversial issues are latent and seldom discussed. We propose that social workers have an important ethical obligation to recognize those disagreements, express their own judgments, listen carefully to divergent views, and be willing to discuss the emerging ethical issues. Moreover, we suggest that the vignette method can be used to train these competencies and study social workers’ responses to ethical dilemmas.

Codes of ethics, core values, and social work practice While there is no common understanding of the nature of social work and the role of social workers in society, it is nevertheless common to argue that social workers agree about some core values (Asquith, Clark, & Waterhouse, 2005). Social work codes of ethics often emphasize values such as social justice, dignity, participation, and inclusion, and such broad principles are supported by both national and international associations of social workers. The International Federation of Social Workers (IFSW) states “right to self-determination,” “right to participation,” “treating each person as a whole,” “identifying and developing strengths,” and “social justice” as core values (IFSW, 2012). Social work organizations also often have a set of explicit values informing their work. In addition, ethical considerations are an integrated part of social work education, and it is often believed that the common education will lead to some similarity in values among social work students. However, since both core values and ethical principles are very abstract, they conceal considerable variation and even disagreement among social workers regarding how these principles should be put into practice. The question is to what degree do social work ethical guidelines and core values, 233

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social work education, and social work organizations’ ethical principles result in uniform and ethical judgments from social workers? We discuss this question by examining theoretical work and empirical studies regarding social work professionals’ judgments and attitudes.

Theoretical approaches to the impact of values and ethics on social work practice For several reasons, social workers’ values are often assumed to be relatively uniform. People with relatively similar motivations and habitual dispositions select the social work profession. Furthermore, the professional education (secondary socialization) as well as common assumptions and approaches in the profession and field of practice (what Bourdieu, 1999, would term doxa) may standardize values to some extent. At the same time, organizational procedures and resource deficits, lack of diversity in available interventions, and legislation and public management (e.g. performance measures) may also exert a pressure to standardize social work practice. Within theories of professions, organizations, management, socialization, and education, there is a strong tendency to emphasize mechanisms that should lead to alignment or even standardization of the social workers’ judgments and practices. However, research also suggests that the values of social work practitioners are influential in the implementation of policy goals (May & Winter, 2009). In addition, differences in social background (habitus and capital) may entail different strategies of positioning within the field of social work and therefore different judgments and practices (Bourdieu, 1999; Landau & Osmo, 2003). However, it is still common to theorize that conflicts and disagreement arise from differences in interprofessional teams rather than from differences within the social work profession itself and to liken these conflicts to struggles among different professions (e.g. Lymbery, 2006). The common assumption is that social work professionals hold uniform values and make similar judgments. Hence, it is relatively uncommon to recognize a high level of disagreement over social work practice among practitioners in the field.

Research results about agreement and disagreement among social workers Studies of social workers’ judgments and attitudes are common. These studies typically examine factors explaining the attitudes of social workers such as religious and political affiliation (Perryman, Barnard, & Terrell, 2018), levels of education and experience, or organizational factors (Alpert & Britner, 2005). Alternatively, said studies may examine how client-related or contextual factors affect social work judgments (Samuelsson & Wallander, 2014) or focus on differences between social work and other professions (Britner & Mossler, 2002). A few studies have explicitly engaged with the question of disagreement within the social work profession (Ejrnæs, 2006; Harrington & Dolgoff, 2008; Landau & Osmo, 2003; Trotter, Brogatzki, Duggan, Foster, & Levie, 2006). Other studies report results that show great disagreement within the social work profession, even though this is not the main research question (Devaney, Hayes, & Spratt, 2017; Pawlukewicz & Ondrus, 2013). In the following text, we present results from two Danish studies showing that social workers frequently hold different and sometimes even conflicting attitudes about the best responses to ethical dilemmas (Ejrnæs, 2006). The studies are based on vignette methodology, in which social workers are asked to read a case of ½ to 1½ pages and report how they would assess and respond to the described case. The studies included 17 vignettes that all concerned fictitious but realistic situations regarding child welfare and child protection. 234

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The  respondents in the two studies were in total 140 social workers employed in Danish municipalities, who each responded to 6–11 vignettes (Ejrnæs, 2006). An excerpt from one of the vignettes is presented below (Ejrnæs, 2006): Lise is 32 years old and has been at a crisis center for three days with her two children Mille, 8 years old, and Nikolaj, 5 years old. When arriving at the crisis center, Lise is miserable and scared. She only says that it has been terrible. The next day, she tells the following about her family’s situation: She is married to Tom, who is 28 years old. The family lives in an allotment shed. They have inherited the shed from Tom’s mother. Tom repairs cars and has a small repair shop next to the shed. He has been a cash benefit recipient previously, but he got tired of attending meaningless activation projects. Lise works at a cleaning company. Their finances are tight. Lise has twice moved in with a friend with the children, because Tom has been violent toward her and Mille. He has never touched Nikolaj. After each episode of violence, Lise hoped that Tom would change. This time, Tom did not hit Lise, but he threatened to take the children and “do something to them”. Lise describes that Tom looked wild and crazy. Lise escaped the house with both children, because Tom fell asleep, probably because he had been drinking heavily. Lise says that she and Tom disagree over the upbringing of the children. He believes that Lise is too soft, especially toward Mille. (p. 78) The vignette continues with further information on Tom and Lise’s relationship, their history together, and Lise, Mille, and Nikolaj’s responses to being at the crisis center. Following the vignette, the respondents were asked 30 questions, such as “Do you believe that the employee at the crisis center who admitted Lise should have referred her to a psychologist?” 28% of the social workers answered yes; the majority answered no. Another question was “If Tom shows up at the crisis center two days later unmistakably drunk and yells through the entry phone that his wife and children have to come home now so they can talk things through, do you believe the employees should send a referral to the municipal social services department?” 65% answered yes. Both questions showed significant disagreement. Other questions showed total disagreement: approximately 40–50% responded “yes” while the other 40–50% responded “no.” These cases included questions about the parents’ participation in an interprofessional meeting, among other considerations. About half of the questions reveal agreement among 80% or more of social workers. In general, the two studies show widespread disagreement among social workers: each of the 17 vignettes contains questions in which 30% or more of the social workers disagree with the majority. Out of 310 questions, there are 83 such questions, and in 38 questions, 40% or more disagree with most of the other social workers. Moreover, one of the studies shows that social workers have very different perceptions of the seriousness of the problems depicted in the vignettes. Looking more closely at the issues that are controversial among social workers yields several examples of disagreement on ethical issues. Social workers do not always agree about when it is appropriate to refer to another professional (e.g. a psychologist). They very often have different opinions regarding parents’ participation in interprofessional meetings about their children. They do not agree about when to establish interprofessional collaboration, and they often do not agree about when signs of neglect or abuse are serious enough to warrant a referral to the municipal authorities. Among the social workers participating in the studies, there is no uniform ethical approach or standardized social work assessment. 235

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The studies suggest that disagreement, even strong disagreement, among social workers is rather frequent when social workers are confronted with cases regarding serious and complicated social problems. Similar results have been found regarding students and professionals in early education and care (Ejrnæs & Monrad, 2010; Ejrnæs, Espersen, Fuglsang, & Monrad, 2015). These results are in line with Landau and Osmo (2003), who find that while there may be a consensus about the significance of a range of ethical principles in social work, there is no consensus about the ranking of ethical principles or their interpretation and application in specific cases (Fox, Ramon, & Morant, 2015). Said results challenge the idea that common knowledge (theory and method), core values, and ethical principles lead to shared attitudes and practices within a profession. Thus, when we examine social work values in practice, it is important to acknowledge that social work professionals differ in their judgments of the same cases. Such differences come not from lack of professionalism. It is rather a fundamental condition in social work with complex social problems because of conflicts of interests, conflicts of values (Aubert, 1963; Ejrnæs & Monrad, 2013), conflicts between discourses (Høgsbro, 2010), differences in life experiences and professional experiences (Rescher, 1993), the indeterminacy of the impact of different interventions (Pedersen & Nielsen, 2009), and the significance of personal values in ethical decision-making (Landau & Osmo, 2003; Maynard-Moody & Musheno, 2012). Although social work professionals share a range of core values and agree on broad ethical principles, there is no reason to assume that they therefore prioritize different ethical principles similarly or that they practice ethical principles in a uniform way (Landau & Osmo, 2003). Furthermore, research has shown that social workers make use of different ethical principles when they reflect on ethics in general social work and when they make decisions in specific situations (Osmo & Landau, 2006).

Latent disagreement among professionals One of the Danish studies shows that social workers generally assume that other social work professionals judge situations and want to behave similarly to themselves. Hence, social workers are generally not aware of the disagreements they may have with their colleagues (Ejrnæs, 2006, pp. 153–182). Similar results have been found for other professions and students in early education and care (Ejrnæs et al., 2015; Ejrnæs & Monrad, 2010, 2016). These findings indicate that the widespread disagreement among social workers is latent. The erroneous belief in agreement among colleagues can be conceptualized as a form of pluralistic ignorance or an “illusion of universality” (Katz & Allport, 1931, pp. 149–154). Merton (1968, p. 431) distinguished between two forms of pluralistic ignorance: the “unfounded assumption, that one’s own attitudes are unshared, and the unfounded assumption that they are uniformly shared.” We have found strong evidence for the latter type of pluralistic ignorance among social workers. Social workers are generally convinced that their attitude is shared by the majority even when most of their colleagues have a different or even conflicting point of view. This type of bias has also been theorized as an expression of “naïve realism,” which means that persons are convinced that they “see” the world “as it is,” which may yield the belief that “reasonable others should see it in the same way” (Pronin, Gilovich & Ross, 2004, p. 795). “Naïve realism” makes it likely that social workers think that colleagues with the same education share their perceptions and action tendencies. An incorrect perception of the actions and attitudes of the majority of other people may have serious consequences for the individual’s own judgments and actions (Brener, Hippel, Horwitz, & Hamwood, 2015; Pronin et al., 2004, pp. 796–797). 236

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The expectation of agreement with professional colleagues may be an expression of trust, but it is problematic that professionals are unaware that their own judgments and attitudes differ from the majority of social workers. Social workers may not be aware that their approach to ethical dilemmas is controversial, and this unawareness may impede reflection and discussion. In this context, it is important to emphasize that one study shows that most of the social worker respondents hold minority attitudes in some areas yet still believe that their attitude is in accordance with the majority (Ejrnæs, 2006, p. 176). Social work professionals should become aware of the widespread disagreement regarding social work practice, because this knowledge may facilitate constructive professional discussions of ethical controversies, multiply the perspectives that social workers apply to a given case, and help social workers increase their reflexivity of the basis of their own judgments. Dilemmas, opposition, disagreement, and conflict can be important in facilitating learning, because colleagues may question habitual practices and discuss alternative practice (Hargreaves, 2001; Pedersen & Nielsen, 2009). Such conflictual and social learning, however, requires that disagreements are articulated and discussed among practitioners. The recognition of diversity in attitudes among social workers may also help social workers better understand the diversity in client preferences and values. Hence, we believe that erroneous conceptions about the attitudes and judgments of colleagues can be detrimental to the collaboration among professionals, collective reflections on ethical dilemmas, and social workers’ professional work performance.

Ethical implications for social work The different views on specified social problems and how to handle them challenge the ideal of social workers as a profession with a set of shared values that guide the professionals’ actions. We do not believe that the widespread disagreement among social workers can be eliminated through professionalization, increased level of education and training, evidence-based social work, or abstract ethical principles. Social work involves conflicts of interests and values that cannot be resolved once and for all. Social work unavoidably touches on conflicts of values and ethical dilemmas, and rather than avoiding such conflicts or handling them individually, social workers need the skills to collectively discover, analyze, and discuss disagreement and conflict as a natural and potentially fruitful part of social work practice. Because disagreement may upset social bonds at work and divert effort and energy into unproductive conflict, professionals may seek to avoid conflicts by not voicing disagreement (Hargreaves, 2001; Rescher, 1993). However, we argue that voicing disagreement is an important part of the professional ethics of social work. This element is especially important since disagreement within the social work profession often goes unrecognized. Professional social workers should be committed to expressing their own individual views and listening carefully to colleagues who hold different opinions. Identifying and analyzing disagreement, collective doubt, and discussion are means of ensuring that the multiple considerations (e.g. societal, organizational, individual) that are important in social work practice are reflected upon. To form a holistic view of their cases, social workers need the skills to seek out their colleagues’ assessments and opinions and use their fellow professionals’ judgments in interplay with client views and preferences. Therefore, social workers need skills in identifying disagreement, understanding the different mechanisms that may cause disagreement, and knowing how to use disagreement as the basis for a more holistic approach that recognizes the uniqueness of the client. 237

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The vignette method – a tool to identify and analyze disagreement In order to facilitate the constructive use of disagreement in the development of social work practice, it is important to create collective spaces for articulating and discussing disagreements. We argue that vignettes can be used to identify areas of disagreement and foster discussions of ethical dilemmas among social work practitioners (Ejrnæs & Monrad, 2012). It is important to examine the values of social work professionals as they are put into practice. Therefore, we must choose methods that allow us to identify areas of disagreement about values in social work practice. Research using vignette methodology makes it possible to investigate how social workers judge and prefer to act in similar situations, thus facilitating the comparison of social workers’ judgments and attitudes. Because vignettes can be constructed by both researchers and practitioners, it is possible to choose content that is particularly relevant to the ethical problems in a given field of practice. Vignettes can be used in focus group discussions or as part of a survey, examining both the areas and extent of disagreement (Fox et al., 2015; Hughes & Huby, 2002; Wilks, 2004). Vignette method can be used to further knowledge of social workers’ attitudes regarding practice-oriented ethical issues as well as to analyze these attitudes. The vignette method is particularly well-suited for comparing attitudes and identifying disagreement in social work practice, as this method allows for insights into social workers’ context-specific judgments in complex situations. Practitioners can apply the vignette method by constructing a one-page case and a set of questions regarding the case, and it is possible for social work offices and organizations to carry out independent small surveys in which they identify and analyze disagreement within the staff about current problems concerning ethical issues. Based on such a survey, members of the staff can discuss the results, and both social workers with a minority view and those with a majority view can present their arguments and reasoning. This approach can facilitate knowledge-sharing, reflexivity, and learning among practitioners. Hence, the vignette method can be helpful to (1) discover and display situations in which social workers disagree about professional judgments, (2) initiate ethical discussions about specific social problems, and (3) develop deliberations about ethical obligations in concrete practice.

References Alpert, L. T., & Britner, P. A. (2005). Social workers’ attitudes toward parents of children in child protective services: Evaluation of a family-focused casework training program. Journal of Family Social Work, 9(1), 33–64. Asquith, S., Clark, C., & Waterhouse, L. (2005). The role of the social worker in the 21st century – A literature review. Edinburgh: Scottish Executive Education Department. Aubert, V. (1963). Competition and dissensus: Two types of conflict resolution. The Journal of Conflict Resolution, 7(1), 26–42. Bourdieu, P. (1999). Structure, habitus, practices. In A. Elliott (Ed.), The Blackwell reader in contemporary social theory (pp. 107–118). Oxford: Blackwell Publishers. Brener, L., Hippel, C.v., Horwitz, R., & Hamwood, J. (2015). The impact of pluralistic ignorance on the provision of health care for people who inject drugs. Journal of Health Psychology, 20(9), 1240–1249. Britner, P. A., & Mossler, D. G. (2002). Professionals’ decision-making about out-of-home placements following instances of child abuse. Child Abuse and Neglect, 26(4), 317–332. Devaney, J., Hayes, D., & Spratt, T. (2017). The influences of training and experience in removal and reunification decisions involving children at risk of maltreatment: Detecting a ‘Beginner dip’. British Journal of Social Work, 47(8), 2364–2383. Ejrnæs, M. (2006). Faglighed og Tværfaglighed – Vilkårene for Tværfagligt Samarbejde Mellem Sundhedsplejersker, Pædagoger, Lærere og Sagsbehandlere. Copenhagen: Akademisk Forlag. 238

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Ejrnæs, M., Espersen, R. B., Fuglsang, T., & Monrad, M. (2015). Pædagoger i Folkeskolen. Copenhagen: BUPL. Ejrnæs, M., & Monrad, M. (2010). Enighed, Uenighed og Udvikling: Pædagogisk Faglighed i Daginstitutioner. København: BUPL. Ejrnæs, M., & Monrad, M. (2012). Vignetmetoden som Sociologisk Undersøgelsesmetode og Faglig Udviklingsmodel. Copenhagen: Akademisk Forlag. Ejrnæs, M., & Monrad, M. (2013). Profession, holdning og habitus: Forholdet mellem pædagogers og forældres holdninger til pædagogiske spørgsmål i daginstitutioner. Dansk Sociologi, 24(3), 63–83. Ejrnæs, M., & Monrad, M. (2016) Forventninger til kollegernes holdninger. Unge Pædagoger, 1, 74–82. Fox, J., Ramon, S., & Morant, N. (2015). Exploring the meaning of recovery for carers: Implications for social work practice. British Journal of Social Work, 45(suppl_1), i117–i134. Hargreaves, A. (2001). The emotional geographies of teachers’ relations with colleagues. International Journal of Educational Research, 35(5), 503–527. Harrington, D., & Dolgoff, R. (2008). Hierarchies of ethical principles for ethical decision making in social work. Ethics and Social Welfare, 2(2), 183–196. Høgsbro, K. (2010). SIMREB – Towards a systematic inquiry into models for rehabilitation. Scandinavian Journal of Disability Research, 12(1), 1–18. Hughes, R., & Huby, M. (2002). The application of vignettes in social and nursing research. Journal of Advanced Nursing, 37(4), 382–386. IFSW. (2012). Statement of ethical principles, international federation of social workers Retrieved from https://www.ifsw.org/wp-content/uploads/2018/06/13-Ethics-Commission-ConsultationDocument-1.pdf Katz, D., & Allport, F. H. (1931). Student attitudes. Syracuse, NY: Craftsman. Landau, R., & Osmo, R. (2003). Professional and personal hierarchies of ethical principles. International Journal of Social Welfare, 12(1), 42–49. Lymbery, M. (2006). United we stand? Partnership working in health and social care and the role of social work in services for older people. British Journal of Social Work, 36(7), 1119–1134. May, P. J., & Winter, S. C. (2009). Politicians, managers, and street-level bureaucrats: Influences on policy implementation. Journal of Public Administration Research and Theory, 19(3), 453–476. Maynard-Moody, S., & Musheno, M. (2012). Social equities and inequities in practice: Street-level workers as agents and pragmatists. Public Administration Review, 72(1), 16–23. Merton, R. (1968). Social theory and social structure. New York: The Free Press. Osmo, R., & Landau, R. (2006). The role of ethical theories in decision making by social workers. Social Work Education, 25(8), 863–876. Pawlukewicz, J. & Ondrus, S. (2013). Ethical dilemmas: The use of applied scenarios in the helping professions. Journal of Social Work Values and Ethics, 10(1), 2–12. Pedersen, M., & Nielsen, K. (2009). Læring, konflikter og arbejdsdeling – en udvidelse af den socialt situerede læringsforståelse. Psyke & Logos, 30(2), 652–671. Perryman, M., Barnard, M., & Terrell, K. (2018). Counselor and social worker perceptions of sexual minorities related to religiosity and political ideology. Journal of Social Work Values and Ethics, 15(1), 4–12. Pronin, E., Gilovich, T., & Ross, L. (2004). Objectivity in the eye of the beholder: Divergent perceptions of bias in self versus others. Psychological Review, 111(3), 781–799. Rescher, N. (1993). Pluralism: Against the demand for consensus. Oxford: Oxford University Press. Samuelsson, E., & Wallander, L. (2014). Disentangling practitioners’ perceptions of substance use severity: A factorial survey. Addiction Research & Theory, 22(4), 348–360. Trotter, J., Brogatzki, L., Duggan, L., Foster, E., & Levie, J. (2006). Revealing disagreement and discomfort through auto-ethnography and personal narrative: Sexuality in social work education and practice. Qualitative Social Work, 5(3), 369–388. Wilks, T. (2004). The use of vignettes in qualitative research into social work values. Qualitative Social Work, 3(1), 78–87.

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31 Ethical study abroad Good ­intentions aren’t enough Melody Aye Loya and Katherine Peters

Introduction In 1968, Monsignor Ivan Illich gave an impassioned speech titled To Hell with Good Intentions to the Conference on InterAmerican Student Projects. In his speech, he discussed “the deep dangers of paternalism inherent in any voluntary service activity” (para. 1). Although the speech was delivered over 50 years ago, the discussion remains relevant today. Study abroad programs have the potential to extend and promote an attitude of “white saviorism” (­Nordmeyer, Bedera, & Teig, 2016, p. 78) if the focus is on student learning to the detriment of the local communities. Some programs, even those that are well intentioned, may “position the visiting students in a position of power over the local population” (p. 78). Developing ethical study abroad programs that foster student learning, but also help develop a sense of cultural humility while avoiding harm to communities, is essential for social work. Social work education seeks to prepare practitioners for their work in the field; experiential education and study abroad programs are excellent methods to teach students some of the realities they will encounter in their practice. However, how can study abroad, particularly shortterm, faculty-led programs, best prepare students, while minimizing the potential negative consequences in communities when dealing with short-term interactions by as-yet unlicensed social workers? We consider these questions below, using resources from the fields of social work and education abroad and describing some important program elements for ethical social work study abroad programs. Although this chapter appears in a book oriented to social work values and ethics, program leaders from multiple disciplines should consider the issues outlined below. The authors believe it is important to situate themselves within the context of this work. They met when the faculty leader conducted a site visit in Costa Rica in anticipation of developing a study abroad program for social work students. After interviewing personnel from four agencies during a weeklong visit, the Institute for Central American Development Studies (ICADS) was selected because of their focus on social and environmental justice. They were well-positioned to develop a program specific to social work, having multiple contacts with agencies, health care providers, and social workers across a variety of settings. The agency has a 30+ year history of providing students with quality internships as well as developing short-term faculty-led programs that are customizable to the course objectives. 240

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Melody Loya is the chair of the Social Work Department at Tarleton State University in Texas. She has led multiple study abroad programs to Costa Rica and to the Dominican Republic. She “fell into” study abroad when teaching an honors class that required an international experience. A program had been developed by others, and was handed to her as a fait accompli. This program focused, to a large extent, on completing service in local communities in rural Costa Rica, along with “cultural” excursions to tourist attractions. During all of the service activities (painting a church and a clinic, digging a ditch to put in a culvert, etc.), interaction with the community was minimal. Because of her discomfort with the paternalistic approach that seemed to be encouraging dependency on volunteers, the site visit mentioned earlier was planned. A new partnership, along with a new approach, was developed. Katherine (Kat) Peters holds a master’s in Education and a master’s in Territorial Rural Development. She has spent close to a decade living in Central America, where she worked in study abroad and volunteered in communities of immigrants, and is currently teaching a course on Global Perspectives at Valparaiso University. Kat was the Assistant Director of ICADS during the development and first years of the social work study abroad program described previously.

Trends in education abroad As university internationalization efforts in the United States continue to grow, many institutions of higher education are professionalizing their study abroad offices and streamlining processes to help more undergraduate students visit other countries as a part of their education. The Institute of International Education (IIE), in their 2017 Open Doors Report on International Education Exchange, found that for the 2015/2016 academic year the number of students going abroad for academic credit increased by 3.8%, part of the overall upward trend in study abroad in the last decades. There has, however, been a slowing in growth in study abroad overall in the past five years, and a shift to shorter-term programs. Between 2009 and 2016, there was a six% increase in students participating in programs eight weeks or shorter (from 11.9% in 2009 to 17.4% in 2016), with nearly two-thirds of those students going abroad for less than two weeks. Semester-long programs have declined in that same period, going from 35.8% to 31.9% of all students going abroad. Students going abroad are mostly White (71.6%) and female (66.5%), but this reality is also changing, with more inclusion of first-generation students, students of color, and nontraditional students (IIE, 2017). In addition, an increasing number of students are participating in short-term, noncredit experiences, internships, and volunteering abroad (IIE, 2017). While the vast majority of students going abroad still go to Europe, there are increasing opportunities for students to visit developing countries, and institutions of higher education have begun to focus more on service learning programs (both locally and globally). There are countless organizations that promote and develop global service programs, touting personal and professional growth opportunities for US students, and development opportunities for host communities. Many of these organizations suggest that global service learning is a winwin-win for institutions, students, and communities abroad, but Crabtree (2013) and others argue that service learning often comes with both positive and negative, and intended and unintended consequences. According to the IIE, Nicaragua, Mexico, and the Dominican Republic were the top three hosts of students engaging in noncredit experiences; the fact that these destinations are developing countries may indicate that these programs are often related to service learning. Ogden (2015) discusses what he termed “colonial students” (p. 37); those students who are excited about going to another country and broadening their outlook, 241

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but are “not necessarily open to experiencing the less desirable side of being there” (p. 37). Faculty leaders of study abroad programs, as well as the providers helping to design study abroad experiences, need to be cognizant of the dangers of increasing study abroad programs to developing countries in light of the colonial tendency. There are advantages to short-term programs. Many post-traditional students cannot step away from jobs or families for an entire semester; a short-term program may be much more manageable. With thoughtful preparation, these programs can still provide opportunities to grow in cross-cultural awareness, experience personal growth, gain communication and language skills, and may have a deeper understanding of the connection between social policies and global impacts. Students may come home with new ideas for practice, and have a greater level of empathy for disenfranchised populations.

Potential ethical issues Study abroad is fraught with potential ethical issues, particularly related to income and power inequality. Many institutions of higher education promote study abroad as a way to improve students’ competitiveness in the global marketplace, a benefit that is not equally attained by the host community. As Barbour (2006) pointed out the seemingly simple action of flying to another country is something that is out of reach for most people in the world. Even attending college or university is reserved for only about 7% of the world’s population. While studying abroad, students bring this privilege and access to resources to their interactions with local people who do not have the same access. The students may gain real learning that they can then be counseled on expressing in their resumes and cover letters for later opportunities, but can the local people who have received those students benefit in the same way? This inequity that is built into the education abroad system can be thought of as learning at the expense of others (Mitchell & Donahue, 2009). Deconstructing these ethical issues requires an analysis of the larger economic and social context of the social location of students and the places they are studying abroad. In colonialism, privileged outsiders arrived to new lands to take resources for their own benefit and gaze upon the local people as somehow inferior. The field of study abroad can come dangerously close to perpetuating a colonial system, in which the infrastructure supports – through program development, student services, and attempts at community integration – the privileged students over the local people (Ogden, 2008). In practice, colonial tendencies can include importing the comforts and expectations of home into a study abroad experience; the employment of an “objectifying tourist gaze,” which penetrates the lives of locals while leaving student relationships and home lives intact; and other manifestations of the attitude of students as consumers, who thus demand conditions and results in exchange for their payment (Sharpe, 2015, p. 228). While we may assume that this is true in “traditional” study abroad programs or by students in disciplines seemingly unrelated to social justice, colonial tendencies may be even more prevalent in programs focused on service learning. Poverty tourism could include a more obvious example of visiting poor neighborhoods abroad in order to take photos and go home feeling grateful for what students have, but it can also include unreflective service learning that seeks to help the poor in the host community. If programs do not encourage students to critically analyze the systems and structures of inequality in our world, we may end up promoting a new ‘civilising mission’ as the slogan for a generation who take up the burden of saving/educating/civilising the world. This generation, encouraged 242

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and motivated to ‘make a difference,’ will then project their beliefs and myths as universal and reproduce power relations and violence similar to those in colonial times. (Andreotti, 2006, p. 41) One powerful example of this kind of poverty tourism is “orphan tourism,” a common practice among short-term service learning programs abroad. Despite the fact that child development experts know that institutionalizing children is detrimental, and despite the fact that 80–90% of children living in residential orphanages abroad have a living parent, many universities continue to promote an uncritical approach to volunteering at orphanages abroad. Organizations (such as the Better Care Network and Catholic Relief Services and their Changing the Way We Care grant) now exist to reduce volunteering in orphanages and transform orphanages into family service providers. However, many students and institutions of higher education continue to see “orphan tourism” as a path toward personal transformation and the development of professional competencies, objectives that can ignore the impact of such practices on the host communities (Freidus, 2017).

Social work values Core social work values should be an important consideration in planning a study abroad program. The core values, or ethical principles, as outlined by the National Association of Social Workers (NASW) [2008], include service, integrity, competence, social justice, dignity and worth of the person, and the importance of human relationships. These ethical principles are also embedded within the Council on Social Work Education’s (CSWE) Educational Policies and Accreditation Standards (EPAS) [2015], which outlines the competencies that graduates of accredited programs should have achieved. In addition, the CSWE Council on Global Learning, Research, and Practice (2015) established basic guidelines for social work international study abroad programs. Of central importance are developing thoughtful outcomes focused on academic learning, and then matching program activities to the desired outcomes. These outcomes and activities should be grounded in the core values of the profession as well as the EPAS, keeping the needs of the host community at the forefront of all planning. Wood and Schroeder (2017) pointed out that “collateral [environmental, economic, and social or cultural] damage” (p. 1) can occur through the impact that programs may have on communities. Keeping the aforementioned core values constantly in mind during planning, travel, and post-travel activities will potentially help mitigate the negative impact on communities. Wood and Schroeder also pointed out that often faculty are not considering these impacts prior to travel; social work should lead the way in conversations regarding the potential impact on host communities.

Ethical study abroad programs Education abroad scholarship has increasingly been developing frameworks for addressing the ethical challenges of studying abroad, including critical literacy and transformative learning. These frameworks are not, however, limited to study abroad programs – they are useful for education in one’s home context as well. Critical literacy is a concept that goes beyond the idea of “critical thinking;” rather, according to Mitchell (2008), critical literacy challenges students to “examine both the historical precedents of the social problems addressed in their [programs] and the impact of their personal action/inaction in maintaining and transforming these problems” (p. 54). In practice, this kind of critical literacy requires both reflection and action, in the Freirean tradition of consciousness raising (Freire, 2003). Reflection upon 243

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one’s own social position (or situatedness) should lead to efforts to redistribute power and transform power relationships, having local communities abroad take the lead in setting the agenda. Student learning outcomes may then be assessed from this vantage point, rather than from objectives that come solely from the home context or institution. Mezirow (2000) described a learning theory that has been tested and debated since his study of women who have returned to university education later in life. He stated, The process by which we transform our taken-for-granted frames of reference (perspectives, habits of mind, mind-sets) to make them more inclusive, discriminating, open, emotionally capable of change, and reflective so that they may generate beliefs and opinions that will prove more true or justified to guide action. (Mezirow, 2000, pp. 7–8) Transformative learning theory posits that students hold viewpoints based on their life experiences, upbringing, culture, or education, and that the resultant paradigm the student employs can only be changed by experiencing disorienting dilemmas, and reflecting on them and planning for new ways of being. Christie, Carey, Robertson, and Grainger (2015) applied this theory in three adult education programs, including an international education program, and found that the practical application of transformative learning theory has ­potential for not only making students more open to others but also equipping students for making actual change in their lives and in the world. In education abroad, various professional organizations discuss approaches for improving learning outcomes, and consider frameworks such as those mentioned previously. The Association of American Colleges and Universities (AAC&U) has developed a list of high-­impact practices for postsecondary education, one of which is diversity/global Learning (Kuh, 2008). The AAC&U VALUE rubrics (Rhodes, 2009) are another resource for tools and practices in this area, particularly under the heading of personal and social responsibility (civic ­engagement – local and global, intercultural knowledge and competence, ethical reasoning, foundations and skills for lifelong learning, and global learning). The Forum on Education Abroad is the standards-setting organization for education abroad in the United States. The Forum’s Standards of Good Practice (2015) include categories such as student learning and development, academic framework, and ethics, which consider some of the issues raised in this chapter. While these organizations seek to improve education abroad programs, a third community of practice has developed in the last years that is now beginning to examine the difficult ethical issues related to global service learning programs: global service learning (GSL) conducts conferences and seeks to influence the field of global education to improve impacts and ethical practices (www.globalsl.org).

Cultural humility The concept of cultural competence formed the foundation for a more nuanced approach to culture and difference, which has been coined “cultural humility” (Tervalon & ­Murray-García, 1998). Cultural competence infers an endpoint; it suggests that one can, perhaps, be “trained into” becoming culturally competent. While the concept was a good beginning point in the quest to better understand working with diverse clients, cultural humility implies a ­process-oriented approach. One should recognize that we can never truly arrive at cultural competence; it is a lifelong endeavor. According to Tervalon and Murray-García (1998), cultural humility requires that we engage in continuous evaluation of self and be willing to critically reflect on our approaches to, relationships with, and communication with others. 244

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Cultural humility also involves critical reflectivity. The willingness to address the inherent power imbalances in helping relationships is essential when engaging in multicultural discourse (Tervalon & Murray-García, 1998). We must address our “understanding [of ] power relations and human rights issues” (Gallardo, 2014, p. 5). Study abroad programs offer an excellent opportunity to explore power imbalances from the standpoint of colonialism, neocolonialism, which may include the impact of free trade zones and structural adjustment among many other examples. Finally, the third component that is necessary for developing cultural humility is “systematically and methodically immersing trainees in mutually beneficial, nonpaternalistic, and respectful working relationships with community members and organizations” (Tervalon & Murray-García, 1998, p. 121). Developing study abroad programs with a focus on learning from others, versus approaching communities as the “expert,” can help students grapple with and move along the continuum of cultural humility. Thus, cultural humility begins with a willingness to listen, to be self-reflective, and to join with others.

Exploring the impact of US policies One important and necessary way of understanding the context for social work programs abroad is to explore the situatedness of students from the United States by increasing the students’ understanding of the impact of US policies abroad. While at home, students experience the complexities of their social positions related to race, class, gender, and other identifiers. While abroad, students come primarily as representatives of the most powerful country in the world, whose policies impact those same complexities in the local context. Any program that seeks an ethical engagement with the host community will consider these policies and complexities, and require students to reflect on their own roles and responsibilities in the current political and economic system. For example, students should be asked to consider their role as consumers of cheap agricultural products grown in developing countries such as coffee, pineapple, or bananas (impacted by US-directed trade policies). What are the impacts of this kind of agriculture on local communities? What are working conditions like? What environmental and social impacts are left behind? What might students-as-consumers do to address negative impacts their consumption causes? Another example that is particularly relevant at the time of this writing: what is the history of the root causes of Central American migration to the United States? How has US military intervention in Central America in the 20th century impacted the lives of the people who are now migrating? What role does the US war on drugs in the region play in the displacement of people from their communities? These questions must be considered when visiting communities affected by these policies if we are to seek an authentic exchange with our hosts while abroad, because these policies directly impact the daily lived experiences of the people with whom we hope to engage for our personal and professional learning. These questions, however, are particular to the C ­ entral American context, and must be reimagined in home contexts and in other regions of the world, as McLaughlin and DeVoogd (2004) point out: educational techniques that promote a critical literacy must be adapted to each unique context. Through the partnership with ICADS, some activities have emerged as important in reinforcing student learning, and to keep the focus on what we are learning from the communities versus what we expect the communities to learn from us. Balancing a two-week itinerary with the following activities has become a foundation of the program: agency and community visits, charlas (lectures), cultural experiences, and homestays. Agency visits are varied, based upon the focus of the program, and are selected based around a central theme. 245

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Most often, within the Costa Rican context, we focus on women’s and children’s issues with an overarching theme of immigration providing context. Access to health care, issues of domestic violence, and sexual health are woven into the fabric of the learning. Charlas are presented by local social workers or other professionals with expertise in the areas under discussion. Cultural activities have included visits to a local market, an artisan’s market, a Latin dance lesson by a well-known choreographer, a visit to the BriBri indigenous community (requiring a two-hour boat ride up the river that borders Panama), going to the Basilica that houses La Negrita, the patron saint of Costa Rica, and visiting an active volcano. Weekend excursions (such as the trip to the BriBri reserve) also incorporate learning focused on the theme of the program. Within the local context, ICADS staff and community partners have noted an important difference between outcomes depending on the level of commitment, preparation, and reflection on the part of faculty members and students before, during, and after a program. While the program activities themselves must be carefully chosen in keeping with the learning objectives that are based on values of mutuality and a critical perspective, the execution of the activities is also extremely important. Specifically, programs should engage in constant orientation for students about expectations, appropriate behavior, and contextual information about the activity. Students should discuss or practice and understand the methodology of each visit including the following: will students be speaking, or community members, or both? What should students wear? How are key words in the local language pronounced? How should students introduce themselves? After each visit, debriefing and time for reflection are critical to help students return to the learning objectives, as well as to process the often complex feelings that this kind of experience can evoke. The social work program described in this chapter was one of the best examples of this kind of intentional preparation and reflection; other programs without the same level of faculty commitment to preparing and debriefing students led to confused and frustrated students who did not know how to engage the carefully prepared activities. Another important tool is evaluation – evaluating not only student learning but also community perceptions and opinions about the program. Thoughtful and intentional engagement with students as well as with host communities (using appropriate social science methodologies for learning from communities) is imperative for understanding the impact of the program and for making adjustments that will increase the potential for transformation that exists in a study abroad program. This kind of study abroad program, one designed to maximize student learning and community protagonism, and to minimize colonial tendencies, reflects the best values of both social work and international education. As practitioners in these fields, we understand that it is necessary to remain vigilant about the ethics of our work and constantly reflect on the nature of our institutions and the real outcomes in which we participate. As we continue to listen to, empathize with, and prioritize the communities with which we engage, we find that we ourselves will also be transformed.

References Andreotti, V. (2006). Soft versus critical global citizenship education. Development Education: Policy and Practice, 3, 40–51. Barbour, J. (2006, October 6). The moral ambiguity of study abroad. Chronicle of Higher Education. Christie, M., Carey, M., Robertson, A., & Grainger, P. (2015). Putting transformative learning theory into practice. Australian Journal of Adult Learning, 55(1), 9–30.

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Council on Social Work Education [CSWE]. (2015). Educational policies and accreditation standards (EPAS). Retrieved August 23, 2018, from https://www.cswe.org/getattachment/Accreditation/ Accreditation-Process/2015-EPAS/2015EPAS_Web_FINAL.pdf.aspx Council on Social Work Education (CSWE) Council on Global Learning, Research, and Practice. (2015). Social work international opportunities for academic credit: Suggested guidelines for study abroad programs. Retrieved August 24, 2018, from https://www.cswe.org/getattachment/2d3ef06f.../Studyabroad_final92310.doc.aspx Crabtree, R. (2013). The Intended and Unintended Consequences of International Service-Learning. Journal of Higher Education Outreach and Engagement, 17(2), 45–65. Freidus, A. L. (2017). Unanticipated outcomes of voluntourism among Malawi’s orphans. Journal of Sustainable Tourism, 25(9), 1306–1321. Freire, P. (2003). Pedagogy of the oppressed. New York, NY: Continuum International Publishing Group. (Original work published 1970) Gallardo, M. E. (2014). Developing cultural humility: Embracing race, privilege and power. Los Angeles, CA: Sage. Ilich, I. (1968). To hell with good intentions. Retrieved from http://www.swaraj.org/illich_hell.htm Institute for International Education (IIE). (2017). Open doors report on international education exchange. Leetsdale, PA: IIEBooks. Kuh, G. (2008). High impact educational practices: What they are, who has access to them, and why they matter. Washington, DC: Association of American Colleges and Universities. McLaughlin, M., & DeVoogd, G. (2004). Critical literacy as comprehension: Expanding reader response. Journal of Adolescent and Adult Literacy, 48(1), 52–62. Mezirow, J. (2000) Learning as transformation. San Francisco, CA: Jossey-Bass. Mitchell, T. D. (2008). Traditional vs. critical service-learning: Engaging the literature to differentiate two models. Michigan Journal of Community Service Learning, 14(2), 50–65. Mitchell, T. D., & Donahue, D. M. (2009). “I do more service in this class than I ever do at my site”: Paying attention to the reflections of students of color in service-learning. In J. R. Strait & M. Lima (Eds.) The future of service-learning: New solutions for sustaining and improving practice (pp. 174–192). Sterling, VA: Stylus. National Association for Social Workers [NASW]. (2008). Code of ethics. https://www.socialworkers. org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English Nordmeyer, K., Bedera, N., & Teig, T. (2016). Ending white saviorism in study abroad. Contexts, 15(4), 78–79. Ogden, A. (2015). The view from the veranda: Understanding today’s colonial student. Frontiers: The Interdisciplinary Journal of Study Abroad, 15, 35–55. Rhodes, T. (2009). Assessing outcomes and improving achievement: Tips and tools for using the rubrics. Washington, DC: Association of American Colleges and Universities. Sharpe, E. (2015). Colonialist tendencies in education abroad. International Journal of Teaching and Learning in Higher Education, 27(2), 227–234. Tervalon, M., & Murray-García, A. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. The Journal of Healthcare for the Poor and Underserved, 9(2), 117–125. The Forum on Education Abroad. (2015). Standards of good practice for education abroad (5th ed.). Retrieved from https://forumea.org/wp-content/uploads/2014/08/Standards-2015.pdf Wood, C. A., & Schroeder, K. (2017). Avoiding collateral damage: Education abroad programs and their impacts on host communities. Trends & Insights, NAFSA: Association of International Educators. 1–5.

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Technological issues

32 Ethical social work practice in the technological era Jim Gough and Elaine Spencer

Introduction Societies across the globe have advanced because of the efficient and reliable technologies designed to solve problems or specific practical issues. Social work practice is immersed in these technologies. So, we need to pay critical attention at the micro and macro level to the ongoing and changing effects of technology, impacting the nature of everyone’s lived experience. Technologies can be things, instrumental objects, like computers or automobiles, or processes/programs like software programs or internet interaction apps, sites, and applications. Technology provides valuable health care options, social options, and our existence in the world. It takes knowledge from science/practical skills and uses it to improve the application of social functions, like communication, transportation, and health. The ethical focus is: whether it is value-neutral, whether it is politically/legally controlled by government or others to exercise power over us or empower us, liberating our open, expressive possibilities or alienating us from them, whether technology changes itself or because of external influences, remains true to its original instrument purpose which effects our concerns for equality, confidentiality, personal integrity, and privacy. We consider positive and negative aspects impacting, influencing, and transforming social work practice everywhere.

The history and progression of technology Throughout humankind’s recorded history, technologies have played a role in the shaping of our societies and the individuals with them. Technologies have enabled us to live better and survive longer as they help us to use our resources in soil, water, and tools better, more effectively and efficiently. The progress of society is in large part due to our ability to collectively adapt our existence to the environment using the instruments provided by technologies. In the last two centuries, technologies have escalated their effects on human existence and social workers need to keep ahead of these changes. Technologies transform our societies and our individual existence inside them. We rely on them on a daily basis to make our lives livable and open to new possibilities of existence. 251

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There is one predominant but false belief that technologies are neutral, independent, and noninvasive tools that we can simply choose to implement or not. There is another often expressed belief that we are safe from the excessive damages of technology because our governments or international agreements are working to protect us against harms. However, both of these beliefs have little foundation. First, technologies are often created to satisfy human needs by independent business-focused entrepreneurs, not political states. The inspiration overall for the use of the technology is to help society but also to make profit. Second, we find political states all over the world scrambling to control technologies that have produced perceived or actual negative effects on their populations. Concerns are raised because of lifestyle changes brought on by technology: less walking/more riding produces poor physical health, less interacting with human beings and more with machines – affects our personal/social relationships, use of language communication, and our affective attachment to other humans. Third, technologies created for one explicit use, change so that, for example the great educational use of television, computers, and cell phones has moved from information and education to a focus on entertainment with gaming become a new predominant use of technologies. Finally, there is a very effective technology to persuade and influence our use of technologies, persuasive technologies. The experimental findings of cognitive psychology, for example, are now used extensively by marketing strategists to influence our lives on a daily basis, influencing our behavior in such a way, using external cues and devices, to circumvent disengaged and dispassionate critical considerations and thought. Our spontaneous decisions are the effect of technologies not an internal censor or conscience operating to control or monitor our behaviors. These features of the historical development of technology give the effective use of technology an imperative that is separate from ethical, religious, spiritual, or political concerns, which means these latter disciplines are scrambling to catch up to it Ellul, 1995). All these features of technology can undermine the trust and confidence that social workers need to interact with their clients in meaningful and caring relationships. Communication technologies have become the new family of relationships where the influence of cyber friends outmatches that of intimate acquaintances and forces, an attachment to technology unprecedented in the history of humankind.

The effects/impact of technology on our relationships with clients We are now in a good position to critically evaluate the nature of our relationships that may be impacted by the advancing integration of technology on our global lives. At the macro level, we can see the influence of the three major trillion dollar companies on our lives: Apple computers, Google, and Microsoft through the influence of social media vehicles and branded marketing initiatives. This technology makes money for these companies. It is designed to influence our choices, circumvent careful, cautious, considered rational thought and deliberation. Where the science behind some technologies may have the perceived belief (social constructionists might disagree with this ideological claim of disinterested detachment to the pursuit of truth for its own sake) developed ethical standards of truth and considered evidence-based conclusions, technology has not. Google, Microsoft, and Apple are in the business of selling their products and their services, protecting their franchises and copyrighted inventions. Technologies are not dedicated to the pursuit of truth, the support and development of better social communities, the elimination of inequalities or disparity-based marginalities but in the consideration of whether they work to produce a profit. An exception to this trend is military and medical technologies that are promoted by 252

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governments generally and not encumbered by budget constraints issuing in the disturbing trend of rapidly rising military and medical expenditures across the world. The effectiveness of technologies is measured on an economic scale or societal need, as in the case of military or medical technologies, but little attention is paid to the way technologies change individuals and the societies they occupy. The social worker is immediately impacted at the macro level by the overwhelming support that may disenfranchise some and alienate others from the benefits of technology. Televisions, computers, and cell phones are often the implements of the upper and middle classes but sought by the lower classes without the resources to afford them. This alienation is systematic and not accidental as the merchandising of technological devices is often built on Veblen’s status endearing need for “conspicuous consumption.” So, the task becomes how to move this technology to all the people equally and protect their individuality and personal self-esteem. At the micro-level, the social worker who tries to forge a meaningful, personal, and professional relationship of trust and confidence with her clients is often fighting the competing influences of depersonalized technology, television, computers, gaming, and cell phones. Educators need to regulate, control, and manage these technologies in the classroom in order to be able to teach, in spite of some techno-babbling administrator’s penchant for the belief in the teaching/mentoring benefits of machines. Caring, meaningful relationships cannot be fostered well, if at all, by machines but certainly there are those who believe this is the next inevitable development of cognitive machines that can anticipate and speak to our every concern. Can we really believe that the compassionate and caring relationship provided a suffering client by a social worker can be replicated successfully by a machine? This may be a humanist bias but even if it were possible, the implications of machines being manipulated to prey on people’s emotions and sentiments seem a serious concern. Social workers have to both understand and empathize with what it means to be a suffering client, to be alone among others, to be disenfranchised, discriminated against in services and attitudes. This means that clients must give their trust and confidence and that social workers must reciprocate with their concerned and caring empathetic responses directed to clients and nothing else. Technology has changed social work practice. The Council on Social Work Education recently envisioned the future of social work, citing technology as one of the two top factors shaping our profession’s future (CSWE, 2018). Social workers, given our leadership skills and the value base of the profession shared around the world (IFSW, 2014), are arguably well-suited to lead social change, using technology to create a more socially just society. Indeed, there is even an internationally linked nonprofit organization, the Human Services Information Technology Association (husITa) dedicated to “[a] world where information technology is harnessed by the human services to promote and support social good and human wellbeing” (“husITa About”, n.d.). The lightning-fast mobilization allowed by social media has documented impact (Lorenzo Wellington, 2015), with examples such as Black Lives ­Matter, and the Idle No More movements (Gilio-Whitaker, 2015). Indeed, technology can have a flattening effect, lessening the positional power or dominance of expert opinion. Parrott and ­Madoc-Jones discuss the enhanced power that individuals and groups have in cyberspace (2008).

Some ethical challenges from technology As social workers we are often the frontline identifiers and negotiators of what is an acceptable social norm in our societies. That is, it is often our responsibility, as knowledgeable observers of the social milieu, to identify ways of making effective use of technologies for our clients and society generally. We need to devise ways of making sure that society and especially our 253

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clients can keep up with technology (through ongoing education and training) as well as using technology to lead us to meaningful changes to benefit everyone but especially the needy in society. So, for example, advocating for technology (including the training and education to make it work) to be made accessible to everyone in society, regardless of their ability to pay, through educational institutions and libraries. We also need to educate ourselves to make sure we, as professional practitioners, are fully trained in the use of technologies to initiate and lead to productive changes in our relationships with the clients we serve. Consider issues around privacy, confidentiality, and even regulation of the profession when the primary mode of professional relationship is through Avatar counseling, for example (Spencer, Massing, Gough, 2017, Gough & Spencer, 2014). Use of web-based counseling services is beginning to be regulated and jurisdictions around the world are establishing standards social workers need to meet in their online counseling or e-therapy (Association of Social Work Boards 2015b). We need to make sure that the technologies we use lead to changes for the better in our relationships with our clients. There is a digital divide that has separated us as individuals from our society and global community. Some computer and communications technologies have physically separated us from other human beings. The digital divide has been linked to lessened critical inquiry and a submerging into opinion, trivia, gossip, and disconnected information. The digital divide also refers to the socioeconomic disenfranchisement of some individuals due to access. Access can be restricted based on geography (rural areas in highly technologically developed countries and entire nations that are not highly technologically developed). Further, access can be restricted by ability to read and speak English, advanced age (over 65), or low income (Broadbent & Papadopoulos, 2013). Access to technology, like all other pieces of the set of social resources, needs to be made more equal. The digital divide is part of capitalist distributions and so needs to be addressed for those on the margins. An individual’s economic situation should not (ethically) be the determining factor in whether or not they can access technology. There is a tendency in many societies for individuals to uncritically seek to align their identities with what they perceive to be their ideological norm: often liberal or conservative in orientation. Communication and persuasion technologies provide the effective means to this orientation. Those without the means cannot be part of this identification process, whether we agree with this homogenization or not. So being able to identify with the prevailing norms in our societies has moved far beyond a “want” and is now firmly entrenched as a primary existential “need.” The technology that promotes social media has done a lot to make sure this transition from want to need remains a conditioned part of human existence.

Personal use of technology and social media The technological imperative impelling technologies of their own self accord, the digital divide separating human beings from each other by their ability to access technology, the conversion of techno-wants into needs has become a pervasive determinant of social success, the determination of coded status norms, and the control of behavior by persuasive technologies to determine acceptable lifestyles and lives all present challenges for social workers in their daily experience. The education of professional social workers must stay current to keep up with the advances in technology to ensure social workers provide compassionate and caring helping relationships (Association of Social Work Boards, 2015a). An exploratory study of technology in beginning social work and social services work education found issues with supply, use, and awareness of privacy and environmental challenges by all categories of respondents (students, educators, and field supervisors) (Shaw-Verhoek, Shephard, Spencer, & Khan, 2014). 254

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Technology can be turned in some ways by political or judicial legislation limiting its use or abuse but more importantly by the impactful, intentional mitigation of technologies’ failures in the design and implementation of meaningful individual lives in caring societies. It is hard to tell people “You don’t need a television, automobile, computer or smart phone” but we all know that meaningful lives without these pervasive devices is not only possible but maybe the fewer of them the better. Human relationships endure as technological ones break, become redundant or loss their status. In our professional practices, maybe we need to focus more on a meaningful life than one that satisfies the techno-norms imposed by persuasive conditioning. At the same time, if access to communications technology can be improved and its use focused on education, enhancing reporting, and observing social phenomena that need to be brought to public attention, like bullying, harassment, intimidation, coercion, then we can all use and take effective control of social media. If it truly can become the voice of the people, then maybe it can help to organize help for those in need, support for those in precarious situations, and aid for those lacking essential resources. In other words, technology harnessed can become a very effective and efficient means of redistribution of access and use of social resources. It can change lives, which, in turn, can bring about bottom-up changes to societies and the global community. If we have enhanced abilities to observe, enlighten, and call out injustices, then maybe society can be improved by the use of technology used for the purpose of promoting beneficial ends, such as clients designing services to meet their needs, and more clearly leading self-advocacy movements. The disability rights movement for example has benefitted from access and inclusion through technology (Hartley, Tarvydas,  & Johnston, 2015). Electronic social work services can meet the needs of many people and increase access in many ways (Mattison, 2012; Reamer, 2013). While the professional use of technology has a significant upside, social workers are cautioned to be fully aware of the personal being professional (and public) in the case of social media. Mukherjee and Clark report that 67% of MSW students surveyed had vented about their field placements on social media, and 81% would accept a social media “friend request” from a client (2012). The personal use of social media has an impact not only on individual social work identity but can also ripple into the reputation of the profession as a whole (Voshel & Wesala, 2015). Social work schools, regulatory bodies, and national and international organizations are working diligently to keep up with the explosion of technology; yet as always, ethical social work practice is best ensured by the individual social worker’s commitment to it (Canadian Association of Social Workers, 2005). This holds true for technology in social work practice as well. Being social media smart as a clinician or a community organizer will require ongoing and accessible education as policies and guidelines change (Canadian Association of Social Workers, 2014).

Recommendations for ethical social work practice integrating technology Through social work education, we can become leaders of broad social change. By “broad” we mean all-inclusive and all-encompassing social change that transforms the situation of all members of society for the better rather than marginalizing some at the advantage of others. As a start, we need to restore social work education to a leading role so that social workers become change agents by using technology to lead us to a better social arrangement that benefits all. We need to equip our students with the best knowledge and skills of how to use technology effectively not as a means of entertainment, a cure for boredom, but rather as a 255

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means for bringing more people into the social conversation, making more openings for those who have few opportunities to participate in society and its directions. Technology not open to access by everyone is a benefit denied for few, a closure to those in need of an opening to opportunities to thrive and survive. Humanity is at a time in its collective history when we need to ensure that what we create, the technologies we develop are clearly within the scope of our control and management so that we can make sure it is helping those who need it and not disadvantaging those who should be equally entitled to its use. Instead of techno-closure for some, isolation for others, and digital divide for classes, globally we need to focus on ways to make technology work as a tool for enhancing social relationships and effective ethical change.

References Association of Social Work Boards. (2015a). Is continuing education enough? Retrieved from http:// www.aswb.orgase Association of Social Work Boards. (2015b). Model regulatory standards for technology and social work practice. Retrieved from www.aswb.org Broadbent, R., & Papadopoulos, T. (2013). Bridging the digital divide – an Australian story. Behaviour & Information Technology, 32(1), 4–13. Canadian Association of Social Workers (CASW). (2005). Guidelines for ethical practice. Retrieved from http://222.casw-acts.ca Canadian Association of Social Workers (CASW). (2014). Social media use and social work practice. Retrieved from www.casw-acts.ca Council on Social Work Education. (2018). Envisioning the future of social work: Report of the CSWE futures task force. Retrieved from https://www.cswe.org/About-CSWE/Governance/ Board-of-Directors/2018-19-Strategic-Planning-Process/CSWE- FTF-Four-Futures-for-SocialWork-FINAL-2.aspx Ellul, J. (1995). The ‘autonomy’ of the technological phenomenon. In R. C. Scharff & V. Dusek (eds.), Philosophy of technology: The technological condition (pp. 386–397). Oxford: Blackwell Publishing. Gilio-Whitaker, D. (2015). Idle no more and forth world social movements in the new millennium. South Atlantic Quarterly, 114, 866–877. Gough, J. & Spencer, E. (2014). Ethics in action: An exploratory survey of social workers’ ethical decision making and value conflicts. Journal of Social Work Values and Ethics, 11(2), 23–40. Hartley, M., Tarvydas, V., & Johnston, S. (2015). The ethics and practice of social media advocacy in rehabilitation counseling. Journal of Rehabilitation, 81(1), 42–51. husITa About (n.d.). Retrieved from https://www.husita.org/about-us/ IFSW (International Federation of Social Workers). (2014). Global definition of social work. Retrieved from https://www.ifsw.org/what-is-social-work/global-definition-of-social-work/ Lorenzo Wellington, D. (2015). The power of black lives matter. Crisis, 122(1), 18–23. Mattison, M. (2012). Social work practice in the digital age: Therapeutic e-mail as a direct practice methodology. Social Work, 57(3), 249–258. Mukherjee, D., & Clark, J. (2012). Students’ participation in social networking sties: Implications for social work education. Journal of Teaching in Social Work, 32(2), 161–173. Parrott, L. & Madoc-Jones, I. (2008). Reclaiming information and communication technologies for empowering social work practice. Journal of Social Work, 8(2), 181–197. Reamer, F.G. (2013). Social work in a digital age: Ethical and risk management challenges. Social Work, 58(2), 163–172. Saxton, G. D., Niyirora, J. N., Chao, G., & Waters, R. D. (2015). #AdvocatingForChange: The strategic use of hashtags in social media advocacy. Advances in Social Work, 16(1), 154–169. Shaw-Verhoek, L., Shephard, N., Spencer, E., & Khan, A. (2014). Technology in social services/social work in Canada. Paper presented at the Association of Canadian Community Colleges, Ottawa. Spencer, E., Massing, D., & Gough, J. (Eds.) (2017). Social work ethics: Progressive, practical, and relational approaches. Don Mills: Oxford University Press. Voshel, E. H., & Wesala, A. (2015). Social media & social work ethics: Determining best practices in an ambiguous reality. Journal of Social Work Values & Ethics, 12(1), 67–76. 256

33 Social work and human services leadership in the new genomic era Kelley Reinsmith-Jones

Since completion of the Human Genome Project in 2003, advances in genomics have progressed rapidly, at times avoiding adequate regulation. The most newsworthy stories have described advances in DNA testing and cloning. More recently have been headlines regarding a DNA editing technique, Clustered Regularly Interspaced Short Palindromic Repeats (CRISP-R), capable of replacing defective parts of the human DNA sequence with healthy ones, even within fetuses. Reverberating moral issues surrounding genetic technology include the definition of being human, the source of the soul, and the preservation of human dignity. Yet little international public or classroom discourse, even from the International Federation of Social Workers, is heard about these concerns. Further, global genetics education for social workers and other social service providers is typically from a basic biology class. In addition, the Ethical, Legal, and Social Implications (ELSI) Research Program, of the National Human G ­ enome Research Institute (NHGRI), has not proven itself as an effective educational tool for social work professionals either locally or universally, thus leaving social workers largely in the dark about how to navigate the murky bioethical waters arising from genomic technology applications. Hence, the voice representing so many disenfranchised has gone practically unheard in discussions involving genetic science and its ethical, social, legal, and spiritual impact on client populations worldwide. However, to truly appreciate the advancement of genetic technology, the possible consequences for global societies, and hence the need for concern and oversight, one must first understand the basic history of genetics, as well as be familiar with some common terms: genetics, eugenics, genomics, and bioethics. A gene is the basic building block of human heredity; genetics is the study of heredity (­Genetic Alliance, District of Columbia Department of Health, (2010). Each person has 23 pairs of chromosomes, which are comprised of both coding genes (contains genetic information) and noncoding genes (nonfunctional), both of which are referred to as DNA (p. 1) and each human cell contains all 23 chromosomes (p. 2). A genome is the complete set of genes found in each cell (p. 3), and therefore, genomics is the study of the whole genome of an entity. Eugenics is the science of controlling hereditable characteristics aimed at changing genetic outcomes, typically achieved through influencing reproduction (Singleton, 2014). Bioethics is concerned with the ethical issues arising from “medicine, life sciences, and associated technologies as applied to human beings” (United Nations Educational, Scientific and Cultural 257

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Organization (UNESCO), 2006, p. 2). Each of these terms is interconnected in today’s scientific landscape particularly pertaining to the field of genomic medicine. The National Institutes of Health’s (NIH) sponsored site of the NHGRI Talking Glossary of Genetic Terms provides basic genetic education.

Global historical perspective of genetics (pre-genome project) Pre-genetic society witnessed a global eugenics movement for race and class purposes of creating “fitter families” and for ridding society of those with undesirable traits while increasing those with desirable characteristics (Kevles, 2016, p. 46) and for population control (Wilson, 2013). Most countries have established formal eugenics oversight and many also established sterilization laws. The following countries and continents are a partial list of those involved (Wilson, 2013): the United States, Britain, New Zealand, China, ­Canada, ­Denmark, ­Sweden, Norway, Finland, Switzerland, Iceland, Estonia, the Czech Republic, Slovakia (practicing sterilizations in 1991), Iran, India (7 million were sterilized in 1976), German colonies once part of German East Africa, and Germany, as well as Russia (­K rementsov, 2011). World War II Germany and the Holocaust are most associated with eugenics with little focus on the US practices, pre- and post-war, including state-sponsored serializations (1907-mid-1970s) affecting 64,000+ persons and involving 33 states (Singleton, 2014). Social workers were sometimes employed to identify which women to sterilize (NASW, 2011; Rose, 2011), to which NASW responds, “It is essential that social workers and others educate themselves about this history to understand where modern discussions of genetic testing and other advanced technologies might lead” (¶12). Eugenics education is provided by Cold Spring ­Harbor ­Laboratory (n.d.), as part of a DNA Learning Center.

Genome project: explanation and expectations The history of genetic testing begins in 1859; the first test for newborns was developed in 1961 for phenylketonuria. In 2003, the Human Genome Sequencing Project (HGP) was completed, an international collaboration for mapping and understanding the design of each cell in the human body, referred to as “the basic set of inheritable ‘instructions’ for the development and function of a human being” (U.S. Department of Health and Human Services [USDHHS], 2016, ¶4). Francis Collins, head of the HGP, believed that the outcome would be a better ability to diagnose and prevent disease (Collins, 2001). The completion of the HGP has been referred to as “one of the great feats of exploration, one that has revolutionized science and medicine” (Boeke et al., 2016, p. 126). More recently there has been the development of the procedure gene editing. The process of gene editing is like using “scissors” to cut genetic DNA, allowing the editing of physical and disease-linked heritable traits, cutting to remove and then adding or replacing where DNA was taken from (USDHHS, 2017, ¶1); the most current editing technology, developed in 2012, is CRISP-R. This technology would allow for the selection of specific traits for future children, while also being functional for medical purposes (Nuffield Council on Bioethics, 2018). Annually, an estimated 8 million children, globally, are born with birth-defects; intrauterine genetic testing and gene editing could potentially offer many a better quality of life (Ricciardi et al., 2018). In addition, being able to eliminate disease-­ related DNA could potentially impact annual deaths due to chronic conditions such as diabetes and cancers, decreasing worldwide disease burden (Cong et al., 2013; Savulescu, Pugh, Douglas, & Gyngell, 2015). Carriers of disease could potentially have children for whom 258

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the disease-related DNA has been edited out, therefore ending the threat of future progeny contracting that disease (Chandrasegaran, Korin Bullen, & Carroll, 2017; Cong et al., 2013; Savulescu et al., 2015).

Personalized genomic medicine The HGP also gave rise to personal genomics, made widely accessible by internet marketing; 23andMe is a common DNA testing kit. However, the HGP also kick-started the initiation of personalized or rather precision medicine. For instance, introducing genomic medicine into primary health care can provide stark improvements in disease risk assessments and more reliable testing, more advantageous medication selection, and individualized treatment and care plans based on a patient’s personal genome (David, 2017), as well as better informed prognoses (U.S. Department of Health and Human Services, 2018b). Personalized medicine’s anticipated results also include decreased treatment side-effects, earlier intervention, reduced costs to patients, and overall enhanced health outcomes (Lazaridis et al., 2014). In this context, mental illness and substance addiction are included. While single genes have not been associated with specific mental health disorders, psychiatric disorders are multifactorial with genetics being one component interacting with physical and social environmental factors (Hesselbrock, Hesselbrock, & Chartier, 2013). In Saudi Arabia, several genomic research initiatives are in progress, and individualized medicine will be used to study congenital malformations largely associated with consanguinity (Abu-Elmagd et al., 2015on reference list). As advantageous as individualized genomic medicine might be, there are barriers to implementation: “access and standardization of technology, reimbursement, regulation, ­evidence-based clinical validity, and ethical dilemmas” (Lazaridis et al., 2014, p. 16), as well as an absence of expertise in primary care and allied health providers (Callier, Toma, ­McCaffrey, Harralson, & O’Brien, 2014; Chapter Outline, ¶5; David, 2017). What most health care providers currently have is “basic genetic literacy” (Callier et al., 2014). As of 2017, there were an estimated 170,000 social workers in the American health care field (U.S. Bureau of Labor Statistics [USBLS], 2018a) and 112,040 US social workers in the fields of mental health and substance abuse (USBLS, 2018b), most of which received no specialized genetics education beyond baccalaureate degree biology.

Public health genomic medicine McWalter and Gaviglio (2015) explain that while personal genomic medicine can assist individuals in achieving better health outcomes, the better health of individuals can impact the health of an entire population, especially when considering genetically transmitted diseases. The Office of Public Health Genomics was created by the Center for Diseases Control in 1997 (McWalter & Gaviglio, 2015). In the United States, over 50% of the population is at risk for developing a potentially fatal disease, such as breast cancer or diabetes, because someone in their family has been diagnosed and therefore, knowing family history can assist in identifying who is at risk (USDHHS, 2018). Genetics and genomic medicine is used to assist in fulfilling all ten essential US public health services, including ensuring that education about genetics and genomics is provided to health care professionals, and others providing health-related services (Center for Public Health and Community Genomics & the Genetic Alliance, 2011). As with individual genomic medicine, there are barriers to the implementation of public health genomics including: regulations and guidelines about the use of genomics, the 259

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need for better informed stakeholders, and enough resources for implementing the objectives to meet the public health genomic priorities (Center for Public Health and Community ­Genomics & the Genetic Alliance, 2011). Ensuring a competent workforce in public health is a concern for all public health providers including social workers. It is estimated that there are currently 118,500 US public health social workers, with a projected increase of 34% for public health social work jobs by 2020 (Careers in Psychology, n.d.); social workers with no genetics education are likely to be hired into many of these positions.

Global genomic medicine The impact of genomics for the purposes of improving community health also extends ­g lobally, primarily through the World Health Organization (WHO), as governed by the World Health Assembly working in 150 countries. World health care is in a crisis due largely to a “dysfunctional system” which has led to a lack of public health (WHO, 2002). It is anticipated that genomic medicine will assist in lessening the global burden of many diseases and conditions, including monogenic disease (heritable diseases involving the mutation of a single gene), communicable disease, cancer, multifactorial disease (disease resulting from the intersection of aging and environment such as heart disease, stroke, and diabetes), and developmental abnormalities and mental retardation (WHO). There are barriers to implementing global genetics, including a shortage of health care social workers in many underdeveloped and developing countries: in 2005, there were only 11,111 registered social workers in South Africa, a slight increase of 1.5% from 1996 (Earle, 2007).

Ethical, legal, and social implications (ELSI) Precision genomics The potential good that genomic technologies and genomic medicine can provide, and the potentiality of genomic medicine’s role in lessening the global disease burden, is tremendous. Yet, one of the barriers to further implementation of genomics is the ELSI of genomic technologies. Many concerns are embedded in ELSI including the enforcement of the Genomic Information Nondiscrimination Act (GINA) of 2008, cultural and religious considerations, and patient informed consent (Callier et al., 2014). For example, genetic information might be accessed by insurance companies and current or potential employers, despite GINA and Health Insurance Portability and Accountability Act (HIPAA) (WHO, 2002). Another ethical issue is designer babies. The term refers to a child developed from a genetically modified embryo in order that the child possesses specific desired traits; parents may choose to have a baby in the interest of genetic disease, sex selection, or to produce a compatible sibling for donating “stem cells, tissue, bone marrow, or donor organs” to a sibling (Lerner, 2012, ¶8). Genetic testing of fetuses may lead to abortions or the destruction of embryos when results show the presence of unpreventable or incurable disease, and testing of adults could lead to preempted suicide when screening for late-onset Alzheimer’s (Davis, 2016). Some argue that knowing risk is more harmful than helpful (Wachbroit, 1998), even when applied to ­newborn screening: concerns of psychosocial screening outcomes include “perceived child vulnerability, parent-child bonding, and self and partner blame” (Frankel, Pereira, & ­McGuire, 2016, p. S25). Whatever the results of screening, competent professionals need to be able to assist with making informed decisions.

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Compared to the more than 100,000 health care social workers in the United States for 2017, there were only 3,100 US genetic counselor jobs in 2016 with a projected growth rate of 29% for 2016–2026 (USBLS, 2018c). This is an indication that while genetic counselors are in high demand, all professions across the health care field, including social workers, need to be genome educated to assist in filling the gap between supply and demand.

Public health genomics The acronym PHELSI (public health genomics ethical, legal, and social implications) is applied to population genomics (McWalter & Gaviglio, 2015). For instance, genetic population testing can be performed outside of a genetics clinic; however, there still needs to be access to resources for assisting patients in the interpretation of the screening data (McWalter & Gaviglio, 2015). The “individualistic fallacy” could be used in stigmatizing populations if the focus of disease cause is limited to individual factors, ignoring multifactorial causes (Aswini & Varun, 2010). For the potentialities of genomics to be fully realized, the technology, and its by-­products, must be accepted by the public; genomics will need to find a method for fitting into an ­individual’s, as well as a population’s, moral or religious value lens (Modell, Citrin, King, & ­K ardia, 2014). After receiving a diagnosis, oftentimes assistance is sought out through friends, family, spirituality practices, and alternative medicine, giving rise to the need for the ­medical systems to coordinate with other community agencies and organizations. I­ llness, even the prediction of illness, affects the whole person and not just the body; the whole person ­approach is the ethical approach. Also, the faith and healing connection is global; worldwide, faith-based organizations administer and/or fund health care delivery systems (Lindgren, Rankin, & Schell, 2015).

Global genomics There are many similarities between the ethical, legal, and social implications for global genomics and those at the population and individual levels. The differences are primarily (1) the application to ELSI for low- and middle-income countries or rather, the more vulnerable and underserved and (2) the role of cultural, historic, and religious factors (WHO, 2010). These ELSI include inequities in both the access to genetics services in general and prenatal diagnosis specifically, legalities that control the alternatives for terminating pregnancies of fetuses affected by disease and abnormalities, both an untrained health care workforce and limited numbers of adequately trained workers, ineffective regulations of genetic information privacy, the discrimination and stigmatization of persons and populations with disorders and diseases, the absence, or weakness, of the regulation of genetic testing, and the insufficient governance of “international collaborative research initiatives” (pp. 15–16). However, international guidelines on ethical issues pertaining to medical genetics do exist and, additionally, most countries have their own (WHO, 1998).

Global regulatory and ethical responses Most countries have formed their own regulatory bodies for the oversight of genomics. Also, the ELSI Research Program division was established in 1990, sponsored by the U.S. ­Department of Health and Human Services’ NIH. The WHO gives access to worldwide ELSI human genome ethics organizations, and applicable codes and declarations.

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The social work response In the United States, the National Association of Social Workers (NASW, 2017) has a practice code of ethics to guide the conduct of all social workers in every social work capacity. In addition, NASW has other sets of standards and guidelines including the NASW Standards for Social Work Practice in Health Care Settings (NASW, 2016) and NASW Standards for Integrating Genetics into Social Work Practice (NASW, 2003). The Standards for Integrating Genetics into Social Work Practice (NASW, 2003) was published the same year as the HGP was completed. It was written to educate social workers about the field of genetics, to increase awareness of how to best work with those impacted by genetics, and to set the course for “expanding current and future areas of social work practice, research, and policy in genetics” (p. 5). While this resource is helpful, the genetic technology transformation, especially the advent of CRISP-R, demands that standards be updated and more emphasis be placed on current genomics and the associated ELSI implications. Other countries have social work standards, and the International Federation of Social Workers (IFSW, 2018) has a global definition of social work, as well as a statement of roles and responsibilities of social work in health care translated in 104 languages. Yet there is nothing written specific to genetics. A search of the codes of ethics for social workers in Australia, Sweden, South Africa, Canada, and Singapore gave no results for genetic related ethics. However, every code of ethics emphasized that competence and knowledge about genetics in practice are essential, that protection of the vulnerable is mandatory, that knowing the cultural differences in the perceptions of genomic practices is critical, and that advocacy, including being active in writing or amending legislation, was necessary. No one can argue that it is impossible to fulfill these obligations if there is no social work genetics knowledge base. The Jackson Laboratory (2018), with guidance from the National Coalition for Health Professionals and Education in Genetics, lists core competencies deemed to be vital knowledge for every health care professional. The Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics, a product of both Columbia University Medical Center and the Hastings Center, provides a wealth of information in the forms of updates, publications, and links to educational materials including videos. While updated educational, genetics-concentrated resources have yet to be developed for the social work profession, the need for such opportunities is being discussed by individual academic institutions and at social work conferences. With so much information available, only time, effort, and collaboration stand in the way of making progress with this effort. Until then, it is the obligation of individual social workers, especially those who work in the health fields, to educate themselves and others they work with. When needing to sit at a table and advocate for a client who is receiving genetic services, whether the client is one person or many, the social worker must be able to participate in that discussion and do so feeling confident in representing their client’s best interest. For the time being, and even after the field of social work advances in this area, the best collaboration will be between social workers and genetic counselors, combining their expertise and skills for delivering the best care and services possible. Given the numbers of social workers, compared to those of genetic counselors, this partnership is essential.

References Abu-Elmagd, M., Assidi, M., Schulten, H., Dallol, A., Pushparaj, P. N., Ahmed, F., . . . Al-Qahtani, M. (2015). Individualized medicine enabled by genomics in saudi arabia. BMC Genomics, 8(1), 1–17.  Aswin, Y. B. & Varun, D. (2010). Genetics in public health: Rarely explored. Indian Journal of Human Genetics, 16(2), 47–54. 262

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Boeke, J., Church, G., Hessel, A., Kelley, N., Arkin, A., Cai, Y., … Yang, L. (2016). The genome project-write. Science, 353(6295), 126–127. Callier, S., Toma, I., McCaffrey, T., Harralson, A., & O’Brien, T. (2014). Engaging the next generation of healthcare professionals in genomics: Planning for the future. Personalized Medicine, 11(1), 89–98. Careers in Psychology. (n.d.). Employment outlook & career guidance for Public Health Social Workers. Retr­ ieved from https://careersinpsychology.org/employment-outlook-guidance-public-health-socialworker/ Center for Public Health and Community Genomics & the Genetic Alliance (2011). Priorities for public health genomics Retrieved from https://depts.washington.edu/cgph/pdf/geno_report_WEB_w_ RFI_1122.pdf Chandrasegaran, S., Korin Bullen, C., & Carroll, D. (2017). Genome editing of human embryos: To edit or not to edit, that is the question. Journal of Clinical Investigation, 127(10), 3588–3590. Collins, F. (2001). Contemplating the end of the beginning. Genome Research 11, (5), 641–643. Cong, L., Ran, F. A., Cox, D., Lin, S., Barretto, R., Habib, N., … Zhang, F. (2013). Multiplex genome engineering using CRISPR/Cas systems. Science, 339(6121), 819–823. Davis, D. (2016). Genetic testing as part of a plan for preemptive suicide in the face of impending dementia. Current Genetic Medical Reports, 4, 86–91. David, S. (2017). Genomic and precision medicine: Primary care. (3rd ed.). San Diego, CA: Academic Press. Earle, N. (2007). Social work as a scarce and critical profession. South Africa: Department of Labour. Retrieved from http://www.labour.gov.za/DOL/downloads/documents/research-documents/­ Social%20work_Dol_Report.pdf Frankel, L. A., Pereira, S., & McGuire, A. L. (2016). Potential psychosocial risks of sequencing newborns. Pediatrics, 137(Suppl. 1), S24–S29. Genetic Alliance, District of Columbia Department of Health. (2010). Understanding Genetics: A District of Columbia Guide for Patients and Health Professionals. Washington (DC): Genetic Alliance, Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK132152/ Hesselbrock, M. N., Hesselbrock, V. M., & Chartier, K. G. (2013). Genetics of alcohol dependence and social work research: Do they mix? Social Work in Public Health, 28(3–4), 178–193. International Federation of Social Workers. (2018). Retrieved from https://www.ifsw.org/health/ Jackson Laboratory. (2018). Core competencies in genetics. Retrieved from https://www.jax. org/education-and-learning/clinical-and-continuing-education/ccep-non-cancer-resources/ core-competencies-for-health-care-professionals# Kevles, D. (2016). The history of eugenics. Issues in Science and Technology, 32(3), 45–50. Krementsov, N. (2011). From ‘beastly philosophy’ to medical genetics: Eugenics in Russia and the Soviet Union. Annals of Science, 68(1), 61–92. Lazaridis, K., McAllister, M., Babovic-Vuksanovic, D., Beck, S., Borad, M.., Bryce, A. H., … ­Farrugia, G. (2014). Implementing individualized medicine into the medical practice. American Journal of Medical Genetics. Part C, Seminars In Medical Genetics, 166C(1), 15–23. Lerner, A. W. (2012). Designer babies. In B. W. Lerner & K. L. Lerner (Eds.). In Context series: ­Biotechnology/Context: Detroit: Gale. Retrieved from http://link.galegroup.com.jproxy.lib.ecu. edu/apps/doc/XAPYSP810662464/SCIC?u=ncliveecu&sid=SCIC&xid=0dcec8a3 Lindgren, T., Rankin, S., & Schell, E. (2015). Working globally with faith-based organizations. In S. Breakey, I. B. Corless, N. L. Meedzan, & P. K. Nicholas (Eds.). Global health nursing in the 21st century (pp. 453–468). Springer. Retrieved from ProQuest Ebook Central, https://ebookcentral. proquest.com/lib/eastcarolina/detail.action?docID=2166649 Mcwalter, K., & Gaviglio, A. (2015). Introduction to the special issue: Public health genetics and genomics. Journal of Genetic Counseling, 24(3), 375–380. Modell, S. M., Citrin, T., King, S. B., & Kardia, S. L. (2014). The role of religious values in decisions about genetics and the public’s health. Journal of Religion and Health, 53(3), 702–714. National Association of Social Workers. (2003). NASW standards for integrating genetics into social work practice. Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=zoFmn HHV0f4%3d&portalid=0 National Association of Social Workers. (2011). Social work and eugenics. Retrieved from http://www. socialworkblog.org/pressroom/2011/11/social-work-and-eugenics/Social National Association of Social Workers. (2016). NASW standards for social work practice in health care settings. Retrieved from https://www.socialworkers.org/LinkClick.aspx?fileticket=f FnsRHX-4HE%3 d&portalid=0 263

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National Association of Social Workers. (2017). The NASW code of ethics. Retrieved from https://www. socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English Nuffield Council on Bioethics (2018). Exploring ethical issues in biology and medicine. Retrieved from http://nuffieldbioethics.org/project/genome-editing Ricciardi, A., Bahal, R., Farrelly, J., Quijano, E., Bianchi, A., Luks, V., … Saltzman, W. (2018). In utero nanoparticle delivery for site-specific genome editing. Nature Communications, 9(1), 1–11. Rose, J. (2011, Decemeber 28). A brutal chapter in North Carolina’s eugenics past. NPR, all things considered. Retrieved from https://www.npr.org/2011/12/28/144375339/a-brutal-chapter-in-northcarolinas-eugenics-past Savulescu, J., Pugh, J., Douglas, T., & Gyngell, C. (2015). The moral imperative to continue gene editing research on human embryos. Protein & Cell; Heidelberg, 6(7), 476–479. Singleton, M. (2014). The ‘science’ of eugenics: America’s moral detour. Journal of American Physicians and Surgeons, 19(4), 122–125. United Nations Educational, Scientific and Cultural Organization. (2006). Universal declaration on bioethics and human rights. Retrieved from http://unesdoc.unesco.org/images/0014/001461/146180E.pdf United States Bureau of Labor Statistics. (2018a). Healthcare social workers. Retrieved from https:// www.bls.gov/oes/current/oes211022.htm United States Bureau of Labor Statistics. (2018b). Mental health & substance abuse social workers. Retrieved from https://www.bls.gov/oes/current/oes211023.htm United States Bureau of Labor Statistics. (2018c). Genetic counselors. Retrieved from https://www.bls. gov/ooh/healthcare/genetic-counselors.htm U.S. Department of Health and Human Services. (2016). All about the human genome project. R ­ etrieved from https://www.genome.gov/12011238/an-overview-of-the-human-genome-project/ U.S. Department of Health and Human Services. (2017). What is genome editing? Retrieved from http://www.genome.gov/27569222/genome-editing/ U.S. Department of Health and Human Services. (2018). Healthy people 2020. Retrieved from https:// www.healthypeople.gov/ Wachbroit, R. (1998). The question not asked: The challenge of pleiotropic genetic tests. Kennedy Institute of Ethics Journal, 8(2), 131. Wilson, R. (2013, September 14). Eugenics internationally. Retrieved from http://eugenicsarchive.ca/ discover/connections/5233cd195c2ec500000000a4 World Health Organization. (1998). Proposed international guidelines on ethical issues in medical genetics and genetic services: Report of WHO meeting on ethical issues in medical genetics, Geneva. World Health Organization. (2002). Genomics and world health: Report of the advisory committee on health research. World Health Organization. (2010). Community genetics services. Retrieved from https://apps. who.int/iris/bitstream/handle/10665/44532/9789241501149_eng.pdf;jsessionid=B10C2960F 21F52EA3A9BC95E2615AE27?sequence=1

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34 Navigating social and d ­ igital ­media for ethical and ­professional social work practice Melanie Sage, Becky Anthony, and Laurel Iverson Hitchcock

Facebook and other social media tools have become commonplace in most people’s lives. ­Approximately, one in four adults in the world are on Facebook, and more than third have two or more social media accounts. Social workers who are not literate in issues related to social media risk missed opportunities with their clients for connection, psychoeducation, and understanding. Some high-profile incidents of professional misuse of social media lead to concerns about the ethical use of these tools. On the other hand, social work practitioners have an opportunity to understand and integrate digital technologies ethically and professionally in practice with clients and communities. Proactive use of social media can range from simply raising awareness of how social media affects client systems, to enhancing digital media competencies of clients served, to communicating with client systems online. Recently, in the United States, the National Association of Social Workers (NASW) offered ethical guidelines for social work practice and education, and other global organizations such as the International Federation of Social Workers (IFSW) offer insight into ethical social work practice with social media. This chapter discusses approaches to ethical decision-­making while using social media in social work practice and addresses considerations such as (1) ­professional presentation of self; (2) managing boundaries; and (3) protecting client privacy. Social media are novel technologies that landed in the social work practice landscape before policies and regulations were prepared to offer guidance for their use. However, social media are not novel when it comes to ethical concerns. Just like any ethical issue, social workers should apply a professional lens and draw from their Code of Ethics, agency policies, regulations and laws, and professional experience. Using these tools alongside structured ethical decision-making frameworks, social workers can make good decisions about the benefits and risks of social media use for any given scenario.

Ethical concerns on social media Social media platforms are those in which people create profiles and can then follow each other’s posts and respond to another person’s content. Social media networks range from very large (Facebook, Instagram, Twitter, and LinkedIn) to very niche and based around a special interest or profession, and each has their own culture, rules, and norms. Typically, 265

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a  social media user creates a profile that is searchable by some other users and then posts pictures, ideas, and opinions. These posts may be viewable to all or shared only with a select group of other users who are approved viewers. In either situation, this is where ethical issues and dilemmas begin to arise. These ethical concerns usually fall into one or more of three categories.

Professional presentation of self A social worker who uses social media on their own time is still a representative of the profession, especially if the social worker is easily identifiable or known to be a social worker. Thus, their public views, especially when they depart from social work values, can cast a negative light on the profession and the person’s employer. If viewed by clients, the social worker’s shared opinions may disrupt working relationships. In some cases, personal views expressed on social media can affect employment and lead to termination. For instance, a child welfare worker posted disparaging remarks on her private Facebook account about the types of clients she served, and a coworker brought them to the attention of a family court judge who ruled that she could not testify as an unbiased witness and therefore could not perform the duties of her job. Inversely, a social worker, who is a good representative of the profession, shares views that align with social work values and ethics, and is clear about self-representation and not speaking for their employer can create opportunities on social media to educate the public. They can improve and correct faulty assumptions about social workers and develop professional connections for peer learning and professional engagement. See the section on Personal Learning Networks later in this chapter for more about the beneficial uses of social media for peer networking. Although a social worker may feel entitled to a personal voice in public spaces, Codes of Ethics do not protect the workers’ voices and personal rights; they define professional ethics and values and protect the right of the client. It is not a professional ethical dilemma to decide whether one’s personal rights to free speech trump those of their professional duties (they do not), but it is certainly an ethical concern if a social worker presents their personal voice in such a way that it interferes with their professional roles. Similarly, some social workers are concerned about the issue of a client discovering the worker’s personal information online. Although the client is not bound by ethical rules that prevent them from engaging in these activities, social workers are responsible for assessing, correcting, and maintaining appropriate privacy of information that appears about them online.

Boundaries Professional boundaries in social work demand relationships in which the social worker recognizes the power they hold over another and where the social worker maintains personal boundaries with those they serve. When using social media, boundary issues emerge regarding social workers and clients who follow each other on social media, and even accidental social media contact, such as when a social worker and client have a mutual friend and this becomes known to either party. Boundary issues may also be present when a supervisor and worker or teacher and student are friends. Boundary crossing is not a new terrain for social workers; rural social workers, in particular, have always had to manage boundary crossings in their communities where a social worker may know most people in a small town in their multiple roles. For instance, in rural 266

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communities, a counseling client may also be the child’s Sunday school teacher or an old high-school friend. Just like in community situations, a dual relationship on social media becomes a boundary violation when shared social media connections potentially cause the client harm or interfere with impartial professional decisions, influence expectations, or infer undue and coercive influence (Reamer, 2003). In cases where a boundary violation exists, the social worker is obligated to end the personal or professional connection.

Client privacy Client privacy issues on social media are multifaceted. First, privacy concerns arise when social workers overshare details about their work in a way which may identify a client. Sometimes this happens innocently, such as when a social worker posts a picture of a happy group of young girls she has been working with at a school to celebrate their graduation from a life skills group. Even if the post is vague and readership is limited, sharing information about clients on social media is a serious privacy concern and can be a legal violation as well. Second, social media platforms are for-profit ventures in most cases, and therefore anything shared on social media is data owned by the for-profit entity. Therefore, it is virtually impossible to protect communication data that occur on social media. Third, clients are entitled to privacy while receiving services, but some social workers believe it is within their purview to search for clients online for the benefit of information discovery. In some cases, this may indeed be appropriate, such as in the situation in which an adoption worker is searching for a missing family member to support reunification. In other situations, searching for clients is viewed as a privacy violation, especially if searches are conducted out of curiosity and no urgent or safety case exists for searching social media.

Ethical dilemmas An ethical dilemma is present when multiple professional ethical imperatives lead to conflicting guidance. Professional social work authorities or professional membership groups, such as the NASW’s Code of Ethics in the United States or the Statement of Ethical Principles by the IFSW, provide guidance about ethical imperatives in the social work field. Because social work ethical imperatives differ across the globe, we use an example of ethical imperatives grounded in moral principles developed by Beauchamp and Childress (1979) which frequently appear in the medical literature: beneficence, least harm, respect for autonomy, and justice. Autonomy means that an individual has the right to their own choices; beneficence means acting in the best interest of the client; non-maleficence means that the provider should act in a way that does no harm to the client; and justice emphasizes fairness and equality in the treatment of clients. These moral principles mirror many of those that are common in global social work professional codes of ethics. When addressing ethical dilemmas through the principles offered previously or through the principles of the Code of Ethics developed by one’s own local or professional social work organization, one ethical imperative is not more important than the other at face value. However, they may come into conflict with each other. For instance, if a client wants to communicate with a social worker over social media, should we respect their autonomy, or favor beneficence and protect the client from the potential privacy-related harms of using social media? To make these decisions, we pair these ethical imperatives with a decision-­ making framework such as the Ethical Rules Screen (Loewenberg & Dolgoff, 1996), the ETHIC model (Congress, 1999), or the Reamer and Conrad (1995) model. Some other role 267

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and field-specific models exist which social workers can also draw upon for guidance. Each of these asks the user to consider a series of questions that help prioritize the principles within a specific situation. In the Reamer and Conrad (1995) model, users are encouraged to take the following steps: (1) determine whether there is an ethical issue or dilemma; (2) identify the key values and principles involved; (3) rank which principles are most relevant to this dilemma based on your professional judgment; (4) develop an action plan and confer with colleagues; (5) implement your plan with professionalism; (6) reflect on the outcomes and consequences. Using this model with the aforementioned ethical dilemma of whether to engage in social media use with a client given the named principles of beneficence and autonomy, the social worker might rank autonomy as a higher priority than protecting the client from a thirdparty provider in this case because the benefit of easy communication is highly valued and the perceived risk of privacy invasion by the third-party provider appears low. However, when implementing the plan to communicate with the client via social media, the social worker may also consider ethical priorities such as informing the client of risks of this type of communication. Discussion with colleagues may lead to the discovery of agency-based policies that may prohibit such communication, which may lead to another plan. On the other hand, the worker may assess the client has frequent crisis situations not well-suited to social media contact that would lead to higher risk if data were breeched, and decide both of the ethical imperatives deserve high value. They may therefore agree to communicate with the client via social media but only about how to arrange the next meeting and not about clinical or crisis issues. To support client autonomy, the worker could also give the client full disclosure regarding potential privacy issues, office regulations, and laws that may govern this type of information sharing so that the client can make their best decision about what to communicate via social media. After the plan is in place, the worker should monitor how it goes to inform a future similar ethical consideration. Readers should note that in some jurisdictions, the adopted Code of Ethics might provide guidance that reaches significantly beyond the Beauchamp and Childress’ moral imperatives offered here, and may explicitly limit the types of social media communication that should occur between social workers and clients. Further, agency policies and laws may direct practice. In these cases, social workers first have an obligation to abide by these regulations and practice guidance to fulfill their professional obligations.

Social workers’ ethical obligation to maintain knowledge about social media Best practice in social work is to meet their clients where they are, and most people are social media users. Given that most clients of social work will also be social media users, it is valuable to consider the benefits of engaging clients via social media, or at least be able to converse professionally with clients about their social media use. Yet the social work literature suggests that there is an “ethical panic” about the intersections of social media and social work practice (Chan, 2016, p. 272). Stanfield and Beddoe (2016) attribute this panic to social work practitioner’s level of comfort and lack of expertise or experience with technology, which can cause fear. In hopes of minimizing this fear and addressing emerging ethical issues, some organizations, including national and international social work associations such as the British Association of Social Workers (2018) and the NASW in the United States (2017b), created social 268

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media policies and technology guidelines for social workers. However, the diversity within the field of social work makes it difficult, if not impossible, to create social media guidelines that fit every social worker, practice setting, or organization. The current IFSW’s (2012) Statement of Ethical Principles and the NASW’s Code of Ethics (2017a) both identify that social workers need to be competent with technology to work within the social work field and that social workers should follow the same ethical principles that they use in face-toface settings. Social workers should apply ethical practices in all aspects of their social work practice, including when engaging clients on social media and other digital spaces. Social workers need to be familiar with both the positive and negative contributions of social media on the profession, and utilize their skill set to critically think about concerns that could arise for them as professional social workers when using social media. Once social workers identify the benefits and concerns, they are encouraged to seek training and supervision to develop competency with social media and understand how it can best fit into their diverse social work practice. For instance, some interventions are emerging that utilize social media, and internet users often seek self-help in social media spaces. Social workers can best assist their clients when they understand these possibilities and help direct their clients to appropriate spaces through psychosocial education. Social workers who maintain their obligations to ethical practice with social media will stay abreast of emerging technologies as well as best practices, which will pave the way for creative and diverse use of social media and other digital tools within the field.

Professional learning networks on social media For any practicing social worker, maintaining competent skills and knowledge over one’s professional career is an ethical obligation. When social workers use social media to collect information related to professional interests and then share this content with other practitioners, the resulting effort is a professional learning network (PLN). This practice aids in the ethical obligation of lifelong learning, as the social worker is using digital tools within social media platforms to curate information and actively engage with others to share information and network. For example, a social worker’s PLN sources might include the use of email alerts from online newspapers, blogs, and scholarly journals to receive updates about research in their area of practice. Then, the social worker chooses quality bits of this information to share, which reflects an ethical understanding of how to assess sound and practice-­ appropriate sources, and can consult and engage with colleagues about the source on social media. Further, by engaging with other professionals from diverse backgrounds and locations, social workers increase their professional exposure which can support the ways they work with clients from different cultures and communities. The professional advantages of using social media to expand one’s learning include access to a larger variety of professionally relevant information in digital form, opportunities to connect with professionals and researchers from around the world, instant access when it is most relevant, and contributing to the public discourse about pressing societal problems. Disadvantages also exist when using a PLN, such as managing the volume and quality of digital content to assure one is sharing professional quality resources that abide by one’s Code of Ethics. As social media allows for quick and easy sharing of almost any type of text, photo, or video, social workers must also promote the ethical use of content through the practice of attribution, and maintain digital literacy to critically assess and reflect on quality, source, and ethical considerations of online content, not only for their professional consumption but also to best inform clients and colleagues about harmful or unethical content. 269

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Guidance for social work educators Social work educators have the dual role of teaching students and practicing professionals about the effects of social media on social work practice while also engaging in their own ethical use of social media. The ethical concerns for social work educators and their learners include those already mentioned in this chapter such as presenting themselves and their work professionally in online environments; protecting learners’ privacy; and maintaining professional boundaries with learners when using social media. For example, social work educators often incorporate social media into assignments, such as having students create a blog about a health-based intervention or using a closed Facebook group for students to post comments about course topics. Educators should share assessments and grading comments only with the learner, not in social media comments in order to protect student privacy. Best practices for the ethical use of social media in learning environments include awareness and compliance with institutional polices and governmental laws that protect student privacy such as the Family Educational Rights and Privacy Act in the United States, and compliance with social media policies of educational programs and laws that govern digital data for students. In addition, educators must work to ensure academic integrity when working with learners. While this is not a new issue for educators, social media and other digital tools make it easy to plagiarize online content or conduct web-based searches for information when taking an exam. To help prevent problems related to plagiarism and cheating, social work educators should educate learners about integrity, and develop and support processes and guidelines to address and monitor violations within the educational program and institution. Authentication of original work in education can include the use of proctoring services that video monitor students during an exam or software products designed to screen student papers for text that are copied from another source, including social media posts.

Guidance for social work organizations Organizations, like individual social workers, experience a variety of benefits when they utilize social media. Organizations who adopt social media can increase awareness of their services, encourage transparency, engage stakeholders, and advocate for specific client populations. The ethical concerns noted for social work organizations are similar to those suggested for individual social workers, including (1) professional presentation of the organization; (2) managing boundaries; and (3) protecting client privacy. These are not new ethical concerns for organizations. For instance, organizations often struggle with client privacy in their waiting areas or other public locations because social workers cannot control what individuals share about themselves. An individual client determines what, when, and how they share information so they could disclose personal information on the organizations’ social media page, which requires monitoring. Social media policies for organizations can address all three of these potential concerns and reduce the risk (Karpman & Drisko, 2016). Due to differing agency agendas, policy needs may be diverse. A suicide prevention hotline may proactively offer texting and social media chat services, whereas an agency that provides probation and parole services may discourage social media contact between workers and clients. Although it is tempting to be risk adverse and limit social media use across the organization, a policy that prohibits social media use may forego possible opportunities to best serve clients and the agency. An organization should develop policies and guidelines that fit their mission, vision, values, and goals. 270

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Because social media continues to emerge in new ways, organizations should refrain from rigid policy that applies to a specific network (like Facebook or Instagram) and instead focus on the ways that workers, clients, and the organization communicate, protect data, and make decisions when using social technologies that are outside the control of the agency. Open communication about social media during meetings or supervision, beyond just setting a policy, can give workers opportunities to consider the ethical use of these tools in practice. By encouraging regular conversations about how social media appears in the lives of workers, coupled with training that supports practical use of social media tools, organizations can help individual social workers develop the knowledge and skills needed to be competent at using social media to meet organizational goals. As technologies evolve, social workers are obligated to maintain their competencies with social media and other forms of digital technologies. Examples of these obligations include engaging in professional conversations, staying current on new developments, and attending trainings on how social media utilization ethically meets the diverse needs of organizations, social workers, and clients.

References Beauchamp, T. L., & Childress, J. F. (1979). Principles of biomedical ethics. New York: Oxford University Press. British Association of Social Workers. (2018). BASW social media policy. Retrieved from https://www. basw.co.uk/resources/basws-social-media-policy Chan, C. (2016). A scoping review of social media use in social work practice. Journal of Evidence-­ Informed Social Work, 13(3), 263–276. Congress, E. P. (1999). Social work values and ethics: Identifying and resolving professional dilemmas. Belmont, CA: Thomson. International Federation of Social Workers. (2012). Statement of ethical principles. Retrieved from https:// www.ifsw.org/statement-of-ethical-principles/ Karpman, H. E., & Drisko, J. (2016). Social media policy in social work education: A review and recommendations. Journal of Social Work Education, 52(4), 398–408. Loewenberg, F., & Dolgoff, R. (1996). Ethical decisions for social work practice (5th ed.). Itasca, IL: F. E. Peacock. National Association of Social Workers (NASW). (2017a). Code of ethics. Retrieved from https://www. socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English National Association of Social Workers (NASW). (2017b). NASW, ASWB, CSWE, & CSWA s­ tandards for technology in social work practice. Retrieved from https://www.socialworkers.org/­practice/ standards/NASW_ASWB_CSWE%20_&_CSWA_Standards_for_Technology.asp Reamer, F. G. (2003). Boundary issues in social work: Managing dual relationships. Social Work, 48(1), 121–133. Reamer, F. G., & Conrad, A. P. (1995). Professional choices: Ethics at work. (Video). Washington, DC: NASW Press. Stanfield, D., & Beddoe, L. (2016). Social work and social media in Aotearoa New Zealand: Educating social workers across shifting boundaries of social work identity. Social Work Education, 35(3), 284–296.

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35 Cross-border social work ­practice and ethics in a digital age Aloha VanCamp, Martin G. Leever, and G. Brent Angell

Across the globe, mental illness has been identified as a major population health issue. The Center for Disease Control and Prevention (2018), Healthy People 2020 (2018), and the World Health Organization (2018) concur that mental illness is a problem of concern that shows no territorial boundaries and is socioeconomically indiscriminate with respect to its presence and impact. In saying this, it is important to appreciate that the concept of mental illness differs between peoples and cultures. The Anishinaabe indigenous peoples, for example, have traditionally perceived mental illness in terms of preternatural possession in the form of the windigo, which is used to explain a range of deleterious thoughts, feelings, and behaviors. Angell (1997) and Angell, Kurz, and Gottfried (1997) discuss this in depth with respect to working cross-culturally. They suggest diverse ways of knowing should guide social workers to assess problems differentially through a lens that is person and situation specific. In so doing, greater understanding is achieved, and promising practices result. Moreover, Angell (2018) presents the case that morally and ethically, social workers engaging indigenous peoples, their systems of support, and their communities need to use a critical theory-based anti-oppressive approach founded on equity, partnership, and collaboration. This echoes and theoretically advances Castellano’s (2004) observation on ethical engagement of indigenous peoples in Canada, which, in turn, has been codified by the ­Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada (2014). Indeed, these tenets surely should guide us in all our work and be applicable to everyone irrespective of culture or location. With the rise of smartphones and other digital technologies, opportunities exist to increase access to health and mental health services provided through the internet. E-mental health (eMH) treatment and e-health are expanding the ways to intervene with people who experience distress. eMH refers to provision of mental health services through the internet and related technologies, including smartphones, videoconferencing, tablets, web- and ­platform-based applications (apps), and other digital options. In 2018, 32 states in the United States required insurance carriers to offer telemedicine coverage. In this burgeoning field, the UK’s National Health Service has created a list of recommended eMH apps to use. In Australia, the Black Dog Institute provides training for providers on how to evaluate apps. 272

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In Canada, Health Canada defines e-Health as “an overarching term used today to describe the application of information and communications technologies in the health sector.” While the United States does not have (at the time of this writing) an overarching agency monitoring tele-health tools, an increasing number of social workers are offering online counseling with secure platforms that meet health care privacy requirements. In addition, the Federal Drug Administration will exercise “enforcement discretion” on apps that assist those with diagnosed psychiatric conditions such as depression and anxiety. eMH apps are rapidly growing in development and popularity and are typically aimed at adults who experience depression or anxiety disorders. In 2014, about 100,000 health related apps were available, with most directly marketed to individuals. The proliferation of apps raises concerns about their usefulness, ethics, and legal responsibilities. Alleman (2002) and Humphreys, Winzelberg, and Klaw (2000) identified three central ethical questions related to eMH: (a) ethical responsibility may not be fulfilled for participants who reside outside of the jurisdiction; (b) participants could not be seen and could not be reliably identified; (c) privacy could not be guaranteed by typing or recorded communications. In 2017, the American National Association of Social Workers published an updated Code of Ethics to include issues regarding the use of technology in social work practice. Nineteen of the changes address ethical responsibilities when using technology in the social work practice, including additional areas of competence when using technology, informed consent when using technology, as well as privacy and confidentiality when providing online service.

Case scenarios for discussion and ethical problem-solving Case scenario 1: smartphone apps There are increasing anecdotal reports that the use of mental health apps and online services is on the rise. Service user, Margaret, is experiencing periods of extreme anxiety related to preexisting trauma after being victimized. She has been seeing a social worker and relies on public transit. Being on a fixed-income, she finds the cost and travel time challenging. Margaret asks the social worker about what apps and online options she might try as an alternative to face-to-face counseling. 1 What evidence-based information is available regarding mental health apps? 2 What might be a basis for evaluating whether an app could be a useful method in working with service users who experience severe anxiety? 3 What should you say to Margaret regarding the use of apps as an alternative ­mental health intervention? 4 Would the service user’s age be a factor e.g. young versus older adult? Why or why not? 5 Does the use of apps help to increase access to mental health care or does it limit or reduce access to care? 6 How do or should factors such as confidentiality and privacy, diversity, and ­socioeconomic status affect professional and/or service user decision-making?

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Case study 2 – suicidal service user Tim is an indigenous veteran. He has been dealing with the pain from a chronic leg injury received while on military duty. Tim had struggled to find a job in the city near the base where he had been stationed and frustrated, decided to move back to his remote home community to live with his parents. Overwhelmed by his physical condition and lack of support services in the community, Tim attempted suicide by drug overdose. After being airlifted to a regional hospital, Tim received culturally nonspecific counseling and medication to treat his condition. Determining that Tim’s condition was now stable enough for him to be discharged, arrangements were made for him to return home; however, there was no mental health workers to monitor and support him at the community’s health clinic. As a social worker, you have agreed to see Tim for counseling via videoconferencing. The first video session took place the following afternoon, and Tim kept all appointments for the first two weeks. By the third week of their video sessions, Tim seemed to be losing his enthusiasm and didn’t think his medication was helping him. At the end of the last session, you asked Tim – as he had in each of the prior sessions – if he had plans to hurt or kill himself. “No,” Tim mumbled, and then, at a fainter volume not picked up by the webcam, he added, “not today.” Two days later, you logged on to the computer for your scheduled session with Tim. When the appointment time arrived, Tim’s username did not show on the screen. Later that afternoon, you were contacted by the nurse at the community’s health clinic who informed you that Tim had completed suicide earlier that day. 1 What factors should be considered before beginning to practice social work counseling online with indigenous peoples or others who live in rural and remote communities? 2 What guidelines with respect to sociocultural sensitivity should be used when working with an indigenous service user and others in ethnically and culturally sensitive ways who are in crisis situations using tele-therapy? 3 What equipment is necessary for online counseling? How does a service provider determine if the equipment meets the criteria for privacy requirements and social work ethical standards in your country? 4 What issues and risks did Tim face given that he was indigenous, a military veteran, and had a history of suicide ideations and attempts?

Anti-oppressive theoretical framework A critical theory perspective on mental well-being is founded on perceptions and approaches that are respectful of human difference and engage the service user and their system in all aspects of the helping process decision-making. This then gives rise to promising practices which are conjoint, novel, uncompromising, and anti-oppressive. In saying this, a critical anti-oppressive approach calls upon helping professionals to embody the practice aphorism of starting where the service user is. To do this, they must align their methods and interventions with what the service user needs and wants. Stemming from this, social workers, and their allied professional colleagues, engage in a shared decision-making process with service users 274

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and their systems to better understand the challenges they face and devise a plan of action that is in the service users’ best interests. An essential ingredient in this requires the social worker to reflect on the work they do in terms of the practice perspective they are making use of. Pozzuto, Angell, and Dezendorf (2005) suggest that if the practice approach lies in the realm of the traditional, it is likely to be founded on professional privilege and be oppressive. If, however, the approach is grounded in critical theory, then it has the promise of being engaging, collaborative, and emancipating. Further, from a nursing perspective, Hopton (1997) suggests that interpersonal helping from a critical perspective must consider ways to challenge structurally reinforced professional dogma and ways of working which oppress service users and impact the helping relationship in ways that affect mental well-being. This aligns with Mullaly and West’s (2018) conceptualization of anti-oppressive practice and the importance of questioning the role that social workers play in either shoring up or confronting oppression and privilege. As such, a critical theory-based perspective and anti-oppressive practice approach supports social work practice focused on ending socioeconomic injustice, including the power imbalance inherent in organizational structures, and supports an egalitarian world free from racism, sexism, and other areas of discrimination in society. The model is an ideal framework for social workers since digital or e-health could potentially equalize people across the globe or conversely, it could increase the divide between people across the globe. The digital environment could empower people and decrease discrimination among them, while others say that it could heighten discrimination based on access to computers, smartphones, and the internet.

Overview of the research on eMH eMH has been the focus of extensive amount of research considering it is relatively a new field of practice. However, research on safety and efficacy of app-based treatments is limited. The current research on eMH includes the benefits of direct to user digital treatment. ­Research suggests this modality is popular, is widely used, and is accessible to underserved populations. For example, MOODGym is a low-cost online intervention that has been available since 2001. It has been used by more than ¾ of a million people. Research also provides evidence that online clinics can address large-scale change and access large numbers of people. For example, MindSpot is an Australian online clinic, focusing on adults with anxiety and depression, that served over 2,000 adults in its first year of operation. Moreover, evidence suggests that supported digital interventions are more successful than unsupported ones. When supported digital interventions are available, they are as supportive as face-to-face interventions. However, it should be noted that the latter conclusion is based on small-scale studies. There have been few comparative studies examining the different types of digital interventions for the same mental health concerns. In addition, it is unclear whether younger participants comply more readily with online applications than older participants. These limitations represent areas for future research.

Interjurisdictional issues While various methods of eMH have been around for nearly two decades, it had been mostly done through the military’s secured platforms. More recently, eMH businesses are readily available and for service providers who wish to work from their computer, it can have good appeal. However, some of these companies are not established by social workers; thus, there 275

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is no code of ethics adhered to. Some of the companies and service providers may not fully understand the issues surrounding privacy and/or laws, and that counselors cannot simply provide services to anyone, anywhere. For example, Novotney (2017) presents the case on an American psychologist who terminated her agreement with an online counseling agency due to interjurisdictional concerns as well as concerns that the business was more concerned about income rather than care. If a social worker wishes to provide services on a cross-jurisdictional or cross-border arrangement, they must understand that they are subject to the laws of all jurisdictions involved. First, the service provider is subject to the board where they are registered or licensed. Second, the service provider is subject to the laws, not only where they are licensed but also the laws where they are physically present as well. Third, the service provider is subject to licensing or regulation to the state where the service user is physically located, and, finally, one should be aware that they are also subject to professional regulation where the service user resides. Finally, the service provider is responsible to the state or provincial laws where the service user resides. There is more due diligence required in these situations and the complexity will deter some service providers. It should be mentioned that some states are developing policy shifts for the emergence and support of tele-health services.

Informed consent, self-determination and confidentiality In many ways, the purpose of the social work profession has always been rooted in the value of self-determination, in helping people to regain control over their lives so that they may pursue goals that give their lives meaning. The most common application of respect for client self-determination is in the adherence to the conditions of informed consent. A social worker must provide information regarding treatments and therapies so that the client may make an informed choice. This typically involves determining the competence of the client, disclosing relevant information, insuring that the client understands the information, and that clients’ choices are voluntary. These ethical requirements apply as much to eMH as they do to traditional face-to-face services, but professionals engaged in eMH should include other factors and pieces of information in the informed consent process. Regarding client competence, we ordinarily focus on decision-making capacity, but with eMH, a provider must also assess the client’s capacity to navigate the technology being used. The disclosure of information component is also affected. First, the provider must discuss the nature of the technology being used, including any associated costs. If the provider is willing to use alternative technologies, those should also be discussed. Second, social workers are traditionally required to inform clients about the limits of confidentiality. This typically centers around the provider’s obligation to breach confidentiality if clients pose a risk of harm to themselves or others. With the advent of eMH, there are additional factors that may affect confidentiality and should be incorporated into the informed consent process. The professional should inform the client of any confidentiality or privacy-related risks associated with technology being used, along with strategies to minimize those risks. Third, eMH across jurisdictions and boundaries will bring into play an array of regional and national laws that may not align but have significant bearing on the services being provided. Because ethical policies and practices related to eMH are rapidly changing, it is recommended that service providers frequently check their licensing or regulatory bodies to be sure of any changes or updates in the area of eMH. For instance, in the United States, three states have already established laws regarding the mental health provider’s legal obligations if providing 276

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eMH services –including the documentation of whether or not a service user has the necessary skills to benefit from tele-health services, the service user’s informed consent, and in the State of California (United States) the service user must provide both written and verbal consent. Finally, one could imagine a client feeling subtle pressure to accept the use of eMH for fear that her therapist might otherwise refuse to offer services. Hence, social workers who make use of eMH should ensure that the client voluntarily accepts it without coercion or undue influence.

Social justice Nearly all social work codes of ethics articulate a commitment to social justice, that is, justice as it relates the distribution of resources, benefits, and burdens in society. Most of the codes underscore values of equality and the protection of vulnerable populations. Given this, we may safely exclude some traditions of justice, such as libertarianism, that minimize the values of equality and the protection of vulnerable people in favor of individual liberty and property. Thus, social workers and the social work profession must work to ensure that all those who need their services have access to them. Sound mental and behavioral health are preconditions to participation in society and its benefits. Ensuring equal access to therapy should be a priority in a just social system. If eMH services are valuable resource, they must be allocated in a way that is fair and equitable. First, it is important to determine where eMH falls in terms of mental health resource priorities. If it is a resource that results in substantial good and helps to overcome obstacles regarding access to therapy, then it should be given high priority. If social work by its very nature is committed to helping the vulnerable, then there may be a number of financial and structural challenges in utilizing eMH to provide services. For instance, will the cost of eMH make it difficult for low-income clients to receive services? Moreover, how will services be provided to clients in geographic locations (such as remote or rural areas) that lack the resources to support eMH technologies? The social work profession must be prepared to respond to these questions, especially when the broader society may not share the same vision of justice and resource allocation.

Security and data transmission In 1996, the United States enacted the Health Insurance Portability and Accountability Act (HIPAA) that identified standards for the privacy, security, and transmission of individuals’ protected health information. That information – including demographic information – ­includes (a) the individuals past, present, or future physical or mental health condition, (b) the provision of health care to the individual, the past, present, or future payment for the provision of health care to the individual and that identifies the individual (U.S. Department of Health and Human Services). Subsequently, these standards were amended to include language specific to electronic health record keeping technology (Health Information Technology for Economic and Clinical Health Act, 2009). In Canada, the federal law – Personal Information Protection and Electronic Documents Act – is similar in many ways to HIPAA, but one should be mindful that provincial laws can differ.

Conclusion In this chapter, we looked at the benefits and implications of using eMH approaches to provide mental health care to service users. Ethical issues and practice challenges can arise when alternative and innovative options for delivering services enter the mainstream in terms of 277

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there being adopted by social workers and accepted by service users. In saying this, the opposite is also true. Service users may become aware of and interested in modalities that have not yet been considered or put into practice by social workers. Regardless, eMH is an option that, although not particularly new, is promising with respect to increasing service user access to mental health services. The challenge, however, is to weigh how to provide the best possible care while ensuring that it is done so ethically and respectfully. The current lack of specific regulations and/or regulatory bodies to protect service users and the public in the realm of eMH is concerning. One cannot embrace the ease and income potential of eMH at the expense of the service user’s right to mental health treatment that is comparable to face-to-face care. Furthermore, given that eMH services can be located beyond the regulatory reach of governing bodies and can be provided by unregulated providers, trying to ensure that social workers and other caregivers are regulated, licensed, and/or properly educated and trained should be concerning in terms of protecting the public. This is particularly true given the vulnerability of those seeking help and the potential for them to be victimized and oppressed. Also, the ethnic and cultural diversity of those seeking service, which can be challenging at the best of times to social workers located in conventional bricks and mortar mental health establishments, is potentially exacerbated when the jurisdictional reach of providers extends out to the World Wide Web. However, this may not be the case. For those in need of psychologically, socially, spiritually, ethnically, and culturally tailored services, having access to a potential global pool of service providers could be beneficial if there was some way to ensure that those providing services and the services that they provided meet established health quality standards of care. It is without a doubt that eMH is not only the wave of the future, but the present state-­ofthe-art. We are a technologically literate people and increasingly predisposed to search the web for explanations and solutions to our symptoms of malaise. In doing so, we hope and expect that the fix is imminent and available. Denying the reality of the possibilities presented by eMH would be akin to denying and/or rejecting available help. As a result, our challenge is to embrace technology, but to do so thoughtfully, ethically, and intentionally. Knowing our limits and finding ways to increase our knowledge and skills demand our resolve to be anti-oppressive in what we think and do as social workers.

References Alleman, J. R. (2002). Online counseling: The Internet and mental health treatment. Psychotherapy: Theory, Research, Practice, Training, 39(2), 199–209. Angell, G. B. (1997). Madness in the family: The windigo. Journal of Family Social Work, 2(2), 179–196. Angell, G. B. (2018). Indigenous peoples and communities: Operationalizing critical theory. In S. Webb (Ed.) Handbook on critical social work. London: Routledge. Angell, G. B., Kurz, B. J., & Gottfried, G. M. (1997). Suicide and North American Indians: A social constructivist perspective. Journal of Multicultural Social Work, 6(3/4), 1–26. Canadian Institutes of Health Research Natural Sciences, Engineering Research Council of Canada, & Social Sciences and Humanities Research Council of Canada. (2014). Ethical Conduct for Research Involving Humans. Retrieved from http://www.pre.ethics.gc.ca/pdf/eng/tcps2-2014/TCPS_2_­ FINAL_Web.pdf Castellano, M. B. (2004). Ethics of Aboriginal research. Journal of Aboriginal Health, 1(1), 98–114. Retrieved from http://www.naho.ca/journal/2004/01/08/ethics-of-aboriginal-research/ Center for Disease Control and Prevention. (2018). Data and publications. Retrieved from https://www. cdc.gov/mentalhealth/data_publications/index.htm Health Information Technology for Economic and Clinical Health Act. (2009). Health information technology for economic and clinical health act. Retrieved from https://www.hhs.gov/sites/default/files/ocr/ privacy/hipaa/understanding/coveredentities/hitechact.pdf 278

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Healthy People 2020. (2018). Office of disease prevention and health promotion. Retrieved from www.healthy people.gov/2020/leading-health-indicators/2020-lhi-topics/Mental-Health Hopton, J. (1997). Towards a critical theory of mental health nursing. Journal of Advanced Nursing, 25(3), 492–500. Humphreys, K., Winzelberg, A., & Klaw, E. (2000). Psychologists’ ethical responsibilities in the ­Internet-based groups: Issues, strategies, and a call for dialogue. Professional Psychology: Research and Practice, 31(5), 493–496. Mullaly, B., & West, J. (2018). Challenging oppression and confronting privilege: A critical approach to anti-­ oppressive and anti-privilege theory and practice (3rd ed.). Toronto, ON: Oxford University Press. National Association of Social Workers. (2017). Code of ethics. Washington, DC: Author Retrieved from https://www.socialworkers.org/about/ethics/code-of-ethics Novotney, A. (2017). A growing wave of online therapy: The flexible nature of these services benefit clients and providers, but the onus is on psychologists to make sure they comply with federal and state laws. Monitor on Psychology, 48(2), 48. Retrieved from http://www.apa.org/monitor/2017/02/ online-therapy.aspx Pozzuto, R., Angell, G. B., & Dezendorf, P. (2005). Therapeutic critique: Traditional versus critical perspectives. In S. Hicks, J. Fook, & R. Pozzuto (Eds.), Social work: A critical turn (pp. 25–38). ­Toronto, ON: Thompson Educational Publishing. World Health Organization. (2018). Mental health. Retrieved from http://www.who.int/mental_health/ publications/en/

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36 Data justice and ­international development An ethical imperative for policy and community practice John G. McNutt

Data justice is an emerging form of social justice that has become ever more salient as the global information economy emerges. While attention to the use of data in any society is consequential, it is particularly important when dealing with highly vulnerable groups or communities in society. Social workers engaged in transnational practice or international development activities face the challenge of representing those who are even more at risk than the poor and disenfranchised in developed nations. This chapter will deal with data justice issues within the context of social work community and policy practice, with special attention to international and transnational development practice. This chapter will address the major issues involved in data justice, what the ethical imperatives are, and discuss how these issues relate to community and policy practice for social justice. The chapter has four parts. The first section deals with the role of data and information in the fate of communities in modern society. The second section extends the industrial era model of social justice to the information age. The third section looks at policies and process for data justice. The final section looks at community social work practice to ensure data justice. This will include a discussion of data justice movements both domestically and internationally but will stress the international dimension.

The role of data and information in the fate of communities in modern society Since the 1970s, much of what we used to call the industrial world has moved into an information society, one where knowledge has become the new store of wealth (McNutt & Hoefer, 2016). We are now well underway in this process and the consequences are real. This does not mean that industrial and agricultural production will not continue, but they will be changed. Robotics and Artificial Intelligence have altered the nature of manufacturing and changed who finds employment. Many workers of our industrial period will find their skills unneeded (see Beniger, 1986).

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This transition has changed the nature of many of the traditional variables that underpinned wealth, poverty, and social justice. Communities that were wealthy during the industrial age (such as much of the American “Rustbelt”) are now pockets of poverty while other communities have benefited from the new economy. This has become a worldwide phenomenon because of the global economy. Communities in many nations are dealing with these new realities. Information poverty and digital inequality are no longer abstract ideas. There is a commonality of community fate throughout the world. While information has always been power, the value of knowledge work has accelerated. Data are critical ingredients of knowledge work and the collection and use of data have become a major activity. Data fuel much of the information economy and play a crucial role in many aspects of all our lives. Someone once referred to data as the new oil. Controlling data means control over people, communities, and events. Datafication (Cukier & ­Mayer-Schoenberger, 2013) refers to the conversion of everyday life into data and has accelerated in recent years. Many of your major life decisions are recorded digitally and available as data for those who have access. The location chip on your smart phone can be helpful if you’re lost but it can also be a tool to prosecute crime. The availability of this data can be useful to a repressive regime that wants to stifle dissent (Dencik, Hintz, & Cable, 2016). While the world is objectively changing, our assumptions about it change less frequently. Perceptions are not always guided by reality but they often affect policies and community actions. One example is our social welfare policy thinking. Many of our ideas about social welfare and social justice are rooted in an earlier time when the situation was noticeably different (McNutt, 2005; McNutt & Hoefer, 2016). The major aspects of social welfare in Europe and the United States are artifacts of the last two centuries and share their time of origins understanding of the workforce and society. The social security act, for example, depends on the assumption of consistent lifespan employment. Social Security’s old age programs were designed to prevent poverty among the elderly at a time when pensions were rare. Unemployment and disability addressed uncommon issues in the workforce. Our evolution to an information economy has stressed the legacy social welfare system in many ways. Contingent employment is becoming more the norm (Smith, 2016; Spreitzer, Cameron, & Garrett, 2017). Innovations like the “Sharing Economy” are changing the nature of some of the workforce. Massive unemployment in the last three decades has pushed the limits of unemployment compensation trust funds. The promise of lifetime employment has been replaced with, for some workers, a daily struggle for work. Against this backdrop, our understanding of social justice is limited by the assumptions that we make about material goods and services in an information economy. The concepts of social and economic justice that used the approach suggested by Rawls (1971) and others suggest that justice is fairness and decisions about resource allocation and other forms of social arrangements should follow this principle. This position is supported by many social welfare scholars and endorsed by professional groups, including social workers. These ideas are reflected in development theory and development policy, particularly the “Basic Human Needs” strategy that was popular in the 1970s and many of the policies that the UN and World Bank have promoted. These theories were a reaction to Modernization Theory (Rostow, 1960) and the GNP maximization policies that were promoted by the development community in the 1950s and 1960s. These approaches were critiqued by development theorists, particularly dependency theorists and advocates for “Another Development.”

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The information economy and the rising importance of data in society suggest that additional investigation is needed to support practice in this new environment. Data justice is part of that analysis.

Data justice as a social justice issue Data justice is an emerging concept in the general area of information ethics. Heeks (2017a, p. 2, 2017b) defines it as “the specification and pursuit of ethical standards for data-related resources, processes and structures.” While noting that there is very little literature on data justice, he goes on to identify four types of data justice. The first is instrumental data justice. Heeks (2017a) holds that “Instrumental data justice means fair use of data; it therefore focuses on the outcome of use of data” (p. 3). Great amounts of data are collected in the modern world. Government and commercial organizations gather data from traditional data collection techniques (surveys, administrative data collection, and so forth) and a plethora of emergence sources (such as social media data and sensor data). This data explosion means that some ethical consideration of data use is essential. This issue is particularly salient today when data are often repurposed for new uses. The second type is procedural data justice. Procedural data justice means fair handling of data along all parts of the information value chain. How data are managed and protected is an important consideration. This is particularly important for highly critical data with vast consequences (such as medical records). This is often more complex and difficult than it first seems, especially when considering massive amounts of data. Next is distributive rights-based justice which “…encompasses rights of privacy, access, ownership and representation; the enactment of which shapes distribution of data resources.” This dimension is particularly critical for those working with marginalized communities. Access is a critical issue. Communities, particularly poorer communities, lack access to critical data that are needed to understand their situation and plan for the future. The environmental justice community has long experience with this type of problem. Many communities lack data about the environmental toxins that are present in their ground and water resources. Lack of access is compounded by a lack of skills to analyze the data. Scientific data require training to analyze and many large data sets require data science tools. Privacy and transparency are also serious challenges in the data justice arena (Ambrose, 2013). Legislation for the protection of privacy and the promotion of open government and transparency are evident in nations throughout the world. The European Union’s General Data Protection Regulation provides extensive protection for personal data on EU residents. The move toward open government has made a great deal of data available to community activists. Finally, there is structural data justice which means “…degree to which society contains and supports the data-related institutions, relations and knowledge systems necessary for realization of the values comprised in a good life” (Heeks & Renken, 2018, p. 7). This final ­a spect of data justice brings together many of the other issues and advocates for an information and data arrangement that promotes development. Heeks (2017a) argues that a Data Justice Manifesto is needed to implement such a data justice emphasis. These four foci cover many issues and raise a number of troubling questions. On balance, they provide an important framework for considering how data should work within social work practice in international development. 282

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Social work, international development, and data justice Social workers have long be concerned with international issues and international practice is a small, but important demographic within the profession (Midgley & Conley, 2010). Many social agencies have strong international ties (see the Red Cross for example). Social development theory, which takes a strong global development stance, has had a strong presence in social work for over half a century. The skills that social workers develop in policy practice and community practice are important parts of the arsenal that development organizations bring to problems throughout the world. International development work, like other areas in the nonprofit and government sectors, is experiencing the growth of data intensive practice (Heeks, 2017a). Data informed practice has been supported by professional groups, foundations, government agencies, and international governance organizations. It seems clear that social workers who practice in the international development arena should promote data justice as a part of their commitment to social and economic justice. This principle raises the issue of how that might be accomplished. The movement toward data justice suggests a number of activities that could be readily incorporated into social work practice. While the dividing line between community and policy practice is often difficult to distinguish, it seems like a reasonably good organizing principle. Policy practice will be considered first, followed by community practice.

Social policy practice Social workers in policy practice roles engage in policy analysis, lobbying, electoral strategies, political action committees, and policy research in order to affect legislation at all levels. This could mean the subnational, national, or international level. Some of the possible interventions might include data protection legislation, open government and open data laws and regulations, data informed policy making, and the creation and enforcement of data codes of ethics.

Data protection legislation Legislation or regulation to create a system of data rights is rare in today’s world. This creates a system where control of one’s data might actually belong to someone else. This is often true in medical research where the data belong to the researcher rather than the subject. Nations have begun to create these rules, but many barriers remain. One of the most comprehensive efforts was the European Union’s General Data Protection Regulation (Carey, 2018), which recently went into effect. While this law extends the rights of individuals to their data, it is not without its critics (Koops, 2014). Other organizations and states are hard at work on their own versions of data use and data privacy legislation. There are limitations of this type of effort. Legislation is a time-consuming process and often takes many years to implement. Technology races forward and often outpaces the protections granted by regulation.

Open government and open data policies Governments collect enormous amounts of data from research they conduct, administrative activities that are part of their day-to-day operations, and sensors that are part of other operations. At one point, these data were difficult or impossible to obtain. The worldwide 283

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movement toward open government has brought with it open data policies that allow or mandate the release of this information. A number of cities have created repositories for open data and there are national repositories as well. While the provision of this data is important, it does not guarantee its usage. Studies have established that provision of data is not enough, and additional efforts are needed (McNutt, Justice, & Carter, 2014). These additional efforts might include marketing and promotion of the repositories.

Data science codes of conduct The use and analysis of massive amounts of data are largely an unregulated process. There are codes of ethics existent and others under development but their enforcement is often limited to professional groups with limited sanctions. The recent question about Facebook data and the 2016 US Elections raises this issue, but it is certainly not limited to this instance. Whether licensing for data professionals is possible or desirable is a question for the political system to address. Legislation and rulemaking are policy functions that are important to the maintenance of effective government. Law and the legal system have their limitations but they provide a way to enforce and encourage certain types of behavior.

Community practice Social workers in community practice organize communities, create programs, raise funds and other resources, run community generate efforts, and mobilize constituencies. There are many community development workers within the international development arena. Community practice might include creation of data collaborative, data philanthropy, data for good (data4good) efforts, civic technology efforts, and civic hacking.

Data collaboratives Data collaboratives are cross sector efforts to make data from different sectors available for solving social problems (Susha, Janssen & Verhulst, 2017). Corporations collect a great deal of data that can be useful to governments and nonprofits. Data collaboratives create the structure and frameworks needed to facilitate those uses. LinkedIn, for example, collects data on labor market behavior that, in some ways, has advantages over that collected by other means. A data collaborative can facilitate that exchange.

Data philanthropy Data philanthropy is a related concept that looks at the donation of data by corporations to public and nonprofit organizations (McKeever, Greene, MacDonald & Tatian, 2018). Data have value and that value is part of corporate philanthropy. It also relates to corporate social responsibility.

Data for good The Data4Good is a movement that brings data science tools to the solution of public issues (Bull, Slavitt, & Lipstein, 2016; Howson, Beyer, Idoine & Jones, 2018). Data science is an emerging professional group that combines knowledge about mathematics, statistics, and 284

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computer science with domain specific knowledge. Data scientists are highly sought after by commercial organizations and command high salaries, making them often out of reach for social justice organizations, even though their skills could be useful in dealing with many vexing social problems. At the same time, many data scientists want more social relevance in their work. Some organizations, such as Data Kind (https://www.datakind.org/), link volunteer data scientists with organizations that can use their skills. The result is often high impact projects that redress social and economic wrongs. Data Kind is an international organization that operates in several nations and promotes efforts in many others.

Civic technology The Civic Technology Movement (McNutt, 2018; McNutt et al., 2016) combines technology, open civic data, and volunteer technologists to reimagine government by developing new and exciting solutions. Organizations like Code for America (www.codeforamerica. org) or its international arm Code for All are leaders in this effort in the United States but civic technology is an international movement. The critical element is that many projects are largely created with volunteer efforts using open civic data.

Civic hacking Civic hackers create new technology for government and nonprofits using volunteer technology labor (McNutt & Justice, 2016). The creation of these systems is often accomplished in either action groups, such as Code for America’s Brigades, or in large competitions such as hackathons. The majority of these efforts make some use of data. In the best traditions of community practice, these efforts combine citizens, volunteer efforts, organizing, and build communities and solve problems with data. These are skills that social workers bring to the international development practice arena.

Conclusion As the world further evolves into a global information economy, the role of data will be critical to many ethical decisions at many levels. Individuals are affected by data, often in profound ways. Communities and nations also deal with data and its consequences. Against this backdrop, data justice becomes an important consideration for policy and practice. It echoes some of the same concerns as Rawlsian social justice analysis. It updates and extends the social work profession’s traditional concerns for the disadvantaged, the downtrodden, and the dispossessed. Many of the issues that data justice addresses have already been addressed in the profession’s past. Concerns for personalization, confidentiality, and context are as old as there is a literature on social work. While the stakes were always high, today they have reached new and frightening levels. The skills in policy practice and community practice that social workers bring to international development are directly applicable to data justice activities. The profession has the commitment, the skills, and the ability to make data justice a reality.

References Ambrose, M. L. (2013). It’s about time: Privacy, information life cycles, and the right to be forgotten. Stanford Technology Law Review, 16(2), 369–421. Beniger, J. R. (1986). The control revolution: Technological and economic origins of the information society. Cambridge, MA: Harvard University Press. 285

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Bull, P., Slavitt, I., & Lipstein, G. (2016). Harnessing the power of the crowd to increase capacity for data science in the social sector. arXiv preprint arXiv:1606.07781 Carey, P. (2018). Data protection: A practical guide to UK and EU law. New York, NY: Oxford University Press. Cukier, K., & Mayer-Schoenberger, V. (2013). The rise of big data: How it’s changing the way we think about the world. Foreign Affairs, 92, 28. Dencik, L., Hintz, A., & Cable, J. (2016). Towards data justice? The ambiguity of anti-surveillance resistance in political activism. Big Data & Society, 3(2), 1–12. Heeks, R. (2017a). A structural model and manifesto for data justice for international development. Development Informatics Working paper #69. Manchester: University of Manchester. Heeks, R. (2017b). Data justice: Addressing equality, sustainability and transformation through data. Presentation at IFIP WG9.4 14th international conference ICTs for promoting social harmony, Yogyakarta, Indonesia, May 22–24. Heeks, R., & Renken, J. (2018). Data justice for development: What would it mean? Information ­Development, 34(1), 90–102. Howson, C., Beyer, M. A. Idoine, C. J., & Jones, L. C. (2018). How to use data for good to impact society. Gartner. G00355735. https://www.gartner.com/doc/3880666/use-data-good-impact-society Koops, B. J. (2014). The trouble with European data protection law. International Data Privacy Law, 4(4), 250–261. McKeever, B., Greene, S., MacDonald, G., Tatian, P. & Jones. D. (2018). Data philanthropy: Unlocking the power of private data for public good. Washington, DC: Urban Institute. McNutt, J. G. (2005). Social welfare policy in an information age: New visions or more of the same? Advances in Social Work Practice, 6(1), 60–67. McNutt, J. G., Guo, C., Goldkind, L., & An, S. (2018). Technology in nonprofit organizations and voluntary action. Voluntaristics Review, 3(1), 1–63. McNutt, J. G. & Hoefer, R. (2016). Social welfare policy: Responding to a changing world. New York: ­Oxford University Press. McNutt, J. G., & Justice, J. B. (2016). Predicting civic hackathons in local communities: Perspectives from social capital and creative class theory. Paper read at the 12th International Society for Third Sector Research Conference, Ersta Skondal University College, Stockholm, Sweden, June 28–July 1, 2016. McNutt, J. G., Justice, J., & Carter, D. (2014). Examining intersections between open government and nonprofit advocacy: Theoretical and empirical perspectives about an emerging relationship. Paper, International Research Society for Public Management Conference 2014, Ottawa, Canada. McNutt, J. G., Justice, J. B., Melitski, M. J., Ahn, M. J., Siddiqui, S., Carter, D. T., & Kline, A. D. (2016). The diffusion of civic technology and open government in the United States. Information Polity, 21, 153–170. Midgley, J., & Conley, A. (Eds.). (2010). Social work and social development: Theories and skills for developmental social work. New York: Oxford University Press. Rawls, J. (1971). A theory of justice. Cambridge, MA: Harvard University Press. Rostow, W. W. (1960). The stages of economic growth: A non-communist manifesto. Cambridge: Cambridge University Press. Smith, A. (2016). Shared, collaborative and on demand: The new digital economy. Washington, DC: Pew Internet & American Life Project. Retrieved from https://www.pewinternet.org/2016/05/19/ the-new-digital-economy/ Spreitzer, G. M., Cameron, L., & Garrett, L. (2017). Alternative work arrangements: Two images of the new world of work. Annual Review of Organizational Psychology and Organizational Behavior, 4, 473–499. Susha, I., Janssen, M., & Verhulst, S. (2017). Data collaboratives as “bazaars”? A review of coordination problems and mechanisms to match demand for data with supply: Transforming government. People, Process and Policy, 11(1), 157–172.

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Spirituality

37 An ethical decision-making model An Islamic perspective Nada Eltaiba

Social work is an international profession that has been practiced in various cultural contexts. The International Federation of Social Workers (IFSW) defines social work as follows: The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work. (IFSW, 2012) The IFSW emphasizes that: “Ethical awareness is a necessary part of the practice of any social workers” (IFSW, 1994). The National Association of Social Workers (NASW) Code of Ethics (2017) outlines these values, including service, social justice, dignity and worth of the person, the importance of human relationships, integrity, and competence. Different political and cultural contexts shape the identity of social work and the ethical practice of the profession. Some social workers in developing countries have called for authentication of the profession (Ragab, 2016; Walton & Abo El Nasr, 1988). Social work ethics have also been criticized for not being inclusive of a variety of cultures, because they are mainly based on Western values. There is a growing number of scholars and practitioners who are calling for cultural sensitivity and for social workers to apply values appropriate to each culture and religion (Eltaiba, 2016; Hugman, 2008). The following is an attempt to examine how a social worker from a Muslim background can manage some of the ethical issues that might be encountered in practice. In my teaching and my practice, I hear many social workers speak about how they incorporate their personal, spiritual values into their professional values when making an ethical decision. Social workers constantly face the challenge of balancing these complex, multilayered values in order to deal with dilemmas and reach a decision. Despite the importance of the subject, social workers from a Muslim background experience a lack of resources and literature discussing these issues, especially within the context of their religion and Islamic principles. Many social workers criticized the lack of training on ethical matters during their academic years or during 289

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their professional practice (Eltaiba, 2016). There is a lack of emphasis on understanding the influence of the self when encountering ethical problems (McAuliffe & Chenoweth, 2008). Social workers bring to their practice their family structure, gender, experience, values, and cultural and religious affiliations – all of which would invite a range of interpretations of ethics for ethical decision-making. For social workers from Muslim backgrounds, the main source of ethics is the Quran: the primary Islamic texts (the holy book for Muslims); and the Hadith (the sayings and traditions of Prophet Muhammad). The main doctrine in Islam is that Allah is the creator, and the human being is a dignified creature. Each and every human being has a moral obligation or responsibility to seek out and recognize al-sirāṭ al-mustaqīm (the righteous path) (El Fadl, 2017). Rahman noted that there is an obligation in Islamic teachings to exercise critical and rational thinking. The tradition is particularly concerned with answering the question: “What ought or ought not to be done?” (Singer, 2013). The emphasis on critical thinking and reflection, when dealing with ethical dilemmas and making ethical decisions, is congruent with social work ethicality. The method is described by McAuliffe and Chenoweth as the process of critical reflection, evaluation, and judgment through which a practitioner resolves ethical issues, problems, and dilemmas (2008). In the daily encounter with clients and communities, there is a need to think critically and reflectively in order to apply an ethical decision process. This is important, because social workers face many ethical challenges when working with clients, families, and communities. When a “[p]ractitioner faces a choice between two equally unwelcome alternatives, which may involve a conflict of moral values, and it is not clear which choice will be the right one,” this is defined by McAuliffe and Chenoweth (2008) as an ethical dilemma. An ethical dilemma is a choice between two equally competing choices (Banks, 2016). The problem arises when there is no consensus on defining the problem or in prioritizing goals. This problem can be initiated by clients, an agency, or the community. Despite the generality in these definitions, there is some variation in the perceptions of what is an ethical dilemma, according to cultural, social, and religious contexts. While there is a common agreement about some aspects of the ethical dilemma, there is variation in its interpretation, in the way social workers perceive it, and in the way they cognitively process it. For example, social workers might agree that a certain case represents an ethical dilemma, but they will probably provide different explanations and interpretations that are based on their own values. These personal values are diverse. The perceptions of ethical dilemmas are based on level of training, experiences, familiarity, and confidence in the role of social work. They also depend on the social worker’s personal values, whether these values are cultural, political, religious, or spiritual. The personal values of the social worker influence their professional ethical decision-making. It is the responsibility of the practitioner to understand how their values might influence their professional conduct and so might interfere in the ethical decision-making process (Eltaiba, 2016). When it comes to practice, there is no single unified response to an ethical dilemma. Everything depends on the context in which the social worker is operating. In order to make a decision, social workers need to adopt a systematic process, described by some scholars as an ethical decision model. Researchers have proposed a variety of decision-making practices. McAuliffe and Chenoweth (2008) discuss three constructed models for ethical ­decision-making: process models, where the structure is clear and well defined, and values and principles are categorized; reflective models, such as feminist approaches, where the emphasis is on self-reflection, power, and the client voice; and cultural models, where attention is paid to inequity. The interest in cultural models is increasing. 290

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The models show some general commonalties. The aim of these models is to provide practitioners with guidelines to assist them to make an insightful decision and offer a rationale and reasoning to inform a decision. But these scholars and practitioner social workers warned that these decision-making models are not to be used as simple methods by which to make a decision. Social workers need to take the process seriously and make an effort in order to ensure accountability and cultural sensitivity (Gray & Gibbons, 2007). It is the process through which practitioners make ethical decisions and attempt to resolve ethical dilemmas. Most protocols include an outline of steps that practitioners can follow to help them approach ethical dilemmas systematically, drawing especially on ethical theory, relevant professional literature, statutes, regulations, codes of ethics, and policies and consultation (Reamer, 2006). Chenoweth and McAuliffe (2005) define it as the process of critical reflection, evaluation, and judgment through which a practitioner resolves ethical issues, problems, and dilemmas. Learning about decision-making enables social workers to feel more confident in justifying decisions, to be aware of some of the guilt feelings, and to identify the morally right ways to practice. Social workers need to build their knowledge of policies from ethics theory, public debates, and media views. They also need to develop skills such as negotiation, interpersonal skills, research, being resourceful, being reflective, and critical thinking. All these capacities will assist the social worker to make a decision. In the following section, I will endeavor to apply critical reflection to a case study which is an example of the highly sensitive ethical dilemmas that a social worker may face.

Case study Fatima is a 16-year-old female who comes from a conservative Muslim family. Fatima was referred to the social worker at the hospital because she was visiting the outpatient clinic. Fatima, who was accompanied by her mother, was found to be two months pregnant. Fatima is not married, and the news came as a shock to her and to her mother. The mother was extremely angry with her daughter. Fatima was crying and appeared to be scared. During the conversation, Fatima revealed that the father is one of her extended cousins. She asked her mother and the social worker not to tell anyone. The mother is worried that, if her father is notified, her daughter will probably be killed. This is an example of a sensitive case that social workers encounter when working with Muslim communities. I chose this example because it is perceived as a challenging one by many social workers from Muslim backgrounds. Al-Krenawi (1999), for example, confronted a similar situation in his practice with a Bedonie community. In the following section, I am going to try to apply an ethical decision steps sequence. Several models are incorporated, including the work of Mattison (2000), Reamer (2006), Elaine Congress (1999), Patricia Kenyon (1998), and McAuliffe and Chenoweth (2008). In the discussion, I endeavor to apply these steps by incorporating Islamic values into the possible perceptions of the majority of social workers from Islamic backgrounds.

1. Define the problem In such a case study, there are multiple layers of dilemmas that confront the social worker. The main dilemma for the practitioner here is whether to reveal the incident or to respond to the family’s request not to report it (in this case, made by the teenager and her mother). It is about an ethical problem that relates to confidentiality and respect

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of privacy. The practitioner who encounters such complex situations would potentially face other ethical problems that complicate the process of ethical decision-making, also related to confidentiality and respect of privacy. Examples of these ethical problems are conflict of interest, acceptance, and the right to self-determination. In relation to conflict of interest, the social worker is required to demonstrate professional behavior, managing personal and professional values conflicts. However, their loyalty is put to the test here. The social worker is obligated, by the contract he or she has with the agency, to be respectful of the agency’s values, and most policies mandate that the welfare agencies or the police should be notified about such cases. This allegiance to the agency’s expectations is challenged by personal cultural, religious values. Sometimes, there would arise a conflicting allegiance, instigated by the same religious personal value system. For example, the practitioner who embraces Islamic values is obliged to abide by the contract he or she has with the agency; as the Quran says: “O ye who believe! fulfil [all] obligations” (Al-Ma’idah 5:1). Also, the Quran praises individuals who are truthful: “Those who faithfully observe their trust and their covenants” (Al-Mu’minoon 23:8). On the other hand, the social worker will find that this conflicts with another concept, related to the commitment to the marginalized and people who are undergoing a trauma. The Hadith says: “Whoever grants respite to someone in difficulty or alleviates him, Allah will shade him on the Day of Resurrection when there is no shade but his” (Source: Sunan At-Tirmidhi 1306, Grade: Sahih). Another ethical problem that might influence the ethical decision-making related to confidentiality in the case of Fatima is the value of acceptance. Some social workers, especially from a devoted Muslim background, might experience feelings of anger toward the teenager who committed, in their view, a sin. In Islam, sexual intercourse is only permitted within the context of a marital arrangement. The Quran says: “Do not draw near to any unlawful sexual intercourse; surely it is a shameful, indecent thing, and an evil way (leading to individual and social corruption)” (l-isrā17.32). Some social workers, especially at the start of their practice, might struggle with acceptance when they come across such problems. They might find it challenging to accept the clients’ situation and feel no resentment toward them (Eltaiba, 2016). This problem is not well explored by ethical literature or among social work practice. One of the arguments that social workers adopt in order to reach balance is not to agree on the act but still to accept and respect the client. Confidentiality and respect of privacy as an ethical value have been stressed by the profession and by various codes of ethics. The value is about ensuring that the information is not being shared with others. Privacy entails the right of people to be protected from any intrusion and to have the choice to decide which information is to be disclosed, when, and to whom. Confidentiality means respecting the obligation for personal information not to be disclosed to others without authentic justification. For a social worker from a Muslim background, the respect for privacy and confidentiality is congruent with an important concept which is known as sater, or not revealing a secret. Sater, in fact, means to go beyond that by making an effort to protect the privacy of the others. Appreciation of human dignity requires that their privacy and confidentiality are protected. It is essential to the integrity of the human being. The Quran says: “We have indeed honored the children of Adam” (Al-Isra 17.70). Social workers from an Islamic background might feel uneasy about possibly revealing such a sensitive matter, which relates to women’s dignity. Protecting a woman

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from revealing her obscenity is the duty of a Muslim. The prophet Mohamed said: “Whoever covers a Muslim is covered by Allah.” This is in relation to honor and any act that might bring any sort of stigma or exclusion from the community. The idea of sater is to give the person an opportunity to rebuild his or her life and obtain a second chance, despite having acted against the teaching of the religion. There is a concept that Allah is forgiving and most merciful, and the obligation of a Muslim is to allow people who commit a sin to connect with Allah to ask for forgiveness. Protecting clients’ well-being and safety is also an obligation of a Muslim. It is the responsibility of the social worker to prevent harm and make sure that he or she is not contributing to exposing Fatima to being killed. The Quran says: “If a man kills a believer intentionally, his recompense is Hell” (l-nisāa, The Women, 4:93). Another concept that might be present in such cases and might interfere with confidentiality is the value of self-determination. This is an essential value in social work; however, in Islamic concepts, the responsibility for the daughter mainly rests with the father and is called Welaya or guardianship. This means the authority is given to the father to make the final decisions for the daughter. Guardianship (wilāya/walāya) means the legal authority to manage the affairs of another person who lacks the required capacity. The presence of a marriage guardian (walī al-nikāḥ) is a formal requirement for the valid contract of a marriage (Mir-Hosseini, Vogt, Larsen, & Moe, 2013). This notion of Welaya does not, of course, give the father permission to end his daughter’s life. When thinking about self-determination, the social worker will take into consideration other family members. Most Muslims come from a collectivist social structure. Any act of an individual will influence the rest of the family members. This kind of problem will have destructive consequences on other family members, who will be potentially stigmatized by the pregnancy of Fatima. Culturally, purity of a woman is not separate from honor of the family (Al-Krenawi, 1999). Such a breach of confidentiality might expose the teenager to danger, because she might be physically harmed by the father or other family members. The blame and the judging of all family members due to an act of an individual do not, however, actually exist in Islam. It is not part of Islamic tradition, but rather of cultural concepts. As the Quran says: “And whatever [wrong] any human being commits rests upon himself alone; and no bearer of burdens shall be made to bear another’s burden” (Quran 6:164).

2. Identify people/systems that might be affected In this case, the teenager is the one who would be most affected. Her safety is under conceivable violation. The mother is also affected, because she is concerned about her daughter. The agency (the host of the client) has responsibility to protect the privacy of the client. The extended family as a whole is affected. In some cases, the social worker would also be affected by the problem, that is, if the social worker decides not to follow the policies, or when he or she is from the same community. Al-Krenawi (1999), for example, commented on possible consequences facing an insider of the community when he was working with a similar story, by saying: “On a private level, the hostility of the woman’s family could create trouble not only for my own family, but also in terms of trying to pressure my family to intervene in my professional work” (p. 491).

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3. Explore possible support The essence of seeking support during daily life events is encouraged by Islamic values. The Quran says: “and their business is conducted through consultation” (ash-Shura 42:38). It is about exploring the knowledge and skills of others who might shed light on the issue at hand. The support for the social worker is varied. It might be a supervisor or a colleague. This should be handled with a high level of confidentiality because of the sensitivity of the case. Some of the colleagues in hospitals would treat these situations with a high level of sensitivity and privacy, with minimal involvement of other professionals if possible. They can also provide support to each other on legal or ethical issues (Eltaiba, 2016). The social worker can also consult with a religious sheikh in order to obtain support in terms of getting religious views on how to deal with the situation. This is especially the case in relation to a potential choice of abortion (if it is a possible option for the client). Some practitioners build a good rapport with imams or religious scholars who provide support in relation to these matters. The support obtained is not only about practical issues but also spiritual care. This consultation is also related to exploring other resources and knowledge in various forms, including written ones. For example, practitioners are directed to consult codes of ethics and literature, to make a more informed decision. Social work values and ethics are incorporated into codes of ethics. Codes of ethics guide practitioners in resolving ethical dilemmas that arise in practice, protect the public from potential incompetent practitioners, ensure self-regulation rather than government control, regulate the interactions of social workers with service users and colleagues, and protect professionals from litigation. Codes of ethics are documents that aim to identify the broad values, principles, and standards of ethical conduct on which a particular profession is based. Despite the importance of codes of ethics, not many Arabic or Islamic countries have put codes of ethics in place specifically for social workers to follow. In this case, the closest option is to look for policies within agencies about such cases (Eltaiba, 2016). Practitioners can explore the literature to identify possible similar cases. The challenge that social workers face, however, is the lack of literature which discusses the application of ethical decision-making with respect to clients. Practitioners might find that not enough research has been done in social work ethics. The case is further complicated by the relative lack of literature in social work ethics in the Arabic and Islamic world. There is not enough research conducted in the area (Eltaiba, 2016). Some social workers would find exploring theological literature useful. This would be specifically around the concepts of respect for privacy, guardianship of the father, and the situations in which the person is permitted to reveal information. This would assist in linking the specific decision-making into a wider context that incorporates professional, religious, and cultural values.

4. Identify a decision It is not an easy task to generalize about the possible choices. Policies differ from one setting to another and change constantly because of the political and social context. The decision should be taken according to the existing policies but should ensure that

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the client is safe. The client’s safety must be the priority for the social worker. It is also important to ensure that the family members will be minimally affected by the decision. In the majority of situations, the social worker has to report the incident. This should be done with as much care of the client (and the mother, in the case of Fatima) as possible. Explain whether the client needs to be referred for some consultations and explain the extent of confidentiality. In my experience of such cases, clients are usually well protected and are dealt with by highly trained staff and teams, from health professionals to child protection and the police. Some of the decisions practitioners take involve looking for shelters that will provide medical and psychological support for the teenager. There are various pieces of legislation that apply to such cases in different settings, to ensure that the teenager is protected from any potential harm.

5. Review a decision When applying the decision, the social worker needs to look into ways to place this final decision into the context of their professional values and religious values. Chenoweth and McAuliffe (2005) address the importance of accountability. Am I comfortable with the outcome, and would I be able to justify my actions? Would I be comfortable telling others about the experience? Would I be comfortable standing in front of my peers and owning my decision? Would I want others to take my behavior as an example? This is a notion which is congruent with the concept of Ihsan in Islamic philosophy. Ihsan means a high sense of responsibility, proficiency, quality, and a positive approach. The Quran says: “And those who strive in Our (Cause) We will certainly guide them to Our Paths: for verily Allah is with those who do right” (Al-Ankabut, Ayah 29:69). No matter what decision the social worker makes in relation to maintaining confidentiality, he or she needs to make sure that it is congruent with his or her spiritual and professional values. At the end of the day, the social worker needs to review their actions and behavior. Do they feel that they have done their best to reach a decision that protects the dignity of the client and the family? This is especially important for social workers who are devoted to their religious values and consider their work to be a worshiping and spiritual experience. Their contribution as social workers is not only a job, but an act for which they will be rewarded by Allah. This is emphasized by Islamic concepts; the Quran calls for individuals to observe their work to high standards, because this will be witnessed by Allah, the prophet, and the believers: And say, Do (right deeds); so Allah will soon see your doing, and His Messenger and the believers (will see). And you will soon be turned back to the Knower of the Unseen and the Witnessed; then He will fully inform you of whatever you were doing. (9:105) My aim in this chapter has been to provide some basis for future dialogue among social workers about these issues. I endeavored to explore the effect of the self and religious values on the development of ethical decision-making. A considerable number

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of social workers from Muslim backgrounds link the self, which invites more discussion around these subjects. There is no training in how to link these thoughts and this spirituality to ethical issues or ethical decision-making. There is a need to explore this further in the literature, to enrich social work practice. Improving our understanding of these cultural and religious dilemmas, and how social workers from a different personal background might understand them, will contribute to the more effective development of the profession internationally.

References Al-Krenawi, A. (1999). Social workers practicing in their non-Western home communities: Overcoming conflict between professional and cultural values. Families in Society: The Journal of Contemporary Social Services, 80(5), 488–495. Banks, S. (2016). Everyday ethics in professional life: Social work as ethics work. Ethics and Social Welfare, 10(1), 35–52. Chenoweth, L., & McAuliffe, D. (2005). The road to social work and human service practice: An introductory text. Melbourne: Thomson. Congress, E. P. (1999). Social work values and ethics: Identifying and resolving professional dilemmas. Boston, MA: Cengage Learning El Fadl, K. A. (2017). Qurʾanic ethics and Islamic Law. Journal of Islamic Ethics, 1(1–2), 7–28. Eltaiba, N. (2016). Social workers in a Qatari health setting: Responding positively to ethical problems. Ethics and Social Welfare, 10(4), 346–360. Gray, M., & Gibbons, J. (2007). There are no answers, only choices: Teaching ethical decision making in social work, Australian Social Work, 60(2) 222–238. Hugman, R. (2008). Ethics in a world of difference. Ethics and Social Welfare, 2(2), 118–132. International Federation of Social Workers (IFSW). (2012). Social work profession. Retrieved November 2012, from www.ifsw.org International Federation of Social Workers (IFSW). (1994). Global social work statement of ethical principles: Retrieved from https://www.ifsw.org/global-social-work-statement-of-ethical-principles/ Kenyon, P. (1998). What would you do? An ethical case workbook for human service professionals. Pacific Grove, CA: Brooks Cole. Mattison, M. (2000). Ethical decision making: The person in the process. Social Work, 45(3), 201–212. McAuliffe, D., & Chenoweth, L. (2008). Leave no stone unturned: The inclusive model of ethical decision making. Ethics & Social Welfare, 2(1), 38–49. Mir-Hosseini, Z., Vogt, K., Larsen, L., & Moe, C. (2013). Gender and equality in Muslim family law: Justice and ethics in the Islamic legal tradition. London: IB Tauris. National Association of Social Workers (NASW). (2017). Code of ethics. Retrieved from https://www. socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English Ragab, I. A. (2016). The Islamic perspective on social work: A conceptual framework. International Social Work, 59(3), 325–342. Reamer, F. (2006). Social work values and ethics. New York, NY: Columbia University Press. Singer, P. (Ed.). (2013). A companion to ethics. Oxford: John Wiley & Sons. Walton, R. G., & Abo El Nasr, M. M. (1988). Indigenization and authentization in terms of social work in Egypt. International Social Work, 31(2), 135–144.

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38 Social work ethics and values An Arabic-Islamic perspective Abdulaziz Albrithen

Social work in the Arab world, similar to any other society, has undergone several changes over time. These changes were societies’ responses to new living conditions brought about by certain natural or man-made situations. One of the most significant changes in the early age of social work was the social transformation associated with the July 1952 revolution. The move then toward socialism and the Arab nationalism brought about significant changes in society due to the political influences related to this move. The vulnerability theory led some to believe that the emergence of nations in the West after the French Revolution also somehow awakened the nationalist feeling in the Arab countries. Another significant change worth noting occurred in the period in the late 1960s and early 1970s, wherein it was believed that a shift toward localization of social work or in other words the shift of focus of social work’s attention toward the indigenous peoples in the Arab nations. This shift was brought about by the strong influence of the Western culture; citing as an example is the strong dependence in the American models and curricula in social work. The United Nations experts working in Latin America, taking the perspective of freedom from sovereignty and subordination, are also believed to have influence in the shift of focus of social work to the indigenous peoples and their communities. In 1975, a trend toward the Islamization of social sciences including social work has been noted. This period signaled the start of build curricula and the collection of academic resources and reference materials based on Islam and the Islamic teachings. The initial building blocks of this change are the first “World Conference of Islamic Education” held in 1977 in the city of Mecca followed by another gathering event in Lugano, Switzerland called the “First International Symposium on Islamic Thought.” In 1982, the second world Islamic educators’ meeting was held in Islamabad, Pakistan. The contributions of Dr. Isma’il Raji al-Faruqi played a valuable role in the early stages of the call for Islamic rooting based on the scientific method which have had a strong influence in shaping the policy of this movement. The trend might be in the same context of the Western nations where some writers such as Gisela Konopka (1910–2003) who connected the roots of social work to the religious values, and Felix Biestek (1912–1994) who believed that social worker serves as a god’s envoy to help their human brotherhood in need.

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The call for Islamic rooting varied among scholars and Islamic writers. Some have called for the rejection all social work knowledge and asking for exclusion of everything and then building new knowledge based on an Islamic perspective (e.g. Ragab, 1996). Others believed that since some social work knowledge is useful for all human beings including the Muslim society, some knowledge is not pure and thus needs to be restructured in the Islam way (e.g. Bashir, 1991). Others see that restructuring the base of knowledge using the “Islamic methodology” should be followed up with new Islamic theories (e.g. Gubari, 1985). Farooqui (1997) suggests that theory construction should go beyond social work to encompass social welfare and social sciences as a whole. Zidan (1985) and El-Sanhuri (1988) call for Islamic rooting dedicated their efforts to replace social work ethics by tentative ethics based on Islamic perspective. Others like Al-Krenawi and Graham (1996, 1997, 1998, 1999, 2001, 2003), Al-Krenawi (1996), Al-Krenawi, Graham, and Al-Krenawi (1997), Al-Krenawi and Lightman (2000), and Al-Krenawi and Jackson (2014) wrote about their professional experiences of social work practice with a certain society (e.g. the Bedouins in the Levant region). As their practices were influenced by some cultural aspects like polygamy, blood vengeance, conflict resolution, traditional healing, family intervention, cultural mediator, the writers gave an impression of a unique model of social work practice. Nevertheless, these contributions were considered as an added value to the cultural perspective but not theoretical perspective. These works may be considered as a new experience and should be beneficial to readers and new or aspiring social work practitioners. The following section will illustrate opinions that go beyond cultural considerations of social work practice. Also, the following section will discuss the core values of social work and how it consistently matches Islamic values.

Analyzing the core values of social work from Islamic perspective In this section, the core values of social work, which are included in most codes of ethics of social work (AASW, 2010; BASW, 2014; CASW, 2005; NASW, 2017), will be discussed and evaluated from the point of view of Islam in order to see if there is any conflict or unsuitable match. “Service” is the first value of social work which requires social workers to help people in need and address social problems through a professional way without personal interests. Social work’s goal is to provide professional services to clients, “people,” and elevate the services to others beyond self-interest. Islam is cognizant of human needs, and neither are practitioners of Islam told to ignore or oppose them. There is no monasticism in Islam. The Islamic term “self-sacrifice” is a principle encouraged in human relationships. It affirms that the secret of progress lies in self-sacrifice, and in the benefits of humans. In addition to that, Islam encourages everyone to make use of all their effort and energy in service to the society and the community that they belong to (Akgunduz, n.d.; Chaney & Church, 2017; El Fadl, 2015; Lammens, 2013; Sardar, 1984; Stefon, 2009; Watt, 2008). “Service” according to the point of view of Islam falls under the terms of “charity” and “philanthropy” and as we know that the seed of social work comes from charity where pioneers provided services to people who suffered from poverty and other human disasters. On the other hand, in Islam, charitable works and concerted effort to give to the poor and needy persons are highly regarded (Bhatia, 2016; Curiel, 2015; Farah, 1987; Hodge, 2005; ­Lammens, 2013; Nasr, 2003; Pring, 2016; Rippin, 2012; Turker, 2016; Wolf, 2016). According to the earlier discussion, “there is a common denominator between Islam and social work which is charity” and based on this there seems no need or logical reason to develop or replace this particular value since it is consistent with Islam and the Islamic pillars. 298

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“Social justice” is the second value in social work that considers social workers as the change agents who challenge social injustice focusing on poverty, unemployment, discrimination, and other form of social injustices. Justice from Islamic point of view is a concept of being morally upright based on e­ thics, rationality, law, natural law, religion, equity, and fairness. It means giving others equal treatment or without discrimination. The goal of social justice is to find a society that enjoys peace, fraternity, love, and welfare. Indeed, Islam extends justice without restriction and encourages practicing social justice for all the members of society including those who are not Muslims, nor relatives such as the neighbors, orphans, and all the needy. Islam gives several meanings to social justice which includes (a) giving every individual what he/she deserves, (b) providing for the basic needs of human beings in such a way that it preserves their honor and dignity, (c) distributing all benefits in society to individuals in a fair way, and (d) ensuring equal opportunities, an access to services to all. Social justice is one of the fundamentals of Islam which calls for equality. Equality in ­Islam stems from conscience and is assured under legislation and is the basis of the unity of the human race. Another fundamental principle of social justice is solidarity “mutual guarantee,” which regulates social relations in the society in its different levels (Qutb, 2000) (a) between the individual and his/her family: cooperation and facilitation, (b) between the individual and the community: making a unification between private and public interest, (c) between societies: acquaintance and dealing, and (d) between generations: unity and destiny. The best example and the highest level of solidarity in Islam is “Zakat,” which is the fourth pillar of Islam. It means giving a certain proportion of one’s wealth annually for the good of others and the community of believers generally. This is a declared obligation and a clear support of the needy. From the earlier discussion, it is clear that social justice is an important component of both Islam and social work. Although the concept of social justice in Islam has deep meanings and wide aspects, it still is consistent with social work without any conflict or disagreement. “Dignity and worth of the person” is the third value of social work. Social work urges social workers to respect the inherent dignity and worth of every person. The practitioners should treat social work clients in a caring and respectful fashion, with a consideration of individual differences and cultural and ethnic diversity. Islam believes in the universal value of liberty to every human being, but the liberty of the human being must not be a source of decay or corruption to the whole community (Chaney & Church, 2017; El Fadl, 2015; Lammens, 2013; Sardar, 1984; Stefon, 2009; Watt, 2008). Not only this, however, there are many Islamic teachings that fall under the value of dignity and worth of the person such as (a) Islam upholds human dignity and fights social and economic injustice, (b) Islam has given high value to human life and health, (c) Islam has put significant emphasis on caring for the sick and disabled and articulated it as a duty, (d) Islam highlights the sanctity of human life by equating the saving of one life with the saving of all of humanity, (e) Islam indicates that good health is crucial for holistic human development, (f ) Islam looks at the intellectual capacity “education and seeking knowledge” of human beings as important to constantly developing life, (g) Islam views spiritual as a very important area for human development and strengthen both relationships (i.e. one with the Creator and the other fellow human beings one needs to fulfill his or her social responsibilities), (h) Islam stresses on fulfilling the social/ethical responsibilities for balanced, holistic development of the human being, and (i) Islam requires a society that provides opportunity for people to nurture and actualize their gifted potential and use it for the benefit of society. 299

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Islamic teachings in dignity and worth of the person are kind of an empyreal that covers many aspects of human dignity such as dignity of individual, group, and society including the environment. From this point of view, dignity and worth of human do not have any clash with social work values. “Importance of human relationships” is the fourth value of social work. Social workers need to recognize the central importance of human relationships and take it as a way to improve the quality of life through social change. Islam looks at human beings as social beings who naturally interact with other human beings. Individuals and their society are both important, but one is not allowed to abuse the other; therefore, the individual is happy and the society is orderly (Chaney & Church, 2017; El Fadl, 2015; Lammens, 2013; Murad, 2005; Sardar, 1984; Stefon, 2009; Watt, 2008). According to Islamic teachings, people are asked to be truthful, trustworthy, humble, kind, and generous. They are also asked to repel evil with goodness, control their anger, and be forgiving. Islam also encourages cooperation between people in accomplishing good tasks, like helping the needy. It sees cooperation with one another in good deeds guarantees the progress of human society and to lead a pleasant and comfortable life. Islam introduces “Ihsaan” which means doing good to other and considered as very important in social relations. It adds to the human relationships, beauty and excellence, and enriches their quality and sweetness. “­Rahmah” is another term which means mercy. Mercy refers to many meaning including tender feelings and emotions, as a result of which one displays the utmost love, warmth, affection, and kindness toward others. Forgiveness in Islam means self-restraint, patience, and forbearance apart from the fundamental sense of overlooking others’ lapses. The earlier discussion illustrates that both Islam and social wok recognize the importance of human relationships. The details also from both do not show any ambiguity or confusion. “Integrity” is the fifth value of social work. In this value, social workers are required to behave in a trustworthy manner. Integrity is an important part of the noble Islamic character as being trustworthy which enhances the sound moral conduct that is inherent in the notion of honesty. Being honest, fair in dealings, punctual, as well as honoring trusts and keeping promises and commitments all implies trustworthiness. Integrity, honesty, trustworthy all cover moral, social, legal, and religious obligations. In the Islam perspective, integrity places principally as code of conduct which leads and guides toward the establishment of human ethics. The core principles of integrity are virtues such as compassion, dependability, respect, honesty, kindness, maturity, objectivity, loyalty, trust, wisdom, and generosity. All these virtues must be internalized in person’s heart and manifested in daily life. Similarly, Islam looks at integrity as the knowledge, awareness, enlivening, and tight grasp to pure values, consistently, together with a full commitment to those values in every spoken word and action to achieve self and organization excellence. From the earlier discussion, there is a wide concept of integrity according to Islamic perspective; however, there is a good matching with the demands of social workers’ characteristics. The code of ethics of social work requires social workers to be honest and trustworthy not only during their professional practice but also throughout their life, which is already emphasized by Islam. “Competence” is the sixth value of social work. According to the code of ethics of social work, social workers practice within their areas of competence making their professional expertise more developed. As professionals, social workers should contribute to the knowledge base of social work. The concept of competence is known as the ability or capacity of a person to perform various roles and tasks in a certain job, where this ability is determined by two interconnected 300

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factors which are intellectual ability and physical ability. The ability of competence also involves integrating knowledge, skills, attitudes, personal values, and the ability to build knowledge and skills based on experience and learning (Bartram & Roe, 2005). The Islamic purposes (either the purposes of people or the purposes of Islam) can be achieved through many ways, but the most important means is the provision of competency and experience for certain persons in jobs and tasks that are appropriate to them in life. ­Honesty is an important responsibility in Islam, and thus it is honesty to assign responsibility to qualified and competent persons. A trustworthy and experienced mandate is a condition of competence. Competence has limited meanings in Islam compared with other values such as service, social justice, dignity and worth of the person, importance of human relationships, and integrity. It focuses on tasks, responsibilities, and leaderships. However, the concept seems to match with the value of social work.

Conclusion The most effective support for human values is the most important cultural element of Islam which is for the good of the people and the society. The comprehensive perspective of ethics in Islam is a holistic view of everything related to human beings. Islamic principles do not go against scientific facts and logical theories, whether they are developed by non-Muslim societies or introduced by non-Muslim scientists (Al-Aidros, Shamsudin, & Idris, 2013). Therefore, Islam does not clash with any profession that seeks peace and respect to humanity. There are some general Islamic principles that affirm the strong relationship between Islam, social work, and human rights such as (a) the right to life, (b) the right to justice, (c) equality of human beings, (d) the security of life and property, (e) the protection of honor, and (f ) the rights of the noncombatants. Generally, there is an Islamic basis which says “Islam is valid for all times, places and nations,” which declares that enough flexibility to accept everything is not prohibited, forbidden, and/or harmful. Accordingly, Islam spreads its knowledge to every humankind; it would also accommodate any useful knowledge including values and ethics. Most of medical and other sciences’ techniques, skills, and values are not explicitly stated in Islam; however, they are widely accepted as useful to human beings and to the environment. By contemplating the history of social work, we find the profession initially emerged through its ethical perspective. The ethical face of social work exists throughout its progress in more than a century. The valuable core of the ethical perspective of social work confirms that the profession will not survive when it abandons its ethical face which focuses on service of humanity. The roots of social work as a profession extend to the early social welfare practices, which have been launched from the perspective of charity and philanthropy. Indeed, this seed has been and still is at the core of social work, despite the emergence of modern theories and scientific models. From the point of view of benevolence, the values and ethical principles have been documented and which have been considered as general humanitarian tendencies. These ethical guidelines of the profession easily conform with religions and human societies and do not have any conflict with Islamic religion in particular which calls for peace, dignity, and human well-being. Some specialists have demonstrated aspects of the convergence and compatibility of some religious teachings including Islam and the values of the social work profession (Albrithen, 2017; Canda & Furman, 2009). Although social work in many Muslim societies is influenced by Western knowledge and experience, the strong influence of Islamic thought and beliefs still remains. In general, there 301

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is no conflict in values between Islam and social work. Therefore, cultural consideration from social work perspective does not indicate by any means that social work practice is different in Muslim society from any other religious societies. From the ethical perspective, social work is a global profession and that its core should be useful for all mankind.

References Akgunduz, A. (n.d.). Norms and values in Islam. Retrieved July 28, 2018, from http://islam.uga.edu/ norms_values.html Al-Aidros, A., Shamsudin, F. M., & Idris, K. M. (2013). Ethics and ethical theories from Islamic perspective. International Journal of Islamic Thought, 4, 1–13. Albrithen, A. (2017). Readings in social work. Riyadh: Saudi Social Studies Society (in Arabic). Al-Krenawi, A. (1996). Group work with Bedouin widows in a medical clinic. Affilia: Journal of Women and Social Work, 11(3), 303–318. Al-Krenawi, A., & Graham, J. R. (1996). Social work practice and traditional healing rituals among the Bedouin of the Negev, Israel. International Social Work, 39(2), 177–188. Al-Krenawi, A., & Graham, J. R. (1997). Social work and blood vengeance: The Bedouin-Arab case. British Journal of Social Work, 27(4), 515–528. Al-Krenawi, A., & Graham, J. R. (1998). Divorce among Muslim Arab women in Israel. Journal of Divorce and Remarriage, 29(3/4), 103–119. Al-Krenawi, A., & Graham, J. R. (1999). Social work intervention with Bedouin-Arab children in the context of blood vengeance. Child Welfare, 78(2), 283–96. Al-Krenawi, A., & Graham, J. R. (2001). The cultural mediator: Bridging the gap between a non-­Western community and professional social work practice. British Journal of Social Work, 31(5), 665–685. Al-Krenawi, A., & Graham, J. R. (2003). Principles of social work practice in the Muslim Arab world. Arab Studies Quarterly, 25(4), 75–92. Al-Krenawi, A., Graham, J. R., & Al-Krenawi, S. (1997). Social work practice with polygamous families. Child and Adolescent Social Work Journal, 14(6), 445–458. Al-Krenawi, A., & Lightman, E. S. (2000). Learning achievement, social adjustment, and family conflict among Bedouin-Arab children from polygamous and monogamous families. Journal of Social Psychology, 140(3), 345–55. Al-Krenawi, A., & Jackson, S.O. (2014). Arab American marriage: Culture, tradition, religion, and the social worker, Journal of Human Behavior in the Social Environment, 24(2), 115–137. Australian Association of Social Workers (AASW). (2010). Code of ethics. Retrieved June 27, 2018, from https://www.aasw.asn.au/document/item/1201 Bartram, D., & Roe, R. A. (2005). Definition and assessment of competences in the context of the European diploma in psychology. European Psychologist, 10(2), 93–102. Bashir, A. Y. (1991). The social policy of elderly within the positive thought and the Islamic perception. Symposium on Islamic Rooting for Social Work. Cairo: International Institute of Islamic Thought (in Arabic). Bhatia, A. A. (2016). American evangelicals and Islam: Their perspectives, attitudes and practices towards Muslims in the US. Transformation: An International Journal of Holistic Mission Studies, 34(1), 26–37. British Association of Social Workers (BASW). (2014). The code of ethics for social work. Retrieved June 27, 2018, from https://www.basw.co.uk/about-basw/code-ethics Canadian Association of Social Workers (CASW). (2005). Code of ethics. Retrieved June 27, 2018, from https://www.casw-acts.ca/sites/default/files/attachements/casw_code_of_ethics.pdf Canda, E. R., & Furman, L. D. (2009). Spiritual diversity in social work practice: The heart of helping. New York, NY: Oxford University Press. Chaney, C. & Church, W.T. (2017). Islam in the 21st century: Can the Islamic belief system and the ethics of social work be reconciled? Journal of Religion & Spirituality in Social Work: Social Thought, 36(1–2), 25–47. Curiel, J. (2015). Islam in America. New York, NY: I.B. Tauris & Co. Ltd. El Fadl, K. A. (2015). Islam and the challenge of democracy: A “Boston review” book. Princeton, NJ: Princeton University Press. El-Sanhuri, A. M. (1988). Towards Islamic rooting for professional values of social organizer. The 2nd Scientific Conference of the Faculty of Social Work. Cairo: Helwan University (in Arabic). 302

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Farah, C. (1987). Islam: Beliefs and observations. New York, NY: Barrons. Farooqui, J. (1997). Islamic perspective of methodology in social phenomenal context (pp. 215–241). In M. Muqim (Ed.), Research methodology in Islamic perspective. New Delhi: Genuine Publications. Gubari, M. S. (1985). Introduction to Islamic social work “casework”. Alexandria: Modern University Office (in Arabic). Hodge, D. R. (2005). Social work and the house of Islam: Orienting practitioners to the beliefs and values of Muslims in the United States. Social Work, 50(2), 162–173. Lammens, H. (2013). Islam: Beliefs and institutions (Vol. 16). New York, NY: Routledge. Murad, M. (2005). Interpersonal relationships in Islam – an Islamic perspective. Leicestershire: The Islamic Foundation. Nasr, S. H. (2003). Islam: Religion, history, and civilization. New York, NY: HarperOne. National Association of Social Workers (NASW). (2017). Code of ethics. Retrieved June 27, 2018, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English Pring, R. (2016). Education, leadership and Islam: Theories discourses and practices from an Islamic perspective. By Saeeda Shah. British Journal of Educational Studies, 64(2), 269–271. Qutb, S. (2000). Social justice in Islam. Oneonta, NY: Islamic Publications International. Ragab, I. (1996). Islamic foundation for social sciences: Concept – curriculum – approaches – applications. Riyadh: Dar Alam Al Kotob for Publishing (in Arabic). Rippin, A. (2012). Muslims: Their religious beliefs and practices. New York, NY: Routledge. Sardar, Z. (Ed.). (1984). The touch of Midas: Science, values, and environment in Islam and the West. Dover, NH: Manchester University Press. Stefon, M. (2009). Islamic beliefs and practices. New York, NY: The Rosen Publishing Group. Turker, D. (2016). Islamic roots of corporate social responsibility. In A. Habisch & R. Schmidpeter (Eds.), Cultural roots of sustainable management (pp. 133–144). New York, NY: Springer International Publishing. Watt, W. M. (2008). Islamic philosophy and theology. New Brunswick, NJ: Transaction Publishers. Wolf, L. F. (2016). Islam: An introduction by Catharina Raudvere. Journal of Islamic Studies, 28(2), 221–224. Zidan, A. (1985). Ethical values of casework from Islamic perspective. The 10th International Conference on Statistics, Scientific Accounts, Social and Population Researches. Cairo: Ain Shams University (in Arabic).

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39 The Pope Francis’ philosophy and the social work values Silvana Martínez and Juan Agüero

Jorge Mario Bergoglio is an Argentine Jesuit born on December 17, 1936 in the ­neighborhood of Flores, Buenos Aires City, Argentina. He is son of an Italian immigrant and ­A rgentine mother. At 21 years old, he entered the novitiate of Jesus Company and studied theology at the Faculty of Theology of the Maximum College of Saint Joseph, located in San Miguel, Buenos Aires, Argentina. One of his professors was the theologian Juan Carlos Scannone, one of the founders of the Liberation Theology and People’s Theology. This theologian exerted a great influence on Bergoglio, who was ordained a Priest in 1969, Auxiliary Bishop of Buenos Aires in 1992, and Cardinal in 2001. He performed as Argentine Episcopal Conference President between 2005 and 2011. As Cardinal he holds many positions in the Vatican and exerts a great influence for his charisma, simplicity, capacity for dialogue, ecumenism, and social compromise. In 2013, he was elected Pope and adopted the name of Francis in homage to Saint Francis of Assisi, recognized for his option for the poor, the detachment of material goods, and the surrender to God. In this chapter, we link the Pope Francis’ philosophy with the social work values. In the first place, we refer to development of Liberation Theology in Latin America. In the second place, we describe and analyze the People’s Theology in Argentina and its influence on Pope Francis’ philosophy. In the third place, we refer the links with the support values by the social work.

Liberation Theology in Latin America In the 1960s, it emerged in Latin America, with the name of Liberation Theology, a movement of lay, priests, and bishops that sought a profound change in the Latin American Catholic Church. Its objective was to accompany the accelerated processes of change that occurred in the world and the liberation demands of the Latin American and Caribbean peoples. This occurred in a context of struggle against oppression and domination and its consequences in terms of poverty, social inequality, marginality, social exclusion, ignorance, misery, abuse of power, and exploitation. The three most important figures of this movement, in 304

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terms of the theoretical contribution, the criticism of classical theology, the originality of the contribution, and the notoriety and influence achieved at continental and intercontinental levels, were Hugo Assmann from Brazil, Gustavo Gutiérrez from Peru, and Leonardo Boff from Brazil. Other figures stand out for their testimony and commitment such as the bishop of Recife, Brazil, Helder Cámara and the Colombian priest Camilo Torres. In Argentina, Juan Carlos Scannone, Lucio Gera, and Rafael Tello, among others, stand out as the founders of People’s Theology, an Argentine version of Liberation Theology. Liberation Theology was built on the basis of the great changes promoted by the Second Vatican Council, convened in 1958 by Pope John XXIII and taking place between 1962 and 1965. This pontiff, who goes down in history with the denomination of “the Good Pope,” governed the Catholic Church during a very short period between 1958 and 1963. Shortly after the Council began, Paul VI passed away as new Pope, who not only continued with the Council but also deepened it and put it into practice. This Pope governed for a period of 15 years between 1963 and 1978. During this period, there were very profound changes in the Catholic Church, among which the most important were: • • • • • • • • •

ecumenism, the opening and presence in the world, the search for justice as a prerequisite for peace, the involvement in political and social issues, respect for cultural diversity, the use of native languages in liturgical celebrations, the simplicity of the ecclesial symbols, the preeminence of the pastoral and the major participation of lay people and women, among others.

These changes promoted by the Second Vatican Council lift the barriers that had been built in the Catholic Church and that had closed it on itself, isolating it from the problems of the world. They enable the participation of laity and priests in the struggles for the popular liberation of oppression and domination carried out by students, intellectuals, artists, peasants, and workers. It is becoming aware and building the political dimension of faith and this is the most genuine origin of Liberation Theology, which begins to be built from a base shaped at first by small groups of laity and priests. In March 1964, a first meeting of Latin American theologians was held in Petropolis, Brazil. Attendees included Juan Luis Segundo from Uruguay, Lucio Gera from Argentina, and Gustavo Gutiérrez from Peru. From this first meeting multiply the working meetings of theologians and laity that analyze various aspects of the Latin American reality in relation to the new ways of living the faith proposed by the Second Vatican Council. This contributes to these reflections the studies of social sciences that account for the failure of developmentalism in Latin America and the deepening of dependence, poverty, and exploitation. For these meetings diverse documents are elaborated and discussed. They are installing themes such as the poor and justice, charity and violence, the unity of history, and the political dimension of faith. Between 1965 and 1970, nearly 300 documents were collected. In 1968, the Second General Conference of the Latin American Episcopate convened to analyze the documents and conclusions of the Second Vatican Council. It was held in ­Medellin, Colombia. In this conference, the discussion focused on the deepening of these same issues that were already working and that would later be the central themes of Liberation 305

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Theology. In this period, diverse groups were formed and manifested. The 38 Chilean priests elaborated a document on the encyclical Populorum Progressio. The Movement of Priests for the Third World of Argentina was founded in 1967 and was led by Lucio Gera, Gerardo Ferrari and Carlos Mujica, whose performance extends until 1976. The 18 Bishops of Latin America, Asia, and Africa are led by Helder Camara, bishop of Recife, Brazil, who produced a document in 1967 interpreting the encyclical Populorum Progressio within the framework of the reality of the Third World. The figure of the priest Camilo Torres of Colombia is also highlighted. The deepest foundation of Liberation Theology is the experience of poverty and the poor. This painful reality is also its starting point as a scientific field of reflection on faith. Do not start from a theory of poverty but from the pain of the poor, from the blood spilled, from hunger, from the illness of the poor. This is the original experience that challenges theology. When the Liberation Theology speaks of the poor, it is referring to an exploited social class. Its starting point is the verification of a very concrete fact, a structural situation of injustice. It is not a spiritualization of poverty but a sacralization. Liberation is linked to the class struggle as a historical fact. That is why it is liberating praxis. It recognizes as a fact the struggle between the oppressed and the oppressors, between the exploited and the exploiters. It is a struggle to abolish and not to disguise the causes that generate poverty and exploitation, in order to build a more just, free and humane socialist society and not a society of conciliation and apparent and fallacious equality. In the first half of the 1970s, Liberation Theology expanded throughout the Latin ­A merican continent and came into contact with other theologies of Asia and Africa. Its diffusion and influence greatly increase through meetings, publications, magazines, study centers, and the incorporation of new theologians that enrich the debate. Among these new theologians are Leonardo Boff from Brazil, Raúl Vidales from Mexico, Ronaldo Muñoz from Chile, Jon Sobrino and Ignacio Ellacuría from El Salvador, Pablo Richard Guzmán from Chile, and Enrique Dussel from Argentina. Leonardo Boff argues that the term liberation emerged in Brazil at the beginning of the 1960s when the problem of underdevelopment began to be discussed. First it was understood as a problem of technical delay or asymmetric interdependence within the same system. Then, it was understood as a problem of dependence on hegemonic centers. This gives rise to the liberation as counterpart of the same process. The opposite correlation that best explained the problem was dependency-liberation. The idea of liberation is installed in the final document of the third General Conference of the Latin American Episcopate held in 1979 in Puebla, Mexico, as an unchangeable framework for the theology and the church of Latin America. In Puebla, liberation is conceived as an integral liberation of all men in their different dimensions: personal, political, social, economic, cultural, and religious. For Boff, liberation is not only an aspiration but also a strategy for the transformation of social relations that generate oppression and domination. To carry it out, the other two strategies that have been commonly applied in Latin America in situations of poverty must be left aside: assistance and reformism. Assistance is linked to social assistance, but it transforms the poor into an object of charity, reinforces dependency, it does not see as a subject of their own liberation by not assessing their capacity for resistance, awareness, organization, and struggle for their own rights. Reformism seeks to improve the situation but without modifying the structure of social order. There can be material development and technical progress but at the expense of the oppressed people and without benefiting it. 306

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The subject of every liberation process is the oppressed people. Liberation is certainly a legitimate aspiration, but it does not reach this if it is not transformed into liberating praxis, that is, into a historical fact, and this is only possible through a joint work, a process of awareness, objectives in common, organization and an articulated collective action, that is to say, a liberation strategy. The Liberation Theology of Leonardo Boff is very similar to the People’s Theology developed in Argentina by Lucio Gera, Juan Carlos Scannone, and Rafael Tello.

People’s Theology in Argentina and its influence on Pope Francis’ philosophy Pope Francis is recognized as a world leader for his values and social compromise. These values are linked to their life simplicity, their capacity for dialogue and ecumenism, their political perspective on social reality, their option for the poor and popular movements, and their deep compromise with the social justice. These values and convictions come from his life philosophy and his theological formation. The ideas of the theologian Juan Carlos Scannone, one of the founders and ideologues of the Liberation Philosophy and Theology and People’s Theology, exerted an enormous influence on Pope Francis. Liberation Philosophy and Theology developed in the 1960s and 1970s and influenced the whole Latin America. They are based on a profound critique of the structures of domination and oppression of the people and on a critique of the Church for its self-referential gaze and for being away from the suffering of the dominated and oppressed. People’s Theology is a genuinely Argentine creation derived from the Liberation Theology. It puts the accent on the people conception, on popular culture, on popular knowledge, on people solidarity, and on popular movements. It has connections with the Justicialism’s philosophy, a political movement created in the 1940s by Juan Domingo Perón. The guiding principles of this movement are social justice, political sovereignty, and economic independence. People’s Theology differs from the theology of liberation by taking as central categories not only the people but also the popular culture, moving away from the Marxist conception of popular vanguard that leads the praxis of liberation. For Juan Carlos Scannone (1978), the category town is historical-cultural. It is a symbol category that designates all those who share a historical liberation project. It is a cultural category because it aims at the creation, defense, and liberation of a cultural ethos or human style of life. It is a historical category because only historically can be determined in each particular situation, who and to what extent can we truly say people. It is a symbol category for its summoning and significant wealth. This conception of the town of Scannone is also shared by Lucio Gera (1974). For these authors, liberation exists in historical and specific cultural molds of the different peoples. Every project of liberation is concretized in the sociopolitical and must bear in mind the history and idiosyncrasy of each town. The theology of the people is totally different at this point not only from the theology of liberation but also from the Marxist conception of socioeconomic class identified with the proletariat or the peasantry. Also, the theologian and philosopher Enrique Dussel (2006) develops the concept of people fundamentally as a political category that encompasses the various sectors, classes, and groups dominated in struggle. It is the sovereign subject from which it emanates and where the political power lies. However, it moves away from the people as a sovereign political community to encompass issues of domination, conscience, and antagonism. It is the passage from town as a political community to town as a historical subject. In this it coincides with Scannone and Gera. 307

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Within the Theology of the People, a group of priests self-styled Option for Poor or Priests for the Third World is formed. Pope Francisco belonged to this group and from there comes his election of the name of Francisco in reference to San Francisco de Asís. The theme of poverty, social justice, and solidarity is central to his thinking and this is reaffirmed in the speech he delivered in Santa Cruz de la Sierra, Bolivia, on October 28, 2014 at the World Meeting of Popular Movements. In this speech he updated the preferential option for the poor that the Catholic Church had made at the Second Latin American Conference of Medellín, Colombia, in 1968. It develops its thinking in three axes: Earth, Roof, and Work. In relation to the Earth, it criticizes the eradication of so many peasants who suffer the uprooting, not by wars or natural disasters but by land grabbing, deforestation, and water appropriation. Consider that these are evils that rip man from his homeland and cause a painful separation not only physical but also existential and spiritual. In relation to the roof, he claims a house for each family. Family and housing go hand in hand. But, in addition, a roof, to be home, has a community dimension. It is precisely in the community where this great family of humanity begins to be built, from the most immediate, from the coexistence with the neighbors. It is the place of popular culture. It is the place where links are built with neighbors. In relation to the work, he argues that there is no worse material poverty than that which does not allow one to earn bread and deprives human beings of the dignity of work. He criticizes the system that puts the economic benefit above the man. If the economic benefit is above humanity or man, then there is a culture of discarding that considers the human being in himself as a consumer good, which can be used and then thrown away. However, for Pope Francis, every worker, whether or not he is in the formal system of wage labor, is entitled to a decent remuneration, social security, and retirement coverage. Finally, Pope Francis rescues the value of popular movements because they express the urgent need to revitalize democracies. It is impossible to imagine a future for society without the leading participation of large majorities and this role exceeds formal democracy. The construction of a world of peace and justice implies overcoming paternalistic assistance. It requires creating new forms of participation that include popular movements and encourages the structures of governments with the inclusion of the excluded in the construction of the common destiny.

The Pope Francis’ thinking and social work values The Pope Francis’ thinking has a strong link with the social work values. His social vision condensed in the ideas of Earth, Roof, and Work expresses the great values supported by social work such as social justice, democracy, human rights, citizenship, sustainable development, wealth distribution, solidarity, freedom, emancipation, among others. The International Federation of Social Workers and International Association of Schools of Social Work (IASSW) included these values in the current Global Statement of Social Work Ethical Principles. This statement was approved in 2018. We next refer to some of these principles. One of them is the recognition of the inherent dignity of the human being. Social workers recognize and respect the inherent dignity and worth of all human beings in attitude, word, and deed. They respect all persons and challenge beliefs and actions of those persons who devalue or stigmatize themselves or other persons. In the same way, Pope Francis strongly rescues the dignity and intrinsic value of every human being. This dignity comes from his condition as a son of God. Another principle is the promotion of the human rights. Social workers embrace and promote the fundamental and inalienable rights of all human beings. Social work is based on respect 308

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for the inherent worth and dignity of all people and the individual and social/civil rights that follow from this. Social workers often work with people to find an appropriate balance between competing human rights. The promotion of human rights is also a central issue in the thinking of Pope Francis. His constant struggle for the respect of these rights has marked his whole life and has been a constant guide of his actions. This concern for human rights has also approached him to the organizations and social movements that fight for these rights. An example is his relationship with the Mothers of the Plaza de Mayo and the Grandmothers of the Plaza de Mayo in Argentina. There is also the social work principle of promotion of the social justice. Social workers have a responsibility to engage people in achieving social justice, in relation to society generally, and in relation to the people with whom they work. This implies the challenging to discrimination and institutional oppression. Social workers promote social justice in relation to society generally and to the people with whom they work. They challenge discrimination, which includes but is not limited to age, capacity, civil status, class, culture, ethnicity, gender, gender identity, language, nationality (or lack thereof ), opinions, other physical characteristics, physical or mental abilities, political beliefs, poverty, race, relationship status, religion, sex, sexual orientation, socioeconomic status, spiritual beliefs, or family structure. It also implies respect for diversity. Social workers work toward strengthening inclusive communities that respect the ethnic and cultural diversity of societies, taking account of individual, family, group, and community differences. At this point the relationship with the Pope’s thought is fully coincidental. Precisely one of its most recognized practices by all is ecumenism, dialogue, and respect for all beliefs. Social justice implies above all the equitable access of all men to resources and fundamentally the just distribution of wealth. Social workers advocate and work toward access and the equitable distribution of resources and wealth. At this point the thought of Pope Francis is absolutely clear and coincidental. In his first encyclical Lumen Fidei dated June 29, 2013 he harshly criticizes the injustice of the world order governed by financial capitalism and neoliberalism. In his second encyclical Laudato si dated May 24, 2015 he condemns the capitalist exploitation of nature and rescues the value of the land as a place of life and fulfillment of the human being. Another approved principle by the International Federation of Social Workers and the International Association of Schools of Social Work is the challenging unjust policies and practices. Social workers work to bring to the attention of their employers, policy makers, politicians, and the public situations in which policies and resources are inadequate or in which policies and practices are oppressive, unfair, or harmful. They must be aware of situations that might threaten their own safety and security, and they must make judicious choices in such circumstances. They are not compelled to act when it would put themselves at risk. The struggle of social workers against unfair policies and practices is also shared by Pope Francis, who has consistently called on governments and world leaders for greater action in favor of world peace, political and religious tolerance, protection of those who flee their countries because of wars and conflicts, among others. It has particularly condemned the enormous concentration of wealth in the hands of privileged minorities and the lack of public policies to combat hunger, illiteracy, lack of work, and opportunities for development of millions of human beings condemned by financial capitalism and neoliberalism. Another principle supported by the Global Social Work is the construction of solidarity. Social workers actively work in communities and with their colleagues, within and outside of the profession, to build networks of solidarity to work toward transformational change and inclusive and responsible societies. This is one of the central themes of the speech of Pope Francis delivered in Santa Cruz de la Sierra, Bolivia, in 2014. Solidarity is the engine of 309

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change in the world and the great hope of building a more just and human social order. For Pope Francis, solidarity is a word that does not always go well. Sometimes it is transformed into a bad word. It cannot be said; but it is a word much more than some acts of sporadic generosity. It is acting in terms of community. It is priority of life for all and not appropriation of goods by someone. It is also to fight against the structural causes of poverty, inequality, lack of work, land and housing, the denial of social and labor rights. It is to face the destructive effects of the empire of money: forced displacements, painful emigrations, human trafficking, drugs, war, violence, and all those realities that many of you suffer and that we are all called to transform. Solidarity is a way of making history and that is what popular movements do. Another ethical principle supported by the Global Social Work is the right to self-­ determination that every human being and every people has. It is the respect for autonomy and for the full exercise of freedom to decide one’s destiny. Social workers respect and promote people’s rights to make their own choices and decisions, provided this does not threaten the rights and legitimate interests of others. In the two Encyclicals mentioned previously, Pope Francis emphasizes the need to respect the right to self-determination of countries and peoples; right to decide how to live; how to govern itself; how to relate itself to other countries and other peoples; right to have a religion; right to one’s own language and worldview. The Pope has publicly proclaimed the need for dialogue between countries and human groups respecting their own interests and values. International Social Work also has an ethical principle the right to participate in ­decision-making when it affects a social group. The people have the right to be heard and to decide on their own destiny. Social workers work toward building the self-esteem and capabilities of people, promoting their full involvement and participation in all aspects of decisions and actions that affect their lives. On his trip to Brazil in 2016, Pope Francis in his speech to young people asked them “to make a mess,” an expression that was a harangue to mobilize, organize, participate actively in social life and be involved in the collective decisions of the society. As if he were a social worker, Pope Francis motivated young people to leave individual comfort, the place of comfort, and encourage themselves to build participation with other young people, to fight for their dreams and to actively participate in society. Finally, the principle of the holistic view of the human being as a multidimensional and historical being. Social workers recognize the biological, psychological, social, and spiritual dimensions of people’s lives and understand and treat all people as whole persons. Such recognition is used to formulate holistic assessments and interventions with the full participation of people, organizations, and communities with whom social workers engage. There is no separation between the biological, historical, social, and spiritual dimensions in the human being. It is a bio-psycho-social-historical unit. Pope Francis shares the same vision of the human being and has expressed this in the two Encyclicals (addressed earlier). Faith in God in the thought of Pope Francis is a faith embodied in history and in the nature with which every human being is constituted.

Conclusion As it has been demonstrated in this work, the thought of Pope Francis and the values held by him have a strong link with the theology of liberation developed by Gustavo Gutierrez, Leonardo Boff, Helder Camara, Enrique Dussel, and other Latin American thinkers and, especially, with the people theology developed in Argentina by Juan Carlos Scannone and 310

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Lucio Gera. The people theology also has a strong influence exercised by the Justicialist ­National Movement created by Juan Domingo Perón in the 1940s. Pope Francis has also had a great influence on the part of these theologians, philosophers, and politicians, both in their formation and in their life experience. His thought is summarized in an admirable way in his demand for Earth, Roof, and Work for all men and women, based on the principles of solidarity and fair distribution of wealth. His thinking is located at the antipodes of financial accumulation, capitalist exploitation, and the oppression and domination of millions of human beings deprived of the least to live. These values of Pope Francis are strongly linked to the ethics and values held by social work as profession, which are also summarized in human rights, social justice, democracy, citizenship, sustainable development, the just distribution of the wealth, freedom, autonomy, and emancipation, among others. As if he were a social worker, the Pope Francis also promotes and defends these same values and supports this same ethic, as has been demonstrated in this work.

References Dussel, E. (2006). 20 tesis de política. México: Siglo XXI Editores. Gera, L. (1974). Cultura y dependencia a la luz de la reflexión teológica. Stromata, No. 40. Scannone, J. (1978). Teología de la Liberación y praxis popular. Salamanca: Sígueme.

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Section XI

Globalism

40 Essential ethics ­knowledge in social work Frederic G. Reamer

Social work ethics has come of age. During the profession’s earliest years, social workers focused primarily, and appropriately, on the nature of social work’s core values. During the late 1800s and early 1900s, commentaries on ethical issues in social work were few and far between, limited especially to discussions of the foundational importance of values such as client dignity, privacy, trust, and self-determination (Emmet, 1962; Pumphrey, 1959; Towle, 1965). Since these early developments in social work education and knowledge building, the broad subject of social work values and ethics has matured significantly. Today’s scholarship on the subject includes much more ambitious, comprehensive examination of a complex array of ethical challenges in the profession. Significantly, some of the daunting ethical challenges facing today’s social workers – for example, ethical issues surrounding practitioners’ and clients’ use of digital and other technology – could not have been imagined when social work was formally inaugurated in the late 19th century (Reamer, 2017). In light of the increasingly complex ethics landscape in social work, it is important that practitioners acquire essential ethics-related knowledge during the course of their professional education and throughout their career (Barsky, 2009; Congress, Black, & Strom-Gottfried, 2009; Reamer, 2001, 2019). Social workers must be especially cognizant of diverse moral norms and ethical standards across and within nations (Hugman & Carter, 2016).

A brief history The ethics knowledge that existed when most social workers completed their formal professional education pales in comparison to today’s knowledge. Certainly, values and ethics have always been part and parcel of social work education and practice. However, the aims and content of ethics education have changed significantly throughout the profession’s history (Emmet, 1962; Johnson, 1955). Social work literature in the beginning of the 20th century, during the earliest chapter of social work’s development, focused primarily on the nature of social work’s values and the moral purposes of the profession (Pumphrey, 1959). Through the 1970s, social work scholars and practitioners focused on a range of issues, especially the profession’s core values, values clarification, and the relationship and occasional conflict between practitioners’ values and the profession’s values (Abbott, 1988; Hardman, 1975; Teicher, 1967; Timms, 1983). 315

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Beginning in the late 1970s and early 1980s, a small group of social work scholars and practitioners – based primarily in England, Canada, Australia, and the United States – ­began to explore the nature of ethical dilemmas in social work more deliberately, focusing primarily on instances when social workers’ duties and obligations clash (Congress & ­McAuliffe, 2006; Reamer, 2019). The literature during this period identified complex moral dilemmas involving such issues as the limits of clients’ confidentiality rights and right to self-­determination, professional paternalism, conflicts of interest, whistle-blowing, administrative and organizational ethics, civil disobedience, and distributive justice (Loewenberg & ­Dolgoff, 1982; Reamer, 1982, 1993). In the early 1980s, a pioneering project sponsored by the Hastings Center and the Carnegie Corporation of America produced a seminal examination of c­ urricular issues related to teaching social work ethics in the classroom (Reamer & Abramson, 1982). These early efforts were an outgrowth of the dramatic emergence of the specialized field of professional ethics, also known as applied and practical ethics, in the late 1970s (­Callahan & Bok, 1980; Rowan & Zinaich, 2002). During the early years of the professional ethics movement, diverse professions – including medicine, law, business, social work, nursing, psychology, engineering, journalism, and the military, among others – began to examine in-depth the nature of ethical dilemmas and issues. Since the mid-1980s, many social workers – in formal social work education courses and continuing education – have been introduced to the connections between ethics concepts and ethical dilemmas they might encounter in practice settings (Doel, Shardlow, & Johnson, 2011; Homonoff, 2008; Reamer, 2001; Royse, Dhooper, & Rompf, 2012). Typically, these discussions explore ethical decision-making models and the relationship between prominent ethical theories and actual or hypothetical ethical dilemmas encountered by social workers (Joseph, 1989; ­Rachels & Rachels, 2011). Key ethical theories include those that focus on inherent moral duties and obligations regardless of the consequences (deontology); the consequences of ethical decisions, especially efforts to determine which outcomes produce the greatest good (teleology, consequentialism, utilitarianism); the importance of interpersonal relationships in ethical ­decision-making (ethics of care); and the role of virtue in ethical decision-making (virtue theory). Extensive literature in the profession explores the ways in which classic moral theories can be used to examine complex ethical issues and dilemmas. Common ethical dilemmas in social work concern: (1) clinical practice – for example, ethical challenges related to confidentiality, client self-determination, boundaries, dual relationships, conflicts of interest, informed consent, use of technology, professional paternalism, and truth-telling; (2) program design, agency administration, and social policy – for example, challenging unjust agency policies or regulations, social injustice and oppression, human rights violations, and distributing limited resources; and (3) relationships among practitioners – for example, reporting a colleague’s unethical behavior and addressing a colleague’s impairment. In recent years, a great deal of social work education has focused explicitly on ­decision-making strategies that practitioners can use when faced with difficult ethical judgments (Barsky, 2009; Mattison, 2000; Reamer, 2019). Typically, these discussions identify a series of steps that practitioners can follow as they attempt to resolve difficult ethical ­d ilemmas. Although these frameworks do not lead to simple, formulaic solutions to c­ omplex ethical issues, there is widespread consensus that they can help social workers organize their thinking and approach ethics challenges systematically and examine complicated ethical ­issues through multiple lenses. Many of today’s social work educators also focus on the important concepts of moral distress, moral injury, and moral courage (Fronek et al., 2017; Gallina, 2010; Groessl, 2017; Kidder, 2006; Osswald, Greitemeyer, Fischer, & Frey, 2010; Pianalto, 2012; Strom-Gottfried, 2016; Weinberg, 2009). 316

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Since the 1990s, social workers have also expanded their focus to include a wide range of ethics-related risk-management issues (Reamer, 2015). A major goal of contemporary ethics education in the profession is to acquaint practitioners with the ways in which sound ethical judgment and management of ethical challenges can protect clients and prevent malpractice lawsuits and licensing board complaints.

Essential ethics knowledge in social work Based on the remarkable expansion of knowledge regarding social work ethics, essential knowledge includes five key themes: (1) the value base of the social work profession and its relationship to practitioners’ values; (2) ethical dilemmas; (3) ethical decision-making; (4) moral distress, injury, and courage; and (5) ethics risk management.

Social work values Social work is among the most values based of all professions (Abbott, 1988; Allen-Meares, 2000). Practitioners are expected to embrace social work’s explicit values and explore the relationship between their values and the profession’s values. Occasionally, social workers encounter challenging circumstances where these values clash. Examples include when a social worker’s religious beliefs conflict with social work values or agency policy (Doyle, Miller & Mirza, 2009; Reamer, 2018a, 2018b), or when a practitioner questions social work’s venerable commitment to addressing issues of discrimination and social injustice (Gil, 1998). There are several prominent examples of conflicts between social workers’ values and the profession’s values, especially clashes between social workers’ faith-based values and traditional social work values (“Missouri School Sued by Student,” 2006; Pacific Justice Institute, 2007; Schmidt, 2010). When such conflicts arise, it is incumbent upon social workers to examine their values and related conduct in light of the profession’s core values in an effort to reconcile these conflicts in a manner consistent with social work’s values and ethical standards. Social workers should recognize that core social work values vary internationally and, at times, within nations and cultures. In some cultures, social workers work in settings where they are expected to maintain strict boundary separation in their relationships with clients; for example, these social workers are expected to decline clients’ invitations to attend important lifecycle events (such as a wedding or baby naming), reject clients’ gifts of appreciation, and avoid disclosing personal information to clients. In other cultures, however, norms are such that social workers may be permitted or expected to have more elastic boundaries in their relationships with clients in order to sustain healthy working relationships and avoid insulting them (Reamer & Nimmagadda, 2017). Similarly, in some cultures, social workers are employed in settings that maintain strict confidentiality protocols and enforce strict informed consent guidelines. In other cultural settings, however, social workers encounter much more fluid confidentiality norms and informed consent standards (Reamer, 2019). For example, in some cultures, social workers are expected to treat the family as the client, not only the individual person who is the primary recipient of social workers’ services. This leads to varying assumptions about with whom the social worker will share clinically relevant information and who will be asked to provide consent to the social workers’ services or release of information. More recent discussions of core social work values have focused on the relevance of the concept of virtue (Pullen-Sansfaçon, 2010). According to virtue ethics, an ethical person has virtuous values and character traits – such as integrity, truthfulness, generosity, loyalty, 317

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sincerity, kindness, compassion, and trustworthiness – and acts in a manner consistent with them. According to a prominent framework (Beauchamp & Childress, 2012), these focal ­v irtues are linked directly to several core moral principles that constitute the moral ­foundation of professional practice: autonomy (similar to social work’s traditional value of ­client self-­determination), non-maleficence (avoiding harm), beneficence (acts of mercy and kindness), and justice (promoting fairness and just deserts). From this point of view, ethical judgments spring from these core values and character traits rather than from formal ethical rules and standards per se (Beauchamp & Childress, 2012; MacIntyre, 1984).

Ethical dilemmas Situations sometimes arise in social work where professional duties and obligations, rooted in core values, clash (Banks, 2012; Barsky, 2009; Congress, 1999; Dean & Rhodes, 1992; ­Hugman, 2013; Reamer, 2012, 2019). This is when social workers must decide which ­values – as expressed in various duties and obligations – take precedence. Conflicts among core professional duties lead to ethical dilemmas. The philosopher W. D. Ross (1930) argues that conflicts among individuals’ prima facie moral duties lead to difficult choices regarding one’s actual duty. Prima facie duties are those that individuals are inclined to perform, when considered individually. Actual duties are those that individuals choose to perform when prima facie duties clash, that is, the prima facie duties that should take precedence over others when they conflict. The enduring challenge in professional ethics is establishing criteria by which practitioners decide which prima facie duty should take precedence. In social work, ethical dilemmas can arise in the context of clinical work; administration and management; advocacy and community organizing; policy practice; and research and evaluation. For example, clinical social workers may have to make difficult ethical choices between clients’ right to confidentiality and practitioners’ duty to protect third parties from harm, or regarding the limits of clients’ right to self-determination. Social work administrators sometimes face ethical dilemmas related to allocating limited resources, addressing impaired or incompetent employees, and complying with unjust regulations. Community organizers may face difficult moral choices about engaging in civil disobedience to protest a draconian public policy or managing conflicts of interest. Social work researchers may wrestle with issues related to the protection of participants in research and evaluation projects.

Ethical decision-making The phenomenon of ethical decision-making in the professions has matured considerably in recent years. Today’s social work educators and practitioners have far more access to scholarly literature and concepts related to ethical decision-making than did their predecessors. Typically, ethical decision-making frameworks include several key steps, for example: (1) identify the key ethical issues, including the values and duties that conflict; (2) identify individuals, groups, and organizations who are likely to be affected by the decision; (3) identify all possible courses of action and the participants involved in each, along with the possible benefits and risks for each; (4) thoroughly examine the reasons in favor of and opposed to each possible course of action, considering relevant ethical theories and principles, codes of ethics, legal principles, social work practice theory, standards and principles, and personal values; (5) consult with colleagues and appropriate experts, such as supervisors, agency administrators, ethics experts, and—when there are legal issues involved—attorneys; (6) make the decision and document the decision-making process; and (7) monitor, evaluate, and document the 318

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decision (Barsky, 2009; Dolgoff, Loewenberg, & Harrington, 2009; Reamer, 2019). Social workers can apply these decision-making frameworks when they analyze ethical dilemmas.

Moral distress, injury, and courage Many ethical dilemmas arise out of social workers’ encounters with morally questionable practices in the settings in which they are employed. Examples include social workers whose supervisors insist that they violate widely embraced ethical standards (for example, falsifying budget documents or misrepresenting the nature of services provided to clients) or whose employers promote and support policies that social workers regard as morally abhorrent (for example, policies that violate clients’ fundamental rights and practices that overlook abuse of clients by staffers). These phenomena can lead to what have become known as moral distress and injury. Moral distress entails a collision between workplace demands and social workers’ core values (Fronek et al., 2017; Gallina, 2010; Weinberg, 2009). Such distress often requires social workers to make exceedingly difficult ethical judgments about whether to disclose ethical misconduct (known as whistle-blowing) and resign their employment. Moral courage is also a core concept that is central to social work ethics (Groessl, 2017; Kidder, 2006). This entails the courage to take action despite possible negative risks and consequences, for example, when a social worker may risk disciplinary action or employment termination if she exposes wrongdoing at her agency. Moral courage is rooted in the German concept of Zivilcourage, which entails a willingness to challenge authority and, when necessary, take on unpopular causes in the name of justice (Comer & Vega, 2011; Kidder, 2006; Osswald et al., 2010; Pianalto, 2012; Strom-Gottfried, 2016).

Ethics risk management Social workers must be concerned about the risk-management ramifications of their ethical decisions and actions, particularly the possibility of professional malpractice and misconduct (Houston-Vega, Nuehring & Daguio, 1997; Reamer, 2015; Strom-Gottfried, 2000). Contemporary social workers are much more sensitive to these issues than earlier generations of practitioners, primarily due to increases in litigation and licensing board complaints, especially in the United States, which has an unusually high litigation rate (Ramseyer & Rasmussen, 2010). It is important for social workers to fully understand the ways in which ethical issues and judgments occasionally lead to malpractice claims, ethics complaints filed with professional associations, and licensing board complaints. Malpractice claims can be filed against social workers in courts of law. A typical lawsuit seeks monetary compensation for emotional, physical, or financial damages allegedly caused by the social worker’s conduct. Ethics complaints can be filed against social workers with licensing boards, regulatory bodies, and professional social work associations. Evidence of practitioner misconduct can lead to sanctions such as probation, suspension, expulsion, license revocation, mandatory supervision, and consultation, among others. To minimize risk to clients, employers, and practitioners themselves, social workers should identify ethical issues that are directly and explicitly related to their particular practice setting. For example, a social worker in a school setting should pay special attention to minors’ rights to privacy; disclosure of confidential information to school officials, parents, and guardians; minors’ right to consent to services; and boundary issues related to social workers’ self-­d isclosure, management of social media and social networking in relationships with ­clients, and responding to clients’ invitations and gifts. In contrast, social workers in a 319

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health care facility (such as a nursing home, hospital, rehabilitation center, or hospice program) should focus on key bioethical issues related to advance directives, durable powers of attorney for health care, confidentiality guidelines, proper use of institutional ethics committees, informed consent, and end-of-life decisions. A social worker in a substance abuse treatment program must know about strict confidentiality laws that are tailored to those settings and unique boundary challenges that arise when former clients of the program are hired as staffers. A social worker who does outreach work with people who struggle with homelessness must reflect on the limits of clients’ right to self-determination and the challenge of professional paternalism. A social worker in a correctional facility or on a military base should focus on the unique confidentiality guidelines that govern those settings. In most social work settings, key risks pertain to management of client rights, confidentiality and privacy, ­informed consent, service delivery, boundary issues and dual relationships, conflicts of interest, documentation, defamation of character, supervision, training, consultation, referral, fraud, use of technology, termination of services, and practitioner impairment.

Conclusion Ethics knowledge in social work has blossomed. Key elements include social work v­ alues; ­ethical dilemmas; moral distress, injury, and courage; ethical decision-making; and ­ethics-related risk management. Ethics education – both in the academy and throughout social workers’ careers – is a vital element of professional development. It is imperative that social workers have a solid command of current ethical challenges, ethical standards, ethics literature, conceptually based decision-making frameworks, and risk-management policies and practices. Further, social workers should be keenly aware of differences in ethics-­related norms across and within cultures and nations. Having this core knowledge enhances ­social workers’ ability to uphold the venerable values of the professions, make sound ethical ­judgments, protect clients, and protect themselves. It is especially important for social workers to recognize that ethical issues and challenges in the profession are not static. Indeed, many ethical issues faced by today’s social workers could not have been anticipated by the profession’s earliest practitioners. Social workers must be alert to emerging ethical issues and vigilant in their efforts to address them diligently.

References Abbott, A. A. (1988). Professional choices: Values at work. Silver Spring, MD: National Association of Social Workers. Allen-Meares, P. (2000). Our professional values and the changing environment. Journal of Social Work Education, 36, 179–182. Banks, S. (2012). Ethics and values in social work (4th ed.). Basingstoke: Palgrave Macmillan. Barsky, A. E. (2009). Ethics and values in social work: An integrated approach for a comprehensive curriculum. New York: Oxford University Press. Beauchamp, T., & Childress, J. (2012). Principles of biomedical ethics (7th ed.). New York, NY: Oxford University Press. Callahan, D., & Bok, S. (Eds.). (1980). Ethics teaching in higher education. New York, NY: Plenum. Comer, D. R., & Vega, G. (Eds.). (2011). Moral courage in organizations: Doing the right thing at work. ­A rmonk, NY: M.E. Sharpe. Congress, E. P. (1999). Social work values and ethics. Belmont, CA: Wadsworth. Congress, E. P., Black, P. N., & Strom-Gottfried, K. (2009). Teaching social work values and ethics: A curriculum resource (2nd ed.). Alexandria, VA: Council on Social Work Education. Congress, E. P., & McAuliffe, D. (2006). Social work ethics: Professional codes in Australia and the United States. International Social Work, 49, 151–64. 320

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Dean, R. G., & Rhodes, M. L. (1992). Ethical-clinical tensions in clinical practice. Social Work, 39, 128–32. Doel, M., Shardlow, S. M., & Johnson, P. G. (2011). Contemporary field social work: Integrating field and classroom experience. Thousand Oaks, CA: Sage. Dolgoff, R., Loewenberg, F., & Harrington, D. (2009). Ethical decisions for social work practice (8th ed.). Belmont, CA: Thomson/Brooks Cole. Doyle, O. Z, Miller, S. E., & Mirza, F. Y. (2009). Ethical decision-making in social work: Personal and professional values. Journal of Social Work Values and Ethics, 6. Retrieved from http://www. socialworker.com/jswve/content/view/113/67/ Emmet, D. (1962). Ethics and the social worker. British Journal of Psychiatric Social Work, 6, 165–72. Fronek, P., Briggs, L., Kim, M., Han, H., Val, Q., Kim, S., & McAuliffe, D. (2017). Moral distress as experienced by hospital social workers in South Korea and Australia. Social Work in Health Care, 56, 667–85. Gallina, N. (2010). Conflict between professional ethics and practice demands: Social workers’ perceptions. Journal of Social Work Values and Ethics, 7(2), 928–943. Gil, D. (1998). Confronting injustice and oppression: Concepts and strategies for social workers. New York: Columbia University Press. Groessl, J. (2017). Leadership in the field: Fostering moral courage. Journal of Social Work Values and Ethics, 14(1), 72–79. Hardman, D. G. (1975). Not with my daughter you don’t! Social Work, 20, 278–285. Homonoff, E. (2008). The heart of social work: Best practitioners rise to challenges in field instruction. The Clinical Supervisor, 27, 135–169. Houston-Vega, M. K., Nuehring, E. M., & Daguio, E. R. (1997). Prudent practice: A guide for managing malpractice risk. Washington, DC: NASW Press. Hugman, R. (2013). Culture, values, and ethics in social work: Embracing diversity. New York: Routledge. Hugman, R., & Carter, J. (Eds.). (2016). Rethinking values and ethics in social work. London: Palgrave. Johnson, A. (1955). Educating professional social workers for ethical practice. Social Service Review, 29, 125–36. Joseph, M. V. (1989). Social work ethics: Historical and contemporary perspectives. Social Thought, 15(3/4), 4–17. Kidder, R. (2006). Moral courage. New York, NY: William Morrow Publishers/Harper Collins. Loewenberg, F., & Dolgoff, R. (1982). Ethical decisions for social work practice. Itasca, IL: F.E. Peacock. MacIntyre, A. (1984). After virtue (2nd ed.). Notre Dame, IN: University of Notre Dame Press. Mattison, M. (2000). Ethical decision making: The person in the process. Social Work, 45, 201–212. Missouri School Sued by Student Who Refused to Support Gay Adoptions. (2006, November 2). USA Today. Retrieved from http://www.usatoday.com/news/nation/2006-11-02-gay-adoption_x.htm Osswald, S., Greitemeyer, T., Fischer, P., & Frey, D. (2010). What is moral courage? Definition, explication, and classification of a complex construct. In C. L. S. Purey & S. J. Lopez (Eds.), The psychology of courage: Modern research on an ancient virtue. (pp. 149–164) Washington, DC: American Psychological Association. Pacific Justice Institute. (2007, April 4). Jacqueline Escobar terminated for sharing faith on own time. Retrieved from http://pacificjustice.org/legal-edge/jacqueline-escobar-terminated-sharing-faithown-time Pianalto, M. (2012). Moral courage and facing others. International Journal of Philosophical Studies, 20(2), 165–184. Pullen-Sansfaçon, A. (2010). Virtue ethics for social work: A new pedagogy for practical reasoning. Social Work Education, 29(4), 402–415. Pumphrey, M. W. (1959). The teaching of values and ethics in social work (Vol. 13). New York, NY: Council on Social Work Education. Rachels, J., & Rachels, S. (2011). Elements of moral philosophy (7th ed.). Boston, MA: McGraw-Hill. Ramseyer, J., & Rasmussen, E. (2010). Comparative litigation rates. Harvard John M. Olin Discussion Paper Series No. 681. Retrieved from http://www.law.harvard.edu/programs/olin_center/papers/ pdf/Ramseyer_681.pdf Reamer, F. G. (1982). Ethical dilemmas in social service. New York, NY: Columbia University Press. Reamer, F. G. (1993). The philosophical foundations of social work. New York: Columbia University Press. Reamer, F. G. (2001). Ethics education in social work. Alexandria, VA: Council on Social Work Education. Reamer, F. G. (2012). Boundary issues and dual relationships in the human services. New York: Columbia University Press. 321

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Reamer, F. G. (2015). Risk management in social work: Preventing professional malpractice, liability, and disciplinary action. New York: Columbia University Press. Reamer, F. G. (2017). Evolving ethical standards in the digital age. Australian Social Work, 70, 148–59. Reamer, F. G. (2018a). The social work ethics casebook: Cases and commentary (2nd ed.). Washington, DC: NASW Press. Reamer, F. G. (2018b). Ethical standards in social work: A review of the NASW code of ethics (3rd ed.). ­Washington, DC: NASW Press. Reamer, F. G. (2019). Social work values and ethics (5th ed.). New York: Columbia University Press. Reamer, F. G., & Abramson, M. (1982). The teaching of social work ethics. Hasting-on-Hudson, NY: Hasting Center. Reamer, F. G., & Nimmagadda, J. (2017). Social work ethics in India: A call for the development of indigenized ethical standards. International Social Work, 60, 182–95. Ross, W. D. (1930). The right and the good. Oxford: Clarendon Press. Rowan, J., & Zinaich, S., Jr. (2002). Ethics for the professions. Belmont, CA: Wadsworth. Royse, D., Dhooper, S. S., & Rompf, E. L. (2012). Field instruction: A guide for social work students (6th ed.). Upper Saddle River, NJ: Pearson. Schmidt, P. (2010, July 20). Augusta State U. is accused of requiring a counseling student to accept homosexuality. Retrieved from http://chronicle.com/article/Augusta-State-U-Is-Accused/123650/ Strom-Gottfried, K. (2000). Ensuring ethical practice: An examination of NASW code violations. Social Work, 45, 251–61. Strom-Gottfried, K. (2016). Moral courage. In A. J. Viera & R. Kramer (Eds.) Management and leadership skills for medical faculty: A practical handbook. (pp. 183–190). New York, NY: Springer. Teicher, M. I. (1967). Values in social work: A reexamination. New York: National Association of Social Workers. Timms, N. (1983). Social work values: An enquiry. London: Routledge and Kegan Paul. Towle, C. (1965). Common human needs. Washington, DC: National Association of Social Workers. Weinberg, M. (2009). Moral distress: A missing but relevant concept for ethics in social work. Canadian Social Work Review, 26(2), 139–152.

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41 Welcoming the stranger The ethics of policy and practice with migrant and refugee populations Susan Schmidt

In evolutionary terms, humans have been migrating since practically the beginning of time. Scientists trace the earliest human remains to Ethiopia some 200,000 years ago, with evidence that homo sapiens began migrating to other parts of the world about 60,000 years ago, perhaps due to changes in rainfall patterns (Harzig, Hoerder, & Gabaccia, 2009; National Geographic, n.d.). Evidence of migration has been preserved in fossils, recorded in documents, remembered through oral histories, and instilled through religious leitmotifs of exile, pilgrimage, and welcoming the stranger. From these anthropological and historical perspectives, human migration (both voluntary and involuntary) appears recurrent, without which a majority of humans would not be where they are today. At the same time, this history and remembrance includes periods of xenophobia and discrimination toward the alien, the foreigner, the outsider. Considering this human narrative of both hospitality and exclusion, acceptance and interdiction, what role should social workers play? To what do our professional ethics call us? According to the UN refugee agency (UNHCR), “War, violence and persecution have uprooted more men, women and children around the world than at any time in the seven-­decade history of UNHCR…” (United Nations High Commissioner for Refugees (­U NHCR), 2017). In addition to forced migration caused by war, oppression, or other protection issues, people also migrate for reasons pertaining to economics, family, and opportunity. Ethical migration matters involve questions of who belongs in a society, how new­ elcomed, what help they receive, how resources are shared, how special needs comers are w are accommodated and differences accepted. As a profession focused on service, social justice, and human well-being, social workers have much to offer people, communities, and societies impacted by migration, and migrant populations facing heightened vulnerabilities including children, victims of violence and trauma, minority populations, the elderly, and infirm. This chapter uses an inquiry-based approach to address five questions relevant to migration work, using the United States as the primary context with lessons from other regions. As ethical common ground, this chapter uses the Statement of Ethical Principles (2012) of the International Federation of Social Workers (IFSW) as a shared statement of ethical values, augmented by the US National Association of Social Workers (NASW) Code of Ethics. In addition to professional conduct, the IFSW ethical principles highlight: 323

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• •

respecting human rights and human dignity; promoting social justice, through • challenging discrimination and unjust practices, • recognizing diversity, • distributing resources equitably, and • working in solidarity (2012).

Safeguarding human rights is a shared social work principle enshrined in the Universal Declaration of Human Rights (UDHR) and explicitly mentioned in 75% of social work ethical codes examined in one study (Keeney et al., 2014) underscoring their strong correlation with the profession. Social work’s emphasis on the powerful potential in change, on the strengths inherent in each individual and community, and on the benefits of diversity – while acknowledging our own biases and assumptions – makes the study of migration an opportunity to examine our understanding of human dignity as reflected in our treatment of others.

Why should social workers care about migration, and what is our history with migrant populations? The social work profession is rooted in work with immigrant populations. In the United States, this practice emerged through the settlement house movement of the late 19th century, a British model in which students served and advocated for people living in poverty (Fabricant & Fisher, 2013). Social reformers such as Jane Addams and Lillian Wald brought this model to Chicago (Hull House) and New York City (Henry Street Settlement), by which social workers would “settle” in poor and largely immigrant communities, adapting to industrializing urban environments that had few social supports (Stuart, 2013). Since then, social workers have continued to work with migrant populations through both faith-based and secular organizations engaged in refugee resettlement, community development, education, child welfare, health care, etc. Social workers have also conceived of policy remedies for vulnerable populations, such as the creation of Special Immigrant Juvenile Status for abused, abandoned, and neglected undocumented children under juvenile court jurisdiction, when return to their country of origin is against their best interests (Schmidt, 2017). Immigrants have been central to a US identity as a “nation of immigrants,” though this disregards earlier indigenous populations and the forcible migration and trade of enslaved people from Africa. Alternately, immigrants have been a convenient scapegoat, blamed for the ills of society regardless of the accuracy of such attacks (Feldman, 2011). When particular groups are denigrated – such as refugees, immigrants, or particular ethnic/­r acial groups – social workers should challenge such claims, and empower the disparaged. Similarly, social workers should embrace evolving language that humanizes, demonstrates respect, and reflects how people refer to themselves, which may be different from popular or political usage (e.g. a person with “undocumented” or “unauthorized” status, rather than an “illegal alien”). Social work’s professional values include respecting diversity and challenging discrimination, reflecting the priority given to working with and advocating for minority groups in changing societies. The social work profession’s commitment to human rights ensures that work with migrants will continue to be a significant aspect of professional service, as migrating people face human rights abuses before, during, and after the migratory experience. 324

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What are just immigration policies? The presence of newcomer populations can provide economic and cultural opportunities such as revitalizing under-resourced areas; adding cultural, culinary, and linguistic diversity; and expanding the employment base through skilled professionals and entry-level employees. On the other hand, migrant populations can at times unsettle receiving communities and lead to questions about identity, or whether a community’s resources are sufficient for everyone. US immigration policies currently prioritize family reunification, US labor market needs, diverse country of origin representation, and humanitarian concerns (Kandel, 2018), correlating broadly to social work’s concern for the importance of human relationships, an equitable distribution of resources, the value of diversity, and concern for human rights. In considering what are just immigration policies, three principles seem particularly relevant: protection; fairness; and human relationships. Given the social work principles of respecting human rights and promoting social justice, protection holds particular relevance to the treatment of refugees and asylum seekers fleeing various and evolving forms of persecution. The UDHR states that “Everyone has the right to seek and to enjoy in other countries asylum from persecution.” (United Nations General Assembly, 1948, Article 14). This commitment is further enshrined in the 1951 Convention on the Status of Refugees, and the 1967 Protocol Relating to the Status of Refugees, together signed by 148 countries (UNHCR, 2015) and defining refugees as persons outside their country of nationality “owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion” (UNHCR, 2010, p. 14). How we interpret the refugee definition determines the procedures and eligibility for those deserving protection. Social workers should support and advocate for generous treatment toward people seeking refugee protection. Concerns about protection should include the ways in which migrants can be taken advantage of, robbed of dignity, or treated unjustly. Paralleling US mass incarceration generally, and of African Americans in particular, the prolonged detention of immigrants – coupled with private prison corporations’ financial incentives to increase such detentions – raises serious concerns (Ackerman & Furman, 2013). Social workers should be among the professions raising questions of due process, financial conflicts of interest, fair treatment, and alternatives to detention for immigration detainees. Protection concerns also relate to the treatment of vulnerable populations warranting special care, such as children, the elderly, and infirm. In the United States, questions of protection and justice arise regarding the separation of migrant children from their parents, the legal status of young people brought to the United States as children, and a lack of legal representation for children in immigration proceedings. In all of these situations, the vulnerability and developmental needs of children should be prioritized. Though the United States has yet to ratify the Convention on the Rights of the Child (CRC), its distinction as the most ratified treaty in the world arguably gives it the status of customary international law (Sahl & Deane, 2016; United Nations General Assembly, 1989). The scenarios mentioned violate several CRC articles: ignoring the best interests of the child as a primary consideration (­A rticle 3); disregarding that children should not be separated from parents against their will (Article 9); and ignoring a right to “legal help and fair treatment” (Article 40). The UDHR further enshrines the right to seek asylum (Article 14), and freedom from “cruel, inhuman or degrading treatment or punishment” (Article 5). In pursuing fairness, immigration policies should hold to the UDHR foundational principle that “All human beings are born free and equal in dignity and rights” (United Nations General Assembly, 1948, Article 1). This argues against restrictive or exclusionary policies 325

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based on race, religion, nationality, gender, or sexuality. US policies, such as the Chinese Exclusion Act of 1882, and the contemporary Presidential Executive Order 13769, nicknamed the “Muslim Ban” for primarily excluding immigrants from Muslim countries (Federal Register, 2017), each singled out particular groups for differential treatment based on nationality or religion, and should thus be critiqued by social workers for discriminatory treatment. Fairness also argues for mechanisms to achieve stability and permanence, through a reasonable process toward citizenship. Finally, immigration policies necessarily deal with family relationships in determining which relatives may accompany or follow an immigrant or refugee. The IFSW Statement of Ethical Guidelines includes “treating each person as a whole” within families, communities, and societies (2012). The NASW Code of Ethics takes this idea further with the ethical principle to “recognize the central importance of human relationships” (2018). The UDHR refers to the family as “the natural and fundamental group unit of society…entitled to protection by society and the State” (United Nations General Assembly, 1948, Article 16), an idea echoed in the Philippine Association of Social Workers’ (PASWI) Code of Ethics which identifies the “family as the basic unit of society,” vital to “growth and development” (n.d.). Within immigration policies, therefore, mechanisms should exist for refugees and immigrants to migrate or reunite with close family members in their country of reception. Policy definitions of families should consider cultural practices of both the home and host countries as well as family norms for minority groups (cultural, religious, sexual), in order to prevent discriminatory practices.

What role should social workers play in immigration enforcement? Social workers have a duty to both individuals and to the larger society, the latter at times incorporating social control with involuntary clients. With respect to immigration enforcement, social work employment may involve: adjudication of refugee and immigrant status and benefits; monitoring, housing, or detaining people with pending or irregular immigration status; border control mechanisms; refugee or immigrant case management and program administration; etc. The combined duties of caregiver and enforcer have great potential to create ethical conflicts. Derluyn (2018) captures this professional tension in work with unaccompanied children: So, the professionals responsible for the care of unaccompanied minors are representatives of the state, but are simultaneously situated between the state and the child… They have to act in the best interest of the child, but are simultaneously acting as the gatekeepers of the state. (p. 6) As referenced earlier, the United States at times detains asylum seekers and separates migrating children and parents. Social workers might respond by: •

• •

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Working within government systems, while also voicing ethical concerns through appropriate internal channels, and sharing ethical conflicts with professional social work organizations. Working within government or contracted roles, while refusing to carry out policies that violate professional ethical principles. Working for private organizations outside of government, in order to critique, influence, supplement, and provide alternatives to government policies and practices.

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Social workers of goodwill may disagree about appropriate professional roles. Some social workers may engage in advocacy and resist immigration policies that counter social work values. Others may recognize the needs of individual migrants within government and enforcement systems, and the professional contributions that social workers can make to those affected. In addition to policy work, Furman, Sanchez, Ackerman, and Ung (2014) encourage social workers to find ways of infiltrating immigration detention systems, for the good of immigrants within those systems: “Social workers from community agencies should seek to work within the detention centers, as community advocates, or as members of other criminal justice systems to provide case-management services to transmigrants and their families” (p. 816). Cemlyn and Nye (2012) demonstrate that social workers can function within government systems while maintaining social work values, using the example of age assessments for ­a sylum-seeking youth in the United Kingdom. They illustrate that social workers a­ dhering to social work values can remain child-centered, rather than bureaucratic, so that the ­a ssessment is one part of a holistic approach. In short, social work professional values remain paramount and frame the process. These professional values should include the confidential handling of sensitive immigration status information. This ethical question may hinge on whether a particular social worker feels inclined to make a difference inside or outside government systems. Those inside immigration systems may struggle with the appropriate and humane use of power, while those working outside of public immigration systems may struggle with a lack of sufficient power and resources to address visible needs. Ultimately, ethical practitioners are needed in both the public and private immigration spheres.

What type of cultural adaptation should social workers promote? Both the IFSW ethical principles and the NASW Code of Ethics incorporate respect for diversity, with the NASW promoting the expansion of cultural knowledge and competence, safeguarding rights, equity, and social justice for all (Standard 6.04). These contemporary aspirations belie the profession’s earlier involvement in forced cultural assimilation such as removing Native American children from their homes for placement into boarding schools and foster homes (Weaver, 2013). How can the profession apply lessons from this painful past to current work with refugee and immigrant populations? The words we use as professionals may convey our own views and assumptions regarding cultural acclimation, even causing offense to those whose cultural identity is in question. Berry (1997) distinguished between the following terms: • • • •

Integration – biculturalism that combines the host and heritage cultures; Assimilation – adopting the host culture and discarding the heritage culture; Separation – rejection of the host culture and maintenance of the heritage culture; Marginalization – rejection by the host culture and/or the heritage culture.

Additional concepts include: •

Acculturation – changes resulting from contact with culturally dissimilar influences; multidimensional aspects include practices (language, food), values (individualism, ­familism, communalism), and identity, in relation to both the heritage and receiving cultures (Schwartz, Unger, Zamboanga, & Szapocznik, 2010); 327

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Reactive ethnicity – holding strongly to one’s culture in the face of discrimination, while resisting the adoption of the host culture (Rumbaut, 2008); Enculturation – selectively retaining aspects of one’s heritage culture, and selectively adopting elements of the host culture (Schwartz et al., 2010); Cultural maintenance – retaining strong ties to one’s heritage culture.

These varied terms indicate a spectrum of experiences in how humans interweave family and societal cultures, with expectations varying by location and individual. Canadians ­famously view themselves as a mosaic, while those in the United States describe themselves as a melting pot. The mosaic imagery suggests that immigrants maintain something of their original culture, while the melting pot implies that these differences dissolve over time. Segal considers this quandary by asking, “Should the host country accommodate immigrants and refugees, or should immigrants and refugees adapt to the host country?” (2013, p. 16). One’s expectations may depend, in part, on contextual history, with Canada organized around “accommodation” and “possessive individualism” (e.g. French Catholic Quebec joined through war to English Protestant Ontario) compared to the US motto of “e pluribus unum” (“out of many one”) (Matthews, 2017). As another comparison, consider Denmark’s 2018 law, “One Denmark without Parallel Societies: No Ghettos in 2030” (Ngo, 2018), requiring that children over one year of age and from areas classified as “ghettoes” attend daycare centers for instruction on Danish language and culture (Barry, 2018). Danish social workers – working with immigrant clients, in daycare centers, or the policy arena – might question: whether immigrant parents are afforded self-­ determination in deciding whether to participate in such childcare and instruction; whether the law treats immigrant families with respect; whether the law recognizes the strengths of cultures beyond just the dominant one; and whether the law engages in negative discrimination against particular cultural or ethnic groups. Social work professionals, in this and similar situations, may look for approaches that promote self-determination, and respect human dignity and diversity. They may also advocate for policy changes that incorporate these principles, and that recognize the protective benefits for youth of maintaining their heritage culture while also integrating their receiving culture (Telzer, Yuen, Gonzales, & Fuligni, 2016). Other ethical dilemmas involve expectations to speak, read, or write a country’s primary language, and what accommodations are made for those who have not yet developed such skills. Social workers may have opportunities to create learning opportunities for clients, and to advocate for translation and interpretation services that allow equal access to services and benefits. US policy requires that federally funded services provide meaningful access (e.g. interpretation or translation) to persons with limited English proficiency (LEP, 2018); social workers can help to ensure that such policies are followed. Language differences raise the unfortunate but common ethical issue of children used as interpreters for their parents. Though strongly discouraged, due to the boundary-crossing and role reversal created for both child and parent, such practices nonetheless occur in social work and other professions (Marsiglia, Booth, & Baldwin, 2013). Social workers should proactively avoid such occurrences and discourage these practices by others.

How should social workers balance the interests of the native born and the foreign born? In times of scarcity, or conflict, people who have “come from away” may be targeted for exclusion, removal, discrimination, or harsher treatment. They may be made a scapegoat for 328

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society’s problems. In some cases, immigrant populations may be stereotyped or stigmatized in connection to certain crimes or behaviors. What is the role of social workers in these situations? The NASW Code of Ethics (2018) notes: Social workers are cognizant of their dual responsibility to clients and to the broader society. They seek to resolve conflicts between clients’ interests and the broader society’s interests in a socially responsible manner consistent with the values, ethical principles, and ethical standards of the profession. Social workers should be mindful of the needs of both newcomers as well as local populations. In refugee camp contexts, resettlement services, or immigrant assistance, this may mean ensuring that both refugees and native communities have comparable access to resources to prevent a sense of favoritism or inequity. Social work practitioners can use their community organizing and community development skills to prevent or minimize conflicts before they arise, while educators can help social-workers-in-training to examine their own immigration beliefs and biases that may be absorbed from families and society. Social workers can promote equitable treatment within communities, can empower groups toward self-help, and can build bridges between different national and ethnic groups within communities.

Conclusion This discussion of ethical issues in policy and practice with migrant and refugee populations has addressed a few common dilemmas, but not all. In the ethical questions considered here, social workers have resources in their supervisors, colleagues, professional associations, and academic institutions. In addition, migrant and refugee clients, community organizations, and faith groups can be important partners in working toward cultural understanding and respect. Valuing diversity complements the social work profession’s reverence for continued learning about other cultures and ourselves. In working with migrants and refugees, social workers live out our ethical principles of social justice and protection of human rights, just as humans continue migrating as they have for millennia.

References Ackerman, A. R., & Furman, R. (2013). The criminalization of immigration and the privatization of the immigration detention: Implications for justice. Contemporary Justice Review, 16(2), 251–263. Barry, E. (2018, July 1). In Denmark, harsh new laws for immigrant ‘ghettos.’ The New York Times. Retrieved from https://www.nytimes.com/2018/07/01/world/europe/denmark-immigrant-­g hettos. html Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46, 5–34. Cemlyn, S. J. & Nye, M. (2012). Asylum seeker young people: Social work value conflicts in negotiating age assessment in the UK. International Social Work, 55(5), 675–688. Derluyn, I. (2018). A critical analysis of the creation of separated care structures for unaccompanied refugee minors. Children and Youth Services Review, 92, 22–29. Fabricant, M., & Fisher, R. (2013, June). Settlements and neighborhood centers. Encyclopedia of social work online. Federal Register. (2017, January 27). Executive order 13769: Protecting the nation from foreign terrorist entry into the United States, 82 FR 8977. Retrieved from https://www.federalregister.gov/­documents/ 2017/02/01/2017-02281/protecting-the-nation-from-foreign-terrorist-entry-into-the-united-states 329

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Feldman, J. (2011). Manufacturing hysteria: A history of scapegoating, surveillance, and secrecy in modern America. New York: Pantheon Books. Furman, R., Sanchez, M., Ackerman, A., & Ung, T. (2014). The immigration detention center as a transnational problem: Implications for international social work. International Social Work, 58(6), 813–818. Harzig, C., Hoerder, D., & Gabaccia, D. (2009). What is migration history? Cambridge, MA: Polity. International Federation of Social Workers. (2012). Statement of ethical principles. Retrieved from https://www.ifsw.org/statement-of-ethical-principles/ Kandel, W. A. (2018, June 22). A primer on US immigration policy. CRS Report R45020. Retrieved from https://fas.org/sgp/crs/homesec/R45020.pdf Keeney, A. J., Smart, A. M., Richards, R., Harrison, S., Carrillo, M., & Valentine, D. (2014). Human rights and social work codes of ethics: An international analysis. Journal of Social Welfare and Human Rights, 2(2), 1–16. Retrieved from https://jswhr.com/journals/jswhr/Vol_2_No_2_December_2014/1.pdf Limited English Proficiency [LEP]: A Federal Interagency Website. (2018). Executive Order 13166. Retrieved from https://www.lep.gov/13166/eo13166.html Marsiglia, F. F., Booth, J. M. & Baldwin, A. (2013). Individual practice with undocumented immigrants. Encyclopedia of social work online. New York: Oxford University Press. Matthews, R. (2017). Canada and the United States: Alternate realities? The Sociological Quarterly, 58(3), 340–349. National Association of Social Workers. (2018). Code of ethics of the national association of social workers. Retrieved from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-EthicsEnglish National Geographic. (n.d.). Genographic project: Map of human migration. Retrieved from https:// genographic.nationalgeographic.com/human-journey/ Ngo, M. (2018, July 3). “No ghettos in 2030”: Denmark’s controversial plan to get rid of immigrant neighborhoods. Vox Media. Retrieved from https://www.vox.com/world/2018/7/3/17525960/ denmark-children-immigrant-muslim-danish-ghetto Philippine Association of Social Workers Inc. (n.d.). Social workers’ code of ethics. Retrieved from http:// www.paswi-national.org/code-of-ethics/ Rumbaut, R. G. (2008). Reaping what you sow: Immigration, youth, and reactive ethnicity. Applied Developmental Science, 12(2), 108–111. Sahl, S., & Deane, C. (2016). UPDATE: Researching Customary International Law, State Practice and the Pronouncements of States Regarding International Law. Retrieved from http://www.nyulawglobal.org/globalex/Customary_International_Law1.html Schmidt, S. (2017, July). Special immigrant juvenile status. Encyclopedia of social work online. Schwartz, S. J., Unger, J. B., Zamboanga, B. L., & Szapocznik, J. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65(4), 237–251. Segal, U. (2013, June). Immigration policy. Encyclopedia of social work online. Stuart, P. (2013, June 11). Social work profession: History. Encyclopedia of social work online. Telzer, E. H., Yuen, C., Gonzales, N. & Fuligni, A. J. (2016). Filling gaps in the acculturation gap-distress model: Heritage cultural maintenance and adjustment in Mexican–American Families. Journal of Youth and Adolescence, 45(7), 1412–1425. United Nations General Assembly. (1948, December 10). Universal declaration of human rights. Retrieved from http://www.refworld.org/docid/3ae6b3712c.html United Nations General Assembly. (1989, November 20). Convention on the rights of the child. Retrieved from https://www.ohchr.org/en/professionalinterest/pages/crc.aspx United Nations High Commissioner for Refugees. (2010, December). Convention and protocol relating to the status of refugees. Retrieved from http://www.unhcr.org/en-us/3b66c2aa10 United Nations High Commissioner for Refugees. (2015). States parties to the 1951 convention relating to the status of refugees and the 1967 protocol. Retrieved from http://www.unhcr.org/3b73b0d63. pdf United Nations High Commissioner for Refugees. (2017, June 19). Forced displacement worldwide at its highest in decades. Retrieved from http://www.unhcr.org/en-us/news/stories/2017/6/5941561f4/ forced-displacement-worldwide-its-highest-decades.html Weaver, H. N. (2013, June). Native Americans: Overview. Encyclopedia of social work online.

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42 From the Welfare State to welfare markets Organization and management of UK social work/social care Stephanie Petrie

The ethics and values of social work in the United Kingdom have been defined by its changing relationship with the state. A brief overview of the history of social work and its emergence as a profession during the height of the Welfare State will begin this chapter. The impact on social work ethics and values of “markets” in human services; the devolution of Scotland, Wales, and Northern Ireland; and “austerity” policies will follow. In conclusion, it will be argued that the future of social work in the United Kingdom as a profession with distinct ethics and values is in jeopardy.

Social work beginnings and emergence as a profession The 19th-century roots of social work were in Fabian socialism and charitable philanthropy and consequently training, education, and services were piecemeal, uncoordinated, and ­often contradictory. In the 20th century after WWII, the first Labour government created an explicit framework of ethics and values for all human services by establishing the Welfare State. The collective, universal, comprehensive, and equal principles of the Welfare State were enshrined in legislation enacted between 1945 and 1950. The impact of race, gender, sexualities, and ableism as drivers of inequality, however, was not recognized as the primary focus was on material and economic inequalities. When the Conservatives returned to power in 1951 they were also committed to Keynesian full employment and the Welfare State – a postwar consensus in which welfare policies were “beyond” party politics. Within the Welfare State there were three main local authority social work departments with statutory powers and duties: Children’s, Welfare, and Mental Health. There were a­ dditional locations for specialist workers such as Probation Departments and Child ­Guidance Clinics as well as a range of voluntary sector organizations for adults, children, and families. Not all of those employed in these services were called social workers and ­a lthough the values and principles of the Welfare State were common to all human services, qualifications, training, and status varied. The implementation of the recommendations of the Seebohm Report (1968), however, unified the organization and management of social work for the first time and was perhaps the 331

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apotheosis of social work as a distinct profession in the United Kingdom. One department, ­Social Services, was established in each local authority (and swiftly dominated authority budgets) to provide a generic service that was family and community not problem focused. In 1970, the Central Council for the ­Education and Training of Social Work (CCETSW) was established to regulate training and promote good educational practices. Social workers were state or voluntary sector employees with the same qualifying requirements incorporating the same values and ethical standards. ­University-based qualifying programs became the norm.

Introduction of “markets” into human services The postwar economic boom ended in the 1970s and the neoliberal Conservatives, committed to “free” markets and ending state provision, gained power under Margaret Thatcher in 1979 in part due to a sustained economic, political, and moral critique of the Welfare State. The next sea change of social work organization after Seebohm (Barclay, 1982) conceptualized social workers as brokers of services in neighborhoods. Although the report did not envisage welfare “markets” social workers were to be reoriented from solely providing services to organizing and managing services by others in communities. It was legislation in the 1990s that formalized this reorientation into roles prescribed in statute. The National Health Service and Community Care Act 1990 began the transformation of Welfare State services into a framework of welfare “markets.” Local authorities, following on from the marketization of services such as rubbish collection, were now mandated to apply the same approach to services for older adults. Statute required local authorities to enable and regulate provision by others and compete for service contracts in the same way as private and third sector providers. Although the Children Act 1989 did not impose the same market requirements on local authorities as the NHS and CC Act 1990, the political, organizational, and resource context influenced the way in which services for children were delivered through distinct purchasing and providing arms. In some local authorities, social workers investigating child abuse, for example, were organized into purchasing sections whilst fostering and adoption social workers were in providing sections. Short-term planning and frequent changes of worker resulted in the detriment of children (Petrie & Wilson, 1999).

Impact on social work ethics and values Separating the purchase from the provision of services and introducing cost considerations at the individual level during professional assessments of need severed social work from the collective, universal, comprehensive, and equal principles of the Welfare State. Universalism was replaced by “targeting” those most in need but despite the emphasis on user involvement and choice it was argued that the change in nomenclature from “client” to “customer” in policies, legislation, and professional literature was simply tokenistic. Welfare “markets” are not true markets but “quasi-markets” as the service user rarely has purchasing power (Le Grand, 1990). So, from the 1980s, the ethics and values of social work in the United Kingdom have been influenced by the diminution of state involvement in the provision of human services, the increased role of social workers in resource allocation as “care managers” (Postle, 2001), and the conflation of social work and social care. These trends have been evident throughout Conservative, New Labour, Coalition, and Conservative majority and minority governments as the continuation of an explicit political agenda to shrink the role of the state and introduces “free market” principles and values into public sector services. Alongside changes to the role of the state as welfare purchaser rather than provider, policies affecting social work roles, regulation, and deployment became increasingly harnessed to 332

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political agendas. The advent of the New Labour government in 1997 witnessed a strengthened commitment to markets in the public sector and neoliberal economic policies. Their project for welfare, framed within a market paradigm, was the redistribution of opportunity rather than income, sound fiscal policies and tight control of public spending in return for citizen recognition of their moral obligations to society (Burden, Cooper, & Petrie, 2000). The White Paper Modernising Social Services (Department of Health, 1998) identified the primary role of social work as that of reducing “social exclusion” – a term that increasingly replaced “poverty” in policies and guidance. Regulation of social workers was also strengthened, and a register established when in 2001 CCETSW was abolished and replaced by the General Social Care Council (GSCC) in England. For the first-time social work and social care were formally conflated, a combination that does not exist elsewhere in Europe or the United States (GSCC, 2010). Nevertheless, this was an attempt to retain a shared value framework for those involved in marketized social services as the first requirement was to “protect the rights and promote the interests of service users and carers” (GSCC, 2010, p. 5). Conflating social work and social care, however, was also the first step toward undermining social work as a distinct profession. Although recognition of the impact of “difference” on inequalities gained prominence in social work literature and education (Dominelli, 2002) generating new services and approaches, it was suggested social work was already a profession in crisis (Asquith, Clark, & Waterhouse, 2005). Others argued there was a distinct and unique role for social work in the emerging configuration of services (Blewitt, Lewis, & Tunstill, 2007). In 2012, however, social work was further undermined as a distinct profession when the GSCC was replaced by the Health and Care Professions Council (HCPC). Whilst the HCPC did issue social work specific Standards of Proficiency (2017) this body regulates 16 professions from chiropodists, to paramedics as well as social workers. The HCPC standards focus on the social worker as technocrat and although reference is made to professional values these are not specified. The complexity and multiplicity of changes in policies, legislation, professional standards, and regulation have contributed to an ongoing drain of social work expertise and experience from many organizations in England with associated reliance on high-cost agency workers (­Research in Practice, 2015). In 2013, in response to the social work staffing crisis, Michael Gove, then ­Education Secretary, announced a new fast-track intensive five-week social work training program, Frontline, for graduates of nonsocial work degrees. This initiative began in 2014 and is now a registered charity primarily funded by the Department for Education. The independent evaluation of the initial pilot (DfE, 2016) noted the scheme was well-­resourced with a highly effective recruitment campaign aimed at high achieving graduates. Although the evaluation was broadly positive, the researchers stressed that important questions about the long-term impact of the scheme could not be answered. Furthermore “In the context of further investment in Frontline and sector concerns about the funding of mainstream programmes, it would perhaps be understandable if social work educators in England did not rush to embrace Frontline” (p. 11). Schemes such as this are clearly driven by the needs of politicians and employers rather than those recipients of social work services and further changes are now being implemented in England with the Children and Social Work Act 2017. The Act replaces the regulation of social workers by the HCPC with a new arms-length body Social Work England and it remains to be seen whether this will have a positive impact on the recruitment and retention of qualified social workers.

Social work and devolved governments in the United Kingdom It is crucial to consider how the governments of Scotland, Wales, and Northern Ireland, devolved in 1999, have used their powers at subnational level to conceptualize and deploy 333

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social work. The Scottish Social Services Council (SSSC) and the Northern Ireland Social Care Council (NISCC) were both established in 2001 and unlike England continue to date. The Care Council for Wales also established in 2001 acquired additional powers in 2016 and is now Social Care Wales (SCW). In the devolved administrations, the social work profession has had some stability and consistency as in many ways each country retains the ethics and values of the Welfare State. Scotland retains a unified social service with a code of practice for all employers and workers including social workers and the first requirement is “to protect and promote the rights and interests of people who use the service and careers” (SSSC, 2016, p. 7). This mirrors the approach of the GSCC. Since devolution, Wales has moved away from the market model of human services and the principle of cooperation rather than competition is embedded in Welsh Assembly ­policies and legislation. The Code of Professional Practice for Social Care Workers (SCW, 2017a) is the overarching framework and as with Scotland mirrors the GSCC approach. The first requirement is “Respect the views and wishes and promote the rights and interests of individuals and carers” (p. 8). The associated practice guidance for social workers (SCW, 2017b) also begins with that requirement and directs social workers to the definitions of social work by the International Federation of Social Workers and the International Association of Schools of Social Work (p. 8). There is an added duty for social workers in Wales to promote and ensure accessibility of services and information in Welsh. In Northern Ireland, the NISCC’s Standards of Practice and Conduct for Social Workers (2015) begin with the following values, “Respect the rights, dignity and inherent worth of individuals” (p. 4) and there are separate standards for social care workers and students. There are added challenges for social work in Northern Ireland because of the current political barriers to power-sharing. This has meant the Northern Ireland Assembly was suspended in January 2017 and is now governed from Westminster. There are fears that the way the United Kingdom leaves the European Union (Brexit) could trigger conflict again between Loyalists and the IRA if a hard border is imposed between the Republic of Ireland, an EU member, and Northern Ireland. The voting support of the hard-line Democratic Unionist Party of Northern Ireland for the UK Conservative government in return for an additional £1 bill in government aid is also causing tension. Sinn Fein argues the British government has lost credibility as the honest broker embedded in the Good Friday agreement that ended the Troubles in 1998. A final complication is that although all four countries in the United Kingdom have ­established mandatory registers for social workers, each register is separate. This means that a social worker moving from one country in the United Kingdom to another must resubmit required evidence to register in each country – there is no automatic transfer from one register to another.

Impact of austerity policies on social work By the new millennium, the fundamental values of the Welfare State, especially the commitment to universal services, had been superseded by the principle of “targeting” those most in need. Nevertheless, “markets” in human services were well resourced until the global financial crash of 2008. As with many developed countries, this had an enormous impact on the economy and politics in the United Kingdom. The election in 2010 replaced New Labour with a coalition government between the Conservatives and Liberal Democrats. The coalition response to the global crash was to impose “austerity” policies to an extent that was far greater than in any comparable country. Many of the social goods developed during the 334

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early part of the 21st century reduced or diminished as government funding was withdrawn at the same time as poverty increased rapidly under the coalition and subsequent majority and minority Conservative governments across the whole of the United Kingdom (Dorling, 2011; Stuckler & Basu, 2013; Wilkinson & Pickett, 2009). Poverty is still increasing. Figures from the Trussell Trust (2018) who administer food banks across the country reveal that from April 2017 to March 2018, almost one and a half million three-day emergency food parcels were distributed. This was a 13% increase on the previous year that had already increased by 6%. Almost half a million recipients were children. In many families needing food, both parents were in work but received low wages or were in insecure employment. Many others were suffering the consequences of the ­m aladministration of the new comprehensive welfare benefit Universal Credit – universally acknowledged to be fundamentally flawed (Bulman, 2018). Although individual measures, such as a rise in employment, suggest a diminution in poverty, analysis of combined data by the Institute for Fiscal Studies (2018) reveals a much bleaker picture. Absolute child poverty stands at 26% double that of pensioners at 13% (p. 57). Income inequality is substantially higher than in the 1960s and is comparable to the 1990s. In fact, although income inequality remained roughly unchanged between 1961 and 1980, it increased sharply in the 1980s and remained unchanged for the last 25 years apart from minor fluctuations (IFS, 2018, p. 30). The Office for Budget Responsibility’s forecast is that income inequality is likely to further increase in the next few years (IFS, 2018, p. 20). Those aged between 25 and 54 years with long-standing ill-health have been particularly impoverished. They are 70% more likely to be in persistent poverty and together with higher living costs means they are twice as likely to be in material deprivation (IFS, 2018, p. 78). ­Indeed, the UN Committee on Rights of Persons with Disabilities in 2017 called the situation a human catastrophe (Kentish, 2017) and the entire report was highly critical of the current welfare and benefit system in the United Kingdom (UNCRPD, 2017).

Future for social work in the United Kingdom There is no substitute for human judgment in complex human situations. Such judgments take place in the interface between the citizen and the state and are influenced by the social attitudes of the time. Seebohm (1968) established social work at the interface between the citizen and the liberal state. The question now is whether social work has become the handmaiden of harm in the interface between citizens and an illiberal state. “Austerity” can be understood as a political choice designed to further shrink the state and finally end collective, universal, comprehensive, and equal benefits. The National Health Service, acknowledged as one of the major achievements of the Welfare State, is on the point of collapse (Unison, 2018) and may be completely outsourced to US health care companies because of Brexit. For the first time in many decades, the two main political parties in the United Kingdom proposed distinct policy programs. The Conservatives, in government from 2010 initially in coalition and latterly as a minority, adhered to neoliberal deregulation of markets and cuts in public sector funding. Labour, on the other hand, have moved away from New Labour’s policies and propose increased state expenditure to boost the economy and tighter regulation of financial markets. Whichever political project gains dominance it is unlikely that social work will return to the level of professional coherence and shared ethics and values evident in the past. The fragmentation and separation of the organization and management of services for adults and children inevitably mean that unified social work will not return, at least in England. The multiplicity of roles, conflation with social care, variety of training 335

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routes, instrumental regulation, and increased political control have combined to undermine social work as a distinct profession. Although the International Federation of Social ­Workers (IFSW, 2014), the International Association of Schools of Social Work (IASSW, 2014), and the British Association of Social Workers (BASW, 2014) definitions and codes of ethics include the promotion of social justice and human rights as a key characteristic, social work simply reflects the values of the society in which it takes place. In 1942, for example, social workers in Vichy France worked in the Vel’d’Hiv transition camp for Jewish adults and ­children awaiting deportation (Munday, 2015). In South Africa from the beginnings of social work until the democratic election of 1994, all professional education, practices, and services took place within the apartheid system and policies (Smith, 2014). The United Kingdom, like many countries in contemporary times, is facing increasing economic inequalities, entrenched institutional racism, and public hostility to immigrants and asylum seekers fanned by media and political propaganda. Poverty in some parts of the United Kingdom has returned to 19th-century levels (Thane, 2018), and the fragmentation of social work services in the United Kingdom also reflects the situation in the early 19th ­century outlined at the beginning of the chapter. There is no unifying professional framework of ethics and values; social work and social care are commonly conflated; qualifying programs are beginning to diverge in content and approach; registration is country not ­profession specific; and the consequences of political decisions to reduce health and welfare provision have created enormous and increasing hardship. Retaining a coherent professional identity that incorporates the ethics and values of the IFSW, IASSW, and BASW suggests active opposition to harmful political projects is required. The fragmentation and de-­ professionalization of social work in the United Kingdom ensure this is unlikely to happen.

References Asquith, S., Clark, C., & Waterhouse, L. (2005). The role of the social worker in the 21st century – a literature review. Edinburgh: Scottish Executive Education Department. Retrieved July 23, 2018, from http://www.gov.scot/Publications/2005/12/1994633/46334 Barclay, P. (1982). Social workers: Their role and tasks (the Barclay Report). London: Bedford Square Press. Blewitt, J., Lewis, J., & Tunstill, J. (2007). The changing roles and tasks of social workers a literature informed discussion paper. Retrieved July 23, 2018, from https://www.researchgate.net/publication/ 237834709_The_Changing_Roles_and_Tasks_of_Social_Work_A_Literature_Informed_Discussion_Paper British Association of Social Workers. (2014). Code of ethics for social work. Retrieved July 23, 2018, from https://www.basw.co.uk/about-basw/code-ethics Bulman, M. (2018, July 9). Ministers urged to overhaul ‘fundamentally flawed’ universal credit as tenants accrue millions in debt. Independent. Retrieved July 16, 2018, from https://www.independent. co.uk/news/uk/home-news/universal-credit-debt-millions-fundamentally-flawed-dwp-housingfederation-a8438961.html Burden, T., Cooper, C., & Petrie, S. (2000). ‘Modernising’ social policy: Unravelling new labour’s welfare reforms. Aldershot: Ashgate. Department for Education (Df E). (2016). Independent evaluation of Frontline pilot research report. Retrieved July 11, 2018, from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/560885/Evaluation_of_Frontline_pilot.pdf Department of Health. (1998). Modernising social services. Retrieved July 11, 2018, from http://web archive.nationalarchives.gov.uk/+/http://w w w.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_4081593 Dominelli, L. (2002). Anti-oppressive social work theory and practice. Basingstoke: Palgrave Macmillan. Dorling, D. (2011). Injustice why social inequality persists. Bristol: The Policy Press. General Social Care Council. (2010). Codes of practice for social care workers. London: GSCC. 336

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Health and Care Professional Council Standards of proficiency. (2017). Social workers in England. Retrieved July 12, 2018, from file:///C:/Users/steph/Documents/articles/JSWVE/10003B08Standardsofproficiency-SocialworkersinEngland.pdf Institute for Fiscal Studies. (2018). Living standards, poverty and inequality in the UK: 2018. Retrieved July 11, 2018, from https://www.ifs.org.uk/uploads/R145%20for%20web.pdf International Association of Schools of Social Work. (2014). Global definition of social work. Retrieved July 23, 2018, from https://www.iassw-aiets.org/global-definition-of-social-work-review-of-theglobal-definition/ International of Federation of Social Workers. (2014). Global definition of the social work profession. Retrieved July 23, 2018, from https://www.ifsw.org/what-is-social-work/global-definition-of-social-work/ Kentish, B. (2017, August 25). Government cuts have caused ‘human catastrophe’ for disabled, UN committee says. Independent. Le Grand, J. (1990). Quasi-markets and social policy. Studies in Decentralization and Quasi-Markets, 1. Bristol: SAUS. Munday, Alice H. (2015). Remembering French collaboration and resistance during Vichy France during the Vel d’Hiv roundup. Grand Valley Journal of History, 4(1), Article 1. Northern Ireland Social Care Council. (2015). Standards of practice and conduct for social workers. Retrieved July 23, 2018, from https://niscc.info/storage/resources/web_optimised_91740_niscc_ standards_of_conduct_and_practice_bluepurple.pdf Petrie, S., & Wilson, K. (1999). Towards the disintegration of child welfare services. Social Policy and Administration, 33(2), 181–196. Postle, K. (2001). The social work side is disappearing. I guess it started with us being called care managers. Practice, 13(1), 13–26. Research in Practice, Strategic Briefing, Dartington Hall Trust. (2015). Social work recruitment and retention. Retrieved July 12, 2018, from https://www.rip.org.uk/resources/publications/strategic-briefings/ social-work-recruitment-and-retention-strategic-briefing-open-access-download-2015/ Scottish Social Services Council. (2016). Codes of practice for social services workers and employers. Retrieved July 15, 2018, from http://www.sssc.uk.com/about-the-sssc/codes-of-practice/ what-are-the-codes-of-practice Seebohm, F. (1968). Report of the committee on local authority and allied personal. Social Services (the Seebohm Report). London: HMSO. Smith, L. (2014). Historiography of South African social work: Challenging dominant discourses. Social Work, 50(2), 305–331. Social Care Wales. (2017a). Code of professional practice for social care workers. Retrieved July 23, 2018, from https://socialcare.wales/cms_assets/file-uploads/Code-Print-Friendly-English.pdf Social Care Wales. (2017b). Practice guidance for social workers registered with Social Care Wales. Retrieved July 23, 2018, from https://socialcare.wales/cms_assets/file-uploads/The-social-workerApril-2017.pdf Stuckler, D., & Basu, S. (2013). The body economic why austerity kills. London: Allen Lane. Thane, P. (2018). Divided kingdom: A history of Britain 1900 to the present. Cambridge: University Press. Trussell Trust. (2018). End of year stats. Retrieved July 16, 2018, from https://www.trusselltrust.org/ news-and-blog/latest-stats/end-year-stats/ UN Committee on Rights of Persons with Disabilities ‘Concluding observations on the initial report of the United Kingdom of Great Britain and Northern Ireland’. (2017, October 3). Retrieved July 16, 2018, from http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhspCUnZhK1jU66f LQ JyHIkqMIT3RDaLiqzhH8tVNxhro6S657eVNwuqlzu0xvsQUehREyYEQD%2BldQaLP31QDpRcmG35KYFtgGyAN%2BaB7cyky7 Unison. (2018). The NHS crisis in five charts. Retrieved July 23, 2018, from https://www.unison.org. uk/news/ps-data/2018/01/nhs-crisis-five-charts/ Wilkinson, R., & Pickett, K. (2009). The spirit level why equality is better for everyone. London: Penguin.

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43 Trading the hard road Social work ethics and the politicization of food distribution in Zimbabwe Edmos Mthethwa

The social work profession is predicated upon social justice and equality. Such an affirmation depends upon ethical conduct on the part of professional social workers. However, ethical dilemmas do arise that tend to compromise the social workers’ ability to competently discharge their mandate to the poor and most vulnerable in society. This chapter examines the dilemmas encountered by social workers practicing in politically restive environments. The chapter begins by discussing social work ethics together with ethical dilemmas. This is then followed by an examination of the politics of food relief and distribution in Zimbabwe. Last but not least, the chapter ends with recommendations meant to ameliorate the situation.

Background Zimbabwe is a landlocked country in southern Africa. She is a member of various international bodies including the United Nations, the African Union, as well as the Southern African Development Community. As such, the country is a signatory to a number of international conventions and protocols that uphold human rights, good government, and the rule of law. However, in spite of all these international conventions and legal instruments, the ­political context of Zimbabwe, largely borne out of stiff political contestation ushered in by the birth of a strong opposition party (the Movement for Democratic Change) at the dawn of the ­m illennium, has seen the ruling party (the Zimbabwe African Union Patriotic Front ­(­Z ANU PF) maintaining its grip on power, supposedly in violation of international human rights conventions. The recurrent natural disasters including droughts and floods coupled with economic turmoil that has seen Zimbabwe abandoning its own currency by the close of 2008 increased the vulnerability of the general population, particularly those living in rural areas whose livelihood sources are largely agrarian. Such levels of vulnerability provided fertile grounds for the politicization of food aid, particularly by government, which enjoyed monopoly over maize grain in times of scarcity. At the center of food distribution are social workers employed by the state’s department of social welfare. The department of social welfare is mandated to oversee the implementation of drought mitigation schemes, of course in liaison with other stakeholders, such as 338

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politicians that include members of parliament and ward councillors. It is within this context that this chapter examines the ethical dilemmas confronting state employed social workers.

Values and ethics in social work The term ethics has been defined in different ways by different scholars. The difference largely stems from divergent uses to which ethics are put and/or implemented. Within the context of governance and public administration, Menzel (2010) understands ethics to mean the internal rules that drive one to follow or not to follow external rules. In other words, ethics are viewed as the values and principles that guide right and wrong behavior. The word ethics has its origins in the Greek term ethos which means custom, habit, or character (Dolgoff, Harrington, & Loewenberg, 2012). Generally, the term has come to describe the extent to which any professional behavior is morally correct and with how things ought to be. Correspondingly, Barsky (2010) observes that, “Ethics refer to the rules that define what types of behaviour are appropriate and what types of behavior are inappropriate” (p. 2). For social work, professional ethics translate to clarifying critical aspects of professional practice (Robison & Reeser, 2010). Similarly, professional ethics in social work are intended to help social work practitioners recognize morally correct practices and learn how to decide and act ethically in any professional situation (Dolgoff et al., 2012). In the same spirit, it is worth acknowledging from the onset that ethics have always been discussed within the context of values. It is, therefore, common practice for social work literature to speak of values and ethics of social work (see Barsky, 2010; Robison & Reeser, 2010; Wilson et al., 2008). Loosely defined, values simply reflect a priority of preferences (Barsky, 2010). Whereas values identify a person’s sense of “what is good,” ethics identify a person’s sense of “what is right” (Dolgoff et al., 2012). Values therefore represent priorities or ideals, whereas ethics are rules of behavior that should be based on these priorities or ideals. “In essence, ethics are the application of values to human relationships and transactions” (Levy, 1993, p. 1). Usually, values and principles are defined differently by different professions. Nevertheless, values represent professional aspirations toward which each and every profession pins its hopes and desires. The following ethical principles have tended to guide social work practice the world over, although their application has had some contextual variations: • • • • • •

service social justice dignity and worth of the person importance of human relationships integrity competence (Wilson, Ruch, Lymbery, & Cooper, 2008).

For these values to gain traction, they have to be based upon certain principles. Social work literature and practice have tended to depend on Biestek’s (1957) principles of casework. These are acceptance, client self-determination, nonjudgmental attitude, controlled emotional involvement, confidentiality, purposeful expression of feelings, as well as individualization. These are succinctly described as principles that have a moral dimension but which are formulated specifically for a particular form of practice – that of individual casework relationships (Banks, 2010; Hugman, 2008). 339

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It is however worth of note that a discussion of values and ethics is outside the scope of this chapter. Suffice it to say that such values and ethics have suffered repeated breaches, particularly from those social workers working for the state who find themselves torn between adhering to professional commitments at the same time seeking to abide by the practice directives of their principles.

Contextualizing Zimbabwe’s crisis Since Zimbabwe’s independence in 1980, the ruling ZANU PF government has used its anticolonial legacy and its role in the war of liberation to build a nationalist platform with a stated commitment to rectify colonial injustices – a theme that garners support from many leaders in developing countries and Zimbabwe’s rural populace (United States Institute of Peace, 2003). ZANU PF has relied on the use of violence and coercive tactics to consolidate and maintain its power for more than two decades. The primary opposition party following independence, the Zimbabwe African People’s Union was coercively merged into ZANU PF in 1987 (United States Institute of Peace, 2003). A new rise of opposition politics in the late 1990s through the civic-born Movement for Democratic Change (MDC) posed the first serious challenge to the ZANU PF government. The rise of an effective political opposition – the MDC – caused considerable political discomfort to ZANU PF (Bratton & Masunungure, 2008). The labor-led MDC was the first opposition party to challenge ZANU PF’s domination of postcolonial politics in Zimbabwe (Raftopoulos, 2000; Raftopoulos & Phimister, 2004). The rise of the MDC was in part a response to ZANU PF’s policy reforms (Chinyoka, 2017). In the June 2000 parliamentary elections, the MDC won almost half the contested seats, prompting a strong repressive backlash toward the opposition and its supporters. The land occupations and farm takeovers, coupled with the governments fast-track land reform exercise, were premised on the widely agreed need for land reform to address a profoundly disproportionate colonial land tenure system. Although violence and chaos accompanied the process, there appears a widespread societal consensus that this process is largely irreversible. At the same time, there is a strong sentiment that the corruption associated with politicians and their supporters acquiring vast amounts of prime land must be rectified (United States Institute of Peace, 2003). ZANU PF was declared the winner of the March 2002 presidential elections in the face of widespread condemnation by both national and international election observers who hastily declared the plebiscite as neither free nor fair (Raftopoulos & Savage, 2004). The opposition MDC contested the election results in court. Pursuant to that, various international actors including the European Union, the United States, and the United Kingdom swiftly imposed targeted travel restrictions against the then president of Zimbabwe and his inner circle (see ­Besada, 2011). What was widely perceived as the bread basket of Africa turned into a basket case of the world, suffering from the highest rates of inflation, the fastest decline in GDP, and a rapidly increasing number of people dependent on food handouts (The Adam Smith Institute, 2007). As Munemo (2012) explains: “Mugabe’s adoption of drought relief programmes reflected his own political strength or weakness, shifting as his standing changed.” When Mugabe and his ZANU PF party “faced insecure political environment […] they responded to droughts by adopting food aid programmes for adults;” when they were more secure, “drought-relief programmes for adults shifted away from free food aid to cost-effective programmes that avoided dependency and limited waste, such as food for work” (p. 88). This state of affairs has left Zimbabwe as an over politicized state (Sangmpam, 2007). 340

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Divided loyalty: social work and partisan politics The earlier presentation has revealed a knit relationship between the social worker as a professional striving to save vulnerable clients and the political party pursuing partisan goals. The question then remains, what then should the social worker espouse under the circumstances? The answer is simple; first and foremost, social workers in Zimbabwe are employed largely on merit rather than on political cleavages. In practice, however, the civil service in Zimbabwe, like most in Africa, has been seen as a means to reward political supporters with government jobs. Arguably, appointment beyond the entry level is, under the circumstance, likely to be pinned on loyalty and partisan alignment (Peters, 2001). This is justified largely on the need for national unity and mobilization in the face of the difficulties of development. In such situations, loyalty to the nation – or more exactly to the current regime – is considered more important than the possession of certain scores on objective tests or the possession of requisite professional qualifications (Peters, 2001). The late president of Ghana and chief architect of Africa’s liberation Kwame Nkrumah is reported to have thrown his weight behind the politicization of the civil service. According to Peters (2001), Nkurumah remarked thus: “it is our intention to tighten up the regulations and to wipe out the disloyal elements of the civil service, even if by so doing we suffer some temporary dislocation of the service.” For disloyal civil servants are no better than saboteurs (p. 209). This line of thinking cascaded to Zimbabwe at independence in 1980, with the ruling party rolling out a well calculated programe of replacing colonial civil servants with new loyal cadres with the required history and ethos of the revolution (Fisher, 2010). In a bid to increase loyalty to the party, the government proposed the introduction of party loyalty tests for civil servants between 2002 and 2003. Both current and prospective government employees were mandated to pass that test in order to be accommodated within the civil service (Machipisa reporting for the British Broadcasting Corporation, November 22, 2002). Justifying this practice, the then secretary of the Public Service Commission (now Civil Service Commission) doctor Ray Ndhlukula categorically pronounced thus; “civil servants need to be more ‘patriotic,’ committed to the ruling Zanu-PF party and government” (British Broadcasting Corporation, November 22, 2002). The earlier imperatives should focus social workers toward the fact that the values of social work do not exist in isolation from the societies and cultures in which they are practiced, nor from the employing organizations, practitioners, and service users involved (Banks, 2010). It is in this context that social workers, particularly those serving in the department of social welfare, should be analyzed.

Presentation of case examples As indicated previously, the civil service in budding democracies remains heavily patronized, with party politics determining appointments as well as career progression. Consequently, the Western assumptions of a nonpartisan merit appointment are simply not feasible as criteria for evaluating the recruitment and executive actions of social workers in the civil service (Peters, 2001). Historically, food distribution has either been disrupted or hijacked by politicians during election campaigns. Food distribution is a mandate of the government’s department of social welfare. This department remains the main employer of social workers in Zimbabwe (Wyatt, Mupedziswa, & Rayment, 2010). Contrary to ethical stipulations guiding social work training and practice, social 341

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workers employed under the department of social welfare have continued to allow the use of food aid as a political weapon against political opponents by the ruling party. According to Amnesty International (2013), the ZANU PF government has heavily relied on food distribution as a weapon against perceived opponents, particularly in the rural areas (United States Institute of Peace, 2003). The ZANU PF government has always favored in-kind social transfers to direct cash, particularly agricultural inputs and food aid, which allowed it to reward its voters and sanction opposition supporters (Chinyoka, 2017). Chronicling the extent to which food aid is politicized in Zimbabwe, the Zimbabwe Human Rights NGO Forum (2016a) indicated that on 10 February, two brothers were assaulted and arrested at a food distribution point in Muzarabani, Mashonaland Central. The arrest and assault took place following the victim’s enquiry as to why they were ­excluded from receiving maize provided by the department of social welfare. The two were taken to Court and remanded out of custody (Zimbabwe Human Rights NGO Forum, 2016a). The same organization interviewed four victims of food deprivation and political ­v iolence. This time food aid and monetary cash benefits were being distributed by an international ­humanitarian organization using social workers as the core of its staff. The four victims all from Bikita East wards 20, 24, and 25 were denied wheat, maize, and money ($6 per child for basic commodities) that were distributed to vulnerable villagers by a humanitarian ­organization on the basis of being MDC supporters. This food and cash deprivation was ­conducted at the behest of ZANU PF Councillors who did the distribution on January 23 and February 23, 2016 (Zimbabwe Human Rights NGO Forum, 2016a). Similarly, on 15 January, at Kufakwatenzi primary school ward 33 Buhera south, the local member of parliament convened a meeting with a ZANU PF shadow Councillor, a soldier and also a ZANU PF activist where she instructed Councillor Njobo to scrap the old ­register of people receiving food aid and only write down names of people who support ­Z ANU PF (Zimbabwe Human Rights NGO Forum, 2016a). On January 16, in Buhera South Ward 24, another member of parliament hijacked the distribution of maize meant for vulnerable families in Birchenough Bridge Ward 33 under the social welfare food aid program. The MP used party structures to mobilize for the meeting where the social workers’ registers were discarded and new ones drawn up by and for ZANU-PF party supporters. Similarly, on ­January 13, in Mbire in Ward 17, a meeting took place at Majongwe primary school, where a ZANU PF Councillor summoned traditional leaders in the area and instructed them to deny food aid to anyone who did not support the ruling party. Correspondingly, Heal Zimbabwe (2016) reported the exclusion of known opposition supporters and the partisan inclusion of ZANU PF party loyalists in the distribution of ­government food aid and farming inputs. Individuals believed to have refused “assisted ­voting” – where voters are coerced to feign illiteracy and choose ZANU PF election agents to write voting preferences on ballot papers on their behalf – during elections are accused of supporting the political opposition and are denied the inputs. At some distribution points, MDC supporters are allegedly asked to surrender party membership cards and regalia in ­order to receive the inputs (Heal Zimbabwe, 2016). ZANU PF usually favored food aid and farming inputs instead of direct cash. According to the United States Institute of Peace (2003), ZANU PF strategy was to disregard the urban vote in favor of the rural constituency. This ultimately translated into the development of social welfare programs that largely benefit the rural population, from whom the ruling party drew its support (Britz & Tshuma, 2013). 342

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During the 2000–2008 economic crisis, for example, “Agricultural inputs and maize intended for food relief were sold by [ZANU-PF] party functionaries or were awarded to card-carrying acolytes of ZANU-PF, while these supplies were withheld from persons suspected of opposition sympathies” (Bratton, 2014, p. 86). Similarly, Chinyoka (2017) acknowledges a political bias in the distribution of food had continued well after the general election in March 2008. The article reported a senior member of Zimbabwe’s Grain Marketing Board (anonymously) admitting that “… right down to the district level, food distributions, the only source of maize, had been run by the army, the Central Intelligence Organization, the police and the district administrator.” It was more like a campaign tool. Those who were actually supporting the opposition were getting nothing because the CIO wanted to give the grain directly to their supporters. On March 10, 2016, at Deve Business Centre, Ward 24, ZANU PF Councillor ordered the distribution of maize and openly declared that only those villagers who supported ZANU PF particularly during the previous by-elections would receive the maize. The councillor then directed both welfare officers and traditional leaders present that only ZANU PF supporters would receive the maize. He threatened villagers that those who remain defiant by continuing to support other political parties would starve (Zimbabwe Human Rights NGO Forum, 2016b). The distribution of food aid continued to be politicized, selective, and discriminatory. While the government has persistently denied partisan distribution of food, an investigation conducted by the Zimbabwe Human Rights Commission (ZHRC) between May and August 2016 revealed evidence of partisan distribution of food by District Administrators, village heads, headmen, and village secretaries in Bikita East, Mazowe Central, Muzarabani North and South, and Buhera North. The investigations also unearthed unbridled maladministration on the part of District Administrators in contravention of SI 1/2000, which requires public officials to be apolitical. Ruling party members were the major perpetrators of violations in food distribution and in areas such as Bikita East and Mazowe Central constituencies, ZANU PF youths who are not even part of the distribution committees were involved in the distribution of food aid and agricultural inputs (Chinyoka, 2017). During the months of July and August, Heal Zimbabwe recorded a total of 91 cases of ­unfair food aid distribution. Although partisan distribution of food was recorded in most parts of the country, the most affected provinces were Masvingo, Mashonaland, Manicaland, and Mashonaland East. These violations were committed through issuance of politically ­motivated threats during food aid distribution (20), corruption during food distribution (11), and discrimination on the basis of political affiliation (37) or based on food for work activities (23). On the heels of such blatant violations of human rights, the role of social workers in protecting and promoting the underprivileged in society remains subdued. It is worth ­emphasizing that social workers are called upon to pursue social change with and on behalf of vulnerable and oppressed individuals, groups, and communities (Bisman, 2004). Unfortunately, their presence and somewhat active participation in food assistance programs put them on the limelight as accomplices in these violations. This has even dislodged them from their position of human rights defenders (Mtetwa & Muchacha, 2013).

Implications for social work practice It is here contended that under normal circumstances, social workers have to rise above the waters of political oppression, partisan alignment, and systematic unethical disregard of human rights. Professional ethics and values remain paramount to practitioners. As such, they 343

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are judged not according to political and economic vicissitudes that define their practice context but according to internationally acclaimed ethical standards and values (Gaine, 2010). A historic and defining feature of social work is the profession’s focus on individual well-being in a social context. Evidently, the earlier presentation has shown that there are many paths and pitfalls that can ensnare even the most ethically well-intentioned person. A kaleidoscope of rules, regulations, and laws certainly help individuals stay on an ethical path, but no matter how complex an organizational situation might be, it is up to the individual to exercise his moral agency (Menzel, 2010). That is why ethical reasoning is so important. For without the ability to reason through a situation, one is largely left to the moral agency of the organization to determine “right” from “wrong.” And, when taken to the dark side of organizational life, the individual’s moral agency might be stripped away entirely. “What’s good for the organization is good for me” (Menzel, 2010, p. 10). Social workers are not technicians who specialize in fixing things; rather, they are active moral agents charged with the duty of pursuing the social good. As such, when professionals fail to recognize or respond to value conflicts, when they violate their own ethical standards, fall short of self-created expectations for expert performance, or seem blind to public problems they have helped to create, they are increasingly subject to expressions of disapproval and dissatisfaction (Walsh, 2010). It is, however, here argued that the social worker should avoid taking advantage of the vulnerability of clients to pursue his personal self-interests or the interests of his agency. In the case of Zimbabwe, the political directives to treat clients unfairly therefore should be met with a sound professional judgment informed by ethical virtues espoused through remarkable and respectable personal conduct. It is important to recognize that ethical practice is not only the obligation of each individual social worker but also the responsibility of the employing organization and of the profession, as well as a societal phenomenon and responsibility. This chapter argues that what should primarily guide social workers is what Heinze and Steele (2009) referred to as the feminist ethic of care. According to Heinze and Steele (2009), the feminist ethic of care is premised on equity, accommodation of subjectivity and difference, and prioritization of the political margins (Heinze & Steele, 2009). This “ethic” of care, though not widely discussed this way in social work literature, should guide social work practice in politically restive environments. Admittedly, this suggestion is not new to social work theory and practice, with the very origins of social work being traceable to the works of charity and compassion. More so, the definition of social work emphasizes tolerance of diversity. Last but not least, suffice it to say that social workers operating in politically unstable environments require extra support from their professional associations and regulatory authorities such as social workers’ councils in the case of Zimbabwe. Such associations should define ethical standards, stand up to defend and protect practitioners in the event of political manipulation, and offer professional guidance accordingly. Although ethical conduct is intentional behavior for which each individual bears responsibility, the professional association and the regulatory authority must also encourage ethical behavior. In this light, the dilemma stems from the fact that the National Association of Social ­Workers together with the Council for Social Workers have remained aloof when it comes to advocating for and enforcing sound ethical behavior on the part of social workers under their jurisdiction. 344

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Conclusion In conclusion, ethical conduct has always been an integral aspect of social work practice ever since the days of the Charity Organisation Society. However, the proliferation of the profession across the world has put it under immense pressure when it comes to adhering to ethics. This is so particularly in budding democracies such as Zimbabwe where political patronage couched in the manipulation of people’s vulnerability to score cheap political goals by the ruling elite. What remains is for social workers to face up to the seemingly insurmountable task of fending off this pressure and rise above the waters of professional malpractice. Admittedly, social workers need strong professional institutions that spell out ethical standards of practice so that employers and practitioners stay clear about the expected professional conduct with clients.

References Amnesty International. (2013). “Walk the Talk” Zimbabwe must respect human rights and protect fundamental freedoms during the 2013 harmonized elections. L ondon: Amnesty International Publications. Banks, S. (2010). The social work value base: Human rights and social justice in talk and action. In A. Barnard, N. Horner, & J. Wild (Eds.), The value base of social work and social care (pp. 25–39). London: McGraw-Hall. Barsky, A. E. (2010). Ethics and values in social work: An integrated approach for a comprehensive curriculum. London: Oxford University Press. Besada, H. (2011). Zimbabwe: Picking up the pieces. London: Palgrave Macmillan Press. Biestek, F. P. (1957). The Casework Relationship. Chicago: Loyola University Press Ltd. Bisman, C. (2004). Social work values: The moral core of the profession. The British Journal of Social Work, 34(1), 109–123. Bratton, M. (2014). Power politics in Zimbabwe. Boulder, CO: Lynne Rienner Publishers. Bratton, M. & Masunungure, E. (2008). Zimbabwe’s long agony. Journal of Democracy, 19(4), 41–55. Britz, A. C., & Tshuma, J. (2013). Heroes fall, oppressors rise: Democratic decay and authoritarianism in Zimbabwe. Chinyoka, I. (2017). Poverty, changing political regimes and social cash transfers in Zimbabwe, 1980–2016. Helsinci: United Nations University World Institute for Development Economic Research (UNU-WIDER). Dolgoff, R., Harrington, D., & Loewenberg, F. M. (2012). Ethical decision making for social work practice. Belmont, CA: Cengage Learning. Fisher J. L. (2010). Pioneers, Settlers, Alliens, Exiles: The Decolonisation of White Identity in Zimbabwe. Canberra: The Australian National University Press. Gaine, C. (2010). Equality and diversity in social work practice. London: Learning Matters. Heal Zimbabwe. (2016). Human rights violations report for January to March 2016. Retrieved from http://www.healzimbabwetrust.org Heinze, E. & Steele, B. J. (2009). Ethics, authority and war. Non-state actors and the just war. London: Palgrave Macmillan. Hugman, R. (2008). Ethics in a world of difference. Ethics and Social Welfare, 2(2), 118–132. Levy, C. S. (1993). Social work ethics on the line. New York: Haworth. Machipisa, L. (2002, November 22). Party tests for Zimbabwe civil servants. Retrieved from http://news. bbc.co.uk/2/hi/africa/2504359.stm Menzel, D. C. (2010). Ethics moments in government. Cases and controversies. London: CRC Press, Taylor and Francis. Mtetwa E. & Muchacha M. (2013). The price of professional silence: Social work and human rights in Zimbabwe. African Journal of Social Work, 3 (1) 19–43. Munemo, N. (2012). Domestic Politics and Drought Relief in Africa: Explaining Choices. First Forum Press. Peters, B. G. (2001). The politics of bureaucracy: London: Longman. Raftopoulos, B. (2000). The Labour Movement and the Emergency of Opposition Politics in Zimbabwe, Labour, Capital and Society. 33 (2), 256–286. Raftopoulos B. & Phimister I. (2004). ‘Zimbabwe Now: The Political Economy of Crisis and Coercion’, Historical Materialism, 12(4) 355–382. 345

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Raftopoulos B. & Savage T. (2004). Zimbabwe: Injustice and Political Reconciliation. Cape Town: The Institute for Justice and Reconciliation. Robison W. & Reeser L. C. (2002). Ethical decision-making in social work. London: Allyn and Bacon. Sangmpam, S. N. (2007). Comparing apples and mangoes: The over-politicised state in developing countries. New York: State University of New York Press. The Adam Smith Institute. (2007). 100 Days. An Agenda for government and donors in a new Zimbabwe. A paper from Adam Smith Institute International’s Fragile States and Post Conflict Series. Adam Smith International. Retrieved from https://sarpn.org/documents/d0002817 The United States Institute of Peace. (2003). Zimbabwe and the prospects for nonviolent political change: Special report 109, August 2003. Washington, DC: United States Institute of Peace Publications. Walsh, T., (2010) Solution-focused Helper: Ethics and Practice in Health and Social Care. McGraw-Hill ­Education (UK). Wilson, K., Ruch, G., Lymbery, M., & Cooper, A. (2008). Social work: An introduction to contemporary practise. London: Pearson. Wyatt, A., Mupedziswa R., & Rayment, C. (2010). Institutional capacity assessment: Department of social services, Ministry of Labour and Social Services Final Report. Harare: United Nations Children’s Fund. Zimbabwe Human Rights NGO Forum. (2016a). Quarterly political and human rights violations report. January–March. Zimbabwe Human Rights NGO Forum. (2016b). A report by the Zimbabwe Human Rights NGO Forum: April.

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44 The ethics of social work and its professionalization The Italian case Carlo Soregotti and Annamaria Campanini

The beginning of social work in Italy and its main ethical issues We all know the destruction brought by WWII all over Europe. Italy was all but saved from it. Despite that, we should acknowledge that from the ashes of a devastated country, something new, something important, was being prepared, even years before the end of the fascist regime (De Rita, 2011). The situation of the country was harsh, both economically and socially. Cities all over the peninsula had been bombed, many families were slain, the political parties that fought together against fascists and Nazis within the National Liberation Committee supported contrasting ideologies – Catholics, Communists, liberals, and socialists. The country was in need of assistance (Bistarelli, 2011) and a new Constitution, a Republican one, in line with what indicated by the scarce majority of the voters in the referendum. In order to do that, the elected Constituent Assembly worked from June 25, 1946 to January 31, 1948 and wrote down the Constitution of the Italian Republic. The deputies of the Constituent Assembly were not alone in shaping the future of the country: from September 16 to October 6, 1946, many first-level scholars, both national and international, as well as politicians, thinkers, and managers, gathered at Lake Como, in the North of Italy, to participate in Tremezzo Convention. The aim of the meeting was to discuss future national social policies and define the role of social workers within the frame of a to-be-built welfare system. Scholars agree on regarding Tremezzo Convention as a foundational landmark for Italian social work: before that date – which means during the years of Fascism – the Industrial Confederation created the Scuola per assistenti sociali (School for social workers): those professionals, only women, had actually tried to promote women’s emancipation, but they were also very committed with the Fascist regime and ideology, so they have not been acknowledged as inherent part of Italian social work history by many later scholars (Bernocchi et al., 1984). The connections between the Convention and the debates of the Constituent Assembly are evident and meaningful (Nervo, 2012), although not explored enough yet. It is outstanding to see how the lexis, approaches, and aims between the two events resemble and echo each other: the shared target was to create a modern, democratic, and fair society, based on 347

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people’s sovereignty and dignity of each citizen. Alas, not all the conclusions of that convention have been applied to the Italian Welfare yet, and it is a common phrase that even the Constitution still has to be fully applied. Tremezzo Convention indicated some important guidelines for social work which became part also of its ethical standpoints (Stefani, 2011): fighting for women’s emancipation, shifting from the notion of “charity” to “freedom from needs,” establishing social work as a citizenship’s right and a State’s duty, promoting social solidarity, individual and community dignity, helping the recreation of a sense of community among the population through the work of qualified professionals, who could have been in charge of a “great work of moral recovery” (Chiabov, 1947, p. 787). Unlike social work methods of intervention, which were mostly imported directly from the Anglo-Saxon tradition – namely, casework, group work, and community work – ­Italian social work ethics were built around the Italian specific context, with its peculiar set of principles and values. The strong connection between the values of social work and the Italian Constitution provides a quite good evidence of this specificity. In fact, the very same ­principles promoted by the first schools of social work can be found in the debate of the Constituent Assembly; for instance, the discussants of the Art. 2 spoke about individual and social rights, freedom and autonomy, political, economic, and social solidarity, as well as dignity (Camera dei Deputati –Segretariato Generale, 1970). As we will see in the following sections, all those words are nowadays considered fundamental values to social work, and are spelled out in its Code of Ethics. Other areas of social work benefit from the work of the Constitution Assembly, as the Constitution (Gazzetta Ufficiale, 1947) states the main guidelines for its intervention within the society: art. 3 promotes equality, dignity, and freedom of all citizens; art. 30 and 31 try to find a balance between child protection and parents’ rights to grow their children, and they protect maternity; art. 32 defines the respect for human beings as an inviolable limitation to law and State intervention; art. 38 is committed to the protection of disabled and all vulnerable people, explicitly citing social services and social work as means to give guarantees on that (Togni, 1970). It is important to note that the rapporteur of this article considered social assistance as a fundamental means to solidarity; this echoes Comandini’s speech at Tremezzo Convention, in which she pointed out the need for defending social assistance from the idea of charity and social conflicts palliative (Comandini, 1947).

Implementing social work: new challenges The Constitution came into force on January 1, 1948 and Tremezzo Convention was a success, but the process of their implementation was slow and fragmented (Neve, 2008). As the country changes, new principles and new ideas have found their way to become part of the Italian social work structure and ethical basis. Whereas the National Health System, created in 1978 with the law n. 833/78 (Gazzetta Ufficiale, 1978), has led to the unification and coordination of services in the health care, social services remained split and uncoordinated (Dal Pra Ponticelli, 1979), depending on the different development in the diverse areas of the country, as the northern area kept on growing and improving quickly while the southern one kept its services way below the average level. The first comprehensive law and reorganization of the social welfare system was made in 2000, with the law n. 328/00 (Gazzetta Ufficiale, 2000). This law established a national framework that sets the main principles for State role and the minimum level of social assistance. 348

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The center-left government imagined a very high impact for this law (Turco, 2000), and actually, the process of writing its article had been shared and participated by different stakeholders. The notion of subsidiarity between different institutions, both vertically and horizontally, is one of the most important points of this reform, as well as third sector participation in planning intervention, and a role of governance and coordination for public institutions. Compared to the previous system, the law was very innovative, in that it accepted and confirmed several principles that social work had already adopted, like the consideration of the user in his/her complexity and integrity as the central point for ­intervention, and the focus on the prevention of needs (Piva, 2000; Ranci Ortigosa, 2000a). It also enforced a participatory way of planning social policies between the public and the third sector. Scholars correctly identified some critical points of the law: its dependency on further ­implementing acts, an incomplete coverage and guarantee of the right to assistance (Ranci Ortigosa, 2000b), risks of shaping the welfare system on the basis of what is already present and not on the citizens’ needs (Rossetti, 2000), scarcity of resources allocated (Brivio, 2000; Gori & De Roit, 2000), and the separation between health and social assistance (Ferrario, 2000). Unfortunately, the Constitutional Reform approved in 2001 shifted the competence on social assistance from the National government to the Regional ones, making the law 238/00 ineffective. Many but not all Italian Regions keep using it as a guideline to a progressive reorganization of the social assistance area.

A Code of Ethics as a tool for professionalization From the first ASSNAS’ Code of Ethics to the birth of the National Order Although in Tremezzo Convention many scholars strongly supported the idea of social work as a defined and regulated profession, with high standards of qualification and social acknowledgment, the journey toward this goal has been quite long. We could say that both ethics played an important role in the process of professionalization and vice versa: as one of the fundamentals of any profession is the creation of a Code of Ethics (Greenwood, 1957; Tousijn, 1979), it is quite interesting to note how it developed in Italy. As Diomede Canevini (2017) notes in 1987, a group of social workers in Tuscany ­approved the Codice di autodisciplina professionale dell’Assistente sociale dell’Alta Val d’Elsa (Code of the ­social worker’s professional self-discipline in Alta Val d’Elsa). The need of spelling out shared rules and values was the trigger for that small group of professionals, but it was also the sign of a growing awareness amongst the wider professional community: in 1990, several conferences and conventions were organized by Zancan Foundation and Moneta Foundation. The first complete Italian Code of Ethics was made in 1992 by the National Association of Social Workers (Associazione Nazionale Assistenti Sociali, 1992). This code was structured in five parts describing the duty the social worker has to commit to (i) the profession, (ii) the users, (iii) the colleagues, (iv) the employing institution, and (v) the social context. Years before the issue of a specific national law, this code refers explicitly to informed consent, privacy and confidentiality, professional documentation, and professional secret (Diomede Canevini, 2017). Twenty-five years ago, with the law 23 Marzo 1993, n. 84, the Italian Parliament created the Order of Social Workers (OAS), a historical landmark for the profession (Filippini & ­Bianchi, 2013). Within the Italian legislation, professional orders are public and noneconomic institutions, which are autonomous but under the surveillance of the Minister of 349

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Justice. Amongst their duties, they manage the registers of professionals, organize and overview lifelong education, promote, protect, and represent the profession, and hold disciplinary power over their members’ conducts. Since that, the title of social worker has become legally protected by (i) a national access test open only to graduates, (ii) required membership to work as a social worker, and (iii) specific duties for members. In 1996, the first board of the Consiglio Nazionale Ordine Assistenti Sociali (CNOAS) decided to write a formal Code of Ethics, later approved in 1998. Its structure is the same as ASSNAS Code: it focuses on the notion of the social worker’s accountability to different subjects that can be affected by professional’s actions, both directly and not. As already mentioned, the connections to the Republican values stated in the Italian Constitution are very strong here. The Code of Ethics has been revised twice, in 2002 and in 2009. The version of 2002 added the notions of centrality and priority of the human being, the importance of users’ active participation, the need for social workers’ promotion of inclusive social policies, recalling the reflection made for the law 328/00. The 2009 version (http://www.cnoas.it/La_professione/Codice_deontologico.html) improves the notion of people and community empowerment, and strengthens social workers’ commitment to a political dimension, by mentioning the concepts of social justice, fairness, integration, equal opportunities, and multi-culturality (Diomede ­C anevini, 2017).

The status of ethics reflection on social work in Italy As Diomede Canevini (2017) notes, the Italian Code of Ethics fixes quite high ethical standards, and it might be considered demanding for professionals. As any other codes, it does not establish a clear hierarchy of principles, and this can rise ethical dilemmas. Those dilemmas, together with the Code of Ethics itself, have become a specific topic of study for students of social work in many universities. In the last years, several scholars and practitioners have investigated and spread knowledge about professional ethics: Sicora (2005) wrote about reflexivity in social work, which has an indeed clear ethical dimension; since its publication, Neve’s (2008) handbook has been used by students in several universities; Bertotti (2016) wrote about ethical dilemmas and how to take ethically informed decisions in complex contexts of social work. Diomede Canevini and Campanini (2013) edited a book about disciplinary issues, comparing Italian and international systems of social work. Diomede Canevini and Neve (2017) edited a comprehensive manual of ethics in social work, which contains spotlights on the history of the subject, an international comparison, and practical issues. The Order itself, as many education providers, agencies, and private researchers, stimulates investigations that can have a significant influence within the debate on professional ethics; the national enquiry on users aggressively against social workers is one of the most recent examples. Those are just instances of the fruitful production within the field of professional ethics, which can fulfill social workers’ needs for a continuous reflection on their profession. Indeed, the 2009 version of the Code of Ethics states the importance of lifelong education for social workers, and further regulation (Consiglio Nazionale Ordine Assistenti Sociali, 2014) established specific duties: each professional is compelled to gain a minimum of 60 credits every three years, 15 credits of which need to be recognized as “deontological credits” by the local section of the Order. This should grant a constant updating of the social workers’ population, and a specific attention to the topic of professional ethics. 350

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Ethical complaints and how to deal with them Ethical complaints and councils of discipline As we have already mentioned, the Order holds disciplinary power over all the Italian social workers. This makes it the profession’s regulatory body, which has the duty to assess ethical and professional violations. This assessment is made on the basis of the Code of Ethics. In 2012, the Italian Parliament approved a reform of professional orders’ disciplinary powers and disciplinary proceedings. According to this law, enforced by the OAS in 2014 (­Consiglio Nazionale Ordine Assistenti Sociali, 2013a), each regional section of the Order is compelled to create a parallel council (Consiglio Territoriale di Disciplina, CTD), which is independent and has exclusively disciplinary competence. Members of these CTDs are nominated by a judge, their candidates are social workers, with the few exceptions of people with acknowledged competences on professional ethics or conflicts mediation (Consiglio Nazionale Ordine Assistenti Sociali, 2013b). They operate in committees of 3–4 members (Collegi di disciplina) and deal with complaints against social workers all over the Region for a three-year mandate. Proceedings start with the complaint, which can be submitted by any user, state attorney, social worker, people involved in the case of misconduct, or even anonymously. Procedures, phases, and people involved are stated quite clearly in the proceedings regulation: first, the committee gathers further information on the case and decides whether to open formally the proceeding or not (for instance, in case the absence of any misconduct is self-evident). Then, both the social worker and the complainant can provide memories and other documents useful for the judgment. Separate hearings are held by the committee and a final decision is eventually taken. Should any misconduct be proven during the proceeding, the committee imposes a sanction among the four possible, according to the gravity of the misconduct. Those are (i) warning, (ii) censure, (iii) suspension, and (iv) radiation from the social worker register. It is important to note that suspension and radiation mean that the professional has to immediately stop any activity as a social worker. A sanctioned social worker can appeal to the National Council of Discipline, and that will result as the beginning of a new proceeding with a similar structure. If the complainant and the social worker agree on that, the committee may try to conciliate the parts in order to resolve the conflict. If the conciliation succeeds, the committee may, however, sanction the social worker in case of serious ethical misconduct.

Lights and shadows of disciplinary power This system, dealing with complaints, presents many interesting points of discussion. First, it is clear that it contributes to the process of professionalization of the Italian social work, as it is strongly related to professional accountability. It is also a way to have more power balance between professionals and users. Moreover, a close monitoring activity on the complaints could reveal which areas are more conflictual between social workers and their users. Similarly, the analysis of sanctioned ethical misconducts can be useful to understand which parts of the Code of Ethics social workers experience as harder to follow and respect. Some preliminary results of a research on the topic (Soregotti, 2018) highlight some debatable points of the system created to deal with ethical complaints: members of the CTDs have noted that proceedings do have a strong legal approach, which makes users and social workers oppose each other. The high number of rejected or dismissed complaints (76.53% of 196 deontological complaints received by 12 CTDs from 1/07/2014 to 31/06/2017) could 351

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either be due to lack of clarity to the users about what the social worker’s work and duties are or a problematic corporatist attitude. Social workers who do not pay the annual membership fee or do not fulfill lifelong education requirements commit an ethical violation, as those provisions are clearly stated as social workers’ duties within the Code of Ethics. It is, however, controversial to follow the same heavily bureaucratic and economically costly procedures to analyze those “administrative” cases. The implementation of a detailed informative system about CTDs work, together with the collection of information about proceedings and sanctions, could help social workers’ education, by enforcing both undergraduate and postgraduate ethical courses.

Further reflections on ethics On July 5, 2018, CNOAS began a process to approve a new version of the Code of Ethics: it opened a public online consultation in order to collect contributes and suggestions that will be discussed by dedicated committees. This should stimulate debates around ethics, starting from the role of the Code itself – which of course cannot be taken for granted. According to new sensitivities, it is important for Italian social work consolidation, to further reflect on the use and role of technological tools as, for example, social networks. It seems also quite urgent to increase social workers’ awareness of the importance of high-­quality research (Fargion, 2013), with a closer reflection on its ethical implications. The ­ongoing ­economic crisis, data protection, migration flows with integration, and a ­multicultural ­society are other areas that challenge social work and its ethical awareness. Within this p­ rocess, social workers should reconsider the words spoken at Tremezzo Convention by Comandini (1947), who encouraged social workers to have a non-neutral political position and assume a role of advocacy and contribute in the promotion of fairer social policies.

References Associazione Nazionale Assistenti Sociali. (1992). Codice deontologico dell’assistente sociale in Italia. La Professione Sociale, 2(4), 49–72. Bernocchi, R., Canevini, M., Cremoncini, V. M., Ferrario, F., Gazzaniga, L., & Ponticelli, M. (1984). Le Scuole di Servizio Sociale in Italia: Aspetti e Momenti della loro Storia. Padua: Fondazione Zancan. Bertotti, T. (2016). Decidere nel Servizio Sociale. Metodo e Riflessioni Critiche. Roma: Carocci. Bistarelli, A. (2011). Lo scenario dell’immediato dopoguerra. In M. Stefani (Ed.), Le Origini del Servizio Sociale Italiano. Tremezzo: un Evento Fondativo del 1946: Saggi e Testimonianze (pp. 31–52). Rome: Viella. Brivio, V. (2000). Le Province nella legge di riforma. Prospettive Sociali e Sanitarie, 30(20/22), 12. Camera dei Deputati – Segretariato Generale. (1970). La Costituzione della Repubblica nei Lavori Preparatori dell’Assemblea Costituente. Rome: Edigraf. Chiabov, A. (1947). Conclusione. In Atti del Convegno per Studi di Assistenza Sociale 16 September–6 ­O ctober 1946, Tremezzo (Como) (pp. 781–787). Milan: Marzorati. Comandini, M. (1947). Necessità di una cultura storico umanistica per la formazione dell’assistente sociale in Italia: problemi di democrazia e di collaborazione civica. In Atti del Convegno per Studi di Assistenza Sociale 16 September–6 October 1946, Tremezzo (Como) (pp. 741–754). Milan: Marzorati. Consiglio Nazionale Ordine Assistenti Sociali. (2013a). Regolamento per il Funzionamento del Procedimento Disciplinare Locale, Delibera n. 175. Retrieved from CNOAS: http://www.oaspiemonte.org/wp-content/ uploads/2014/04/regolamento-per-il-funzionamento-del-procedimento-disciplinare-locale.pdf Consiglio Nazionale Ordine Assistenti Sociali. (2013b). Regolamento Recante i Criteri per la Designazione dei Componenti dei Consigli Regionali di Disciplina. Retrieved from CNOAS: http://www. oaspiemonte.org/wp-content/uploads/2014/04/Regolamento-recante-i-criteri-per-la-designazionedei-componenti-i-Consigli-regionali-di-disciplina.pdf

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Consiglio Nazionale Ordine Assistenti Sociali. (2014). Regolamento per la Formazione Continua degli Assistenti Sociali. Retrieved from CNOAS: http://w3.ordineaslombardia.it/sites/default/files/Regol amento%20per%20la%20Formazione%20Continua_CROAS%20Lombardia_agg%204ago16.pdf Dal Pra Ponticelli, M. (1979). L’integrazione fra servizi sanitari e sociali. Prospettive Sociali e Sanitarie, 8(17), 2–5. De Rita, G. (2011). Le dimensioni del servizio sociale italiano. In M. Stefani (Ed.), Le Origini del Servizio Sociale Italiano. Tremezzo: un Evento Fondativo del 1946. Saggi e Testimonianze (pp. 65–71). Rome: Viella. Diomede Canevini, M. (2017). Il codice deontologico dell’Assistente Sociale. In M. Diomede Canevini & E. Neve (Eds.), Etica e Deontologia del Servizio Sociale. (pp. 149–165). Rome: Carocci. Diomede Canevini, M., & Campanini, A. (2013). Servizio Sociale e Lavoro Sociale: Questioni Disciplinari e Professionali. Bologna: il Mulino. Diomede Canevini, M., & Neve, E. (2017). Etica e Deontologia del Servizio Sociale. Rome: Carocci. Fargion, S. (2013). Conoscenze, saperi e identità: spunti di riflessione sul servizio sociale. In M. ­Diomede Canevini, & A. Campanini (Eds.), Servizio Sociale e Lavoro Sociale: Questioni Disciplinari e Professionali (pp. 83–92). Bologna: il Mulino. Ferrario, P. (2000). Riforma dei servizi sociali: l’assetto istituzionale. Prospettive Sociali e Sanitarie, 30(20/22), 22–23. Filippini, S., & Bianchi, E. (2013). Le Responsabilità Professionali dell’Assistente Sociale. Rome: Carocci. Gazzetta Ufficiale n. 298. (1947). Costituzione della Repubblica Italiana. Retrieved from Gazzetta Ufficiale: http://www.gazzettaufficiale.it/eli/id/1947/12/27/047U0001/sg Gazzetta Ufficiale n. 360. (1978). Legge n. 833, Istituzione del Servizio Sanitario Nazionale. Retrieved from Gazzetta Ufficiale: http://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/ originario;jsessionid=Q1sAf Jy0iTsDMwpp0KdHIA__.ntc-as5-guri2a?atto.dataPubblicazione Gazzetta=1978-12-28&atto.codiceRedazionale=078U0833&elenco30giorni=false Gazzetta Ufficiale n. 265 (2000). Legge quadro per la realizzazione del sistema integrato di interventi e servizi sociali, n 328. Retrieved from Gazzetta Ufficiale: http://www.gazzettaufficiale.it/eli/ gu/2000/11/13/265/so/186/sg/pdf Gori, C., & De Roit, B. (2000). Le risorse economiche. Prospettive Sociali e Sanitarie, 30(20/22), 19. Greenwood, E. (1957). Attributes of a profession. In G. P. Prandstraller (Ed.), Sociologia delle professioni. Rome: Città Nuova. Nervo, G. (2012). La Costituzione fondamento dei principi del Servizio Sociale. Studi Zancan, 13(6), 5–8. Neve, E. (2008). Il Servizio Sociale: Fondamenti e Cultura di una Professione. Rome: Carocci. Piva, A. (2000). I Comuni e la riforma dell’assistenza (II). Prospettive Sociali e Sanitarie, 30(20–22), 10. Ranci Ortigosa, E. (2000a). Assistenza, prevenzione, promozione. Prospettive Sociali e Sanitarie, 30(20/22), 3. Ranci Ortigosa, E. (2000b). Diritti, servizi, benessere. Prospettive Sociali e Sanitarie, 30(20/22), 17–18. Rossetti, S. (2000). I Comuni e la riforma dell’assistenza (I). Prospettive Sociali e Sanitarie, 30(20/22), 9. Sicora, A. (2005). L’assistente sociale “riflessivo”. Epistemologia del Servizio Sociale. Lecce: Pensa Multimedia. Soregotti, C. (2018). [Le Violazioni Disciplinari degli Assistenti Sociali: Studio Esplorativo Nazionale sul Sistema di Segnalazione ed Elaborazione]. Unpublished manuscript. Stefani, M. (2011). Alla riscoperta di Tremezzo. In M. Stefani (Ed.), Le Origini del Servizio Sociale Italiano. Tremezzo: un Evento Fondativo del 1946. Saggi e Testimonianze (pp. 11–18). Rome: Viella. Togni, G. (1970). Discussione sul diritto all’assistenza 11 settembre 1946. In Assemblea Costituente, La Costituzione della Repubblica nei Lavori Preparatori della Assemblea Costituente (vol. VIII). Rome: Camera dei deputati, Segretariato generale. Tousijn, W. (1979). Sociologia delle Professioni. Bologna: il Mulino. Turco, L. (2000). Una legge della dignità sociale, Prospettive Sociali e Sanitarie, 30(20/22), 1–2.

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45 The ethical question in the Argentine social work Silvana Martínez and Juan Agüero

The social work in Argentina has had, from its beginnings, a strong concern for values and professional ethics. This gave rise to different codes of ethics that showed different conceptions about what these values are, what is understood by ethics, and what the main ethical dilemmas are in the professional practice. The debate on ethics in the profession was acquiring a major degree of complexity, broadening the look and scope of it. From an individual ethical conception, it passes to an ethical-political collective look that includes values and general principles that guide the profession. These values and ethical-political principles are incorporated into the Federal Law of Social Work in the year 2014, with character of public order, and are applied for all the social workers of Argentina. In this chapter, it is described and analyzed this process. In the first part, we refer to the moralizing ethical conception in the Argentine social work. In the second, we analyze the course from the moralizing to ethical-political conception. In the third, we refer to ethical principles established for the Federal Law on Social Work in the year 2014. In the fourth, we reflect about the ethical-political importance of law 27.072. In the fifth, we refer to current ethical political compromise of social work in Argentina. In the sixth, we analyze the ethical career of social work in Argentina. Finally, we conclude this issue.

The moralizing ethical conception in the Argentine social work In Argentina, initially the ethics question was related to the moral and Christian religion. The origin of social work was the concern of the hygienist doctors, and other professionals, for the hygienic conditions and the habits of life of the population. The first Social Service School was created in 1930 with the idea of bringing together “good people,” teaching to “cure social ills,” studying the “theory of social action,” preparing “technicians” for institutions, and being the “new religious temple” of those who make human welfare a “secular priesthood” (Martínez & Agüero, 2008). In the 1960s, the ethics question was installed in the National Conferences of Social Work. These events were organized in every two or three years. The ethical question was considered as a central issue for the profession. At that time, ethics was conceived as an individual duty of the professional. It was based on values linked to Christian moral and philanthropy. 354

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In the course of profession development, Professional Associations were created in each province. This process took place between 1964 and 2014. Laws regulating professional practice and codes of ethics were approved. As 25 codes of ethics were approved, this produced a great heterogeneity in the conception of values and professional ethics. Ethics is conceived as a duty of professional practice and sanctions are established for cases of noncompliance. In 1982, the current Argentine Federation of Professional Associations of Social Service was created. Its members were the 25 Professional Associations of Social Service of Argentine provinces. The ethical question was always present in the meetings of the members of this federation, as stated in the minutes of meetings.

The ethical-political conception in the Argentine social work In 1996, the Argentine Federation of Professional Associations of Social Service promoted the creation of the Mercosur Committee of Professional Organizations of Social Work and integrated it together with Brazil, Uruguay, and Paraguay. In 2000, the Mercosur C ­ ommittee linked the professional exercise with the current political project and approved the following ethical-political principles for social work organizations of Mercosur: The defense of Democracy as constituent of the Law State, citizen participation, and the just distribution of wealth. b The defense of human rights: social, political, civil, cultural, and economic. c The support and promotion of initiatives that favor the incorporation into Mercosur of the social issue, the defense of the interests of the workers, and the participation of the social movements of the region. d The access of all citizens to material and cultural goods without discrimination by ­gender, social class, ethnicity, religion, among others. e The defense of universal social policies with citizen participation in the formulation, implementation, and control of them. f The refusal to transfer the responsibility of the State toward nongovernmental organizations through social volunteering. g Respect for the autonomy of groups, organizations, and social movements. h Respect for the history and collective memory of the people. i The competent professional exercise and the compromise with social demands. j The sanction and validity of laws regulating the profession, codes of ethics, and professional education with common bases in the region. k Respect for the theoretical and political current diversity in the profession. l The quality control of professional practices. m Permanent professional education and the inclusion of ethics in the study plans. n The promotion of decent working conditions for the professional practice of social workers. a

These principles question the prevailing neoliberal model in Latin America, because it is opposed to the values held by social work. These principles aim to strengthen the organizations and professional practices of social workers in each country. Ethics is conceived as reaffirmation of freedom and rejection of the values that found the predominant morality in capitalist society. Ethics is linked to the values of democracy, social justice, dignified working conditions, the just distribution of wealth, and the vindication of the State as guarantor of citizens’ rights (Martínez & Agüero, 2017). 355

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In 2006, the Ethics Commission of Argentine Federation of Professional Associations of Social Service was created. For several years this Commission produced documents related to the ethical dilemmas of the profession. In 2014, a document was approved that establishes the following general ethical principles, in order to guide professional practice in all the country: a

The exercise of social work profession in accordance with the principles, norms, and guarantees established in the international and national treaties, pacts, and declarations regarding human rights. b Perform internships for which the social worker is qualified for their academic education, training, and experience, within the framework of professional responsibilities. c To promote the defense, expansion, and consolidation of democracy in the different areas of professional practice. d Not discriminate against the individual and collective subjects with whom the professional practice is carried out, whether by nationality, religion, ethnicity, social or ­economic condition, ideology, gender identity, or sexual diversity. e Respect the right of individual subjects to privacy, confidentiality, and autonomy, as well as to groups, communities, and social movements. f Promote and generate instances of continuing education, to guarantee the quality of the provided professional services. g Comply and enforce the current regulations governing the practice of the profession. h Generate spaces for supervising professional practice in order to analyze and improve professional practices. i Exercise the right to have actions of physical or psychological protection of social workers. j Orient the professional practice toward the objectives for which the professional services have been required, not abusing the trust or power position for personal benefits. k Contribute to the promotion, formulation, and execution of social policies that favor the effective exercise of human rights. l Participate in public pronouncements assuming ethical-political positions on issues of national, provincial, or municipal interest. m Defend the validity of decent and adequate working conditions for professional practice and autonomy. These principles are based on the conviction that social work is a profession that has a commitment to building a more just and equitable society. Ethics is conceived as a construction that implies reflexivity and not moral prescriptions. It expresses the reasons and grounds for a professional practice oriented to the respect, autonomy, and recognition of the other. It assumes that all professional practice has consequences in the lives of social subjects and society. It also recognizes the need to claim the ethical dimension of the profession, in order to contribute to the processes of emancipation of social subjects as protagonists of their historical development and concretion of their own life projects.

The Federal Law on Social Work In 2014, the Federal Law on Social Work No. 27.072 was sanctioned. This law incorporates the global definition of social work of the International Federation of Social Workers. It establishes four fundamental values for the profession: human rights, social justice, citizenship, and democracy as a way of life and government. This implies a fundamental change of 356

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paradigm in the ethical question. It overcomes the traditional view based on values related to philanthropy and Christian moral. In several articles of the law 27.072, these values are reaffirmed. For example in Article 3, Paragraph a), it establishes as one of the objectives of the law the hierarchy of the social work as profession. The foundation of this norm is the social relevance and the contribution of social work to the validity, current and vindication of human rights, the construction of citizenship, and the democratization of social relations. In Argentina, there is a strong link between social work and human rights. This is related to the last military dictatorship from 1976 to 1983. Professionals and students of social work were persecuted, tortured, and killed for to defense the human rights, demand social justice and wealth distribution, and work with popular sectors. This law comes to recognize and vindicate this fight of many years. In Article 4, the law 27.072 defines social work as a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. It too assumes as central values and principles for social work the social justice, human rights, collective responsibility, and respect for diversities. Underpinned by social work theories, social sciences, humanities, and indigenous knowledges, social work seeks the structures change and the people well-being. This definition is taken from Global Definition of Social Work in Melbourne General Meeting 2014 approved by the International Federation of Social Workers and International Association of Schools of Social Work. Global Definition includes commentaries about values, principles, knowledges, and practices that social work requires. Social work is a practice profession and an academic discipline that recognizes that interconnected historical, socioeconomic, cultural, spatial, political, and personal factors serve as opportunities and/or barriers to human well-being and development. Structural barriers contribute to the perpetuation of inequalities, discrimination, exploitation, and oppression. The development of critical consciousness through reflecting on structural sources of oppression and/or privilege, on the basis of criteria such as race, class, language, religion, gender, disability, culture, and sexual orientation, and developing action strategies toward addressing structural and personal barriers are central to emancipatory practice where the goals are the empowerment and liberation of people. In solidarity with those who are disadvantaged, the profession strives to alleviate poverty, liberate the vulnerable and oppressed, and promote social inclusion and social cohesion. The social work profession recognizes that human rights need to coexist alongside collective responsibility. The idea of collective responsibility highlights the reality that individual human rights can only be realized on a day-to-day basis if people take responsibility for each other and the environment, and the importance of creating reciprocal relationships within communities. Therefore, a major focus of social work is to advocate for the rights of people at all levels, and to facilitate outcomes where people take responsibility for each other’s well-being, realize and respect the interdependence among people and between people and the environment. Social work is both interdisciplinary and transdisciplinary, and draws on a wide array of scientific theories and research. “Science” is understood in this context in its most basic meaning as “knowledge.” Social work draws on its own constantly developing theoretical foundation and research, as well as theories from other human sciences, including but not limited to community development, social pedagogy, administration, anthropology, ecology, economics, education, management, nursing, psychiatry, psychology, public health, and sociology. The uniqueness of social work research and theories is that they are applied and 357

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emancipatory. Much of social work research and theory is co-constructed with service users in an interactive, dialogic process and therefore informed by specific practice environments. This proposed definition acknowledges that social work is informed not only by specific practice environments and Western theories but also by indigenous knowledges. Part of the legacy of colonialism is that Western theories and knowledges have been exclusively valorized, and indigenous knowledges have been devalued, discounted, and hegemonized by Western theories and knowledge. The proposed definition attempts to halt and reverse that process by acknowledging that indigenous peoples in each region, country, or area carry their own values, ways of knowing, ways of transmitting their knowledges, and have made invaluable contributions to science. Social work seeks to redress historic Western scientific colonialism and hegemony by listening to and learning from indigenous peoples around the world. In this way, social work knowledges will be co-created and informed by indigenous peoples, and more appropriately practiced not only in local environments but also internationally. In Article 11, Paragraph b), law 27.072 establishes as one of the obligations of social workers the professional practice with compromise, competence, and professional updating, ­having as guiding principles the human rights, the social justice, the citizenship, and democracy as way of life. The Paragraph c) establishes as one of the obligations of social workers the professional practice in accordance with the norms established in the Ethics Codes sanctioned by professional associations. The professional practices of social workers must have a clear ethical-political positioning. This means fighting for human rights, social justice, self-determination of peoples, freedom, just distribution of wealth and democracy, not only as a form of government but as a way of life. A democracy implies respect for diversity, plurality, different ways of thinking, freedom of expression, participation of citizens in decisions, being able to decide their own destiny and the own government in order to demand a minimum standard of living, dignity, and social protection for all citizens. Professional practices with compromise, competence, and professional updating are a value in themselves because they concern to respect for the people with whom social workers work, precisely because they are people in a situation of vulnerability, with very serious and complex social problems and where, in general, there are many human rights violated.

Ethical-political importance of law 27.072 The ethical-political importance of this law is that, for the first time in Argentina, social work is institutionalized as a profession at the national level. It is a norm of federal scope that goes beyond the mere control and supervision of the professional registration. It is in the same way how social policies entered in 2003 in an accelerated process of institutionalization. This was also achieved for social workers as actors and protagonists of social policies. This process of institutionalization is based on laws sanctioned by the National Congress, which cannot be modified by the government and neither depend on the political will of the government. This mutual strengthening between social workers and social policies, based on laws sanctioned by the National Congress, implies in itself a public policy aimed at further protecting the interests and rights of the most vulnerable sectors of the population. It is a law that creates conditions so that the rights of the most vulnerable people can be exercised effectively through competent professional practices of social workers with their own rights also protected. In this sense, this law comes to protect and prioritize the interests of the people, by establishing as a right but also as an obligation the need for permanent professional education. 358

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It establishes as a guiding principle of professional practices the defense of human rights, democracy as a system of life, and social justice. It is a law that claims social work as a promoter of human rights and processes of social democratization. It also vindicates social workers as actors who have suffered, together with vulnerable and unprotected sectors of the population, the impact of neoliberal policies. These policies have deeply damaged social cohesion in Argentina. In addition, this law protects social workers exposed to accelerated processes of professional burnout by working with social problems of high complexity and high risk. Among these problems there are social violence, addictions, mental health problems, the population deprived of liberty, people with terminal illnesses, child sexual abuse, people in street situations, among others. This law was sanctioned within the framework of almost 40 years of democratic continuity that existed in Argentina. In all these years the democracy has been strengthening in Argentina and this has favored the validity and expansion of the rights of the most vulnerable and excluded people and sectors of the population. It has also favored the installation in society of ethical values supported by social work.

Current ethical-political compromise of social work in Argentina In August 2018, the XXIX National Congress of the Argentine Federation of Professional Social Service Associations was held in Argentina. In this event, representatives of this ­Federation, the Argentine Federation of Academic Units of Social Work, the International Federation of Social Workers, and the Latin American Association of Teaching and Research in Social Work sign a joint document where they express their concern about the serious social, political, and economic context that crosses Argentina and Latin American countries. This context is characterized by the advance of right-wing governments, with neoliberal public policies of labor flexibilization and precariousness, increasing inequalities, and concentration of wealth, which threaten not only the citizenship but also the effective exercise of rights by part of the social subjects in their daily life. This scenario is observed in a very visible way in state violence, the reduction of citizen rights, the criminalization of social protest, the sustained increase in poverty, ideological persecutions, and the subjugation of the rights of State workers. In addition, in the persecution of social workers through arbitrary dismissals and other actions that unequivocal signs constitute of dismantling the Law State. For all these reasons and as social workers and representatives of social work organizations, they emphasize the need to continue working in the collective defense of rights, for a social work that is hierarchical, critical, and compromised to collective organizations and social justice. Professional organizations are spaces and instruments of integration and collective political action. They constitute key political actors in the hierarchy, promotion, and defense of social work. In this sense, they consider that professional organizations are essential to reaffirm the shared principles and strengthen the actions of cooperation and mutual compromise, based on the fundamental value of solidarity. Under these premises, they agree: • • • •

To strengthen cooperation and institutional ties between social work organizations. To contribute to the debates and actions aimed at the defense of human, social, and political rights and the democratization of society. To continue expressing public positions regarding the social, local, national, Latin American, and world reality. To jointly work in defense of labor spaces. 359

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•

To generate joint projects of socio-professional interest that favor the growth and development of collective professional of social work in the countries of Latin America and the Caribbean region.

The ethical career of social work in Argentina From the exposed in this work, we can lower that the social work in Argentina has had at least three great ethical moments. 1 A first foundational moment both for the profession and for professional organizations, where the ethical question is posed as a component of individual professional practice, linked to Christian morality, charity, and philanthropy. The ethical problem is considered as an individual question that is reduced to professional practice. In this context, local Codes of Ethics play a fundamental role for two main reasons: (a) because they point out what is considered morally acceptable for professional practice and (b) because they establish the sanctions that must be applied when professional practices deviate from this framework normative. In this first moment, the professional organizations fulfill two main ethical functions: (1) sanction the Codes of Ethics and (2) monitor their compliance and sanction the breaches. It is a task of professionals disciplining, which transforms professional organizations into useful instruments for social discipline. In this context, professional organizations fulfill roles similar to those assigned to schools, prisons, hospitals, and other social institutions: controlling and disciplining ­behavior according to preestablished patterns for a specific model of society. 2 A second moment where the ethical question is discussed collectively in the field of social work, as consequence of the profound social, political, and economic changes produced by neoliberalism in the 1990s, both in Argentina and in the rest of Latin American countries. These changes affect both the social workers themselves and the subjects with whom they carry out their professional practices. The ethical values that social work had been sustaining as profession are challenged by these changes. It goes from the individual to the collective and from the moral view of ethics to the political gaze. This is reflected in a change of ethics for the ethical-political. It talks about a professional project and it is linked to the country and society project. This brings with it new principles and values for the profession. Among these new principles and values, democracy is recovered as a way of life, the participation of citizens in decision-making spaces, the responsibility of the State as guarantor of citizen rights, and professional practices linked to the working conditions of social workers. 3 A third moment linked to the sanction of the Federal Social Work Law 27.072 that establishes values and guiding principles for social work in Argentina. These values and principles are summarized in the promotion, defense, and vindication of human rights, the search for social justice, the construction of citizenship, and democracy as a way of life. The professional practices of social workers are protected by these principles and values. They constitute parameters that guide these practices. In addition, they give meaning and legitimacy to them and constitute rights and obligations for Social Workers throughout the country. With the incorporation of law 27.072 in the global definition of social work adopted by international organizations, there is an insertion and integration of Argentine social work in international social work. This broadens and deepens the 360

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scope of the principles and values set by law. Other values and principles are incorporated such as sustainable social development, the production of knowledge, the recovery of indigenous knowledge, social cohesion, emancipation, autonomy, freedom, decoloniality, and the fight for rights, among others.

Conclusion In this chapter, we have tried to build an historical career of ethics and values in the social work in Argentina. As we have exposed in this work, the ethical question was present from the beginning of social work in Argentina. However, in its historical evolution, it has undergone important transformations in its content, scope, and implications for professional practice and for the social valorization of social work. Much progress has been made in this area. The changes have been enriching and very important. Social work in Argentina has made an effort to update itself on this topic. On the one hand, this was a consequence of the profound changes of society itself. On the other hand, it obeyed the initiatives of groups of professionals with fighting spirit. It was also the product of a greater and better professional education, as a consequence of changes in study plans and postgraduate careers. We hope that this work will help enrich the view on the ethics and values of social work. This is a very important issue for the profession, because it is directly linked to the rights, not only of citizens but also of the professionals themselves. We hope that our ethical reflection contributes to the construction of a more just, humane, and solidarity world.

References Federal Law on Social Work No. 27.072. Martínez, S., & Agüero, J. (2008). The political-ideological dimension of social work: Keys to an emancipatory social work. Buenos Aires: Dunken. Martínez, S., & Agüero, J. (2017). Memories, logics of power and disputes of meaning in the professional organizations of social work: The case of the Argentine Federation of Professional Social Service Associations 1945–2016. Buenos Aires: Espacio.

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Section XII

Economic issues

46 Ethical decision-making in the age of austerity in the UK Andrew Wills

Derived from traditional paternalistic British philanthropic roots, social work in the United Kingdom is a complex and disputed social construct shared across interest groups containing a narrative of a profession that seeks to address social and structural inequalities, based on self-evident human rights and empowerment. Statutory and non-statutory social work are traditionally a value-based helping and empowering profession that is linked to social problems and social adversity (Bamford, 2015; Cummins, 2018; Gray, Midgley & Webb, 2012; Schulman, 1999; Younghusband, 1981). It is an ethical activity regulated by professional ­standards and codes (BASW, 2012, 2014; Health and Care Professions Council (HCPC), 2017), guided by regulatory ethics and standards, and influenced by professional associations and the wider international professional community and body of literature on social work ethics. Simultaneously accountable to service users, as agents of society and the state, social workers have a professional responsibility to act ethically ( Johns, 2016). A profession with dualities of concern and responsibility, it is both caring as well as a socially controlling, undertaken by compassionate virtuous social workers in the interests of those who experience social adversity. Paradoxically aspiring to be socially transformative, it is simultaneously a cultural and class hegemonic process set within a Western normative capitalist system (Corrigan & Leonard, 1978; Dominelli, 2012). Pragmatically and philosophically, implicitly and explicitly, ethics is indispensable to social work. It is critical to professional reflection (Fook, 2015) and duty-bound to address to mitigate the impact of structural causes of social adversity, the multiplicities of contextual and individual factors of social functioning, deprivation, disadvantage and restricted life chances, without which social work errs toward mere social administrative marshaling of social resources. In its various guises, social work seeks to mitigate both contextual factors of less-than-optimum resources, and opportunities; and the impact of individual circumstances of neglect, abuse and (in)capability, ill-health, disability, and socially disadvantageous patterns of material social deprivation, education, recreation, diet, and social relationships. Honestly and selflessly responding unconditionally to genuine need is a relatively simple ethical stance to take. But social work in the United Kingdom has never been entirely unconditional, unlike its welfarist sister, the National Health Service that is ethically constituted to be free at the point of delivery irrespective of a person’s circumstances (Timmins, 2001). 365

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The simple distinction between health and social services has been deeply embedded within a constitutional system that from 1948 saw health as (mostly) free, and social care dependent upon (mostly) means-testing, with an additional statutory responsibility for safeguarding. The diverse rationalities of social work are subsumed within a logic of a split system in the United Kingdom, administered by various ministries, agencies, and local government with an underlying principle that if a person can provide for themselves, then they should do so; and social work is a gatekeeper to scarce public resources – only those without the means to provide for themselves should be eligible to receive help sufficient to prevent falling through a safety net into greater destitution. Social work in the United Kingdom is an intensely personalized ethical occupation of daily practice of decision-making, and weighing up of “logic, emotion, moral conscience (or) possible repercussions” (McAuliffe, 2010, p. 43) typified by uncertainty, differences, and dilemmas (Borrmann, 2010). In the United Kingdom, a culturally dominant Judeo-­ Christian ethic provides a legacy of selflessly helping people compassionately, applying the virtues of professional wisdom; ethical imagination; courage; respect; care; trustworthiness; social justice; and integrity (Banks, 2012). These virtues are exercised individually by social workers held to moral account. In high-profile cases of child abuse such as Victoria Climbé (Department of Health, 2003), criticism falls asymmetrically, more so on individuals than organizations. In the 2009 inquiry into the high-profile death of “Baby P” (Laming, 2009), despite a renewed system design that theoretically gave emphasis on wider governmental accountability, the dominant theme is the blameworthy cultural trope of the morally accountable social work practitioner (Shoesmith, 2016, p. 181). In a contemporary potent mix of ethical professional standards, statutory professional regulation, blame, and accountability, the current sociopolitical policy of austerity and “cuts” to services increasingly places restraint on professional resources and opportunities. It creates an ethical pressure keg of professional and moral responsibility. The conventional narrative of neoliberalism and austerity (Blyth, 2013; Cummins, 2018) is widely acknowledged. Post-World War II, the United Kingdom saw the creation of the consensual socialist Welfare State and centralized institutions that were never entirely free of an undercurrent of a neoliberalist counter-narrative of right-libertarianism (Nozick, 1974), individualist rational choice, and freedom of financial markets. This found a renewed resurgence during the 1970s onward within the United Kingdom that increasingly pushed back and now continues to push back state welfarism under policies of austerity, seen as a necessary accelerated fiscal response after the banking crisis of 2007/2008 (Cabral, 2013; Le, ­Meenagh, & Minford, 2017; O’Hara, 2014; Pol, 2012). In the United Kingdom, the split between government departments, local government, social care, health and education, the various governmental funding routes is complex and highly politically charged, but “the fact” is unavoidable that has been a considerable and increasing reduction in public funding for health and social care (Morse, 2014). Under the twin assault of an underlying neoliberalist ideology and structural economic change, adult social care spending in the United Kingdom had fallen by 9.9% between 2009/2010 and 2016/2017 at the same time as an aging population had increased, leaving a predicted ­funding gap of £18 million by 2030/2031. Local government spending on social care for older people has been reduced by 17% in real terms and the number of people obtaining social care has fallen by 25% (Kelly, Lee, Sibieta, & Waters, 2018; Kings Fund, 2015; Thorlby, Starling, ­Broadbent, & Watt, 2018). Both statutory and voluntary social work in the United Kingdom rely heavily on public sector spending. Since 2010, there has been a 28% decrease in the overall reduction in 366

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spending on education, and on children and young people’s services; and a reduction of over £5.5 million reduction in spending on local authority children’s services (Department for Education, 2017). The House of Commons Committee of Public Accounts (2018) makes the case that after seven years of austerity, the financial sustainability of local government is questionable, and emphasizes that key funding for the most vulnerable in UK society is under significant pressure. The implications are that local authorities are being forcibly required to “ration” social care and social work services, reducing the amount and level of provision by raising the thresholds for eligibility in addition to finding innovative cheaper ways of delivery. Whilst under the legal obligation to ensure services are provided, (Local Authority Social Service Act, 1970), in August 2018, local councils in England had said that services to children and other vulnerable people will be reduced to a legal minimum (BBC News, 2018a, 2018b). This extreme austerity has implications that only those people with the very highest and pressing need will receive a service, that early intervention services such as community health and social work will be cut. Children living routinely in family circumstances with parents with mental health, domestic abuse, drug misuse, etc. will no longer be given a service unless and until it is absolutely critical to safety (Berg, 2018). Politically sensitive, the detailed administrative cost-cutting process is mostly kept discretely out of the public arena. Apocryphal professional narratives tell of council leaders asking social workers for ideas to cut spending, using less sustainable and less expensive services that ultimately fail to fully and safely meet substantial needs. The impact on the frontline is that social workers find themselves telling people who have asked for help to go elsewhere to voluntary and charitable services that are themselves under pressure. In the internal competition for money, social workers find themselves competitively forcefully arguing and advocating even more vociferously for increasingly scarce services against increasingly constrained criteria. Under these conditions, decision-making becomes less a choice of moral conscience, but more a logic of rule-based organizational fiscal process and procedure. It creates an ethical conflict between the moral virtue of an unconditional response to need and the pragmatic and arbitrary rationing of scarce resources. When resources become limited, decision-­m aking becomes simple rule utilitarianism (Banks, 2012, p. 51) based on Benthamite utilitarian sharing out an insufficient modicum for the greatest many. The difference between what social workers see as a need, the ability to respond in keeping with their professional values, and the ability to provide a sufficiency of service suggests that social workers are conflicted and are prone to “ethical stress” or “moral distress” (Fantus, Greenberg, Muskat, & Katz, 2017; Fenton, 2014). Applied to social care and social work, the egalitarianist left-libertarianism of equality of opportunity and setting the level of entitlement to a decent minimum is contentious. Deciding what constitutes a decent minimum is a decision based on a value judgment. For example, is it ok to provide the decent minimum to avoid absolute poverty but very little more? If everybody gets a fair share of a reduced service but none gets enough, is that socially just? The alternative is the avoidance of large differences through redistributive policies of reducing the services to those who are better off and improving the well-being at the bottom. The rationale is that income inequality itself has harmful social consequences for all, whilst greater equality is better for everybody (Pickett & Wilkinson, 2009). Ethical positions are not necessarily mutually exclusive. Applying Rawlsian redistributive ethics to social work has an appeal to many social workers ( Johns, 2016, pp. 45–46, 58–59; Rawls, 1972, 1999) but there is limited scope under extreme austerity to reduce social inequalities. Under austerity, everybody is entitled to an assessment, but only those in the 367

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very worst position will get a service. This is broadly the current practice of both adult and child social work in the United Kingdom, but applying the Rawlsian maximin rule loses its potency when the maximum service is only the minimum sufficient to avoid the greatest significant harm and the maximum allowable is the minimum that is affordable. Austerity strips back the ethical decision-making of social workers and agencies, increasingly monetizing the value of care, compelling comparative judgments between the merits and value of one individual’s needs over another. This is further differentiated by discriminatory value placed on the social identity of the service user, and the judgment of vulnerability based on cultural concurrency with their assessor, that which is seen as being vulnerable changes with public and political cultural sensitivities. A teenage child at risk of child sexual exploitation prior to 2014 was in most places seen as a low priority, mostly a matter of blaming the child and controlling their behavior; after the publication of the Independent Inquiry into Child Sexual Exploitation (CSE) into Child Sexual Exploitation ( Jay, 2014), CSE cases were suddenly everywhere a high priority that had to be funded. Decision-making has become a changing comparative cynical calculation. Moral sensitivity is subject to maneuvering of public sentiment, and a pragmatic formula and shifting focus that places arbitrary monetized cost-benefit calculation of need versus cost, bracketed by a calculation of potential reputational organizational risk. If the potential reputational risk is high, the value placed on the case is likewise high, and vice versa. Ethical decision-making has become reduced to a pragmatic and rule-based calculation, an inconsistent formulaic process, dependent on parochial organizational culture located in specific place and time (Hugman, 2013). Where there is an insufficiency to meet an indeterminacy of needs, seeking to apply a rule of fair distribution appears defensible. But not all decisions are made on an ethically principled basis but merely the basis of how well the worker can match need to the preferences, sympathies, and fears of an organization. Far from being a “capabilities” approach, there is little recourse to appeal to broad ethical ideals ( Johns, 2016, p. 59; Sen, 2010). In the United Kingdom, the extremes of austerity are stripping back the ethical basis of social work and social workers increasingly struggle to retain an essential decision-making based on the essential rights and wrongs of professional practice (Doel, 2016). Austerity strips back the capacity of the practitioner to make entirely professionally independent ethically principled decisions based on essential humanistic principles. Instead decision-making relies totally upon rationing of an overall insufficiency of resources; an implicit calculation of defensive practice (Whittaker & Havard, 2016); and a shifting arbitrary valuing of one kind of social adversity over another. Whilst social workers compassionately understand and emotionally respond to peoples’ needs, austerity has a tendency to strip back the ethical nature of professional social work. Ultimately, under austerity, social work is reduced to no more than a pragmatic social administration of scarce resources.

References Bamford, T. (2015). A contemporary history of social work: Learning from the past. Bristol: Bristol University Press. Banks, S. (2012). Ethics and values in social work. London: Palgrave. BBC News. (2018a). East Sussex county council cuts services to ‘legal minimum’. BBC News. Retrieved August 8, 2018, from https://www.bbc.co.uk/news/uk-england-45058677 BBC News. (2018b, August 2). Northamptonshire county council: ‘Radical’ service cuts planned. BBC News. [Online]. Retrieved August 8, 2018, from https://www.bbc.co.uk/news/uk-england-north amptonshire-45044923 368

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Berg, S. (2018). Easier to take child into care than get support. BBC News, June 13. Retrieved June 15, 2018, from https://www.bbc.co.uk/news/education-44440265 Blyth, M. (2013). Austerity: The history of a dangerous idea. Oxford: Oxford University Press. Borrmann, S. (2010). Ethical dilemmas in practice. In M. Gray & S. A. Webb (Eds.), Ethics and value perspectives in social work (pp. 51–59). Basingstoke: Palgrave. British Association of Social Workers (BASW). (2012). The code of ethics for social work. Retrieved August 9, 2018, from https://www.basw.co.uk/resources/basw-code-ethics-social-work. British Association of Social Workers (BASW). (2014). Global definition of social work. Retrieved August 9, 2018, from https://www.basw.co.uk/resources/global-definition-social-work Byrne, D., & Ruane, S. (2017). Paying for the welfare state in the 21st century. Bristol: Policy Press. Cabral, R. (2013). A perspective on the symptoms and causes of the financial crisis. Journal of Banking and Finance, 37, 103–117. Corrigan, P. & Leonard, P. (1978). Social work under capitalism. London: Macmillan. Cummins, I. (2018). Poverty, inequality and social work; the impact of neoliberalism and austerity politics on welfare provision. Bristol: Policy Press. Department for Education. (2017). Expenditure by local authorities and schools on education, children and young persons services in England, 2016–17. London: Department for Education. Retrieved June 7, 2018, from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_ data/file/666863/SR71_2017_Text.pdf Department of Health. (2003). The Victoria Climbé: Report of an inquiry by Lord Laming (Cm. 5730). Retrieved August 6, 2018, from https://assets.publishing.service.gov.uk/government/uploads/system/ uploads/attachment_data/file/273183/5730.pdf Doel, M. (2016). Right and wrongs in social work. London: Palgrave. Dominelli, L. (2012). Anti-oppressive practice. In M. Gray, J. Midgley, & S. A. Webb (Eds.), The Sage handbook of social work (pp. 328–340). London: Sage. Fantus, S., Greenberg, R. A., Muskat, B., & Katz, D. (2017). Exploring moral distress for hospital social workers. British Journal of Social Work, 47, 2273–2290. Fenton, J. (2014). An analysis of ‘ethical stress’ in criminal justice social work in Scotland: The place of values. British Journal of Social Work, 45, 1415–1432. Fook, J. (2015) Reflective practice and critical reflection. In J. Lishman (Ed.), Handbook for practice learning in social work and social care. 3rd ed. (pp. 440–454). London: Jessica Kingsley Publishers. Gowdy, E. (1994). From technical rationality to participating consciousness. Social Work, 39(4), 295–315. Retrieved July 11, 2018, from https://academic.oup.com/sw/article-abstract/39/4/362/ 1932962?redirectedFrom=fulltext# Gray, M., Midgley, J., & Webb, S. A. (Eds.). (2012). The Sage handbook of social work. London: Sage. Gray, M., & Webb, S. A. (Eds.). (2010). Ethics and value perspectives in social work. Basingstoke: Palgrave. Health & Care Professions Council (HCPC). (2017). Standards of proficiency. Retrieved August 9, 2018, from http://www.hpc-uk.org/assets/documents/10003B08Standardsofproficiency-SocialworkersinEngland. pdf House of Commons Committee of Public Accounts. (2018). Financial sustainability of local authorities: Fifth report of session 2017–2019. Retrieved July 10, 2018, from https://publications.parliament. uk/pa/cm201719/cmselect/cmpubacc/970/970.pdf ?utm_source=The%20King%27s%20Fund%20 newsletters%20%28main%20account%29&utm_medium=email&utm_campaign=9635750_ NEWSL_HMP%202018-07-10&dm_i=21A8,5QIZQ,SWJZZR,MDHRB,1 Hugman, R. (2013). Culture, values, and ethics in social work. London: Routledge. Jay, A. (2014). Independent inquiry into child sexual exploitation into child sexual exploitation. Retrieved August 6, 2018, from file:///C:/Users/awills3/Downloads/Independent_inquiry_CSE_in_Rotherham%20(4). pdf Johns, R. (2016). Ethics and the law for social workers. London: Sage. Kelly, E., Lee, T., Sibieta, L., & Waters, T. (2018). Public spending on children in England: 2000 to 2020. London: Institute for Fiscal Studies. Retrieved June 15, 2018, from https://www.ifs.org.uk/ publications/13061 Kings Fund. (2015). How serious are the pressures in social care? London: Kings Fund. Retrieved June 7, 2018, from https://www.kingsfund.org.uk/projects/verdict/how-serious-are-pressures-social-care Laming, H. (2009). The protection of children in England: A progress report. London: The Stationary Office. Retrieved August 5, 2018, from http://dera.ioe.ac.uk/8646/1/12_03_09_children.pdf Le, V. P. M., Meenagh, D., & Minford, P. (2017). Tracing the causes of the banking crisis. Applied Economics, 49(43), 4351–4362. 369

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Local Authority Social Service Act (LASSA). (1970). c.42. Retrieved August 9, 2018, from https:// www.legislation.gov.uk/ukpga/1970/42/contents McAuliffe, D. (2010). Ethical decision-making. In M. Gray & S. A. Webb (Eds.), Ethics and value perspectives in social work (pp. 41–50). Basingstoke: Palgrave. Morse A. (2014). The impact of funding reductions on local authorities. London: National Audit Office. Retrieved June 7, 2018, from https://www.nao.org.uk/wp-content/uploads/2014/11/Impactof-funding-reductions-on-local-authorities.pdf Nozick, R. (1974). Anarchy, state and utopia. Oxford: Blackwell. O’Hara, M. (2014). Austerity bites: A journey to the sharp end of cuts in the UK. Bristol: Policy Press. Pickett, K., & Wilkinson, R. (2009). The spirit level: Why equality is better for everyone. London: Penguin Books. Pol, E. (2012). The preponderant causes of the USA banking crisis. Journal of Socio-Economics, 41(5), 519–528. Rawls, J. (1972). A theory of justice. Oxford: Oxford University Press. Rawls, J. (1999). A theory of justice. Oxford: Oxford University Press. Schulman, L. (1999). The skills of helping individuals, families, groups, and communities. Itasca, IL: Peacock Publishers. Sen, A. (2010). The idea of justice. London: Penguin Books. Shoesmith, S. (2016). Learning from Baby P.: The politics of blame, fear and denial. London: Jessica Kingsley. Thorlby, R., Starling, A., Broadbent, C., & Watt, T. (2018). What the problem is with social care, and why do we need to do better? London: The Health Foundation & the Institute for Fiscal Studies/The Kings Fund. Retrieved June 26, 2018, from https://www.health.org.uk/sites/health/files/NHS70-What-Can-We-Do-About-Social-Care.pdf Timmins, N. (2001). The five giants: A biography of the welfare state. London: Harper Collins. Whittaker, A., & Havard, T. (2016). Defensive practice as ‘fear-based’ practice: Social work’s open secret? The British Journal of Social Work, 46(5) 1158–1174. doi:10.1093/bjsw/bcv048 Younghusband, E. (1981). The newest profession: A short history of social work. Stroud: Sutton Publishers.

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47 Some ethical limitations of ­privatization within social work and social care in England for children and young people Malcolm Carey

Since the 1980s, the privatization and marketization of social work and social care services within England and the other parts of the United Kingdom have remained a prominent ­policy-related reform. Its impact has been profound upon social service and formal care delivery and organization, and it has also affected the changing associated role and identity of social workers (Clarke, 1996; Harris, 2003; Jones, 2015). The implications of this increasingly universal neoliberal policy mandate have included the further restricting of the “life chances” of many children and young people in care, a process which not uncommonly goes on to last throughout the life course. Moreover, it will be maintained that privatization often remains central to the commodification of childhood within care, and that marketization plays an important role in socially excluding children. Social workers in England and other parts of the United Kingdom are inevitably drawn into this dystopian political outcome. The chapter is divided into five parts. To begin with some background in policy, market trends and context are provided. We then examine the “commodification” of children and young people within social work and care, before discussing the influence of m ­ arket-led service and professional role fragmentation. Finally, the reduced “life chances” of children in care are discussed, followed by a concluding summary which reiterates some of the key ethical implications of privatization alongside some of their ties to key ethical frameworks.

Policy background and trends Until the 1980s in England and other parts of the United Kingdom, the majority of social work provision and services had been provided by local authorities within local government. This customary means of organizing formal social care began to alter with the expansion of private residential care for adults throughout the 1980s. In 1981, a policy of Compulsory Competitive Tendering had been initiated by the first Conservative Government under ­Margaret Thatcher. It encouraged local authorities to compete with private and voluntary sector providers for local government funded contracts. The National Health Service and Community Care Act, 1990, and Children Act, 1989, subsequently encouraged “quasi-market” based 371

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competition, which included a logic of social workers acting as care or case managers undertaking assessments of need and purchasing care from competing “service providers.” By assessing the needs of “service users,” social workers were to play a key role in restricting access to care services by bureaucratically scrutinizing eligibility for support. They were also encouraged through policy mandates to promote a wider “social work business,” eventually dominated by “for profit” residential, nursing, domiciliary, and foster care services (Harris, 2003; Petrie, 2015; Williams, 2012). A legal distinction had been drawn between services for adults and children, with the Children Act of 1989 prioritizing the role of the voluntary sector above “for profit” companies in the provision of care for children. According to Petrie (2015), however, this legal discrepancy was often obscured when reinterpreted by local authorities within an organizational, political, and resource-led context. For example, due to legal ambivalence and uncertainty, bureaucratic assessment responsibilities, and significant pressures to limit spending, many local authorities relied upon an increasing number of “for profit” providers for services for children and young people, especially in substantive areas such as residential and foster care. In England, from a relatively small proportion throughout the 1970s and 1980s, the ­m ajority of children’s homes are now run by private sector providers. For example, 72% of care homes were run by private companies in 2017, and 7% by voluntary organizations. Only 20% of residential care homes for children are now run by local authorities in ­England, down from 61% in 2000. Moreover, around one third of local authorities no ­longer run any children’s homes in England. Foster care services for children have ­w itnessed similar patterns. For example, between 2000/2001 and 2012/2013, there was a 342% ­increase in the total number of private sector foster care days bought by local ­authorities. In more specialist areas of provision, private sector provision again dominates. Residential special schools, for example, provide educational provision for very vulnerable children in rural areas. In 2017, just over two-thirds (57 in total) of residential special schools were run by the private sector, in comparison to three local authority owned homes (LaingBuisson, 2016; Ofsted, 2017). Much of the ideological rationale used to justify marketization within social work and care initially centered upon breaking up an inefficient and bureaucratic monopoly of state owned services, fortified by seemingly self-seeking welfare professionals such as social workers. Such provisions often failed to provide meaningful and lasting support to children and young people (Parton, 2014). Despite this, evidence suggests that privatization has tended to further intensify bureaucratic labor processes, as well as lead to a relative switch of public to private sector market dominance (Williams, 2012). Parton (2008), for example, has argued that modern social work for children and families is now more about collecting and processing information, rather than providing direct support: a political tendency which has followed the priority given to risk-averse child protection and safeguarding within markets of care. Regarding market domination, private equity firms have replaced many of the services for children previously provided by nonprofit public and voluntary sectors. For example, two of England’s three biggest private sector providers of foster care are owned by private equity firms. In children’s residential care where monopoly provision is common, Williams (2012) notes how problems of takeovers and the offloading of assets sit alongside poor employment rights for staff which generates numerous problems if seeking to provide consistent support for residents. Such challenges, alongside numerous others including financial irregularities and inefficiencies, have led to claims that children and young people are increasingly commodified within fragmented markets of care. 372

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Commodification of service users An abundance of bureaucratic assessments, contracts, and related auditing and performance related targets within quasi-markets of social care have meant that meeting the explicit needs of children or young adults can often become marginalized as priority. Indeed, a needs-­related focus upon bureaucratic processes has meant that children as “service users” can become lost within multifarious procedures as they are codified, quantified through data collection, and scientifically evaluated according to ranked needs. Such administrative and ­fi nancially driven mechanisms lead to “service users” gaining a market exchange value among competing service providers, while also being perceived increasingly as a financial burden by resource strapped local authorities. Such complex cultural, economic, and political processes within quasi-market fields can remain especially prone to reconstructing children or young people as commodities who are caught within a discursive and administrative storm of formal meetings, evaluations, contract negotiations and ongoing assessments, therapeutic ­d iagnoses or consultations. This is typically alongside ongoing discussions between welfare professionals, local authorities, and service providers about who should provide and pay for care (Humphris & Sigona, 2017; Petrie, 2015). Although such dehumanizing political cultures will affect all children, they are perhaps especially pronounced for children with more specific needs. For example, Humphris and Sigona (2017) have recently detailed how fragmented service outsourcing – including an increasing reliance upon out-of-county care placements – are being used by many local authorities in England to distance themselves from their statutory and legal responsibilities toward unaccompanied asylum-seeking children (UASC). Here, the legal principle of maintaining the “best interests” of children embodied in international law has seemingly become reconstituted within a “market logic” discourse to subsequently reduce many UASC to “raw materials for private profit.” The ascendancy of private sector service providers helps to maintain an ideological distance between the increasingly business and ­resource-centered goals of managers within social services, and frontline social workers who often seek to focus more on meeting the complex needs of UASC. A tendency for managers to increasingly recruit newly qualified social workers to save money mean that experienced employees are increasingly rare despite their experiential insight often being valuable to children. In relation, the practical and ideological push for efficiency savings leads to UASC often being moved many miles away to unfamiliar counties because the cost of their care is likely to be lower and, as we shall see later, vacancy places are rare in some counties. Such outcomes often lower any capacity to provide consistent and appropriate care, as well as placing some such children at potential risk of neglect or abuse. Finally, ongoing ­m arket-based, organizational or legally enshrined restructuring within local authorities helps to further destabilize support. Another example of more specific support relates to disability. Again, evidence here suggests that markets – and the work of welfare professionals within – often struggle to cope with meeting more complex needs. Morris (2005), for example, has argued that disabled children tend to require more highly skilled and sensitive support. The prevalence of audits, performance related targets, bureaucracy, and significant reduced resources within markets of care has meant that more person-centered forms of social work for disabled children have virtually disappeared. Further evidence of a high turnover of staff and preference given to less experienced employees within local authorities has again countered the potential to meet many of the diverse needs of disabled children. In addition, traditional prejudices can be further fueled by such outcomes. For example, with limited available time and greater priority 373

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being given to risk averse practices and safeguarding, there can quickly emerge a tendency to prioritize the physical safety of disabled children, as opposed to recognizing their more nuanced cultural, social, or identity-related needs (Morris, 2005; Taylor et al., 2015).

Fragmented social work and services A consistent criticism made against extensive marketization within the United Kingdom has remained the negative impact of service fragmentation upon professional roles and identity, alongside the undermining of consistent support provided for service users. Clarke (1996, pp. 59–64), for example, has detailed the relative “dismemberment of social work” which has generated “a problem of identity, values and loyalty” for social work staff. Fragmentation due to market-based reforms within wider welfare has led also to redesigns of “systems of provisions” in tandem with restructured financial arrangements, organizational controls, directions, and relations between staff, leaders, and “service users.” Transaction costs and spending restraints have also increased substantially with the rise in market-based commissioning. More boundaries persist between competing service providers, with each less likely to collaborate and instead compete against one another for contracts and other finite resources. This all creates ongoing tension and conflict between providers and professionals, increasingly in competition over scarce resources. Privatization within social work has led to a significantly higher proportion of separate service providers, especially in core business sectors such as residential and foster care. In ­England during 2017, for example, private organizations ran a total of 1,538 (72%)  ­children and young people’s residential care homes, voluntary organizations 164 (8%), and local authorities 434 (20%) (Department for Education, 2017; LaingBuisson, 2016). Closer examination, however, reveals deficits in terms of the capacity of each market to provide consistent and reliable support. In particular, nationwide, there remain substantial geographical and service inconsistencies. For example, there are 41 care homes serving a population of just over 200,000 (1 per 4,878 people) within Rochdale, 514 residential care homes in the North West of England serving a total population of 6.9 million (1 home per 13,424 people), and 130 homes serve more than 7.8 million people (1 home per 60,000 people) in London (­Department for Education, 2017; Williams, 2012). The location of care homes is now more likely to be strongly influenced by factors such as the relative cost of housing stock in a local area, as opposed to social care related needs in a specific locality. Subsequently, in order to reduce costs, many children are relocated by local authorities far away from their original place of residence. This dislocation of so-called “pinball kids” can promote further risks, including making children much more vulnerable to engaging in crime, or of experiencing neglect, further social exclusion, or even abuse (Humphris & Sigona, 2017; Williams, 2012). Biehal, Cusworth, Wade, and Clarke (2014) analyzed data drawn from 156 local authorities over three years in the United Kingdom to report that essential care plan reviews following the placement of a child in a care home or within foster care were “rarely held.” Wide variation also persisted in how staff were dealt with following any allegations of neglect or abuse within residential homes, and few young people were removed from a placement if allegations had been made. Moreover, the lines of responsibility between local authorities for children placed out of authority “could sometimes be confusing” according to the authors, with shared record keeping often not apparent and the management of allegations between neighboring local authorities “sometimes uncertain with respect to which areas took the lead on investigations.” 374

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Any risks to children and young people through service fragmentation can multiply further when other factors are taken into account. For example, sociologists such as Giddens (1991) and Lash (2007) have argued for many years that societies have become more fragmented and atomized, as well as dislocated or fluid according to social norms and cultural expectations. Among other examples, local communities have shrunk in scale along with changes in the size of families and relative influence of extended families or authority figures including professionals. An increased reliance upon new technologies persists, alongside reduced access to welfare benefits and greater levels of temporary employment and unemployment. Increased geographical migrations persist, alongside more diverse populations who now appear to be more consciously aware of their identities than previous generations. In addition, levels of inequality and social exclusion have increased within most Western societies, and identity-related freedoms of sort and largely superficial forms of equality are often supplanted by much greater political pressures to be independent and autonomous (Bauman, 2000). Such and other changes suggest that potential levels of risk or abuse increase for many children and young people in care, and that support should be more consistent and reliable rather than fragmented, detached, or absent.

Circumscribed life chances for children and young people It is now widely recognized that many children and young people in care experience significantly reduced “life chances.” Examples include an increased likelihood of entering the criminal justice system – not uncommonly during childhood or early adulthood – alongside significantly reduced employment and educational opportunities in later life. The likelihood of experiencing mental health problems and/or engaging in “sex work,” substance misuse or developing addictions, and entering prison can again increase significantly. For example, despite the proportion of children in care representing less than 1% of the general population, 25% of the adult prison population and 49% of young men in the criminal justice system have previously been in care. During 2015 in England, only 14% of children in care achieved five or more GCSE passes, in comparison to 53% of children in the general population. A total of 61% of children in care was diagnosed as having a special education need compared to 15% of the general population. Teenage pregnancies for under 18s are almost ten-fold higher amongst young adults leaving care than their non-care peers, with a conception rate of 22% in comparison to 2.3% among the general population in England and Wales (Datta, ­Macdonald, Barlow, Barnes, & Elbourne, 2017; Office of National Statistics, 2016; Prison Reform Trust, 2017). Although it’s not easy to directly link some of these outcomes to privatization since many children in care have always experienced reduced life chances, some studies are beginning to illustrate a close association between marketization and circumscribed life chances for children. For example, in drawing from evidence including a participatory research component, the Prison Reform Trust (2017) has highlighted the corrosive impact of increasingly inconsistent care for young service users. This includes the negative impact of changes in where children live, are educated, and who is able to offer practical or emotion support. One young male participant who was 15 years old when interviewed epitomized the impact of inconsistent support within the care system: “Since July 2013 I have been to 16 schools and I have been in 15 different placements all around the country…All of my offending has been whilst in care.” Such fragmented care, alongside a lack of preventative support (including for families prior to children being taken into care) and limited professional support, can have a sustained 375

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influence upon the potential for children to engage in criminal behavior. In relation, the Howard League for Penal Reform (2016) has detailed how police in England and Wales continue to be called out to children’s residential homes thousands of times a year. For example, across a total of 16 police forces, there were 10,299 callouts in 2014–2015. The report argues that local authorities, the police, Ofsted, and central government are ignoring or not addressing “bad practices at the three-quarters of England’s 1,760 children’s homes that are run by private companies.” In addition, the report isolates a “tipping point” at age 13 for many children in care, at which point societies sympathy evaporate and “rather than being helped, [children] are pushed into the criminal justice system.” Some studies, however, have reiterated the impact of positive and consistent support in care. For example, Sebba et al. (2015) drew from case study research with 26 teenagers across six local authorities (and who were in foster care for at least 12 months) to stress that many of the young people in care had improved their educational abilities. Crucially, this was much more likely the longer the young person has been living in a stable foster care placement. Again, such outcomes are more likely with consistent and often experienced social work support, alongside resources and support provided to families prior to children being taken into care. Ferguson (2017), however, has noted that positive contact for families or children with social workers tends to now be extremely limited or nonexistent beyond initial assessments, formal investigations, or fleeting appearances at a Court of Law.

Some ethical implications of privatization Three principle ethical concerns have been raised about extending privatization within social work and care for children and young people. First, quasi-markets of social care have a tendency to commodify and objectify younger clients through the prism of market-based discursive processes that reconstruct children as “service users.” However, children as service users typically lack the emotional maturity, knowledge, and experience to advocate on their own behalf, even if empowered to participate. Although social workers acting as case managers are intended to facilitate decision-making for service users, evidence suggests that this assumption is deeply flawed due to numerous obstacles, including limited available resources and time (Ferguson, 2017; Parton, 2008; Petrie, 2015). As we have seen from some of the research examples presented, within quasi-markets, choice and consistent support can be extremely limited for many children and young people, and they can quickly be reduced to signifying a cost burden by local authorities. Such examples suggest that some key core ethical principles – such as the importance of maximizing informed consent and human dignity stressed in bioethical theory – are compromised. Second, in relation to maximizing choice, one crucial argument made to support the extension of the private sector within quasi-markets of social care has remained that of making care services and provisions more flexible to meet more diverse needs (Harris, 2003). Among ties to other ethical frameworks, this perspective appears to fit closely with Kant’s key categorical imperative principle that any person is not treated as a “means to an end” (Singer, 1993). As we have seen, however, groups such as asylum seeking or disabled children tend to be especially vulnerable to objectification and social exclusion due to market-centered outcomes such as priority being given to reducing costs by local authorities and business centered managers; or profit above all else by some service providers, some of whom are based abroad (Williams, 2012). Finally, all key ethical paradigms including those stressed in professional codes of ethics prioritize varying degrees of equality or social justice. Such principles are perhaps more 376

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pronounced within the ethics of care, but also prevail within aspects of deontological, utilitarian, and bioethical frameworks. As discussed, there persists evidence that privatization within social work and care increases the likelihood of children and young people experiencing disadvantage and social exclusion throughout their life course. This is perhaps most apparent regarding the poor life chances of young people and adults previously in care as children. Although some evidence suggests that consistent social work support and reliable services can improve the life chances for children in care, many current market-centered provisions are clearly failing to meet these objectives. It has been argued that increasingly privatization remains central to many of these inequitable outcomes, each of which carries important ethical implications.

References Bauman, Z. (2000). Liquid modernity. Cambridge: Polity. Biehal, N., Cusworth, L., Wade, J., & Clarke, S. (2014). Keeping children safe: Allegations concerning the abuse or neglect of children in care. York: University of York/NSPCC. Clarke, J. (1996). After social work? In N. Parton (Ed.), Social theory, social change and social work (pp. 36–60). London: Routledge. Datta, J., Macdonald, G., Barlow, J., Barnes, J., & Elbourne, D. (2017). Challenges faced by young mothers with a care history and views of stakeholders about the potential for Group Family Nurse Partnership to support their needs. Children and Society, 31(6), 463–474. Department for Education. (2017). Children looked after in England (including adoption), year ending 31 March. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_ data/file/556331/SFR41_2016_Text.pdf Ferguson, H. (2017). How children become invisible in child protection work: Findings from research into day-to-day practices. British Journal of Social Work, 47(4), 1007–1023. Giddens, A. (1991). Modernity and self-identity: Self and society in the late modern age. Cambridge: Polity Press. Harris, J. (2003). The social work business. London: Routledge. Howard League for Penal Reform. (2016). Criminal care: Children’s homes and criminalising children. London: Howard League. Humphris, R., & Sigona, N. (2017, December 20). Outsourcing the ‘best interests’ of unaccompanied asylum-seeking children in the era of austerity. Journal of Ethnic and Migration Studies. Published Online. Retrieved from https://www.tandfonline.com/doi/full/10.1080/1369183X.2017.1404266 Jones, R. (2015). The end game: The marketisation and privatisation of children’s social work and child protection. Critical Social Policy, 35(4), 447–469. LaingBuisson (2016). The potential for developing the capacity and diversity of children’s social care services in England. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_ data/file/573035/LaingBuisson_report_December_2016.pdf Lash, S. (2007). Power after hegemony: Cultural studies in mutation? Theory, Culture, and Society, 24(3), 55–78. Morris, J. (2005). Children on the edge of care: Human rights and the children act. London: Joseph Rowntree Foundation. Office of National Statistics. (2016). Conceptions in England and Wales: 2014 Statistical Bulletin. Newport: Office of National Statistics. Ofsted. (2017). Children’s social care data in England 2017: Main findings. Retrieved from https:// www.gov.uk/government/publications/childrens-social-care-data-in-england-2017/childrenssocial-care-data-in-england-2017-main-findings#all-childrens-homes Parton, N. (2008). Changes in the form of knowledge in social work: From the ‘social’ to the ‘informational’? British Journal of Social Work, 38(2), 253–269. Parton, N. (2014). The politics of child protection: Contemporary developments and future directions. Basingstoke: Palgrave Macmillan. Petrie, S. (2015). “Commodifying” children: The impact of markets in services for children in the United Kingdom. International Journal of Child, Youth and Family Studies, 6(2), 275–294. Prison Reform Trust. (2017). In care, out of trouble. London: Prison Report Trust. 377

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Sebba, J., Berridge, D., Luke, N., Fletcher, J., Bell, K., Strand, S., …, O’Higgins, A. (2015). The ­educational progress of looked after children: Linking care and education. Bristol: Data Rees Centre. Singer, P. (1993). How are we to live? Ethics in the age of self-interest. Oxford: Oxford University Press. Taylor, J., Cameron, A., Jones, C., Franklin, A., Stalker, K., & Fry, D. (2015). Deaf and disabled children talking about child protection. Edinburgh: University of Edinburgh/NSPCC. Williams, Z. (2012). The shadow state: A report about outsourcing of public services. London: Social Enterprise UK.

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Section XIII

Special topics

48 Unconscious awareness The implicit and oppressive ethical context of bilingual social work practice Pablo Arriaza

Ethical and practice guidelines by national professional associations, governmental agencies, and private institutions suggest that cultural sensitivity and cultural humility are central to ethical social work practice. Unfortunately, these guidelines have not explicitly addressed language competence among bilingual social workers as an imperative to such cultural sensitivity or cultural humility. Furthermore, language competence among bilingual social workers has not been understood or explicitly described as an ethical obligation but rather as a matter of skills’ convenience. The current number of bilingual social workers in the United States cannot meet the demands of social service agencies, hospitals, or private sectors providing services to people who are monolingual or who have limited language skills. This chapter presents the ethics of bilingual social work practice in systems that do not support, respect, or empower these social workers and service seekers. A brief review of the literature will be presented to discuss oppressive factors experienced by bilingual social workers and identify standards of practices to empower bilingual social workers, people with Limited English Proficiency (LEP), and agencies. Contemporary ethical challenges intersecting all systems of social work practice will be discussed in relation to bidirectional and reciprocal responsibilities between bilingual social workers, people identified as LEP, agencies, professional associations, and private institutions. The chapter will conclude with recommendations to address structural challenges, minimize ethical dilemmas, and empower professionals, people with LEP, and agencies to clarify roles and responsibilities across micro, mezzo, and macro systems.

Implicit unconscious-awareness of social work ethical imperatives Social work practice is both a science and an art. The scientific aspect of social work practice is a tangible, structural, and measurable process of many evidence based practices, theories, and models. The artistic component, however, is often misunderstood, misused, and often an uncomfortable process for novice and well-experienced social workers alike. The uneasiness of considering, integrating, and fusing the artistic aspect to social work practice often stems from a comprehensive lack of awareness regarding this simple yet complicated construct, art. Questions have been raised regarding the rigor of infusing the art with the 381

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science. The challenge in considering a reflective practice model of social work practice, where both science and art exist simultaneously and considered in chorus, is certainly not a new phenomenon. The profession of social work has a long history of morphing into new processes, dynamics, and creating contemporary social work interventions focused on social justice, empowerment, and giving voice to marginalized and oppressed individuals and communities. We, however, continue to struggle, as a profession, to have a clear, dynamic, and holistic definition of social work practice which consistently integrates the science and the art without dichotomizing the profession. Integrity, respect, social justice, competence, human relationships, and service are a few of the core values frequently used to describe, define, clarify, and differentiate the social work profession from other social and allied helping professions. Although these values are well-conceptualized by social workers, and the profession in general, they do not protect or prevent ethical dilemmas from emerging and intersecting in practice. To underscore the significance of ethical grounding in social work practice, social work licensing boards across the United States mandate that licensed social workers provide evidence of ethics continuing education training at every license renewal period. It may seem reasonable to assume that completion of a two or three-hour ethics training every two to three years decreases ethical challenges. The fact that there has been an increase in such mandated ethics trainings by licensing boards provides rationale to the contrary. Consequently, narratives, books, journals, and professional social work conferences have certainly increased their attention on ethics. Nevertheless, ethical dilemmas are often perceived from an explicit and monolithic process when in fact social work ethical dilemmas are often implicit with a hint of awareness. This process that I will call unconscious awareness is a powerful process as it directly intersects ethical decision-making. Regarding bilingual social work practice, for example, decisions regarding language competence and/or language congruence of the provider, client, and of the organization are often decided without explicitly applying ethical principles. The unconscious awareness dynamic emerges when we do not engage in effective self-awareness, honest and efficacious evaluation of our professional skills and qualifications, and, of course, when language competence, for those who are bilingual, is not explicitly and consciously addressed by professionals (micro system), organizations (mezzo systems), and societal/governmental (macro) systems.

Semantics and bilingualism A brief discussion is warranted to understand language from different perspectives and clarify specific terminology often misused. First of all, it is crucial to understand that language evolves over time as a result of various societal phenomenological events such as advances in technology. Increased access to electronic communication, via smart phones for instance, has changed language. New words have been created and now people can even have a conversation in virtual platforms simply by using symbols identified as “e(i)mojis.” Language then is socially constructed and mediated by changes in technology and also by increased rates of migration, and changes in acculturation and assimilation rates. People who are in the process of acculturation understand the cultural values of a new community but have not fully incorporated these values and other attributes, such as language, into their new social identity. Assimilation, on the other hand, occurs when the predominate values of the existing community/society, where the person lives, become primary. In the past, language has been used to determine levels of assimilation. Today, we know that assimilation is a process that requires more than proficiently speaking the target language of the community where the 382

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person lives. Assimilation, like acculturation, can be perceived as a process which involves language, culture, morals, affective (feelings), and a connection to the dominant group. This connection to the dominant, or majority group, seems to require acceptance into such group. Assimilation, then, is a process of incorporating new values, cultural norms and morals, and having the perception of acceptance. In that case, language acquisition, or competence, is one variable mediating acculturation and assimilation. Assimilation occurs across cultural systems and settings. Social workers, for example, pursuing new professional opportunities, experience a process of assimilation when beginning a new job. Consequently, language is at the center of this process. For bilingual social workers, the terms translation and interpretation become essential when providing bilingual social work service. These terms are often erroneously used interchangeably. Translation takes place in writing while interpretation takes place verbally. Translation of documents such as power of attorneys, court documents, prescriptions, and informed consent happens when words are changed (translated) into another language. In contrast, interpretation ensues when words are changed (interpreted) from one language to another language. ­Examples of these include translating – writing – the directions of a medication regimen given in English into Spanish and interpreting – talking – by interpreting what a doctor is explaining to a patient. ­Interpretation happens in real-time while translation does not have such requirement; documents can be translated at a later time. What about language competence then? How does language competence intersect ethical matters in the practice of bilingual social work? As discussed previously, then, it is easy to begin asking competence-laden questions such as, how does a physician requesting interpretation services determine language congruence between the bilingual social worker and the patient/family? How is language competence established for the bilingual social worker? Who is ultimately responsible for determining language competence? Who is best positioned to provide interpretation and translation services?

Professional and governmental guidelines Professional organizations follow professional ethical guidelines. The National Association of Social Workers (NASW), for example, provides social workers with professional guidelines, a Code of Ethics, that align with the values, philosophy, and morals of the social work profession. Throughout the years, NASW has revised the code of ethics to represent and address contemporary trends in social work practice. Although the code of ethics is comprehensive, historically, language competence has not been an explicit topic discussed as a guideline or standard of practice. In fact, most organizations and credentialing organizations discuss language in relation to the client/consumer/patient and do not overtly address or question the language self-efficacy or competence of the provider or the organization at large. To this extent, many helping professions and organizations have not translated professional ethical guidelines into the most common languages spoken in the United States, Spanish, and languages of Asia. Such lack of attention informally and unconsciously oppresses these groups by not having ethical guidelines available in their expressive and receptive languages. The oppressive factor then surfaces when people who do not have the same opportunities to understand or have available professional ethical guidelines, as English speakers, in their primary expressive and receptive language. This dynamic of unconscious oppressive awareness further reinforces the power-differentials that often lead to errors in delivering ethical biopsychosocial and spiritual services. Many of these (medical) errors, regularly fatal, have been extensively discussed in the literature (Flores et al., 2003; Jacobs et al., 2001). 383

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Regarding U.S. Federal guidelines, Title VI of the Civil Rights Act of 1964 prohibits discrimination to people based on national origin, which includes language and people who do not speak English. While Title VI has existed since 1964, it has taken several decades to further formalize more explicit discussions regarding provision of health care services to people who have been identified as having LEP. In 2000, President Clinton signed Executive Order 13166 which specifically addresses “Improving access to services for Persons with Limited English Proficiency” (https://www.justice.gov/crt/executive-order-13166). In 2002, the Department of Justice (DOJ) provided further guidance on how to apply Executive Order 13166 with people with LEP receiving Federal financial assistance but “declined to set, as part of the DOJ Recipient LEP Guidance, professional or technical standards for interpretation applicable to all recipients in every community and in all situations” (https://www.gpo.gov/fdsys/pkg/FR-2002-06-18/pdf/02-15207.pdf ) (p. 41456). The DOJ addressed language competence but left the decision to assess such competence to agencies. Without clear guidance on ethical responsibilities regarding language competence or how and when to assess for language competence, professional and accrediting organizations were also less directive in creating explicit language competence assessment plans (https://www. lep.gov/resources/2011_Language_Access_Assessment_and_Planning_Tool.pdf ). Increased attention on equitable ederal services to people with LEP did not fully render a conscious discussion regarding language self-efficacy and language competence of biopsychosocial and spiritual medical service providers until 2011 when the DOJ published guidelines for language access assessment. Although this “Language Access and Planning Tool” focused on Federal agencies, the guidelines are applicable across systems and need to be considered by all agencies and organizations providing services to people with LEP. Finally, Title 1557 of the 2010 Affordable Care Act (ACA), enforced by the Health and Human Services Office for Civil Rights, reinforced Civil Rights of people with LEP by addressing non-discriminatory provision of ACA. Title 1557 provided a vital modification in changing the word “competent” to “qualified” when referencing interpreters. This is an important change in semantics because it prompts bilingual professionals as well as organizations to explicitly consider the “qualifications” for being a bilingual social worker, for example. These Federal guidelines inform provision of language services to people who are LEP receiving medical services across Federal agencies. It has been left to non-Federal organizations to continue this dialogue of language competence with people who are LEP receiving non-Federal biopsychosocial and spiritual (medical) support. Institutions such as the Latino Social Work Organization and researchers (Arriaza, 2015; Martin, 2014; Rolland, Dewaele, & Costa, 2017) have broadened the discussion regarding the intricacies of bilingual biopsychosocial and spiritual service provision. Engstrom in 2004 and again in 2009 presented an initial discussion regarding the complexities of bilingual social work practice. Engstrom’s research and narratives prompted deeper discussions among social work leaders and researchers (Arriaza, 2015; Engstrom & Min, 2004; Engstrom, Piedra, & Min, 2009; Marrs Fuchsel, C, 2015; Furman, Loya, & Russell Hugo, 2013), to impart opportunities to discuss ethical implications of bilingual social work practice across systems.

Bidirectional and reciprocal ethical responsibility The words “ethics” and “ethical” have been used to define and describe morals and virtues as they apply in biopsychosocial and spiritual social work practice. These words can be misused and misunderstood despite explicit definitions among professional organizations such as in the NASW Code of Ethics. It is, however, the responsibility of individual social workers to 384

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incorporate the meaning of “ethics” into their practice. Because the meaning of these words is mediated by various aspects of the self, including life experiences, culture, race, ethnicity, as well as the organization or agency where services are provided, challenges exist when bilingual social workers, for instance, are faced with language complexities. The context within these areas serves as the first step to incorporating the ethics of the social work profession into a personal reflective model of social work practice. Reflective social work supervision is one variable to consider to enhance self-awareness, self-reflection, and ethical decision-making. Bilingual social workers, often working in fast-paced organizations, with increased caseloads, long working hours, complicated cases, limited or nonexistent social work supervision or peer support, and limited structural/community/­organizational support may not have the advantage to slow processes down to question aspects of their practice such as their level of language competence. These challenges, at a minimum, place bilingual social workers at risk for burnout and worse, it enhances opportunities for malpractice. It may seem implausible to think that simply being bilingual places a social worker at risk for malpractice. However, when organizations do not question language competence, do not assess level of language competence in a second language, do not provide support or incentives to enhance language skills, do not question the effect that having a higher caseload than monolingual colleagues has on the bilingual social worker, and do not provide financial reward for providing services in two languages, then it becomes an expectation to not question language competence. This dynamic is further reinforced when new social work graduates are offered employment opportunities and their multilingual skills are highlighted in the interview or simply offered an interview because of the words “bilingual” align with the job announcement and resume. It is indeed an additional skill, but the language efficacy and qualification of such skills, as discussed in Title 1557, must be question with equal value to social work clinical skills, for instance. The responsibility to question, assess, and determine language competence of bilingual social workers rests in both the social workers and larger systems such as agencies, hospitals, and companies. This can be best understood from a bidirectional and reciprocal relationship. Social workers, as outlined by the NASW Code of Ethics, have the ethical responsibility to inform these larger systems about their areas and levels of social work practice competence, including language skills. In sequence then, larger systems inform and determine the qualifications of social workers to meet the needs of the larger system. To minimize ethical dilemmas, as it relates to bilingual social work practice, these two systems must inform each other. Regrettably, this has not been the norm because there has been minimal awareness placed on evaluating bilingual social workers’ language skills. Arriaza (2015) revealed that bilingual social workers may be rating their professional Spanish language skills at similar levels as their social Spanish language skills. The majority of the 321 participants also reported questioning at times their Spanish language skills. Questioning language skills becomes an ethical issue when self-doubts about language competence are not explored in the actual practice of social work. The challenge, as posed earlier, is the reinforcement of pseudo language competence that takes place within the reciprocal and bidirectional relationship of the bilingual social worker and the larger system ( job site). When language competence is assumed because the person has a Spanish sounding name, or the person has an accent, or the person indicates that they were born in a Spanish speaking country and grew up speaking Spanish at home, the potential for malpractice increases. It is the responsibility of the self-identified bilingual social worker and the larger system(s) to determine level of language competence prior to providing social work services. When assumptions are made regarding level of language skills or competence, bilingual social workers must recall that NASW 385

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Code of Ethics sections 4.01 and 4.06 guide them to consider and assess levels of competence and avoid misrepresenting their professional skills (https://www.socialworkers.org/About/ Ethics/Code-of-Ethics/Code-of-Ethics-English). Systemic oppression, based and reinforced with fear, can be targeted with empowerment by bilingual social workers who must keep their code of ethics in the forefront when interviewing for jobs, seeking new community opportunities, and engaging in policy-level work. Consulting the NASW Code of Ethics and integrating aspects of this code in letters of introduction, during job interviews, and later during supervision, may decrease assumptions, by others, of pseudo language competence. The aim of this chapter is not to question if a social worker speaks a second language or not, but to reinforce the awareness that speaking a second language within the ethics of social work practice does not automatically translate into having a professional level of language competence. The ability to effectively provide social work services in two languages with equal rigor and competence must be perceived as existing independently from having a social ability to speak a second language other than English. Being bilingual in a social setting does not mean that the person is also bilingual in professional settings. Social work practice requires specialized skills, specialized vocabulary and terminology, and specialized knowledge of theories and interventions. Qualified bilingual social workers must acknowledge, with confidence, that they can deliver uniformed social work services in both languages.

Contemporary ethical challenges and proposed actions An ecosystemic perspective can be presented to identify current ethical challenges experienced by bilingual social workers. First, at the micro-individual level, bilingual social workers experience oppressive factors by not having the support of mezzo-organizational, systems recognize language skills and empower them. As previously discussed, such support, recognition, and empowerment exist within bidirectional and reciprocal systems. Therefore, social workers have the ethical responsibility, as outlined in the NASW Code of Ethics, to assess their language skills when identifying as “bilingual.” Social workers have the ethical responsibility to avoid or stop situations such as “drive by” informal interpretation often taking place in hallways with requests to “interpret something really quickly.” In the event that the social worker is a qualified bilingual provider, mechanisms must exist to follow standards of practice to minimize malpractice and ethical dilemmas. When these mechanisms do not exist, the responsibility of the social worker is to identify the need for a systematic process and execute it. A quarter of the hospitals with the greatest need for language services do not provide such services in a systematic way, and nearly a third of all US hospitals do not offer language services at all (Smith, 2010). Bilingual social workers can effect change by increasing awareness regarding the need to have qualified bilingual services, setting clear limits and boundaries to clarify roles and responsibilities, and advocating for equitable compensation (Musser-Granski, J., & Carrillo, D, 1997). It is essential for social workers to question their understanding of cultural differences by using a cultural competence perspective. Culture is also socially constructed, thus understanding a specific culture must be perceived from cultural sensitivity, cultural awareness, or cultural humility perspective. No one is culturally competent at all times, across similar cultures, or across contexts. However, cultural humility reinforces the bidirectional responsibility of cultural awareness between the social worker and the client system. This, too, is a change proposed by the NASW. Bilingual social workers have the responsibility to create support systems to address the needs of all people, especially people who are marginalized, vulnerable, oppressed, 386

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and without a voice. People who are LEP often fall in these categories and further experience barriers to health care services (Kim., G, et al., 2011 & Garrett, C.R., Treichel, C.J., Ohmans, P., 1998). Social workers must be consciously aware that engaging in interpretation services without having formal training or deemed a qualified interpreter parallels malpractice. ­Policies must be created within agencies to avoid role blurring and respect and compensate bilingual social workers for the language skills. These systems must address workload and adjust it according to appropriate client to social worker ratios. Furthermore, supervision must be offered by agencies and explicitly address language efficacy and proficiency. At the macro policy level, social workers must continue advocating for interpretation and translation services to become a standard of practice when providing biopsychosocial and spiritual services to people who have LEP. Advocating at the Federal level with health care insurance companies is fundamentally essential. In summary, bilingual social workers must assess their language skills when identifying as being bilingual. They have ethical responsibilities to address the needs of people identified as LEP by either being qualified as an interpreter and/or as a translator or create systematic mechanisms to address the language needs of this vulnerable population. Shifting the narrative from an unconscious awareness dynamic to a conscious awareness model empowers bilingual social workers and decreases potential for malpractice. The “end only justifies the means” if followed by ethical, explicit, conscious, and efficacious social work practice.

References Arriaza, P. (2015). Spanish language self-efficacy beliefs among Spanish-speaking social workers: ­Implications for social work education. Journal of Social Work Education, 51(3), 550–565. Engstrom, D., & Min, J. (2004). Perspectives of bilingual social workers. Journal of Ethnic & Cultural Diversity in Social Work, 13(1), 59–82. Engstrom, D., Piedra, L., & Min, J. (2009). Bilingual social workers: Language and service complexities. Administration in Social Work, 33(2), 167–185. Flores, G., Barton Laws, M., Mayo, S. J., Z ­ uckerman, B., Abreu, M., Medina, L., & Hardt, E. J. (2003). Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics, 111, 6–14. Furman, R., Loya, M., & Russell Hugo, S. (2013). The paucity of social workers prepared to work with Latino populations. Smith College Studies in Social Work, 8(3), 170–184. Garrett, C. R., Treichel, C. J., & Ohmans, P. (1998). Barriers to health care for immigrants and nonimmigrants: A comparative study. Minnesota Medicine, 81, 52–55. Jacobs, E. A., Lauderdale, D. S., Meltzer, D., Shorey, J. M., Levinson, W., & Thisted, R. A. (2001). Impact of interpreter services on delivery of health care to limited-English-proficient patients. Journal of General Internal Medicine, 16, 468–474. Kim, G., Aguado Loi, C., Chirboga, D., Jang, Y., Parmelee, P., & Allen, R. (2011). Journal of Psychiatric Research, 45, 104–110. Marrs Fuchsel, C. (2015). Spanish-English bilingual social workers: Meeting the linguistic needs of Latino/a clients. Journal of Ethnic & Cultural Diversity in Social Work, 24(3), 251–255. Martin, S. (2009). Illness of the mind or illness of the spirit? Mental health-related conceptualization and practices of older Iranian immigrants. Health & Social Work, 34, 117–126. Musser-Granski, J., & Carrillo, D. (1997). The use of bilingual, bicultural paraprofessionals in mental health services: Issues for hiring, training, and supervision. Community Mental Health Journal, 33, 51–60. Rolland, L., Dewaele, J.-M., & Costa, B. (2017). Multilingualism and psychotherapy: Exploring ­multilingual clients’ experiences of language practices in psychotherapy. International Journal of Multilingualism, 14(1), 69–85. Smith, D. (2010). Health care disparities for persons with limited English proficiency: Relationships from the 2006 Medical Expenditure Panel Survey (MEPS). Journal of Health Disparities Research and Practice, 3(3), 57–67. 387

49 Interprofessional ethics Working in the cross-disciplinary moral and practice space Donna McAuliffe

There is a strong rationale for cross-disciplinary understanding of professional ethics, conduct, and standards of behavior, regulatory processes, diverse worldviews, and cultural practices. The complexity of organizational structures and workplaces that dominate health, social services, education, legal, environmental, and housing sectors demand coworkers to share decision-making processes that often have ethical dimensions. Social workers must ­acquire good knowledge not only of their own professional codes of ethics and value positions, but also reach an understanding of the positions of colleagues who have quite different discipline backgrounds. Rigorous and principled ethical decision-making depends on professionals who can collectively consider a case from a range of vantage points, using a common language to identify ethical dimensions based on ethical theory to provide justified decisions. This strengthens the argument for ethics to be viewed as an interprofessional endeavor. Social work, like all other professional disciplines taught at the tertiary level, requires a carefully scaffolded curriculum with focus on development of knowledge and skills over a specified period of time, typically four years. Alongside knowledge and skills lie values, those principles, beliefs, and attitudes that influence actions, decisions, and behaviors in practice. There is clear agreement in social work education literature that exploration of values needs to start from the beginning of a students’ course of study, and continues on through professional supervision. Students need opportunity to develop skills in critical reflection that will help them to understand their own value positions over time, and there is an acknowledgment that some students may come to social work study with values that are misaligned with those of the profession (Hugman & Carter, 2016). Curriculum therefore needs to provide spaces where students not only learn about what the values of the profession are, but are provided opportunity to explore areas that are perhaps not personally comfortable. The learning outcomes should be to move students to a position of being able to hold personal positions in such a way that they will not impact on the rights of others to hold an alternate position. In some cases, of course, students may decide that their own religious, spiritual, political or cultural worldviews are not congruent with the values of social justice and human rights and make an informed decision to pursue a different career path. Having students in a class that challenge the expected traditions of values can provide a beneficial learning experience for peers, as this can be one of the first exposures they may have to what they are likely to 388

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encounter in the real world of work. Social work educators do students no favors if they set up expectations that everyone working in the social, health, or human services are caring people who hold consistent values. Instead, students need to be armed with the knowledge that when they move into practice, they will not be working only with other social workers, but with people from a broad and diverse array of disciplines, and some (if not many) will pose positions in collective decision-making that are antithetical to the values of social work. This chapter therefore explores the ways in which social workers can engage in interprofessional learning about values and ethics so that they are better prepared for interprofessional ethical decision-making in practice.

From silos to the field: traditional ethics education unwrapped There have long been debates in social work education about what content is deemed “core” (required) and what is recommended but could be positioned more in the elective space. As social work becomes subject to regulation in more countries, these specifications are more tightly nailed down by accrediting bodies whose mandate is to ensure that social work graduates have the required knowledge and skills to enter the workforce as competent practitioners. Chenoweth and McAuliffe (2018) have set out eight domains of practice for social work that include: • • • • • • • •

Work with individuals Group work Work with families and partnerships Community work Social policy practice Organizational practice, management, and leadership Research and evaluation Education, training, and consultancy

On the basis of these domains of practice, it is easily argued that social workers need to have sound knowledge of human development and the phases of the lifespan; the theoretical foundations of social work inclusive of social and psychological theory; the organizational, legal, and policy context of practice; the basics of research and evaluation; and cultural issues inclusive of equity and diversity. Social work education also needs to ensure development of skills in communication and interpersonal relationships that span all domains of practice; conflict management and dispute resolution; advocacy and leadership; group work practice and group facilitation; community development and community capacity building. The inclusion of knowledge about social work values and ethics, and the skills required for principled, systematic, and justifiable ethical decision-making, arguably span all domains of practice. There are no domains of practice, and no practice fields, in which moral considerations, ethical issues, problems, and dilemmas will not arise. It seems clear that social work values and ethics should not only be infused throughout all content in a curriculum, but should also be included as a stand-alone and discrete course. It is common for ethics to be paired with law but the danger here is that the importance of knowledge about legal parameters often dominates and obfuscates ethics. Ethics is also often incorporated in courses about human rights and social justice, which is entirely reasonable; however, the risk here is that ethics remains at the meta-level while attention is also needed to ethics at the micro-level. Students need to be able to connect knowledge about ethical theory to the broader body of social work theory 389

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and understand how different ethical positions based on deontology, utilitarianism, or virtue ethics might influence assessments, decisions, and actions. A review of a number of generic social work theory texts found little evidence of inclusion of ethical theory in this important base of knowledge. This disconnect of ethical theory from other social work theory, and the integration of ethics with other content areas, has the concerning potential to sideline ethics from the status of “core” content in its own right. An exploration of a number of other professional disciplines shows ethics being treated in much the same way as social work. Most importantly, ethics education is as much siloed in other disciplines as it is in social work, that is, taught only within the discipline itself, and not across disciplines. In psychology, nursing and midwifery, occupational therapy, medicine, education, law, and business, ethics content is infused, integrated with other knowledge areas, and in some instances stands alone as a discrete course. An example is provided by the British Psychological Society that recommends where, how, and what ethics content should be taught, specifically for psychologists and from only a psychologist standpoint. A US survey of psychology programs revealed that 96% of respondents had an ethics course and these courses were psychology specific (Domenech et al., 2014). Medical ethics education has been the subject of much debate over many decades with the conclusions now being that use of simulations and case-based teaching are the best ways to keep medical students engaged with complex topics that they may have yet to actually experience in real life. These include dealing with end-oflife dilemmas, giving patients bad news, and duty of care obligations. The many challenges of medical ethics education were explored by Carrese et al. (2015) and concluded much work was still needed to achieve anywhere near consistency in ethics education across the many medical programs in the United States. Ethics education in nursing has largely paralleled that of medicine, with acknowledged shifts from emphasis on the macro level legal paradigm to what has become known as “micro-ethics” or the focus on ethical standards in patient care such as unsafe medication practices, poor infection control, or breaches of patient confidentiality (Krautscheid, 2017). A report on Ethics Education in Business Schools (AACSB International, 2004) in the United States concluded that corporate governance, fiduciary obligations, censorship and privacy, environmental impact, and use of human subjects in marketing research should all be core components of business and management programs. In the field of law, it has long been recognized that legal ethics has taken second place to seemingly more important curriculum and this trend has minimized the significance of ethical obligations such as an understanding of conflict of interest, loyalty, and confidentiality (Rhode & Luban, 2004). This brief discipline overview of a sample of professions that intersect with social work shows a reluctance to engage in ethics education outside the discipline silo model of traditional higher education. In educating students for the real work of practice, ethics educators should clearly acknowledge the collegial relationships that will inevitably take place in the broad range of human services that graduates will be employed within. The field of health care is perhaps the most notable example, with the multidisciplinary team approach well established. Social workers are part of teams with other allied health, medical, and nursing practitioners, and are an important party to ethical decision-making in relation to patients and their families. Outside of health, social workers work alongside lawyers, community corrections workers, psychiatrists and police in provision of youth justice services, domestic and family violence interventions, and forensic mental health. In the community sector, social workers work in partnership with environmental planners, managers of not-for-profit and for-profit organizations, housing providers, and income management services. Given this context, it is not difficult to see how stepping outside of the discipline silos in ethics education can have considerable value. 390

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Promoting an alternate approach: interprofessional ethics education Moves toward interprofessional education (IPE) have history dating back some decades, most markedly in the medical, nursing, and allied health fields but then expanding to other disciplines. One of the most cited definitions of IPE was provided by the Centre for Advancement of Inter-Professional Education (CAIPE, 2000) who stated that: “Inter-professional education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care” (McAuliffe, 2014, p. 14). The World Health Organization championed the IPE cause setting out statements from 2008 urging professional disciplines to begin working more collaboratively in the interests of patient care. In the last decade, there has been an upsurgence in literature and organizations that promote IPE as best practice in education of students in the health field with outcomes from IPE cited as: enabling each profession to improve its own practice to complement that of others; engender inter-professional capability and inform joint action to instigate change; and engage with systematic knowledge generation and research, with the ultimate aim of improving services to individuals, families, and communities (McAuliffe, 2014). There are a number of terms that are used interchangeably in the IPE space including “multi-disciplinary,” “inter-disciplinary,” and “trans-disciplinary” (Garner & Orelove, 1994; Jessup, 2007). The essential message is that when different professions come together in teams they must learn to negotiate principles of behavior within a team, structures that support patterns of behavior, and processes of how practice as a team is carried out (Clark, Cott, & Drinka, 2007). Underlying this is the need for interprofessional respect, the ­understanding of the varied value positions of others, and the capacity to hold one’s own position while ­ itzgerald, navigating respectful communication and problem-solving together (Fortune & F 2009; Hawley, 2007). These important elements of IPE indicate the value of shifting the traditional siloed uni-professional teaching paradigm to one of more collaborative engagement with others within specified courses in a curriculum. It is not uncommon for students in the physical health disciplines to learn together about anatomy, physiology, chemistry, or pharmacology. Bringing students together for these sorts of courses is often a pragmatic resource effective way to ensure dissemination of core content. It is not so much about ensuring that students learn with and from each other, but more about design strategies of managing classes where students require the same body of knowledge, exposure to laboratories, and hands-on access to experiments and research. There may well be some side benefits in having medical students mixing with pharmacy, dental, or exercise science students, but the main aim is not so much about exploring the different foundations of the professions with a view to promoting a more cohesive workforce in the health field at a later date. Where IPE comes into its own is in those courses that set up simulated situations in which students from different disciplines work together in a deliberative and collaborative way to problem-solve a clinical case involving a patient. The way this is most traditionally done in medical education is by use of the Objective Structured Clinical Examination (OSCE), a formal examination process that includes various combinations of students from medicine, nursing, dentistry, occupational therapy, nutrition and dietetics, pharmacy, physiotherapy, and speech therapy. The focus of the OSCE in this context is on patient scenarios that involve physical symptoms, assessment and treatment, and most of the literature on OSCEs is limited to this physical context which is why disciplines like social work and psychology are rarely included. The increased attention to IPE, however, has seen inclusions of social work in OSCEs in fields of mental health 391

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and psychiatry (Sharma, Chandra, & Chaturvedi, 2015), and there has been development of simulation-based OSCEs for social work education that might at times involve students from other disciplines. Having established that social work lies on the fringes of IPE, at least in health care education, the argument is posed that social work must then find ways to draw other disciplines into its own educational sphere so that social work students can benefit from active engagement with students from the disciplines that they will become colleagues with in future practice. As author of an interprofessional ethics text that establishes the case for professional ethics courses to take this important role for social work, it is instructive to note that the social justice mandate of social work provides a justification for progressing interprofessional ethics in this way (McAuliffe, 2014). The following section provides examples of how an interprofessional ethics course, situated within social work, can provide an IPE experience for students of any discipline, and can provide social work students with exposure to the value positions of others to assist readiness for practice in multidisciplinary workplaces.

Developing an interprofessional ethics curriculum: finding the common ground The key to developing an ethics curriculum that will allow expansion of knowledge, exploration of value positions, and experiential methods of assessment is to first map out what the common ground is within professional education. The starting point is to go back to what we understand the hallmarks of a profession to be. Every profession has a distinct body of knowledge that defines what its profession does; a theoretical base that provides explanation for what is done; a foundation of values and ethics that provide guidance for conduct, ­decision-making, and action; and a social contract with users of services that their best interests and those of their families and communities will be upheld as being of primary importance and above self-interest (McAuliffe, 2014). For the sake of illustration, let us develop a hypothetical professional ethics course that includes social workers, nurses, teachers, occupational therapists, psychologists, criminologists, and environmental scientists. The starting point is to map out the rationale for teaching ethics from an interprofessional perspective, which includes laying out the organizational context within which graduates from any of these disciplines might eventually work. It is not a difficult case to make that an occupational therapist will most likely not practice in isolation, but will be part of a multidisciplinary team whether the field of practice is with children or in aged care. Teachers will inevitably have students who have contact with the juvenile justice system, or children with disabilities or mental health concerns that will bring them in contact with psychologists, psychiatrists, and social workers. An environmental scientist conducting an impact assessment in an ecologically vulnerable community may engage with social workers, health professionals, journalists, or lawyers. Nurses will work alongside medical colleagues and the full range of allied health professionals. Establishing this workforce reality and the need for different professions to understand each other and begin communication about their professional mission are the start points. The second point of common ground is the establishment of a shared knowledge base about ethical theory. It has previously been stated that a core component of professional education is knowledge of the theoretical foundations of practice, whether these be sociological, psychological, structural, critical, humanist, or strength-based perspectives, and that ethical theory is rarely taught as part of theories for practice. Ethical theories based on moral philosophy provide students with a way of making sense of decisions. When students look at 392

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political decisions about resource management, for example, through the eyes of an ethical perspective, they will see utilitarian principles at play (the greatest good for the greatest number), or they may find decisions based on an ethic of care approach. They will find deontological reasoning, communitarian rationales, and contractarian perspectives. It is important for students to be able to identify when an absolutist position has been taken (for example, a rigid legal interpretation), or when a relativist position that might take cultural issues into account more readily has been adopted. Different professional disciplines will have been subject to a socialization process that will have schooled them in particular ways of approaching problems. These socialized responses can create barriers to effective inter-professional communication (Hall, 2005), and ethics education can serve to shake this up by presenting alternate approaches to viewing the world. The third area of common ground is the regulatory frameworks and processes that govern professional practice. Some professions are subject to high degrees of regulation and scrutiny, like medicine and nursing, while others are also regulated but to a lesser degree, like psychology, teaching, or occupational therapy. Then there are the group of professions that are regulated in some countries but not in others. Social work falls into this category, as does rehabilitation counseling, and youth work. In order to advocate well for service users who may have received less than optimal quality service, professionals need to know the regulatory frameworks of their colleagues. They also need to know whether their colleagues have a professional code of ethics that guides their practice, and whether there are differences in expectations about conduct. As an example, most professional codes of ethics stipulate that engaging in an intimate or sexual relationship with a current client or patient is unethical, whereas guidance on relationships with former clients may differ and in some case time frames may be imposed. Some codes of ethics may acknowledge that practitioner self-­d isclosure or the acceptance of gifts may be appropriate in some circumstances, where other codes will prohibit this or remain silent on particular issues. All professions are now dealing with the complex emerging ethical issues around technology and social media, and workplace policies are far from consistent in this area. One way of guiding students toward ethical dialogue with each other in the interprofessional context is to set assessment that requires them to explore a contentious ethical question, explore this from a number of different professional perspectives, and examine relevant ethical codes and guidelines for conduct. Examples of ethical questions could include: “Should a woman who is pregnant be given access to free, safe-injecting equipment?;” “Should an elderly man with dementia be allowed to reside in his own home until his death as expressed in his advance health directive;” “should euthanasia be made legal for those suffering chronic mental illness?;” “should a young person be provided with contraceptive pills without the knowledge of her parents?;” “should a newborn be removed from the mother at birth where there have been other children removed due to neglect and abuse?;” “should a therapist accept a friend request from a former client?;” “should a disability support worker accept an expensive gift given in gratitude by the family of a client?;” “should an adult sex-­ offender who has refused rehabilitation in prison be given parole to live in the community?;” “should same-sex couples be denied the right to adopt children?.” Exploration of these sorts of ethical questions enables the student to explore both personal and professional positions with students from different professional backgrounds to elicit deeply held moral convictions and explore the congruence between personal and professional values. The assessment can also require students to examine the position of others from an ethical theory perspective enabling exploration of justification for positions taken and shifted. Giving students opportunity to develop their own ethical question and search out others who they can engage in 393

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dialogue with provides space for deep examination of questions that they might have been grappling with through their studies. This is particularly useful for students who do have deeply entrenched personal values that might be in conflict with those of the profession they are endeavoring to enter. Of even greater value is encouragement to engage in ethical dialogue with those already in practice so that the realities of ethical decision-making can have more defined impact. The final area that should be included in an interprofessional ethics course is ethical decision-making. Fortunately, there are many ethical decision-making models that have been developed across a number of disciplines, social work being the primary contributor (­McAuliffe & Chenoweth, 2008). The significance of introducing other professionals to the social work ethical decision-making frameworks and models is the focus on critical reflection, cultural sensitivity, and a more inclusive process than is often presented in models from other disciplines like psychology, nursing, and business. Assessment can be devised that allows students to explore application of an ethical decision-making model from a range of professional perspectives. One of the best ways of achieving this is to develop full and rich case studies that have a core ethical dilemma and a number of stakeholders potentially in conflict with each other. Requiring students to explore the ethical dilemma with reference to the ethical codes of different disciplines will further extend knowledge for future practice.

Keeping ethics on the organizational agenda: implications for ongoing professional development Ethical decision-making models and their application to case scenarios also need to be presented to practicing social workers through continuing professional development. Most social work codes of ethics set the requirement for professional supervision as an ethical obligation, and using an ethical decision-making model as a way of working through a complex case is a good way of ensuring that continued attention is paid to the ethical dimensions of practice. There are many ways to ensure that ethics maintains a distinct place on the agenda of organizations, from monitoring the moral climate of the organization and staff teams, through to ensuring ethical conduct at the group and individual level. Reamer (2001) developed the ­Social Work Ethics Audit Risk Management Tool that continues to form a useful baseline from which to evaluate policies and processes within organizations. Social workers, if well educated in professional ethics, will be mindful of conflicts of interest, boundary crossings and violations, confidentiality and privacy provisions, duty of care and duty to warn obligations, workplace and collegial relationships, assessments of competence, impaired practice, and self-care. These are the topics that, in the workplace, can be discussed in interprofessional forums with professionals from a range of disciplines. If practitioners have had previous exposure to interprofessional ethics discussions in their years of study, they are more likely to be open to a continuation of these types of discussions in their places of employment. This again offers strength to the argument for professional ethics to be taught within a context of IPE.

References AACSB International. (2004). Ethics education in business schools: Report of the ethics education task force. Retrieved from https://www.aacsb.edu/~/media/AACSB/Publications/research-reports/ ethics-education.ashx Carrese, J., Malek, J., Watson, K., Lehmann, L., Green, M., McCullough, L., … Doukas, D. (2015). The essential role of medical ethics education in achieving professionalism: The Romanell report. Academic Medicine, 90(6), 744–752. 394

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Centre for the Advancement of Interprofessional Education. (2019). What is CAIPE?. Retrieved from https://www.caipe.org/about-us Chenoweth, L., & McAuliffe, D. (2018). The road to social work and human service practice. Melbourne, VIC: Cengage. Clark, P. G., Cott, C., & Drinka, T. (2007). Theory and practice in interprofessional ethics: A framework for understanding ethical issues in health care teams. Journal of Interprofessional Care, 21(6), 591–603. Domenech, M., Erickson, J., Thomas, J., Forrest, L., Anderson, A., & Bow, J. (2014). Ethics education in professional psychology: A survey of American Psychological Association accredited programs. Training and Education in Professional Psychology, 8(4), 241–247. Fortune, T., & Fitzgerald, M. (2009). The challenge of interdisciplinary collaboration in acute psychiatry: Impacts on the occupational milieu. Australian Occupational Therapy Journal, 56(2), 81–88. Garner, H., & Orelove, F. (1994). Teamwork in human services: Models and applications across the lifespan. London: Butterworth-Heinemann. Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19(Suppl. 1), 188–196. Hawley, G. (2007). Ethics in clinical practice: An interprofessional approach. Harlow: Pearson Education. Hugman, R., & Carter, J. (2016). Rethinking values and ethics in social work. London: Palgrave Macmillan. Jessup, R. (2007). Interdisciplinary versus multidisciplinary care teams: Do we understand the difference? Australian Health Review, 31(3), 330–331. Krautscheid, L.C. (2017). Embedding micro-ethical dilemmas in high-fidelity simulation scenarios: Preparing nursing students for ethical practice. The Journal of Nursing Education, 56(1), 55–58. McAuliffe, D. (2014). Interprofessional ethics: Collaboration in the social, health and human services. London: Cambridge University Press. McAuliffe, D., & Chenoweth, L. (2008). Leave no stone unturned: The inclusive model of ethical decision making. Ethics and Social Welfare, 2(1), 39–49. Reamer, F. G. (2001). The social work ethics audit risk management tool. Washington, DC: NASW Press. Rhode, D., & Luban, D. (2004). Legal ethics. New York: Foundation Press. Sharma, M. K., Chandra, P. S., & Chaturvedi, S. K. (2015). Team OSCE: A teaching modality for promotion of multidisciplinary work in mental health settings, Indian Journal of Psychological Medicine, 37(3), 327–329.

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50 Social work practice and ­bullying in the workplace Jim Gough

Bullying is a spectrum activity that takes a variety of shapes within a myriad of workplace circumstances that require an ethically informed and equipped social worker response. The distinctive features of bullying in all its manifestations are sometimes difficult to identify and explain because there has been a kind of collective deliberate ignorance of it. Many are intentionally guilty of ignoring behavior that is bullying. This follows a principle of least effort as people naturally want to stay in their present state and where onlookers find it initially easier to ignore a stressful situation than initiate help to a victim. We may do this out of fear of reprisals or because aspects of bullying, part of the overall bullying set of activities, seem innocuous. We may be in unintentional denial of bullying, similar to someone with the symptoms of a serious disease denying any connection between the symptoms and the disease. Finally, we may not be clear what behavior constitutes bullying rather than behavior associated with an aggressive and dominant personality. In business, for example, and lately in public politics, aggressively dominant personalities seem esteemed as exhibiting exemplary characteristics of good leaders, no-nonsense administrators, and effective “take-charge” managers. Our collective ignorance, doubts, and confusions about the identification of bullying in the past meant we didn’t react with any moral outrage. Now, however, the situation is changing, as societies across the globe start to “out” bullying in ways that sexual aggression against women is now outed (Mohawald, 1994). The victims initially without a voice have gained one with collectivist movements like “me too,” across the world, communicated on social media. The first ethical task of the social worker is trying to identify the various ways that bullying can occur in the context of her workplace, a workplace that often includes the marginalized in societies, those most vulnerable to the activities of bullying. The internet and social media have provided bullies with access to what seems an anonymous venue for pursuing and torturing their victims, sometimes into suicide. Bullying is often hidden because of our complacent acceptance of its effects and sometimes we react with a response blaming the victim like “you need to toughen up, this is the nature of the job and you need to learn to deal with it” kind of responses. However, this makes all of us silent, complicit, accomplices of the bully and provides a false excuse instead of a justification. 396

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We need to clearly separate bullying behavior from what I call justified compelled compliance. The latter may be mistaken for bullying and if we are not clear about the differences then we could unjustifiably blame someone for bullying when their behavior was justified. In an institutional workplace setting, supervisors and managers need to have support for dealing with employee noncompliance with known published rules, laws, procedures, processes, or agreements. For example, when an agency manager requests a social worker to document the details of the situation of one of her clients in a timely and detailed manner and the social worker refuses, then the manager may have the right to compel compliance to a judicial response. This could take the form of a reprimand or even be as extreme as the cause for justified dismissal. This reprisal is not intended to demean, intimidate, or harm the non-compliant individual but rather to compel compliance against potential harm to client, social worker, supervisor, or agency. Justified compelled compliance must be handled in a judicial not arbitrary or personalized manner. So, we need to be contextually aware of the differences between justified compelled compliance and the unjustified threats and intimidation of the bully. The latter is often characterized by the bully’s fear of the good standing, valued nature or character of his victim and uses bullying to “bring the victim down to size,” to satisfy his envy of the victim’s status or esteem within the organization of the workplace. Those frustrated by justified compelled compliance of course might resort to bullying as the only remedy to the failure of a more ethically acceptable approach, further potentially compounding some of our identification confusions.

The feedback loop and the bullying payoff The bully either gets what he wants or she doesn’t. Either way without intervention the motivation to continue bullying has its own self-perpetuating momentum. There is no environmental social cue to trigger change. If the bully gets to exercise unwanted and unjustified power over another, then the loop is closed. If she doesn’t get what she wants, the satisfaction in the process of continuing to demean and intimidate another seems to continue, feeding another closure to the feedback loop. This is win-win for the bully. Societies are so structured or constructed that the bully who seeks her own security through the intimidation of others paradoxically undermines everyone’s security including his own if the behavior goes unchallenged. After a period of time, bullies can achieve a reputation as a bully, which – by itself – can produce threatening and intimidating outcomes sought by the bully. In this case, the cost to the bully is minimal as his reputation within an organization does the work for him to get the outcome he desires.

Social workers and bullying Social workers should be engaged change agents, not distant onlookers. We need to heighten our observational awareness of the signs of bullying, partly on the basis of the observed behavior of the aggressor and on observations of the effects of actions on the victim. First, bullying is a cluster or web concept of interrelated phenomena: physical violence, aggression and physical threats, physical and psychological coercion, emotional intimidation, harassment, belittling, aggression, humiliation, and mobbing. There is no central core to the cluster. The recipe for bullying in particular contexts can include any number of the set of components mentioned previously in any number of possible combinations. Sometimes not all strategies are immediately apparent but opening up one thread reveals the existence of 397

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others. Violence is often tied to bullying, placing it at the ethically intolerant threshold. Bullying is often tied to intimidation, placing it at the middle of the ethnically intolerant threshold of acceptability, but it might not involve either of these components. This creates confusion about how to separate bullying from other wrongs, such as incest, and it blurs the distinction between control and the legitimate appeal to authority (Salomons, 2013). Second, it is also difficult to isolate the practice of bullying from the class of acts of a very forceful or demonstrative assertive administrative or manager, producing acts which while inappropriate cannot be unethical bullying. So, for example, if someone in administrative authority over me tells me to do something that is within my job description and responsibilities and I do not want to do it, his or insistence that I complete the task or face a reprimand is perhaps at the more tolerated end of the threshold of ethical acceptability. In each case considered, context and education will play a role in deciding where the action of bullying falls and whether it is tolerable or not. Third, bullying may have different manifestations and strategies, depending on gender. Jean Jacques Rousseau, for example, argued that women’s special gift of manipulative guile compensated for her lesser physical strength and equalized her situation with males, allowing her to exert the power of cunning control (Mohawald, 1994). Some research supporting this claim suggests girls may be just as aggressive as boys but not in a physical way, instead demonstrating the features of indirect relational aggression which is “insidious, sophisticated” often involving false rumors, verbal abuse, concealed premeditated manipulation, and intimidation (Southworth, 1999). The abuse of social media to humiliate and demean teenagers in front of their peers, sometimes contributing to suicides, has shown that the tolerance for these activities is at the lower end with their acceptance very unlikely. The problem is sometimes characterized as the chronic female aggressor who is successful at concealing strategies that create depression, anxiety, physical complaints, and tremendous fear in their victims. Fourth, the more bullying is open to public scrutiny, the more victims may feel empowered to report it, the more we, the public, become aware of it and express our displeasure. What also might happen is that bullying has become the inaccurate cover term for what previously was under the categories of racial harassment and intimidation or sexual innuendo and abuse. This makes the precise identification of bullying difficult and subsequently solving the problem of bullying more complicated. However, it is important to recognize as there is generally low tolerance for sexual harassment, any connection of these behaviors to bullying makes the subsequent acts of bullying less tolerated exceeding the mean threshold of acceptance.

The problem The problem with bullying starts with its identifying defining conditions. Bullying is a method of conveying fear in someone or some group of people who the perpetrator wishes to exercise dominating power or control over for essentially egoistic motives or self-­satisfaction. The acts of verbal aggression, intimidating false gossip, backstabbing, openly belittling ­people, manipulative gestures or actions, so-called “put downs,” are in themselves wrong. These humiliations and aggressions are intended to isolate, harm, intimate for compliance and to mentally induce an ongoing and continuing developing pervasive fear in the victim. It is rarely a one-time phenomenon but a pattern that is repeated by the offender. The damage is to the individual’s autonomy characterized as her sense of self, self-esteem or self-worth, and the self-determination of the individual’s own identity. There are two unethical and unacceptable motivating drivers of bullying: (a) egotistical and inappropriate use of power or control over another and (b) the use of this control to 398

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create mentally and emotionally debilitating pervasive fear in the victim or victims. This pervasive fear is often life-controlling, causing the victim to lose any hope of a secure and dignified existence. Whether the controlling abuse is physical or mental, the aggression can have the same devastating effect on the bully’s victim(s). There is also the victim becomes abuser reciprocal effect as successful bullying tactics against a victim can cause the victim to use such tactics against another victim in the perpetuation of the wrong through successive people. The Canadian Association of Social Workers (CASW) Code of Ethics states the foundation of social work practice: “Social work is founded on a long-standing commitment to respect the inherent dignity and individual worth of all persons” (Spencer et al., 2017), which serves as a benchmark to determine how to rank order rights and duties specified in the CASW Code. Yet, the bully in his actions violates the victims set of rights, a rights violation which can be classified under the fundamental right to the dignity, security, and integrity of the person: rights to liberty, equality, fair treatment, autonomy, self-determination, and so on. Bullying is patterned harassment which is centered on achievement of the two goals of control and fear so that there is a continuum of activities supporting this dual goal. The victim of bullying is imprisoned in a free society, and controlled in the interests of an enslaving aggressor. Violation of this cluster of rights is in opposition to the CASW Code of Ethics, which promotes empowerment of vulnerable people who are oppressed (Spencer et al., 2017), and the ­Canadian Charter of Rights and Freedoms, which is itself derived from and prior ­dependent on the United Nations Universal Declaration of Human Rights (1949) (Gough, 2010). ­Finally, ­bullying is self-perpetuating, an ongoing disposition to continue to engage in behavior, activities that fulfill the bully’s egoistic values. That is, the bully who finds some initial ­satisfaction with this activity during his or her formative years often grows into the successful role of bully continuing to perpetuate his or her bullying activities throughout his or her lifespan in a changing set of circumstances, from schoolyard to human resources director or administrative manager (Cade, 2011). This is why we need to set a low tolerance level for unacceptable bullying to stop this ratcheting-up effect from schoolyard to workplace. Despite these protections, bullying is a problematic practice that has existed for a long time. Mobbing occurs when other bullies join the single bully (known as the bandwagon effect) and use their collective weight to intimidate and harass the victim (Govier, 1986). We cannot discount the possibility of one person bullying a group of people or the possibility of a group of people bullying one person, but the core relationship has the same intention. There are those who need to think of themselves as having the power to create fear in others. Their status as the oppressor in a relationship seems important to their self-image molded around social control. The victim of bullying needs to believe that the threat is real, that the intimated claim to action, anticipated bad results, or predicted consequences will occur. To make such beliefs plausible, some actions may be necessary either to this victim or some other, in order to solidify and tangibly demonstrate reality of the threat and intimidation. There is a thin line here, of course, because as soon as the bullying threat is carried out, then the practice takes on a new direction, adding the dimension of actual physical or psychological violence. The CASW Code (2005) indicates that “Social workers uphold the right of every person to be free from violence and threat of violence” (Spencer et al., 2017), a clear indication that this path for the bully is inconsistent with her professional ethical obligations. However, the bullying can be a precursor to violent action, crime, or assault and sometimes this is directed to the messenger, the social worker herself. It can seem to the victim that compliance with bullying is better than the possible violent consequences of such demonstrations. Of course, the problem with compliance is that it does not necessarily reduce the bully’s actions or the victim’s fear, but can have the roller-coaster effect of actually escalating it. 399

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So, bullying is: (i) rarely unintentional and intentionally and directly produces significant psychological, emotional, or life choices or physical harm to another individual or individuals, (ii) often a patterned set of activities prolonged over a protracted period of time, (iii) sometimes involves an audience of bystanders/witnesses who may or may not be instrumental in halting the bullying, but need not involve anyone other than the victim and perpetrator, (iv) involves an aggressive egotistical individual who feels no empathy for his/ her victim(s), (v) has no gender, age, or demographic predispositions or predeterminations as it can be aggressive or passive aggressive in character, (vi) represents significant workplace and society costs in the harm(s) produced to the efficiency of the organization as well as the health of the workers involved, (vii) dispersed throughout societies with no single location, and is pervasive in time or historical place, (viii) a practice that has no accepted response but rather a set of possible responses still in the testing stages, (ix) often a hidden practice going unnoticed inside the private spaces of organizations, (x) the unethical use of another person to satisfy the self-interests of the oppressor, harming victim’s self-esteem, self-worth, and the ability to be self-determining in controlling the telling of their life’s story (Cade, 2011).

The workplace in society Especially in democracies but also in other forms of government, the workplace is often an isolated and distinct place with society. People in this place often do not have the same personal protections they may have in society generally. The workplace is a protected domain of activity which is not democratic. The workers work for the salary decided by the employer and the employer has power over the workers in terms of deciding whether they have a job and the nature of that job. Of course, many societies have intervened to provide protection for workers through unions and international organizations to prevent abuses. But generally the situation of power imbalance remains, the employer/boss is not elected, not a representative of the workers, and cannot be voted out of power. Astute managers are now aware that workplace bullying is harmful to workers performance on the job, both the bully who devotes an inordinate amount of time to taunting and demeaning his victims rather than effectively working at the tasks associated with his job, and the victim loses self-esteem and a genuine sense of belonging in the workplace which causes him to devote his time to trying to protect himself against harm, rather than efficiently working at his job. Time lost on effective workplace activity instead of the divergent activities of bullying is costly to the bottom line but often not easily quantifiable. The workplace itself provides fertile ground for bullying in large part because of the situation it occupies in society as distinct and separate from other social situations, part of a nexus of businesses involving aggressive competition involving rules and behavior appropriate to such competition, and because often people are isolated in a business and belief it best to remain in their cubicle doing nothing but their job–ignoring all else around them. So the workplace environment needs enlightenment on the nature and strategies of bullies in the workplace and this may best be accomplished by professional social workers whose reliable information and effective countering strategies may help businesses to deal with workplace bullying (MacDonald, 2011).

Social workers and the context for a solution Social workers are the canaries in the coal mine sounding the warning that bullying is increasing in their job situation and society. They are often the first to identify serious ethical 400

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problems in our society. They have firsthand knowledge, personal experience of those who are being harmed. They perceive the varying and multiple contextually based social causes of harm, not relying for their knowledge on detached and objectified statistical claims. Social workers are professionally mandated to activate for change where change can produce beneficial results for those in need (Spencer et al., 2017). Social workers can give a voice to, and act for those who are disadvantaged in society regardless of the cause of their being disadvantaged. So, social workers are in a unique and important situation to help remedy and even eliminate bullying as some social workers operate in schools as wellness personnel, in workplaces and public service agencies where the management of the needs of many is open to the abuse of bullying bureaucracies. Social workers are immersed in real-life narratives walking pathways that many other citizens never could or never would navigate (Gough & Spencer, 2014). On the face of it, then, social workers should be both capable and able to facilitate needed social change to bring about the end of bullying or at least to put it squarely under the critical light of public disapproval (Spencer et al., 2017). However, social workers also can be subject to bullying: bullying by colleagues and coworkers in holistic social management teams, bullying by clients demanding more services than they are entitled to or demanding services for which they are not entitled at all, and bullied by managers of public service agencies or private service organizations. So, it may be difficult for the bullied to (a) do their jobs adequately, (b) avoid undo stress in the workplace organization caused by bullying, (c) avoid being disloyal to the agency or organization that either allows or turns a blind eye to bullying within its organization, (d) avoid being excluded or socially isolated, (e) avoid being the brunt of jokes, offensive remarks, or a pattern of harassment, (f ) avoid the belittlement, embarrassment, humiliation, undeserved punishment, or deliberately designed impossible work assignments, (g) avoid undeserved demotions, threatening abuse, malicious rumors, or false gossip and innuendo, (h) avoid the belittlement, undermining of personal integrity leading to a feeling of uselessness and alienation caused by patterned bullying (Southworth, 1999). There needs to be some careful thought to what obligations are placed on the bullied victim. Retaliation is likely to escalate the harm to her, so she needs the support of social workers working within a supportive society. It is incumbent on society to support social workers to secure the best working conditions, minimally, since we all rely on their ability to identify bullying when and where it occurs. Encouraging “outing” of bullying strategies and practices, educating social workers in the ways of the bully and ways to mitigate the influence of bullies is a start. This needs to be infused in our reactions to bullying wherever it occurs, in the playground where the bully takes the high ground and hurls insults at his chosen victim, on the ice rink during a hockey game as the enforcer intimidates the opposing team’s fast skating forwards, in the workplace where managers take authority as power over others, in the political arena where the so-called political leaders exercise their power to influence and intimate their opponents.

References Cade, V. (2011). Bully free at work. Calgary, AB: Performance Curve International Publishing Gough, J. (2010). Some historical and philosophical considerations about the United Nations Universal Declaration of Human Rights. The Quint, 2(2), 33–53 Gough, J., & Spencer, E. (2014). Ethics in action: An exploratory survey of social workers ethical decision making and value conflicts. Journal of Social Work Values and Ethics, 11(2), 22–25. Govier, T. (1986). A practical study of argument. New York, NY: Mayfield Publishing. MacDonald, A. (2011). Workplace bullying or troubled supervision? The Advocate, 36(3), 10–11. 401

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Mahowald, M. B. (1994). Philosophy of woman: An anthology of classic to current concepts. New York: ­Hackett Publishing. Salomons, C. (2013). The need to control is the root of bullying. The Red Deer Advocate, June 22, A7. Spencer, E., Massing, D., & Gough, J. (2017). Social work ethics: Progressive, practical and relational approaches. Don Mills, ON: Oxford University Press. Southworth, N. (1999, October 23). Report of research conducted by Professor Debra Pepler, Director of York University’s LaMarch Centre for Research on Violence and Conflict Resolution. Toronto Globe and Mail, A3.

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51 Ethics in the end Robert E. McKinney, Jr. and Stephen M. Marson

At the turn of the 20th century, most people, even in the “civilized” world, were born, worked, raised children, lived, and died without ever traveling outside of a 50-mile radius of the places of their birth. The turn of the 21st century, however, was a different world. Many of us travel well over 50 miles every day just to go to work – or maybe even just to go to lunch. The changes in technology, transportation options, and the advent of social media have even made it possible for people to live in one part of the world and work with or on behalf of clients and coworkers who are many time zones away. These changes have compelled social workers and social work professional organizations to rethink and recast the way that we navigate the myriad ethical conundrums in which we find our clients, client systems, our work settings, and ourselves. Further complicating our professional decision-making processes are the advances of modern medicine. Social workers who work primarily with elderly clients, for example, are even having to think about who qualifies as a “senior citizen” and exactly what that means as regards providing services to them. Genetic research findings have made treatment options more targeted, but they have also added layers of complexity around the issues of pregnancy planning, ability/disability work, and disease management. Stem cell research advances have increased options for patients with previously untreatable medical conditions, but the costs and technologies that are related to these treatments have put them out of reach of large numbers of people. In the field of social work education, we frequently speak to our students about ethical dilemmas. To be true to the original meaning of the word, a dilemma is a situation in which there are exactly two options (notice the “di” at the beginning of the word), both of which come with unavoidable negative consequences (hence the phrase, “caught on the horns of a dilemma”). Today’s technological and social landscapes, however, frequently leave social workers with such a dizzying array of options, many of which are untenable for various reasons, that the old days of ethical dilemmas may seem more desirable. Despite all of the benefits of new technologies, modes of transportation, communication options, our 21st-century world is still rife with people who are underserved, marginalized, victimized, tortured, and forgotten. The drive that compelled so many of us, hopefully all of us, to choose Social Work (capitalization intentional) as the way that we would spend our 403

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lives is still there. Clients, patients, and communities are still in need. What, then, are we as social work clinicians, educators, researchers, community organizers, and case managers to do as we obtain toward that greater good and find ourselves on the horns of a dilemma? A trilemma? A quadrilemma? How about an octolemma? How can we remain true to the notion of ethically striving toward our clients’ goals when we are operating across multiple legal jurisdictions, in different time zones, and among conflicting cultural expectations? Progress, it seems, is fraught with challenge. The authors in the work at hand have covered a wide range of topics, from a wide range of perspectives, and across a wide range of geography. They represent multiple nationalities, races, sexual orientations, genders, socioeconomic statuses, religions, and political ideologies; despite this, the core principles of professional social work are still discernable threads that weave through the tapestry of their collected works.

Worth and dignity of human beings One of the core skills of successful social workers is the ability to make and sustain relationships. Our stock in trade is our ability to work with those people, groups, and communities who, for whatever reasons, may have had challenges with interpersonal interactions. Our efforts to make these connections meaningful and productive are bound in our professional attitude that people have an inherent worth that is not defined merely by their political ideologies, abilities, or religious beliefs. In this edition, our authors have illustrated this core principle well, although perhaps most poignantly in the chapters on working with right-wing youth in Germany, criminal justice, disability, and the section on the myriad perspectives of abortion and abortion rights.

Doing no harm “First do no harm,” that phrase commonly, although incorrectly, attributed to Hippocrates, is one with which most of us are familiar. Physicians and other health care providers worldwide have taken an oath similar to this for hundreds of years. As a part of our ethical mandate, the idea of doing no harm has even added responsibility. Not only must we be mindful of not harming our clients in the moments when we’re working with them, but we must also carry that with us at all times, ensuring that our broader actions don’t indirectly harm them, either. We fight against political injustices because they can bring harm to underserved and underrepresented populations. We remain diligent when we accidentally meet our clients and former clients in public spaces, careful to avoid violating their trust and privacy. The idea of doing no harm is also represented by all of our authors as an underlying basic assumption. Particular chapters that highlight this idea include the chapter on social worker self-care, the chapters on group social work, and the chapters on micro practice settings.

Respect for diversity Imagine a six-sided die. One side reads, “I am an individual with my own needs and history and deserve to be treated as such,” while the opposite side reads, “I want to be treated just the same as anyone else and given the same rights and responsibilities.” Another side reads, “I recognize that each person is unique and has the right to expect to be understood in his or her own individual way,” while the side opposite reads, “I understand that I am expected to treat everyone the same, showing no favor or partiality to any person or group.” The final 404

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pair of sides read, “We as peers understand that we as a group deserve recognition of our group culture, values, and ideals, all of which are fundamental to our group identity,” which is opposed with, “We as a group understand that there may be members of our group whose culture, values, and ideals are different from ours as a group, yet those persons may still be identified as part of our group.” It is often as if we as social workers are asked to cast this die so that it lands with all six sides up. Respect for diversity is, at the very least, complicated. Despite this, Social Work as a profession sees itself as the torchbearer for diversity of all types – diversity of thought, opinion, lifestyle, gender, age, status, sexual orientation, religion, and on and on. The idea of diversity is represented in this book first in the authorship itself. A cursory look at the last names and employment settings of the contributors to this tome reflects a dizzying array of backgrounds, languages, and cultural landscapes. The sections on diverse values, spirituality, globalism, and economic issues are all rife with discussion of the challenges of diversity.

Human rights and social justice Almost any activity undertaken by a social worker in the context of working with marginalized and underserved people can be couched as a push for human rights and social justice. We give voice to the voiceless in individual practice settings; we advocate for policy change in our macro settings. Human rights and social justice are at the crux of everything that we do. This is complicated, though, because the concepts of human rights and social justice, though well defined in the literature, are still open for interpretation – the section on the ethics of abortion illustrates this is grand detail. The contributors to this text have demonstrated the importance of the application of ethical concepts and practices regarding human rights in the contexts of criminal justice, end-of-life care, food distribution/hunger, ability/disability work, and any myriad other potential practice settings.

The future? What does the future look like for the study, research, and practice of Social Work Ethics? In a nutshell, no one knows. The challenges of our changing political, cultural, and natural climates are unpredictable. Technological advances will continue to change the ways that humans work, relax, communicate, learn, and heal. All of this will require social workers, and the profession at large, to remain responsive and agile, all while remaining true to the needs of our clients, the tenets of our profession, and the values of our own inner selves, which are what compels us to enter the field. We are, and may remain, blindsided by information from new and unknown sources. Much of this information may be useful and of merit, but the politicization of many of our media outlets should give each of us pause as we begin to digest what we hear. As the global physical environment changes, many of the daily struggles with hunger, malnutrition, and disease that have for decades been largely issues that residents of the “civilized” world have only heard about fleetingly may become more pervasive; alternatively, changes in technology may result in new methods for growing, harvesting, and distributing food, thus actually reducing these problems. In either case, social workers will need to be able to respond. Ongoing political and ideological shifts may result in changes to borders, shifts in languages and customs, and reallocation of resources – again, social workers will have to be prepared to respond ethically. Technological advances in medicine and medicine delivery may change life expectancies, disease detection and management (at both the individual 405

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and the population levels), and birth rates. At the forefront of these changes will be social workers, whose jobs will include ensuring that all of these activities are managed ethically and equitably. We hope that this volume has provided some practical and concrete information about the relatively abstract concepts of Social Work Ethics. As our world changes, it is inevitable that methods for the application of social work ethical principles will change, too. Social Work researchers and practitioners continue to talk, research, and write about ethics. As the editors of this book, we look forward to being a part of and platform for that further discussion.

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Note: Bold page numbers refer to tables and page numbers followed by “n” denote endnotes. abortion: ambivalence of 117–22; culture and 104–5; ethical decision-making models and 105–6; eugenic 113; female babies 113; hard reduction 121; illegal 118; prochoice position in social work 109–16; prolife position in social work 101–8; right to participation and 103; right to self-determination and 101–6; social work and ethical controversies of 118–19; surgical 112 absolutists 15, 16 ACA see Affordable Care Act 2010 (ACA) accommodation 95, 328, 344 acculturation 66, 327, 382, 383 Ackerman, A. 327 ACT Alberta 144 Acts of Apostles 1 act utilitarianism 18–19 ADA 91 Addams, J. 110, 324 additive goods 20 administrators, ethical action by 70–1 Affordable Care Act 2010 (ACA), Title 1557 384, 385 African Union 338 Åhman, E. 103 Al Bahar, M. 87 Albrecht, G. 96 Al Gharaibeh, F. 88 Ali, J. 104 Alinsky, S. D. 204 Al-Krenawi, A. 291, 293, 298 Al-Krenawi, S. 298 Allanson, S. A. 120, 121 Alleman, J. R. 273 Al-Matary, A. 104 alt-right-movement 206 altruistic gestures 161 Alvargonzalez, D. 122 ambivalence of abortion 117–22; benefits of 119–20

ambivalent social workers 119; actions at macro level 121–2; actions at micro/mezzo levels 121; actions for 120–1 Amnesty International (2013) 342 Angell, G. B. 272, 275 anti-oppressive theoretical framework 274–5 apartheid 75–8 Apple computers 252 applied ethics see practical ethics Arabic-Islamic perspective, of social work ethics and values 297–302; core values, analysis of 298–301 Arab society, barriers to designing code of ethics for social workers in 83–9; cultural context 85–6; gender difference and family structure 86; limited role of social work associations 87–8; quality of education of social workers 86–7 Arab Spring 84 Argentine Federation of Academic Units of Social Work 359 Argentine Federation of Professional Associations of Social Service 355 Argentine social work: current ethical-political compromise of 359–60; ethical career of 360–1; ethical-political conception in 355–6; ethical question in 354–61; Federal Law on Social Work No. 27.072, 354, 356–8, 360; ethical-political importance of 358–9; moralizing ethical conception in 354–5 Aristotle 16, 28–9; on moral courage 227 Arriaza, P. 385 Arrington, P. 38 Artificial Intelligence 280 Ashcroft, J. 138 assimilation 327, 382–3 Assmann, H. 305 ASSNAS’ Code of Ethics 349–50 Association of American Colleges and Universities (AAC&U), VALUE rubrics 244

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Index

Astbury, J. 120, 121 attentiveness 217–18 audience 53, 54 austerity policies, impact on social work 334–5 Australia: criminal justice practice 151; essential ethics knowledge in social work 316 autonomy 20, 144–6, 267, 268 bandwagon effect 399 Banks, S. 29, 67, 226, 227 Barad, K. 215–18 Barbour, J. 242 Barsky, A. E. 227, 228, 339 basic goods 20 basic needs 10, 11, 13, 281 BASW see British Association of Social Workers (BASW) batterer intervention programs (BIPs) 138 Bauman, Z. 63 Beauchamp, T. L. 20, 267, 268 Becker, L. 193 Beddoe, L. 268 behavioral health disorders 151 being human 111–12 being rendered capable 219 beneficence 20, 36, 268 Bentham, J. 16, 18, 29 Bergoglio, J. M. 304 Bertotti, T. 350 Better Care Network 243 Bickenbach, J. E. 93–6 bidirectional ethical responsibility 384–6 Biehal, N. 374 Biestek, F. P. 297, 339 bilingualism 382–3 bioethics 24, 257 biological parenthood 105 BIPs see batterer intervention programs (BIPs) Black, P. N. 192 Black Dog Institute 272 Black Genocide 114 Black Lives Matter 253 blasphemy 1 Boff, L. 305–7, 310 Boroditsky, L. 90 boundary crossings 158 boundary issues 157–62; altruistic gestures 161; dual relationships, management of 161–2; emotional and dependency needs 160–1; intimacy 159–60; personal benefit 160; unanticipated circumstances 161 boundary violations 157–8 Bowie, N. E. 22 Bozalek, V. 221n1 Brazil 104, 305, 306, 310, 355 Brexit 334, 335 British Association of Social Workers (BASW) 268, 336 408

British Psychological Society 390 Brownlee, K. 46, 47 Brown, M. 79 bullying 396–401; payoff, feedback loop and 397; problem 398–400; social workers 397–8, 400–1; workplace in society 400 burnout 38–9 Busch, N. 130 CAIPE see Centre for Advancement of InterProfessional Education (CAIPE) Cámara, H. 305, 306, 310 Campanini, A. 350 Campbell, J. 132 Canada: criminal justice practice 151; cultural adaptation 328; e-Health 273; essential ethics knowledge in social work 316; ethical engagement of indigenous peoples in 272; security and data transmission 277 Canadian Association of Social Workers (CASW) Code of Ethics 397 Canadian Charter of Rights and Freedoms 397 Canadian Institutes of Health Research 272 care: definition of 216; diffracting, through justice 215–21 Care Council for Wales 334 caregiving 219, 220 care-receiving 220 Carey, M. 244 caring about 219–20 caring for 220 caring with 220 Carnegie Corporation of America 316 Carrese, J. 390 case study abroad: cultural humility 244–5; programs 243–4; social work values 243; US policies, impact of 245–6 Castellano, M. B. 272 Castle, R. 92 Catholic Church 304, 305, 308 Catholic Relief Services 243 CC Act 1990, 332 CCETSW see Central Council for the Education and Training of Social Work (CCETSW) CDC see Center for Disease Control and Prevention (CDC) Cemlyn, S. J. 327 Center for Disease Control and Prevention (CDC) 272; on intimate partner violence 136 Center for Research on Ethical, Legal & Social Implications of Psychiatric, Neurologic & Behavioral Genetics 262 Central Council for the Education and Training of Social Work (CCETSW) 332, 333 Central Intelligence Organization 343 Centre for Advancement of Inter-Professional Education (CAIPE) 391 Čepulionytė, D. 105

Index

CF see compassion fatigue (CF) challenging time ethical actions 65–71; barriers, overcoming 68–9; with coworkers 69–70; moral courage 66–7; moral distress 65–6; by profession 71; by supervisors and administrators 70–1; tools and strategies 67–8 Changing the Way We Care 243 Character-Based Decision-Making Model 106 characters 53–5 charity 298, 348 Charity Organisation Society 345 charlas 245, 246 Chenoweth, L. 291, 295, 389 child abuse 18, 53, 118, 128, 129, 366 Child Abuse Prevention and Treatment Act 144 Child Guidance Clinics 331 childhood family violence (CHV) 137 Children Act 1989, 332, 371, 372 Children and Social Work Act 2017 333 Childress, J. F. 20, 267, 268 child sexual exploitation 368 Chinas one-child policy 113 Chinese Exclusion Act 1882 326 Chinese Ministry of Health 113 Chinyoka, I. 343 Christianity 110 Christie, M. 244 CHV see childhood family violence (CHV) circumscribed life chances, for children and young people 375–6 civic hacking 285 Civic Technology Movement 285 civil disobedience 46–7, 48; criteria for 46; definition of 46 Civil Rights Act of 1964, Title VI 384 Clark, J. 255 Clarke, J. 374 Clarke, S. 374 classic utilitarianism 19 client autonomy 66 client-centered approach 129 client confidentiality 192 client privacy 267 Clinton, B. 384 cloning 257 Clustered Regularly Interspaced Short Palindromic Repeats (CRISP-R) 257, 258, 262 CNOAS see Consiglio Nazionale Ordine Assistenti Sociali (CNOAS) Code for All 285 Code for America 285 Code for America’s Brigades 285 Code of Professional Practice for Social Care Workers 334 Codice deontologico dell’Assistente Sociale 8 Codice di autodisciplina professionale dell’Assistente sociale dell’Alta Val d’Elsa (Code of the: social

worker’s professional self-discipline in Alta Val d’Elsa) 349 cognitive dissonance 48 cognitivists 15 “Collaborative Post-Alinsky” Community Organizer 203 collective reflexivity 80 Collins, F. 258 Collins, P. H. 130 colonial students 241–2 colonization/colonialism 75–6, 77 Columbia University Medical Center 262 Comandini, M. 348, 352 Combellick-Bidney, S. 104 commodification of service users 373–4 communication 25, 26, 49, 67, 70, 80, 128, 193, 252, 254, 268, 273 communitarianism 20 community 32, 33 community-based theory see communitarianism Community Developer 203 Community Organizer 203–4 Community Planner 202, 203 compassion 20 compassion fatigue (CF) 39 competence 25, 33; Arabic-Islamic perspective of 300–1 Compulsory Competitive Tendering 371 confidentiality 154, 292; client 192; cross-border social work practice in digital age 276–7; in group work 192–3, 194 conflict 54 Congress, E. P. 291 Conrad, A. P. 267, 268 Conron, K. J. 137 conscience 44–9; communication 49; consistency 48; definition of 44; importance of 44–5; liberty of 46–7; non-evasion 48–9; raising 47; social work 49; universality 48 conscientiousness 20, 45, 46, 49 conscientious objection 46 consequentialism 17, 316 Conservatives 331, 332, 334, 335 Consiglio Nazionale Ordine Assistenti Sociali (CNOAS) 350, 352 Consiglio Territoriale di Disciplina (CTD) 351–2 consistency 48 conspicuous consumption 253 contingent employment 281 Convention on the Status of Refugees (1951) 325 Cook, K. O. 194 Cooper, J. 227 core values 233–4 Corradetti, C. 93–6 Costa Rica 240, 241, 246 Council for Social Workers 344 Council of Europe 144 409

Index

Council on Global Learning, Research, and Practice 243 Council on Social Work Education (CSWE), Educational Policies and Accreditation Standards 243 councils of discipline 351 courage 319; definition of 225–6; moral 226–8, 230–1; physical 226; psychological 26; in social work 226–8 coworkers, ethical action with 69–70 Crabtree, R. 241 Craven, E. C. 114 criminal justice practice 151–5; confidentiality 154; cultural awareness and social diversity 154; dignity and worth of people 153–4; global social work values and ethics 152–3; human rights 153; interruption of services 154–5; self-determination and empowerment 154 CRISP-R see Clustered Regularly Interspaced Short Palindromic Repeats (CRISP-R) critical conscientization 78 critical consciousness 77–9, 357 critical literacy 243 cross-border social work practice and ethics in digital age 272–8; anti-oppressive theoretical framework 274–5; e-mental health treatment 275; informed consent, self-determination and confidentiality 276–7; interjurisdictional issues 275–6; security and data transmission 277; social justice 277 cross–case analysis of codes of ethics 9, 10, 12 cross-disciplinary moral 388 CSWE see Council on Social Work Education (CSWE) CTD see Consiglio Territoriale di Disciplina (CTD) Cuba, criminal justice practice 151 cultural: acclimation 327; awareness 154; competence 85, 244; dissonance 194; humility 244–5; maintenance 328 culture: as barrier to design code of ethics 85–6; and reproductive rights 104–5 curriculum 34, 130, 388, 392–4 Cusworth, L. 374 Daniels, D. J. 138 Danis, F. S. 129 Dascal, Nathan 78 data, role in fate of communities in modern society 280–2 data collaboratives 284 Data4Good 284–5 data justice 280–5; community practice 284–5; definition of 282; instrumental 282; international development and 283; procedural 282; as social justice issue 282; social policy practice 283–4; social work and 283; structural 282 410

Data Kind 285 data philanthropy 284 data protection legislation 283 data science 284–5; codes of conduct 284 data transmission, cross-border social work practice and ethics 277 decision-making see ethical decision-making decolonization, in South Africa 80 democracy, in South Africa 76–7 Democratic Unionist Party of Northern Ireland 334 denial 46; of human trafficking 145–6 Denmark: eugenic abortion 113; “One Denmark without Parallel Societies: No Ghettos in 2030” 328 deontological theories 17, 20 deontologists 17 deontology 51, 56, 59–61, 316 Department of Health and Human Services 261 dependency needs 160–1 Derluyn, I. 326 designer babies 260 Despret, V. 215–17, 219, 220 developmental social work 78–9 DeVoogd, G. 245 Dezendorf, P. 275 Dhai, A. 195 diffracting care through justice 215–21; attentiveness 217–18; being rendered capable 219; relational ontologies 216–17; responseable social work 221; responsibility 218–19; trust 219–20 digital divide 254 digital media: navigation, for ethical and professional social work practice 265–71 dignity 153–4; of human beings 298–9, 404 dignity and worth of the person, Arabic-Islamic perspective of 298–9 Diomede Canevini, M. 349, 350 disability ethics 90–7; definitions of 90–2; ethical landscape 94; ethical meandering 92–4; policies and practices 94–6 disability rights policies and practices 96 disagreement about ethics and values in practice 233–8; codes of ethics, core values, and social work practice 233–4; ethical implications for social work 237; latent disagreement among professionals 236–7; research results about 234–6; theoretical approaches to impact of 234; vignette method 238 discernment 20, 218 disciplinary power, lights and shadows of 351–2 discrimination: challenging to 309; systematic 1 distress: definition of 228–9; ethical 229; moral 229–31, 367; physical 229; psychological 229; in social work 229–30; spiritual 229 distributive rights-based justice 282 divided loyalty 341

Index

DNA testing 257 Domestic Abuse Intervention Program (Duluth, Minnesota) 137–8 domestic violence (DV) 127, 128, 131–3, 137 Donagan, A. 19 do no harm 36, 404 doxa 234 dual relationships 23, 157–62, 192; management of 161–2 Dussel, E. 306, 307, 310 DV see domestic violence (DV) Ebener, D. 32 Educational Policies and Accreditation Standards (EPAS) 243 egoism 18 e-Health 272; definition of 273 Ellacuría, I. 306 El Salvador, criminal justice practice 151 El-Sanhuri, A. M. 298 ELSI see Ethical, Legal, and Social Implications (ELSI) Research Program embodied rights 91, 92, 94–6 e-mental health (eMH) treatment 272, 275–8; ethical questions related to 273; informed consent, self-determination and confidentiality 276–7; interjurisdictional issues of 275–6 emic perspective 53, 55, 386 emotional needs 160–1 emotional turmoil 48 empowerment 130, 154, 188, 357, 386 enculturation 328 Engelbrecht, L. 79 England see United Kingdom (UK) English, A. 143 English Protestant Ontario 328 Engstrom, D. 384 EPAS see Educational Policies and Accreditation Standards (EPAS) equality 19, 277, 299 essential ethics knowledge in social work 315–20; brief history of 315–20; courage 319; ethical decision-making 318–19; ethical dilemmas 318; ethics risk management 319–20; injury 319; moral distress 319; social work values 317–18 Essential Steps for Ethical Problem-Solving model 106 ethical complaints 23, 351 ethical decision-making 318–19, 394; in age of austerity in UK 365–8; model, Islamic perspective of 289–96; affected people/ systems, identification of 293; identification of decision 294–5; problem definition 291–3; reviewing decision 295–6; support, seeking 294; models, and abortion 105–6 Ethical Decision-Making Process model 106

ethical dilemmas 318; of social media 267–8 ethical distress 229 ethical geography of macro practice 201–4; Community Developer 203; Community Organizer 203–4; Community Planner 202; Social Movement Organizer 204 ethical landscape 94 Ethical, Legal, and Social Implications (ELSI) Research Program 257; global genomics 261; precision genomics 260–1; public health genomics 261 ethical meandering 92–4 ethical-political conception, in Argentine social work 355–6 Ethical Principles Screen model 106 ethical problem-solving: smartphone apps 273; suicidal service user 274 ethical standards, definition of 22 ethical stress 229, 367 ethical study abroad 240–6; potential ethical issues 242–3; programs 243–4; trends in 241–2 ethical theories 15–21; rights-based theories 19–20; theories of normative ethics 17–19; virtue ethics and ethics of care 20–1 ETHIC model 267 ethics boom 83 Ethics Commission of Argentine Federation of Professional Associations of Social Service 356 Ethics Education in Business Schools 390 ethics of care 20–1 ethics of self 79 ethics risk management 319–20 etic perspective 53 EU see European Union (EU) eugenic abortion 113 European Union (EU) 144, 340; General Data Protection Regulation 282, 283 extreme right-winged youth cultures: approaches to combat 207–9; characteristics of 206; in classical sense 211; ethical dilemmas of 209–11; freedom of speech versus hate speech 207; in Germany 206–13; harm reduction 211–12; social work and 207 Facebook 265, 271, 284 Family Court Act 128 Family Educational Rights and Privacy Act 270 family structure, as barrier to design code of ethics 86 Farooqui, J. 298 Federal Drug Administration 273 Federal Law on Social Work No. 27.072, 354, 356–8, 360; Article 4, 357; Article 3, Paragraph a 357; Article 11, Paragraph b 358; Article 11, Paragraph c 358; ethical-political importance of 358–9 feedback loop, and bullying payoff 397 411

Index

female babies, abortion of 113 feminist framework to intimate partner violence 129–30 feminist new materialisms 216–17 Fenton, J. 229 Ferguson, H. 376 Ferrari, G. 306 fertilization 111 fetal abnormalities, abortion due to 104 fetus 109, 111, 113; pain-capable 112 Figley, C. 39 First International Symposium on Islamic Thought 297 Flexner, A. 2 followership 68 food distribution in Zimbabwe, social work ethics and the politicization of 338–45; background of 338–9; case examples, presentation of 341–3; divided loyalty 341; implications for social work practice 343–4; values and ethics in social work 339–40 foreign born and native born, balancing 328–9 Forum on Education Abroad, Standards of Good Practice 244 Foucault, M. 78, 79 fragmented social work and services 374–5 France, professionalization of social work practice 85 freedom of speech versus hate speech 207 free market 332 Freire, P. 77 French Catholic Quebec 328 Freud, S. 44 Freudenberger, H. 38 fundamentalism 45 Furman, R. 327 Gade, C. B. N. 76 Gallagher, A. 67 Gandhi, M. 204 Gastmans, C. 230 Gaviglio, A. 259 GCC see Gulf Cooperation Council (GCC) gender-based violence 104 gender difference, as barrier to design code of ethics 86 gene 257 gene editing 258 General Data Protection Regulation (European Union) 282, 283 General Social Care Council (GSCC) 333, 334 genetics 257; global historical perspective of 258 genocide, in United States 113–14 genome 257 Genomic Information Nondiscrimination Act (GINA) 260

412

genomic medicine: global 260; personalized 259; public health 259–60 genomics 257; global 261; precision 260–1; public health 261 Gera, L. 305–7, 311 Germany: extreme right-winged youth cultures in 206–13; freedom of speech vs. hate speech 207; professionalization of social work practice 85 Gewirth, A. 20 Ghana 95 Giddens, A. 375 Gilbert, M. S. 111 Gilligan, C. 217 GINA see Genomic Information Nondiscrimination Act (GINA) Global Centurion Foundation 144 global genomic medicine 260 global genomics 261 global service learning (GSL) 244 Global Statement of Social Work Ethical Principles 308 good-aggregative utilitarianism 18 Good Friday agreement 334 Goodman, B. 77 Google 252 Gore, M. S. 111 Gottfried, G. M. 272 Gove, M. 333 Graham, J. R. 298 Grainger, P. 244 Grain Marketing Board 343 Greece, professionalization of social work practice 85 Greenleaf, R. 29–31 groupthink 69–70 group work, ethical challenges in 191–5 GSCC see General Social Care Council (GSCC) GSL see global service learning (GSL) guardianship (welaya) 293 Gulf Cooperation Council (GCC) 87 Gumpert, J. 192 Gutiérrez, G. 305, 310 Guzmán, P. R. 306 Hacker, P. M. S. 145 Hadith 290 Hain, Peter 77 Hamby, S. 132 Haraway, D. 215–20 harm reduction 211–12 Hartley, D. 38 Hart, S. V. 138 Harvill, R. 194 Hastings Center 262, 316 hate speech vs. freedom of speech 207

Index

Health and Care Professions Council (HCPC), Standards of Proficiency 333 Health and Human Services Office for Civil Rights 384 Health Canada 273 Health Insurance Portability and Accountability Act (HIPAA) 132, 260; security and data transmission 277 Healthy People 2020 272 Healy, L. 94 Heal Zimbabwe 342, 343 Heeks, R. 282 Heinze, E. 344 Henry Street Settlement 324 Henshaw, S. K. 103 HGP see Human Genome Sequencing Project (HGP) Hill, T. 45, 48 HIPAA see Health Insurance Portability and Accountability Act (HIPAA) history and development of social work ethics 22–7 Hochfeld, T. 79, 80 Hochstetler, S. 49 holistic approach to work 30 holistic view of the human being 310 Holmes, C. A. 37 Hölscher, D. 77 homo sapiens 323 honesty 301 Hopton, J. 275 House of Commons Committee of Public Accounts 367 Howard, A. R. 38 Howard, J. 45, 48 Howard League for Penal Reform 376 Hull House 324 human dignity 29, 63, 110, 146, 292 Human Genome Project 257 Human Genome Sequencing Project (HGP) 258, 259, 262 humanity 32–3 human life protection, social work’s ethos of 109–10 human rights 29, 60, 91, 405; criminal justice practice 153; international analysis of 7–13; promotion of 308–9; social work and 110–11; to utilitarianism 201–4 Human Services Information Technology Association (husITa) 253 human trafficking, legal and ethical consequences of 143–6; ethics 144–5; international interventions 144; prostitution 145–6; social work interventions 146; vulnerable populations 143–4 Hume, D. 16

Humphreys, K. 273 Humphris, R. 373 husITa see Human Services Information Technology Association (husITa) IAASW see Israeli Association for the Advancement of Social Work (IAASW) IASSW see International Association of Schools of Social Work (IASSW) Ibrahima, B. 80, 81 ICADS see Institute for Central American Development Studies (ICADS) “Ideal Type” method 201 Idle No More 253 IFS see Institute for Fiscal Studies (IFS) IFSW see International Federation of Social Workers (IFSW) Ihsan 295, 300 IIE see Institute of International Education (IIE) illegal abortion 118 Illich, M. I. 240 immigration enforcement, social worker’s role in 326–7 impaired body 92 impairment 39–40 implicit unconscious-awareness, of social work ethical imperatives 381–2 importance of human relationships, ArabicIslamic perspective of 300 Independent Inquiry into Child Sexual Exploitation (CSE) into Child Sexual Exploitation 368 indigenous social work 80–1 indirect relational aggression 398 information, role in fate of communities in modern society 280–2 informed consent 55, 66; cross-border social work practice in digital age 276; in group work 192 inherent dignity of human being 308 injury 319 Instagram 271 Institute for Central American Development Studies (ICADS) 240, 241, 245, 246 Institute for Fiscal Studies (IFS) 335 Institute of International Education (IIE), Open Doors Report on International Education Exchange (2017) 241 institutional oppression 309 instrumental data justice 282 integrated principle-based approach (IPA) 28, 31–4 integration 140, 327 integrity 20, 32, 55, 68, 70, 79; Arabic-Islamic perspective of 300; social workers 104–5; types of 31 intelligence 32, 33

413

Index

inter-agency collaboration, importance of 128 interjurisdictional issues, of eMH treatment 275–6 International Association of Schools of Social Work (IASSW) 88, 308, 309, 334, 336, 357; relational practice 59 International Conference of Social Work 110, 111 International Federation of Social Workers (IFSW) 2, 7, 12, 87, 88, 111, 265, 308, 309, 334, 336, 356, 357, 359; disability ethics 94; human services leadership 262; international social work ethical principles 29; relational practice 59; social work codes of ethics 233; social work, definition of 289; Statement of Ethical Principles 8, 9, 22, 23, 118, 120, 267, 269, 323–4, 326 International Labor Organization and Walk Free Foundation 144 international social work ethical principles: evolution of 28–9; IFSW 29 International Statement of Ethical Principles: people as whole persons, treating 102–3; right to participation, promoting 103; right to selfdetermination, promoting 102 interpersonal reflexivity 80 interprofessional education (IPE) 391–2, 394 interprofessional ethics 388–94; curriculum development 392–4; implications for ongoing professional development 394; interprofessional education 391–2; traditional ethics education 389–90 interruption of services 154–5 intimacy 159–60 intimate partner violence (IPV) 127, 128; cases, barriers to upholding self-determination in 128; case study vignette 132–3; complexities in 129; danger assessments of 132; feminist framework to 129–30; long-term effects of 136; motivational enhancement therapy for 139–40; and post-traumatic stress disorder 139; recommendations & practical applications for assessing 130–2; safety planning for 132; social work clinical practice and 135–40 involuntary parenthood 105 IPA see integrated principle-based approach (IPA) IPE see interprofessional education (IPE) IPV see intimate partner violence (IPV) Islamic perspective, of ethical decision-making model 289–96; affected people/systems, identification of 293; decision, identification of 294–5; decision, reviewing 295–6; problem definition 291–3; support, seeking 294 Israel, human rights 10 Israeli Association for the Advancement of Social Work (IAASW), Code of Professional Ethics of the Social 10 414

Italian Code of Ethics 349, 350 Italy: Constituent Assembly 347, 348; disciplinary power, lights and shadows of 351–2; ethical complaints and councils of discipline 351; ethics of social work in 347–52; challenges 348–9; further reflections on ethics 352; human rights 10; National Association of Social Workers 349; National Council of Discipline 351; National Liberation Committee 347; Order of Social Workers 349–50; professionalization, code of ethics as tool for, ASSNAS’ Code of Ethics 349–50; status of ethics reflection on social work 350; professionalization of social work practice 85 Jackson, S. O. 298 Jacobs, E. 194 Jamal, K. 22 Jameton, A. 229 Jeffreys, N. 38 job burnout 39 Judaic Talmud 110 judicial self-appraisal 48 just distribution of wealth 309 justice 20; data 280–5; social 7–12, 29, 33, 60, 78, 277, 281 Justicialist National Movement 311 justified compelled compliance 397 just immigration policies 325–6 Kant, I. 16, 17, 28, 44 KASW see Korea Association of Social Workers (KASW) Katiuzhinsky, A. 96 Keeney, A. J. 8 Kennedy, E. 38 Kenyon, P. 291 Ketchland. A. 87 Kidder, R. M. 228 King, M. L. 204 Klaw, E. 273 Koenen, K. C. 137 Konopka, G. 297 Korea Association of Social Workers (KASW), Code of Ethics 11 Kukathas, C. 49 Kulkarni, S. 130 Kurz, B. J. 272 Landau, R. 236 Langston, D. 44 language 104–5 Language Access and Planning Tool 384 Lash, S. 375 latent disagreement among professionals 236–7 Latin America 297; Liberation Theology in 304–7

Index

Latin American Association of Teaching and Research in Social Work 359 Laudato si 309 leadership: servant 28–34; social work and human services leadership, in new genomic era 257–62 League of Arab States 83, 84 legalism 51, 56 Leighton, N. 87 LEP see Limited English Proficiency (LEP) Levett, C. 143 lexical ordering 19 Liberal Democrats 334 Liberation Theology, in Latin America 304–7 liberty of conscience 46–7 Lightman, E. S. 298 Limited English Proficiency (LEP) 328, 381, 384, 387 limited role of social work associations 87–8 Lindsay, T. 194 LinkedIn 284 Local Authority Social Service Act 1970, 367 locality development 203 locus-aggregative utilitarianism 18 Løgstrup, K. 62 Loony, A. 152 Loya, M. 241 Lukes, S. 93 Lumen Fidei 309 McAuliffe, D. 290, 291, 295, 389 McCarthy, J. 230 McLaughlin, K. A. 137 McLaughlin, M. 245 McPhail, B. A. 130 McQuiod-Mason, D. 195 McWalter, K. 259 macro self-care 41 Madoc-Jones, I. 253 Maiti Nepal 144 managerialism 63 Mandela, N. 77 marginalization 327 Marx, K. 16 Masson, R. 194 Mattaini, M. A. 80, 81 Matteson, M. 119 Mattison, M. 130, 131, 291 MDC see Movement for Democratic Change (MDC) media publicity about professional misconduct 24 mental distress see psychological distress Menzel, D. C. 339 Mercosur Committee of Professional Organizations of Social Work 355 mercy (rahmah) 300 Merton, R. 236

metaethics 15 MET see Motivational enhancement therapy (MET) Mezirow, J. 244 MI see motivational interviewing (MI) micro-ethics 390 Microsoft 252 Middleman, R. 194 migrant and refugee populations, ethics of policy and practice with 323–9; cultural adaptation 327–8; just immigration policies 325–6; native born and foreign born, balancing 328–9; social workers care about migration 324; social worker’s role in immigration enforcement 326–7 Miles Principle 90, 94 Mill, J. S. 16, 18, 44 MindSpot 275 minimization of suffering 19 miscarriage see abortion Mitchell, T. D. 243 Modernising Social Services 333 modernity 59 Modernization Theory 281 Moneta Foundation 349 MOODGym 275 Moon, K. A. 129 moral courage 66–7, 68, 69; barriers to 228; definition of 226; in social work 226–8; strategies for addressing 230–1 moral distress 65–6, 68, 69, 229, 319, 367; causes and effects of 230; recommendations for addressing 70–1; in social work 229–30; strategies for addressing 230–1 Moral Distress Education Project 71 moral relativism 93, 96–7 moral residue 66 moral resilience 68 moral self-indulgence 47 morals–ethics distinction 93 Morrall, P. 77 Morris, J. 373 Morris, R. 87 Motivational enhancement therapy (MET), for intimate partner violence 139–40 motivational interviewing (MI) 121, 131, 133 Movement for Democratic Change (MDC) 338, 340, 342 Movement of Priests for the Third World of Argentina 306 Mujica, C. 306 Mukherjee, D. 255 Mullaly, B. 275 Munemo, N. 340 Muñoz, R. 306 Murray-García, A. 244 mutual aid 194, 195 Mwansa, L. 76 415

Index

naïve realism 236 narrative ethics (NE) 51–7; application of 54–5; comparison of 56; elements of 53–4; rationale for 52–3 NASW see National Association of Social Workers (NASW) National Abortion Federation 118 National Association of Social Workers (NASW) 2, 13, 114, 265, 268, 344, 349; case study abroad 243; Code of Ethics 11, 128, 131, 267, 269, 273, 289, 323, 326, 327, 329, 383; history and development of 22–6; self-care 36–7; Delegate Assembly 23, 25; human services leadership 262; social work conscientiousness 49; social work education and self-care 40; social work practice and self-care 40; Standards for Integrating Genetics into Social Work Practice 262; Standards for Social Work Practice in Health Care Settings 262; Task Force 23; unconscious awareness 383–6 National Coalition Against Domestic Violence 131 National Conferences of Social Work 354 National Council of Discipline 351 National Health Service and Community Care Act 1990, 332, 371 National Human Genome Research Institute (NHGRI): ELSI Research Program 257; Talking Glossary of Genetic Terms 258 National Institutes of Health (NIH) 258, 261 native born and foreign born, balancing 328–9 natural duties 19 Natural Sciences and Engineering Research Council of Canada 272 Ndhlukula, R. 341 negative utilitarianism 19 neglect 18 neoliberalism 66; in South Africa 77 NE see narrative ethics (NE) Neve, E. 350 new genomic era, social work and human services leadership in 257–62; ethical, legal, and social implications: global genomics 261; precision genomics 260–1; public health genomics 261; explanation and expectations 258–9; global genomic medicine 260; global regulatory and ethical responses 261; personalized genomic medicine 259; pregenome project 258; public health genomic medicine 259–60; social work response 262 New Labour 332–5 New Zealand, criminal justice practice 151 NHGRI see National Human Genome Research Institute (NHGRI) Nicholls, D. 80 Nicholson v. Williams 128 Nietzsche, F. 16, 44 NIH see National Institutes of Health (NIH) 416

NISCC see Northern Ireland Social Care Council (NISCC) Nkrumah, K. 341 Noddings, N. 217 noncognitivists 15 nondiscrimination 23 non-evasion 46, 48–9 nonmaleficence 20 non-malfeasance 36 nonsubtractive goods 20 normative ethics 15; theories of 17–19 norms of professional courtesy 22 Northern Ireland 333, 334 Northern Ireland Social Care Council (NISCC), Standards of Practice and Conduct for Social Workers 334 Novak, M. 114 Novotney, A. 276 Nulty, M. 122 Nuttman-Shwartz, O. 96 Nye, M. 327 OAS see Order of Social Workers (OAS) Objective Structured Clinical Examination (OSCE) 391–2 occupational hazards of social work profession: burnout 38–9; compassion fatigue 39; impairment 39–40; secondary trauma 39; vicarious trauma 39; work-related stress 38 O’Connell, D. 32 Office for Budget Responsibility 335 Ofsted 376 Ogden, A. 241 Okech, D. 96 Ondrus, S. 130 one-child policy 113 open data policies 283–4 open government 283–4 Order of Social Workers (OAS) 349–50, 351 Ordine Assistenti Sociali Consiglio Nazionale [National Council of Social Workers), Code of Ethics 10 Orton, S. 194 OSCE see Objective Structured Clinical Examination (OSCE) Osmo, R. 236 outcome-based models 93 pain-capable fetus 112 Palanski, M. E. 31 Paraguay 355 parochialism 45 Parrott, L. 253 partisan politics 341 Parton, N. 372 PASWI see Philippine Association of Social Workers (PASWI) Patel, L. 79

Index

patient rights 24 Paul VI 305 Pawlukewicz, J. 130 people as whole persons, treating 102–3 People’s Theology, influence on Pope Francis’ philosophy 307–8 Perón, J. D. 307, 311 personal benefit 160 Personal Information Protection and Electronic Documents Act 277 personalized genomic medicine 259 person-based models 93 perspective 53 Peters, B. G. 341 Peters, K. 241 Peterson, C. 226 Petrie, S. 372 PHELSI (public health genomics ethical, legal, and social implications) 261 philanthropy 298 Philippine Association of Social Workers (PASWI), Code of Ethics 326 physical courage 226 physical distress 229 Plato 16 PLN see professional learning networks (PLN) plot 54 pluralistic universalism 94 Polaris Project 144 political ethics of care 216–17 politicization 338, 341, 405 Pope Francis: philosophy, People’s Theology influence on 307–8; thinking and social work values 308–10 Pope John XXIII 305 Popper, K. 19 Populorum Progressio 306 possessive individualism 328 postmodernism 79 postmodernity 59, 60 post-traumatic stress disorder (PTSD) 39; intimate partner violence and 139 potential ethical issues 242–3 poverty 152, 243, 281, 306, 333, 335, 336 Power and Control Wheel 138 Pozzuto, R. 275 practical ethics 15 practitioner ethical misconduct 24 precision genomics 260–1 principles of casework 339 Prison Reform Trust 375 privacy 66, 282 privatization of social work and care, in UK for children and young people: circumscribed life chances 375–6; commodification of service users 373–4; ethical implications 376–7; fragmented social work and services 374–5; policy background and trends 371–2

Probation Departments 331 problems of moral hazard 22 procedural data justice 282 pro-choice perspective 101–6, 118, 122 Professional Associations of Social Service of Argentine 355 professional: behavior 1–2; boundaries 266–7; impairment 23; integrity 29 professionalization, code of ethics as tool for: ASSNAS’ Code of Ethics 349–50; status of ethics reflection on social work 350 professional learning networks (PLN), on social media 269 professional presentation of self 266 profession: ethical action by 71; social work as 331–2 pro-life perspective 104, 118, 120, 122 Prophet Muhammad 290 prostitution 145–6 Protocol Relating to the Status of Refugees (1967) 325 provocative pedagogy 77 psychological courage 226 psychological distress 229 PTSD see Post-traumatic stress disorder (PTSD) public good 202 public health genomic medicine 259–60 public health genomics 261 Pullen-Sansfacon, A. 79 Putman, D. 226 quality of education of social workers, as barrier to design code of ethics 86–7 quasi-markets of social care 332, 371–2, 373 Quran 85, 290, 292–5 ranking of conflicting duties 19, 20 ranking of values 19 rationalism/rationality 29 Rawls, J. 19, 281 Raz, J. 46 Reaching Out Romania 144 reactive ethnicity 328 realism, naïve 236 Reamer, F. G. 31, 128, 131, 267, 268, 291, 394 “reasonable accommodation” clause 95 Reason and Morality (Gewirth) 20 reciprocal ethical responsibility 384–6 Red Cross 283 redistributive ethics 367 reflexivity 77–8 relational ontologies 215, 216–17 relational practice 58–63; social work values and 58–9; and virtue ethics 61–3 relationships with clients, effects/impact of technology on 252–3 relativism 16, 93; moral 93, 96–7 relativists 15, 16 417

Index

repression 46 reproductive rights, culture and 104–5 Research on the Fetus 112 resilience 41; moral 68 resolution 54 respect for diversity 309, 404–5 respect of privacy 292 response-able social work 216, 221 responsibilities of social workers: to broader society 24; to client 24; to colleagues 24; in practice setting 24; as profession 24; as professional 24 responsibility 218–19 Rice, B. 129 Rice, G. 130 Richmond, M. 23, 110 rights-based theories 19–20 right to participation 310; promoting 103 right to self-determination 103–5, 118, 310; promoting 102 right-wing activists, as social workers 209 Riley, D. 211 Roberts A. L. 137 Robertson, A. 244 Robotics 280 Roe v. Wade 105, 114 Rome, S. 49 Ross, W. D. 318 Rothman, J. 203 Rousseau, J. J. 398 rule utilitarianism 18–19, 367 rule worship 17 safety: definition of 128; relationship with selfdetermination 127 SAH see Strength at Home (SAH) program Salmon, R. 193 SAMSHA 139 Sanchez, M. 327 SASW see Singapore Association of Social Workers (SASW) sater 292, 293 Scandinavia, professionalization of social work practice 85 Scannone, J. C. 304, 305, 307, 310 Schimmel, C. 194 Schroeder, K. 243 Schulzke, M. 93–5 Scotland 333, 334 Scottish Social Services Council (SSSC) 334 Scuola per assistenti sociali (School for social workers) 347 SCW see Social Care Wales (SCW) Sebba, J. 376 secondary traumatic stress (STS) 38, 39 Second Vatican Council 305 security, cross-border social work practice and ethics 277 418

Sedgh, G. 103 Seebohm, F. 332, 335 Seebohm Report 331 Segal, U. 328 Segundo, J. L. 305 self-admonition 48 self-care 36–41; definition of 37; domains of 37; ethics of 36–8; implications of 41; importance of 37; macro 41; occupational hazards 38–40; social work education and 40–1; social work practice and 40; Wounded Healer framework 37–8 self-determination 19, 20, 80, 103; criminal justice practice 154; cross-border social work practice in digital age 276–7; in IPV cases, barriers to upholding 128; relationship with safety 127; right see right to self-determination self-reflexivity 80 Seligman, M. E. P. 226 semantics 382–3 sense of community, promoting 30 separation 327 Servant as Leader, The (Greenleaf ) 29, 30 servant leadership (SL) 28–34; principles 30–1, 32 service 30, 32; Arabic-Islamic perspective of 298 service-centered approach 129 Sevenhuijsen, S. 220 Sewpaul, V. 77 sex trafficking 145 sexual inequality 130 Shafer, W. 87 Shah, I. H. 103 Sharing Economy 281 sharing in decision-making 31 Sicora, A. 350 Siebert, D. C. 39 Sigona, N. 373 Silent Scream, The (film) 112 Simcock, P. 92 Singapore, human rights 11 Singapore Association of Social Workers (SASW) 12; Code of Professional Ethics 11 Singh, S. 103 Sinn Fein 334 SL see servant leadership (SL) Sloan, L. 87 Smart, J. J. C. 17, 19 smartphone apps 273 Smith, L. 78, 79 Smith, T. 80 Sobell, L. 140 Sobrino, J. 306 Social, Work Ethics Audit Risk Management Tool 394 Social Care Wales (SCW) 334 social development theory 283 social diversity 154

Index

social exclusion 333 social isolation 194 social justice 7–12, 29, 33, 60, 78, 281, 405; Arabic-Islamic perspective of 298; crossborder social work practice and ethics 277; issue, data justice as 282; promotion of 309 “social justice-citizenship” perspective 203 social media: client privacy 267; ethical concerns on 265–7; ethical dilemmas of 267–8; navigation, for ethical and professional social work practice 265–71; personal use of 254–5; professional boundaries in 266–7; professional learning networks on 269; professional presentation of self 266; social work educators, guidance for 270; social workers’ ethical obligation to maintain knowledge about 268–9; social work organizations, guidance for 270–1 Social Movement Organizer 204 Social Sciences and Humanities Research Council of Canada 272 Social Services 332 social work. see also individual entries: conscientiousness 49; definition of 8, 22, 289, 357; ethos of human life protection 109–10; and human rights 110–11; moral courage in 226–8 social work education, and self-care 40–1 social work educators, guidance for 270 social workers: ambivalent 119–21; barriers to designing code of ethics for, in Arab society 83–9; and bullying 397–8, 400–1; care about migration 324; cultural adaptation, promotion of 327–8; ethical obligation to maintain knowledge about social media 268–9; native born and foreign born, balancing 328–9; quality of education 86–7; responsibilities of 24; right-wing activists as 209; role in immigration enforcement 326–7; role in protection of unborn children 109–14 social work organizations, guidance for 270–1 social work practice, and self-care 40 Socrates 16 solidarity 220; construction of 309–10 somatic distress see physical distress South Africa: colonization and apartheid 75–6; critical consciousness and reflexivity 77–8; decolonization 80; democracy 76–7; developmental social work 78–9; future for social work in 336; indigenous social work 80–1; neoliberalism in 77; postmodernism and ethics of self 79; social work ethics and values within education and practice 75–81; Ubuntu 193–4 Southern African Development Community 338 South Korea, human rights 11, 12 Spain, professionalization of social work practice 85

Spears, L. 31 Special Immigrant Juvenile Status 324 spiritual distress 229 Spolander, G. 79 SSSC see Scottish Social Services Council (SSSC) Standards for Integrating Genetics into Social Work Practice 262 Standards for Social Work Practice in Health Care Settings 262 Standards of Self-Care Guidelines 40 Stanfield, D. 268 Statement of Ethical Principles (IFSW) 8, 9 Steele, B. J. 344 Steinberg, D. 193 Stephen (protomartyr) 1 Strength at Home (SAH) program 140 Strom-Gottfried, K. 228 structural data justice 282 STS see secondary traumatic stress (STS) SUD treatment 138, 139 suicidal service user 274 supervisors, ethical action by 70–1 surgical abortion 112 Suttner, Raymond 76 SWOT (strengths, weaknesses, opportunities, and threats) analysis 195 systematic discrimination 1 Tarasoff v. Regents of the University of California 132 team culture 70 technological era, ethical social work practice in 251–6; effects/impact on relationships with clients 252–3; ethical challenges 253–4; history and progression 251–2; personal use 254–5; recommendations 255–6 teleological theories 17–18, 20 teleology 56, 316 Tello, R. 305, 307 Tervalon, M. 244 Thatcher, M. 332, 371 Theology of the People 308 theories of normative ethics 17–19 Theory of Justice, A (Rawls) 19 Theory of Morality, The (Donagan) 19 Timberlake, E. M. 194 Timko, C. 138–9 TIP see Treatment Improvement Protocol (TIP) Title VI of the Civil Rights Act of 1964, 384 Title 1557 of Affordable Care Act 2010, 384, 385 To Hell with Good Intentions (Monsignor Ivan Illich) 240 Torres, C. 305, 306 traditional ethics education 389–90 transparency 70, 282 transpersonal development 106 trauma: secondary 39; vicarious 39 Treatment Improvement Protocol (TIP) 139 419

Index

Tremezzo Convention 347–9, 352 Tronto, J. 215–20 Tropman, J. E. 203 Trump administration 206 Trussell Trust 335 trust/trustworthiness 20, 62–3, 219–20, 301 Truth and Reconciliation Commission 76 truth-telling 202 Turkmenistan, criminal justice practice 151 Turner, N. 152 Tutu, D. 76 UASC see unaccompanied asylum-seeking children (UASC) Ubuntu 76, 193–4 UK see United Kingdom (UK) unaccompanied asylum-seeking children (UASC) 373 unanticipated circumstances 161 unborn children protection, role of social workers in 109–14 UN Committee on Rights of Persons with Disabilities (UNCRPD) 335 unconscious awareness 381–7; bidirectional and reciprocal ethical responsibility 384–6; contemporary ethical challenges and proposed actions 386–7; implicit, of social work ethical imperatives 381–2; professional and governmental guidelines for 383–4; semantics and bilingualism 382–3 UN Convention on the Rights of Persons with Disabilities 92 UN Convention on the Rights of the Child (UNCRC) 111, 113 UNCRPD see UN Committee on Rights of Persons with Disabilities (UNCRPD) UN Declaration of Human Rights (UNDHR/ UDHR) 95, 111, 113, 399; Article 3, 110; Article 5, 110; Article 6, 110; Article 7, 110 UNDHR/UDHR see UN Declaration of Human Rights (UNDHR/UDHR) undue hardship 95 unemployment 281 Ung, T. 327 UNHCR see United Nations High Commissioner for Refugees (UNHCR) unintended pregnancy 103 United Kingdom (UK) 206, 340; Brexit 334; Children Act 1989, 371, 372; for children and young people, ethical limitations of privatization within social work and social care in 371–7; circumscribed life chances 375–6; commodification of service users 373–4; ethical implications 376–7; fragmented social work and services 374–5; policy background and trends 371–2; Department for Education (Df E) 333; essential ethics knowledge in social work 316; ethical 420

decision-making in age of austerity in 365–8; ethics and values of social work in 332; future for social work 335–6; General Social Care Council 333; National Health Service 272, 335, 365; National Health Service and Community Care Act 1990, 371; social work and devolved governments 333–4 United Nations (UN) 144, 281, 297, 338 United Nations General Assembly 7, 110; National Association of Social Work 114 United Nations High Commissioner for Refugees (UNHCR) 323 United Nations Human Rights and Social Work Manual 12–13 United States 13, 95, 340; case study abroad policies, impact of 245–6; Child Abuse Prevention and Treatment Act 144; civic technology 285; criminal justice practice 151; cultural adaptation 328; eMH treatment 276–7; essential ethics knowledge in social work 316; ethical study abroad programs 244; Family Court Act 128; Family Educational Rights and Privacy Act 270; genocide in 113–14; human rights 11; immigrant populations in 324; intimate partner violence 135, 136; just immigration policies 325–6; precision genomics 261; social welfare in 281; traditional ethics education 390; Trump administration 206 United States Institute of Peace 342 United States National Association of Social Workers 110 univariate analysis of codes of ethics 9, 9, 12 Universal Credit 335 Universal Declaration of Human Rights (UDHR) 7–9, 12, 13, 324 universalism/universality 48, 332; pluralistic 94 Uruguay 355 US Federal Trade Commission 23 utilitarianism 60, 316; act 18–19; classic 19; good-aggregative 18; human rights to 201–4; locus-aggregative 18; negative 19; rule 18–19, 367 Vally, S. 78 VAWA see Violence Against Women Act (VAWA) veil of ignorance 19 vicarious trauma (VT) 39 victimization of women 105 Vidales, R. 306 vignettes 234–5, 238 VIGOR safety plan 132 Villa, R. 88 violence: childhood family 137; domestic 127, 128, 131–3, 137; intimate partner 127–32, 135–40 Violence Against Women Act (VAWA) 132, 133

Index

virtue ethics 20–1, 317–18; relational practice and 61–3 virtue theory 316 vital courage see psychological courage voice 53 VT see vicarious trauma (VT) vulnerable populations, human trafficking of 143–4 Wade, J. 374 Wald, L. 324 Wales 333 Walker, D. 139–40 Weinstock, D. 47 welfare markets 332 Welfare State 331–6; impact on social work ethics and values 332–3 well-being 20, 36, 60, 63, 105, 106, 109–10; definition of 13 Western experience, historical trajectory of social work ethics in 59–61 West, J. 275 West, R. 105 whistle-blowing 319 White Paper for Social Welfare 76, 78 WHO see World Health Organization (WHO) Williams, B. 19 Williams, Z. 372 Wills, G. 117–18 Winzelberg, A. 273 Wood, C. A. 243 Wood, G. 194

work-related stress 38 World Bank 281 World Conference of Islamic Education 297 World Health Organization (WHO) 92, 272; on global genomic medicine 260; on global regulatory and ethical responses 261; on interprofessional education 391 World Medical Association 195 worth of human beings/worth of people 153–4, 404 Wounded Healer framework 37–8 Yammarino, F. J. 31 Zakat 299 Zancan Foundation 349 ZANU PF see Zimbabwe African Union Patriotic Front (ZANU PF) ZHRC see Zimbabwe Human Rights Commission (ZHRC) Zidan, A. 298 Zimbabwe, social work ethics and the politicization of food distribution in 338–45 Zimbabwe African People’s Union 340 Zimbabwe African Union Patriotic Front (ZANU PF) 338, 340–3 Zimbabwe Human Rights Commission (ZHRC) 343 Zimbabwe Human Rights NGO Forum 342 Zivilcourage 319 zygote 109, 111, 112, 114

421