1. Ethics and Boundaries
Jeff Wright, MSW, LCSW

2. agenda Introductions Bioethics video
End of Life Small group discussion
Review Code of Ethics/MPSW 20
Break…
Boundaries discussion (small group exercise)
Models for framing ethical dilemmas
Sharing and resolving your ethical dilemmas
Wrap-up

3. Introductions Name and where you work
How many years have you been a Social Worker?

4. Why are these trainings relevant?
We’re all practicing Social Workers, do we really need help with this stuff?
Does resolving ethical dilemmas get easier?
What gets in our way of really being able to think about, and resolve issues that happen everyday?
What do you hope you get out of this presentation today?

5. End of life ethics(bioethics)

6. Small groups
What issues do you encounter around end of life decisions?
How do you feel your employer addresses end of life issues with families and residents?
What could be done better?
What types of ethical dilemmas do you encounter, from the standpoint of our Code of Ethics?

7. NASW standards for palliative & end of life care
Ethics and values
Encompasses both profession and contemporary bioethics standards
Knowledge
Particularly around family systems
Assessment
Foundation of practice. May need to reassess and revise treatment plans frequently.
Intervention/treatment planning
Utilizes assessment strategies

8. Standards cont’d Attitude/self-awareness Empowerment and advocacy
Compassion, sensitivity, and belief in the client’s rights to self-determination and dignity.
What else here?
Empowerment and advocacy
Sometimes we are the only voice for our clients
Documentation
Guessing you all could teach this part!
Interdisciplinary Teamwork
Essential in end of life care

9. Standards cont’d Cultural competence Continuing education
What are challenges for us here?
Continuing education
This is a changing field, we need to stay ahead of the curve
Supervision, Leadership, and Training
Share your expertise when you can

10. Lunchtime?

11. What are Ethics? Ethics: the “rightness” or “wrongness” of an action.
The Code of Ethics does not require a particular theory as a base
Many ethical theories, positing a base on which ethics may be constructed:
Absolutist
Something is intrinsically right or wrong
Relativist
All ethical situations are different
Teleological/Consequentialism
“The ends justify the means”

12. Core Beliefs and values
Most likely drives you to do what you do.
What are your inherited values?
How have these changed through the years?
How do you navigate the challenge of having your personal and professional values conflict?
Managing value conflicts can be just as challenging as ethical dilemmas. The key is self-awareness.

13. Law and ethics are not the same.
Law – legal justice; following the norms established by society through the political process (legislature): Chapter 457, MPSW 20
Ethics – focus is on social justice; doing what is right. Ethics may be in conflict with unjust laws: NASW Code of Ethics
Examples of this in your settings?
Examples from the political world?

14. Let’s Review MPSW 20 Note:
MPSW 20 addresses principally the obligations to clients.
MPSW 20 is phrased in negative terms, I.e., what you should not do.
Almost all of what is contained in MPSW 20 appears also in the NASW Code.

15. MPSW 20 Conduct
20.01 Gross negligence: “…the performance of professional services that does not comply with an accepted standard of practice that has a significant relationship to the protection of the health, safety or welfare of a patient, client, or the public and that is performed in a manner indicating that the person performing the service knew or should have known, but acted with indifference to or disregard of, the accepted standard of practice.”

16. MPSW 20 Conduct
20.02 Unprofessional conduct…includes, but is not limited to, engaging in, attempting to engage in, or aiding and abetting the following conduct…..
Comparison sheet.

17. Applicability of Codes of Ethics
Rule of the court: In legal matters regarding ethical practice, the code of ethics of the largest professional organization in the field shall apply.

18. Structure of the NASW Code
Preamble(includes Core Values)
Purpose
Ethical Principles
Ethical Standards: Ethical responsibilities
To clients
To colleagues
In practice settings
As Professionals
To the social work profession
To the broader society

19. Core Values Service Social Justice Dignity and worth of the person
Importance of Human relationships
Integrity
Competence

20. Service
“Social workers’ primary goal is to help people in need and address social problems.” [NASW Code]
Service to others, above self-interest
Encouraged to engage in pro bono service [volunteer skills with no expectation of significant financial return.

21. Social Justice
“Social workers challenge social injustice.” [NASW Code].
Social workers pursue social change, esp. on behalf of vulnerable and oppressed groups.
Focus on poverty, unemployment, discrimination, and other forms of social injustice.
Promote sensitivity to and knowledge about oppression.
Strive to ensure access to needed information, services, and resources.
Equality of opportunity and meaningful participation in decision making.

22. Dignity and Worth of the Person
“Social workers respect the inherent dignity and worth of the person.” [NASW Code]
Mindful of individual differences and cultural, social diversity.
Promote socially responsible self-determination.
Enhance self-determination.
Cognizant of responsibilities to both client and society.

23. Importance of Human Relationships
“Social workers recognize the central importance of human relationships.” [NASW Code]
Recognize that relationships are the vehicle for change.
Engage people as partners.
Strengthen relationships among people in order to promote, restore, maintain, and enhance the well-being of individuals, families, social groups, organizations, and communities.

24. Integrity
“Social workers behave in a trustworthy manner.” [NASW Code of Ethics]
Continually aware of social work’s mission, values, ethical principles, and ethical standards.
Act in accord with them.
Act honestly and responsibly.
Promote ethical practices in organizations with whom they are affiliated.

25. Competence
“Social workers practice within their areas of competence and develop and enhance professional expertise.” [NASW Code]
Strive to increase professional knowledge and skills.
Apply the knowledge and skills in practice.
Aspire to contribute to the knowledge base of the profession.

26. Ethical Responsibilities: 1. To Client
Primary commitment to clients
Self-determination
Informed consent
Competence of social work skills
Cultural & social diversity competence
Avoidance of conflict of interests
Proper boundary setting
Privacy and confidentiality
Client access to records

27. Ethical Responsibilities: To Client (continued)
No sexual relationships or harassment
Proper physical contact
Accurate & respectful language
Fair & reasonable fees
Clients who lack decision-making capacity
Proper termination

28. Ethical Responsibilities: 2. To Colleagues
Respect
Confidentiality
Interdisciplinary collaboration
Consultation
Proper referrals
Proper boundary setting
Resolution of unethical conduct of colleagues
Action to resolve incompetence of colleagues

29. Ethical Responsibilities: 3. In Practice Settings
Supervision & consultation
Education & training
Performance evaluation
Proper record keeping
Proper billing practices
Proper transfer of clients
Administration
Staff development
Commitment to employer
Resolution of labor disputes

30. Ethical Responsibilities: 4. As Professionals
Competency
Non-discrimination
Non-interference of private conduct
No use of dishonesty, fraud or deception
Treatment for impairments
Accurate representations
No solicitation of clients
Proper acknowledgment of credit

31. Ethical Responsibilities: 5. To the Profession
Integrity
High standards of practice
Advancement of ethics, values, knowledge & mission
Evaluation & research
Prevent unqualified practice of social work
Monitor policies & programs
Keep current with knowledge
Informed consent for research
Protection of research subjects
Confidentiality in research & evaluation

32. Ethical Responsibilities: 6. To the Broader Society
Promotion of general welfare
Facilitation of informed participation in public policies & institutions
Assistance in public emergencies
Engagement in social & political action to ensure equal access
Action to expand choice & opportunity
Promotion of respect for cultural & social diversity
Prevention of discrimination & exploitation

33. Confidentiality
Essential to the full and satisfactory completion of the work
Basis of the fiduciary relationship
Shared:
With informed consent
Compliance with law
Prevent serious, foreseeable, and imminent harm

34. Federal Laws regarding Privacy
HIPAA – The Health Insurance Portability and Accountability Act of 1996
Food, Drug, and Cosmetic Act (21 USC 301 seq.)
ERISA of 1974 (PL 93-06)
Gramm-Leach-Bliley Act (GLBA - PL ) - privacy regulations for financial institutions and health care companies
FERPA provisions regarding school health records and educational records (20 USC 1232 g)
FIA (5 USC 552a) and the Privacy Act of 1974 (5 USC 552) regarding records maintained by federal agencies
Clinical Laboratory Improvement Amendments (42 USC 263 a, and 42 CFR, Part 493)

35. common ethical situations
Client asking for advice
Therapist or life coach?
Taking a public stance on a controversial subject.
Client gifts.
Client invitations to events.
Cultural differences.
Other common ones…?

36. Break time…

37. Boundaries A systems concept: social boundaries
Within personal boundaries, we enact our roles.
Dual relationships: entering into a relationship in addition to worker- client

38. Distinguish: Boundary Violations/Boundary Crossings
Deliberate, constructed
Providing benefits for the professional
Crosses the line of ethical practice
Ethical obligation: avoid the violation to begin with
Inadvertent, unintended
Neutral in regard to any benefits
Creates ethical quandaries which can be resolved.
Ethical obligation: attend to the ethical issue.

39. Boundary Crossings and Violations
Intimate relationships
Personal benefit
Emotional and dependency needs
Altruism
Unavoidable circumstances
[Frederic Reamer]

40. Note: Boundary violations and crossings can occur at the
Micro level – in our work with individuals
Mezzo level – in our work with families and groups, and
Macro level – in our administration, management, supervision, organizational change efforts, community development, and social action efforts

41. Boundary Violations Are potentially exploitative
Produce a service or benefit outside of the worker-client relationship
Cross the boundaries of ethical practice
May impair the judgment of the professional
May produce negative consequences in the client: anger, low self-esteem, inability to use professional services

42. Attend to:
The Before: clients you have reason to believe will make their way to you.
The During: Attend to the lines which are not to be crossed
The After: Basic consideration: potential of harm to the client

43. Small groups
What are recurring boundary issues that happen in working with the population that you work with?
How do you avoid them, or resolve them when they do occur?

44. Ethical Decision Making
Determine: an ethical issue or an ethical dilemma? [conflicts of values, rights, responsibilities].
Identify key values and principles; rank them. [Go deep into the Code]
Identify key persons, groups, organizations with a stake in the issue/dilemma
Identify all possible courses of action
Examine reasons for & against each action
Consult with colleagues, supervisor, ethics board; do not do this alone.
Select the strategy, implement it, document it.
Reflect on outcomes: Monitor, evaluate, document
[From: Reamer, Frederic G. (2001). Ethics education in social work.
Alexandria, VA: Council on Social Work Education, pp ].

45. Let’s take a shot at resolving your ethical dilemmas
We will use Reamer’s framework on the previous slide

46. Wrap-up Questions, random thoughts, etc…
If you have suggestions or feedback for me, feel free to stop and chat after we end, or send me an at: