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Ethical Decision-Making

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Title: Ethical Decision-Making


1
Ethical Decision-Making
  • Chapter 3

2
Chapter Purpose
  • Discuss the purposes and functions of ethical
    decision making
  • Identify and discuss the legal duties of
    professional helpers
  • Access the laws that regulate the practice of
    social work in their locale
  • Identify and discuss the fundamental values of
    social work
  • Discuss the ethical principles and standards that
    guide social work practice
  • Identify the relevant legal duties and ethics
    that might apply in various professional contexts
  • Analyze and determine the relative priority of
    competing legal and ethical obligations though
    the development and use of a case-specific values
    hierarchy
  • Use critical thinking skills to reach and ethical
    decision and plan appropriate action

3
Social Work
Obey?
Pledge?
  • Laws, Values and Ethics

Abide?
4
Social worker investigated for missing government
money, January 31, 2005
  • Saskatchewan social worker was convicted, tried
    and found guilty in connection with a million
    dollars in missing government money.
  • Hynes started welfare files for 16 fictitious
    people, issuing cheques in their names and
    starting bank accounts and credit cards for
    several of them, boosting her income by about
    7,000 a month. At least a million dollars went
    missing over a 10-year period.
  • Hynes was convicted of defrauding a bank in
    Newfoundland in the 1980s for more than 600,000
    but was later pardoned after spending two years
    in jail.
  • She then obtained a Masters in social worker and
    moved to Saskatoon. Her criminal record was not
    checked when she was hired in 1989 as mandatory
    criminal record checks were not instituted until
    1997.
  • She was found guilty of fraud and sentenced to 4
    years in a federal penitentiary
  • This minister comments "This is a very huge
    breach of trust

5
Kitchener-Waterloo CAS worker commits PERJURY in
court Feb 5, 2004 (Canada Court Watch Report)
  • A Kitchener, Ontario couple submit documents
    which appear to show that a worker with the
    Waterloo, Ontario, Children's Aid Society made
    false and misleading statements under Oath to a
    court in which the Waterloo CAS worker,
  • Seana Dobbin-Gayowsky,
  • Said she was a social worker.  Yet, a letter from
    the Ontario College of Social Workers indicates
    that Ms. Seana Dobbin-Gayowsky was not registered
    with the College 
  • Under the law in the Province of Ontario, workers
    cannot claim to be social worker unless they are
    duly licensed and registered with the Ontario
    College of Social Workers.

6
Which of these social workers have exposed
themselves to the threat of a malpractice suit?
  1. A social worker finds himself attracted to a
    client and begins a sexual relationship with her.
  2. A second social worker quits the profession
    before starting a relationship with her client.
  3. A third social worker meets with a divorced
    father who asks the social worker to provide
    therapy for his children who are suffering
    emotional trauma because of the divorce and the
    therapist agrees without the mothers consent.
  4. A fourth social worker, wishing to help a poor
    client, agrees to trade services and lets the
    client do carpentry on his house in exchange for
    therapy.

7
Answer All of Them
  • In a litigious age when its said that anybody
    can sue anyone for anything, social workers in
    clinical and therapeutic practice appear to be
    especially vulnerable.
  • According to records kept by the National
    Association of Social Workers (NASW) Insurance
    Trust, malpractice suits against social workers
    have increased dramatically over the past 25
    years.
  • Part of this increase is due, no doubt, to the
    infamously litigious climate we live in, in which
    social workers clients are simply more aware of
    their opportunities to sue and seek monetary
    compensation for real or imagined damages.

8
Understanding Your Legal Obligations
9
Malpractice
  • A form of negligence that occurs when a
    practitioner acts in a manner inconsistent with
    the professions standard of care the way an
    ordinary, reasonable, and prudent professional
    would act under the same or similar
    circumstances (Reamer, 1994)

10
Common Features of Malpractice
11
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12
Malfeasance
  • Where the professional intentionally engages in a
    practice known to be harmful
  • Malfeasance is ordinarily defined as the
    commission of a wrongful or unlawful act
    (Bernstein Hartsell, 1998 Gifis, 1991).
  • Thus,
  • A social worker who engaged in a sexual
    relationship with a client after convincing her
    that this would be therapeutic
  • A social worker who used so-called rebirthing
    techniques without proper training or empirically
    based evidence of effectiveness
  • A social worker who traveled with a client and
    misappropriated some of the clients funds, in
    the name of re-parenting therapy,
  • Could all potentially be accused of malfeasance

13
Misfeasance
  • Where the professional makes a mistake in the
    application of an acceptable practice Employer
  • Getting in trouble for things you did
  • Most common malpractice acts among NASW members
    (Reamer, 1995).
  • Thus,
  • A social worker who used hypnosis, art, or
    wilderness therapy techniques negligently
  • Either because of inadequate training or lack of
    skill
  • Might be accused of misfeasance these clinical
    approaches, which are based on solid research and
    theoretical foundations, should only be used by
    practitioners who have sufficient training,
    knowledge, and competence.

14
Nonfeasance
  • Where the professional fails to apply a standard,
    acceptable practice when action is needed
  • Getting in trouble for what you didnt do (e.g.,
    visit a client at a prescribed time).
  • Not visiting a client at a specified and agreed
    up time and place would be an example
  • Failure to refer a client for consultation or
    treatment

15
The GOOD NEWS
  • In the US between 1969 and 1990 a total of 634
    claims were filed against the NASW Insurance
    Trust, compared to the 60,000 NASW members
    insured through the trust (Reamer, 1995)
  • Canada has a good track record too
  • Most complaints against social workers in the
    popular media do not translate to actions against
    individuals, and in fact the number of formal
    complaints submitted to the regulatory boards
    remains consistently low from year to year.
  • Ontario, the province with the largest number of
    registered social workers, received 30 complaints
    in 2000.
  • Quebec had 28 open files at the end of the last
    fiscal year.
  • Alberta was next highest with 8 complaints.

http//www.casw-acts.ca/SW-Forum/CdnSWForum-Regula
tion.htm
16
Protecting Yourself
  • To reduce the risk of civil claims or
    disciplinary complaints against social workers,
    AON Reed Stenhouse Inc., in co-operation with the
    CASW and your insurer offer protection
  • CASW PROFESSIONAL LIABILITY INSURANCE PROGRAM
  • PROFESSIONAL LIABILITY
  • For damages resulting from a negligent act,
    error, omission or malpractice arising out of
    your professional capacity as a social worker.
  • SOCIAL WORK
  • It is not the role of your insurer to define the
    activities of a social worker. If the activity is
    approved by your Provincial Organization (CASW
    member), then your professional liability
    insurance coverage would apply.
  • DISCIPLINARY COSTS
  • Provides for the cost of defending you against a
    disciplinary action brought against you. 

17
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18
Sanctions
  • Paying the Consequences of Professional Misconduct

19
CONSEQUENCES
20
Repressed Memories
  • To Trust or Not to Trust

21
Trust Memory?
  • Question Trust Memory?
  • Answer Dont!!!

22
Repressed memories
  • A hot issue since the mid 90s. Number of
  • Cases exloded. ? Into the thousands.
  • People have been sued and convicted
  • Of ghastly crimes (often involving relatives)
  • Based on concept of repression (Introduced by
    Freud).

23
Trust Memory? Repressed Memories?
  • So-called Repressed Memories brought back by
    therapists and hypnotists are very dubious in
    terms of scientific support, and the hazards this
    dubious hypothesis presents is profoundly
    frightening!

24
Case in Point
  • Eileen was 8 years old when her friend Susan died
    in 1969.  Twenty years later Eileen had grown up
    and had a daughter who reminded her of her long
    lost friend Susan. 
  • One day when Eileen was looking into her
    daughters eyes she suddenly remembered what had
    happened to her friend Susan 20 years
    previously. 
  • Eileen had witnessed her own father sexually
    assault and then murder Susan by hitting her with
    a rock.  He had then threatened to kill Eileen if
    she told anyone. 
  • Her father was subsequently found guilty of
    murder and sentenced to life.  (Reported by
    Zimbardo et al 1995).

25
  Susan                 Eileen in later
life          Eileens father
     
26
Trust Memory? Repressed Memories?
  • George Franklin (the father) served 6 years of
    his sentence before being acquitted of the
    murder. 
  • At trial Eileen had failed to inform the court
    that shed been hypnotized prior to the return of
    the memory. 
  • Franklin later sued Eileen, her hypno-therapist
    and the prosecuting counsel (outcome unknown!). 
  • He claimed it had all been a case of false
    memory syndrome in which a false memory had been
    created by the process of hypnosis.

27
Repressed memories
  • While it is impossible to tell in an invididual
    case, some things are very troubling...
  • Scientific concept of Repression is extremely
    shaky. No evidence that it can happen. In fact,
    the opposite seems to be true (PTSD)
  • It has been shown that very vivid memory can be
    implanted into the minds of both adults and
    children. The subjects cant discriminate real
    vs. implanted memories.
  • The process of recovery (recovery therapy) is
    very similar to the process used for artificial
    implantation.
  • Evidently wrong recovered memories seem to be
    progressive, ? the reports of the abuse get more
    and more severe over time.

28
Whats the issue?
  • We potentially have a situation in which someone
    who is having troubles in life and is seeking
    answers is told to determine whether or not
    memories for historical events in their lives
    exist
  • What are some techniques that are used to
    assist recollection?
  • hypnosis, imagery, dream analysis, story telling

29
Conclusion
  • We cannot know with certainty (without
    corroborating evidence) whether a derepressed
    memory is true
  • Therapists should engage in probing this
    possibility very carefully
  • avoiding suggestive questions
  • remaining unconvinced without corroborating
    evidence
  • being gently confrontational to encourage
    patient to consider the possibility that the
    events didnt happen

30
Disability
  • Any restriction or lack (resulting from an
    impairment) of ability to perform an activity in
    the manner or within the range considered normal
    for a human being.

31
Disability
  • Disability is difficult to define because it is a
    multi-dimensional concept with both objective and
    subjective characteristics
  • According to the Ontario Human Rights
    Commission
  • Pyhsical disability, infirmity, malformation or
    disfigurement that is caused by bodily injury,
    birth defect or illness, and without limiting the
    generality of the foregoing, including diabetes
    mellitus, epilepsy, any degree of paralysis,
    amputation, lack of physical co-ordination,
    blindness or visual impediment, deafness or
    hearing impediment, muteness or speech
    impediment, or physical reliance on a guide dog
    or on a wheelchair or other remedial appliance or
    device,
  • A condition of mental retardation or impairment,
  • A learning disability, or a dysfunction in one or
    more of the processes involved in understanding
    or using symbols or spoken language,
  • A mental disorder, or an injury or disability for
    which benefits were claimed or received under the
    insurance plan established under the Workplace
    Safety and Insurance Act, 1997.
  • "Disability" should be interpreted in broad
    terms. It includes both present and past
    conditions, as well as a subjective component,
    namely, one based on perception of disability.

32
Disability in Canada
  • Some 3,601,000 Canadians have a disability
    thats one in eight.
  • The rate of disability increases with age
  • Disability rates are highest among older seniors
    (75 and over), with fully 53.3 percent in this
    age group reporting a disability
  • The majority of Canadians with disabilities have
    mild to moderate disabilities.
  • Childhood disabilities is more likely to be
    severe to very severe compared to working-age
    disabilities.

33
Disability Rates by Age, Canada and Provinces
34
Disability in Canada
  • Mobility, agility, and pain-related disabilities
    are by far the most common types, each accounting
    for approximately 10 percent of reported
    disabilities nationally. Four percent of
    respondents reported a hearing limitation.
  • About 1 percent of the population overall have
    psychological disabilities, while 2 percent have
    learning- and 2 percent memory-related
    disabilities.
  • Learning disabilities are prominent among
    children of school age and young adults, but less
    common among seniors.

35
Types of Disability in Canada
36
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37
Selected Government of Canada Disability Programs Selected Government of Canada Disability Programs Selected Government of Canada Disability Programs Selected Government of Canada Disability Programs Selected Government of Canada Disability Programs Selected Government of Canada Disability Programs
Type of Disability Infirm Severe and prolonged disability Permanent disability Long-term or recurring Not specified
Objectives Infirm Severe and prolonged disability Permanent disability Long-term or recurring Not specified
Antidiscrimination       Employment Equity Act (self-identified)  
Daily living activities and assistance in home Infirm Dependant Credit Caregiver Credit Disability Tax Credit    
Income CPPD Veterans pension  
Employment Learning CPPD vocational rehabilitation Attendant care deduction OF (Self-identified) CSLP (3 provisions) EAPD
38
Canadian with Disabilities Accountability
Framework
39
For More Information
  • http//www.disabilitypolicy.ca/resourcesNational.p
    hp

40
Ontarians with Disabilities Act, 2005
41
Whats a HIPAA?
42
What is HIPAA?
  • HIPAA ( Health Insurance Portability and
    Accountability Act) was passed in 1996.
  • Department of Health Human Services (DHHS)
    issued the final Privacy rule in April 2001.
  • Regulation requires compliance by April 14, 2003

43
What Information is covered under HIPAA
  • Personal Health Information (PHI)
  • Anything that can potentially identify an
    individual

Name Zip code of more than 3 digits Dates (except
year) Telephone and fax numbers
Email addresses Social Security Numbers Medical
Record Numbers Health Plan Numbers License numbers
44
Privacy Objectives
  • Protect patients rights by giving them access to
    their health information and control over how it
    will be used
  • Improve the quality of care by restoring trust in
    the health care system
  • Protect the security privacy of all medical
    records that are used or shared in any form

45
Why do we need a Privacy Rule?
  • HIPAA came about as the result of concerns from
    patients regarding
  • Breeches in Confidentiality
  • Three cases in point
  • Accidentally, hospital in Michigan posted
    thousands of patient medical records on the
    Internet
  • Employee from a Florida health department took
    home a disk containing names of 4,000 patients w/
    positive HIV tests.
  • Congressional Candidate stated that her campaign
    was derailed when the media published her
    psychiatric treatment after a suicide attempt.

46
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47
Personal Health Information Protection Act 
(PHIPA), 2004
  • Canadian counterpart to HIPAA
  • Provides consistent and comprehensive rules
    governing the collection, use, retention,
    disclosure and disposal of personal health
    information in the custody and control of health
    information custodians

48
According to ocswssw
49
Student Activity
  • The following scenario deals with professional
    integrity as it relates to protection of client
    identity
  • Did the student intern act in the right way?
  • What might you have done?

50
Standards for Privacy of Individually
Identifiable Health Information
51
Are breaches of confidentiality ever justified?
  • Write down 3 situations in which a breach of
    confidentiality might be justified?

52
Circumstances in which confidentiality might be
breached for ethically or legally justifiable
reasons include cases where professional knows or
suspects
  • That an individual is acting illegally.
  • That an individual is harming others.
  • That an individual might harm others in future.
  • That an individual is harming themselves.
  • That an individual might harm themselves in
    future.
  • That a minor is being exploited or abused by
    others.
  • That a competent adult is being exploited or
    abused by others.

53
The Duty to Care
  • You must take reasonable care to avoid acts or
    omissions which you can reasonably foresee would
    be likely to injure your neighbour
  • Lord Atkin 1932

54
Duty of Care
A social worker's initial contacts, including
screening and intake, are key to establishing a
duty of care
  • An explicit duty of care occurs, for example,
    when a social worker establishes a working
    agreement, bills a client, or places his or her
    name in a client's record.
  • A practitioner might implicitly establish a duty
    of care by providing counseling over the
    telephone or emergency back up for a colleague.

55
  • If the person knows that the practitioner is a
    social worker and assumes that the practitioner
    has delivered professional services, the
    practitioner will have to prove that he or she
    did not establish professional duty. However,
    this may be difficult.
  • For example, if a social worker lectures to a
    community group and speaks to a group member
    alone during a break, the practitioner may have
    established duty of care. If the person assumes
    that the practitioner has provided expert
    services, he or she will more than likely be
    found to have established a duty of care because
    the practitioner's actions spoke for themselves
    (Bennett et al., 1990).

56
Duty of Care
  • A Legal Term applicable to across a wide range of
    domains
  • In the health professional domain
  • A person who practices in a health profession
    owes the patient a duty.
  • The duty of care involves applying skill,
    knowledge, diligence and caution when caring for
    clients.

57
Duty of Care
  • Ms. Young a former Memorial University student
    had successfully sued the university and Social
    Work professors Leslie Bella and William Rowe
    (former director of the School of Social Work).
  • Ms. Young claimed that the university and the
    social work professor had breached a duty of
    care owed to students when she reported a
    suspected case of child abuse based on an
    academic paper written by her in 1994. The
    province's Child Protection Services waited two
    years until 1996 before investigating the report
    after which Ms. Young was quickly cleared of any
    suspicion in the matter.
  • In 2003 a jury awarded Ms. Young a total of
    839,400 in damages relating to her complaint.
  • The university disagreed with that decision
    citing errors made by the jury, Ms. Young's
    solicitor and the trial judge. The appeal was
    heard in June of this year and the decision
    favouring Memorial University was rendered in
    October.

58
What does this mean for YOU?
  • Doing what is reasonable
  • Working to level of competence
  • Higher the competence, higher the expected
    standard
  • Judged against respected body of opinion
  • Reasonable in relation to level of experience
  • Considered clinical risk

59
Duty to Respect Privacy
60
Duty to Maintain Confidentiality
  • Confidentiality
  • Professional norm that information shared by or
    pertaining to clients will not be shared with
    third parties
  • Privilege
  • The disclosure of confidential information in
    court proceedings
  • Informed consent
  • Under most circumstances, clients must give
    informed consent before you may share information
    with another person or organization

61
Confidentiality
  • Professional norm that information shared by or
    pertaining to clients will not be shared with
    third parties

NASW Code of Ethics
62
NASW Code of Ethics
63
Confidentiality
  • The NASW Code of Ethics (1996) recommends that
  • Clients be apprised of the limits on client
    confidentiality before they begin to disclose.
  • This is part of obtaining informed consent, and
    should occur at the beginning of treatment before
    any opportunity for disclosure occurs.
  • Note that unusual circumstances can arise. Thus,
    it is wise practice to anticipate when you could
    potentially breach confidentiality and to inform
    the client of this anticipation.

64
Duty to Inform
  • Obligation to educate about
  • Your qualifications and field of expertise
  • Extent of services offered
  • Privacy practices
  • Matters of cost, length of treatment, risks,
    probability of success, best practices, practice
    guidelines and community resources
  • Duty to warn

65
Once informed
  • The Client must give consent
  • This is a fundamental client right

66
Informed Consent
1. Relevant Information
2. Client Competence
3. Acceptance or Rejection
67
CASW Informed Consent, May 2007
  • CASW recently developed a new document entitled
    Informed Consent and Confidentiality
  • Canadian Association of Social Workers
    Guidelines.
  • Electronic copies of the guidelines are available
    on the Members Site of the CASW website

68
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69
Duty to Report
  • Outrages against humanity
  • Child abuse, child neglect, child molestation,
    incest
  • Exploitation of children, elderly, physically or
    mentally challenged or developmentally disabled
  • Procedures for reporting vary from place to place

70
Duty to Warn and Protect
  • Responsible to warn potential victims
  • Responsible to take action to protect people a
    client might harm
  • Tarasoff v. California Board of Regents

71
Tarasoff v. Regents
  • This University of California student was stalked
    and killed by fellow student Prosenjit Poddar
    after he had discussed his intention to kill her
    with a University Health Service psychologist.
  • Her family sued and the resulting court opinions
    formed the basis for general acceptance of the
    notion that treating professionals have a duty to
    protect known intended victims.

72
Class Activity
  • Break Into Groups
  • Read the Case Study Presented
  • Identify the issues at hand
  • What would you do as the social worker?
  • What are the possible consequences of your
    action(s)?

73
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74
So manyHow to protect myself?
  • First and foremost, know that laws in your area
    as they relate to areas of practice
  • In Ontario e-law website offers downloads of each
    law
  • Be especially familiar with the Social Work and
    Social Service Work Act
  • Know the major codes of ethics
  • Discuss with experts, fellow students,
    supervisors observations, experiences, confusion
  • Ask questions
  • Be aware
  • Be proactive take steps to protect yourself from
    potential problems

75
www.e-laws.gov.on.ca
E-law Government of Ontario Website Allows you
to search for any type of law Allows you to
download the law
76
Social Work and Social Service Work Act
77
Understanding the Fundamental Values and Ethics
of Social Work
78
Most common ethical violations (Strom-Gottfried)
  1. Sexual activity
  2. Dual relationship
  3. Other boundary violations
  4. Failure to seek supervision or consultation
  5. Failure to use accepted practice skills
  1. Fraudulent behavior
  2. Premature termination
  3. Inadequate provisions for case transfer or
    referral
  4. Failure to maintain adequate records or reports
  5. Failure to discuss policies as part of informed
    consent

79
NASW Bulletin Ethical Dilemma of the Month
  • Identify the ethical dilemma
  • What would you do?

80
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81
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82
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83
The World of Social Work
  • Organizations and Governing Bodies

84
International Federation of Social Workers (IFSW)
85
IFSW Aims
86
NASWs Preamble to the Code of Ethics
87
Council on Social Work Educations endorsement of
the NASW Code of Ethics
  • http//www.cswe.org/CSWE/

88
NASW Procedures for Professional Review (National
Association of Social Workers, 2005)
  • Available online
  • http//www.socialworkers.org/nasw/ethics/procedure
    s.pdf

89
Preface
90
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