Anyone who’s followed my blogs recently knows that I’m a social work student currently in my last year for my MSW. One of my classes right now is Advanced Clinical Ethics and is supposed to teach us how to behave in an ethically responsible manner when counseling our patients. Today my class received an email from our professor which detailed the rationality behind this past week’s discussion assignment.
The hypothetical ethical dilemma was a difficult one indeed. I am counseling a client who is coming to me for drug addiction. My client divulges to me that she committed a crime a long time ago in which someone was injured, but she was not caught for it. Instead, another woman was convicted of it and is serving a lengthy prison sentence for a crime she did not commit. After repeated urging, the client refuses to turn herself in and has reminded me of my obligation to client confidentiality. The question is simple – do I break that confidentiality and turn her in or maintain confidentiality and let an innocent woman continue to serve time for a crime she is innocent of?
My answer to the discussion question was an honest one. I would tell my client that I have no choice but to try to help the woman wrongfully incarcerated, but that I would do this in a manner that would be least damaging to my client. I would let my client decide whether I go to the State Attorney to try and garner a plea bargain for my client, taking into account that she did come forward and is making progress in turning her life around, or I would simply go to the State Attorney and tell them that the woman they incarcerated is innocent but I can’t tell them how I know that due to client confidentiality, thereby running the risk of them re-opening the case and my client being found out (at which point they probably would not be so willing to work out a plea agreement). I would tell my client that those are her choices and she can decide, but that it is my ethical responsibility to take action.
The email from my professor today made me very angry. I went into social work because I want to help people. I want to promote social justice without having to become a police officer. I want to be one of the good guys that comes in and helps the underdog. Maybe it’s hereditary…..I come from a long line of firefighters, state troopers, paramedics, EMTs, military…..the innate sense of justice and responsibility to society is in my blood and is a part of my core being. So what am I supposed to do with this?
This is the email sent to the entire class from my professor. I have removed my professor’s name as well as the name of my university in the hopes of minimizing the potential academic flashback (yes, I will probably get into trouble for posting this but I feel the public has the right to know what their counselors and therapists are being taught):
Winter 2013
DISCUSSION QUESTION MODULE 3
What a great discussion week! Your posts were very good. It is evident from your posts, you are taking your profession seriously and want to be the best social worker you can be!
Issues in case:
Client reveals to her social worker she committed a crime.
Client reveals another woman is serving time in jail for this crime to her social worker.
The social worker has asked the client to reveal this information to authorities and client refuses.
Main Ethical dilemma: Does the social worker have the ethical responsibility to keep confidentiality or should she report what Mary’s has told her to the proper authorities? What is the social worker’s Ethical responsibility using the Dolgoff’s Ethical Principles? This was the assignment.
Any other information provided in this scenario is not pertinent to the main ethical conflict for the social worker.
It does not matter how long the client is in treatment. It does not matter what the client is in treatment for. The relationship between social worker and client does not matter in making the ethical decision. It does not matter how long ago the crime was committed.
This question asked specifically to discuss your answer using Dolgoff’s Ethical Principles.
Principle 1: Protection of all human life, including the client and the lives of other people. Takes precedence over every other obligation.
Neither Social Worker’s client nor the woman in jail is in imminent danger to their lives. “Imminent danger meaning “physical threat of death to either of them” Both women are safe. You should not use your perception of prison as an unsafe place where the woman might be “killed or maimed (beat up).” If you believe prisons are unsafe and “dangerous”, could you serve on a jury and judge a person to prison and keep your ethical principle to keep ALL people from harm?
That being said, this Principle does not apply to the Social Worker’s dilemma and the social worker MUST keep confidentiality.
Principle 2: Equality and Inequality…equal persons have the right to be treated equally. The client and the woman in jail are equals and should be treated as such. The “system” treated both women equally. The client escaped the system and the system “tried” the woman in jail and found her guilty with the information available to them.
This principle does not apply to Social Worker’s dilemma.
Principle 3: The social worker should make practice decisions that foster a person’s autonomy, independence and freedom. A person does not have the right to decide to harm him/herself or anyone else on the grounds that the right to make such a decision is her/his autonomous right.
The first sentence leads SW’s to understand this is most important. As such, the social worker does not have the right to break confidentiality. The social worker does not have the right to make a decision for client. Revealing the client committed a crime might or would lead the client’s freedom to be compromised. It is not the social worker’s autonomous right to break confidentiality.
THIS PRINCIPLE SUPPORTS KEEPING CONFIDENTIALITY.
Principle 4: A social worker should always choose the option that will cause the least harm, the least permanent harm, and or the most easily reversible harm. This principle does apply. We are looking at these Principles remembering our client is the “person” unless the principle states “all people”. This principle does apply.
THIS PRINCIPLE SUPPORTS KEEPING CONFIDENTIALITY.
Principle 5: A social worker should choose the option that promotes a better quality of life for ALL people, for the individual as well as for the community. This principle does apply. The woman in jail needs to be considered under this principle. Her quality of life could be improved (getting out of jail) if the client confesses to the crime. But the client’s quality of life would or might be in limited (going to jail) if she confesses. This principle does apply.
THIS PRINCIPLE SUPPORTS BREAKING CONFIDENTIALITY.
Principle 6: A social worker should make practice decisions that strengthen every person’s right to privacy. Keeping confidential information inviolate is a direct derivative of this obligation. This principle does apply.
THIS PRINCIPLE SUPPORTS KEEPING CONFIDENTIALITY.
Principle 7: A social worker should make practice decisions that permit her to speak the truth and to fully disclose all relevant information to the client and to others. This principle does apply. The social worker should discuss with the client truthfully her feelings on the legal obligation of the client to confess to the proper authorities she committed the crime.
THIS PRINCIPLE SUPPORTS KEEPING CONFIDENTIALITY.
The NASW Code of Ethics is the FIRST resource to use in any ethical decisions. Since this question asked you ONLY to use the Dolgoff’s Ethical Principles, and if you only used Dolgoff’s Ethical Principles, you could make an ethical decision. I think at this point you want an answer to whether to keep or break the client’s confidentiality.
Based on the NASW CODE OF ETHICS:
(c) Social workers should protect the confidentiality of all information obtained in the
course of professional service except for compelling professional reasons. The
general expectation that social workers will keep information confidential does not
apply when disclosure is necessary to prevent serious, foreseeable, and imminent
harm to a client or other identifiable person or when laws or regulations require
disclosure without a client’s consent. . (Tarasoff v. Regents of University of
California 17 Cal. 3d425, 131 Cal. Rptr. 14,551 P. 2d 334, 1976.)
REMEMBER THIS CODE SUPERCEDES ALL OTHER CODES. BASED ON NASW CODE WE ARE OBLIGATED TO KEEP CONFIDENTIALITY.
In Mary’s case, using the above Code, as we must before using any other Principles, the social worker MUST keep confidentiality. The social worker has no knowledge of foreseeable or imminent harm to either her client or the woman in prison. “HARM” is the key word in that sentence. “HARM” meaning “threat of death” or “life threatening maiming.”
Consulting with a supervisor or a peer social worker is always advisable with difficult cases. If you determined you must report this “crime”, you should do so disclosing the least amount of information necessary while keeping your client’s confidentiality. Also seek legal counsel before reporting.
Using the Dolgoff’s Principles, Principal #1 is the hierarchy of all other Principles. As explained above, we are bound to confidentiality in Mary’s case.
If you came up with a different answer and it was based on the NASW Code of Ethics and Dolgoff’s Principles, it is the right answer for “you” with the knowledge you had at the time.
That being said, if you have determined a different answer BASED IN ANY WAY ON FEELINGS ABOUT THE CLIENT’S BEHAVIOR, THE “TERRIBLENESS” OF PRISON, THE “POOR WOMAN” IN PRISON” “I COULDN’T LIVE WITH MYSELF” OR SIMILAR THOUGHTS, her “Cowardly behavior”, please know those are “value judgments” and should not be used in any ethical decision.
The author makes a true statement in your book. She states there are no final or universal answers to difficult ethical questions. I would add as long as we keep our personal values and morals separate from ethical decisions and base decisions on knowledge of NASW Code of Ethics and Dolgoff’s Principles we are being ethical, responsible and professional social workers.
I would caution you all not to add more to the “cases” we discuss than the information that is known. When you add suppositions, you cloud your judgment. Also, answer the question that is asked: this week it was use the Dolgoff’s Principal….said nothing about applying Code of Ethics. It is ok to add to posts but always keeping centered on the question asked.
A great week students! The posts were, for the most part, professional and based on Knowledge of the NASW Code of Ethics and Dolgoff’s Principles. Again a reminder to post and reply respectfully to the discussion board. You all showed an open mind to take in other’s opinions which either strengthened your opinion or changed your opinion.
Basically, this email is using accepted philosophy to justify one of the primary things wrong with our communities today – there is no regard for the greater good and it is every man for themselves. My professor’s responses sit wrong with me on so many different levels I don’t even know where to begin. Clinically speaking, what kind of a person are we helping our client to become? Someone who has no ability to accept the consequences of their actions and has no regard for their fellow man. If situation were only slightly altered and my client were a child and the other woman was another child wrongfully serving a timeout, a parent or counselor would be vilified for allowing such an injustice. After all, we’re teaching the one child that she can get away with doing wrong if she simply lies about it and there will be no consequences. And for the child serving the timeout, she’s being taught that there’s no such thing as fairness or justice in the disciplinary system. This was actually covered in my Child Psych class and we were educated about the psychological dangers involved in such scenarios. So, again, clinically speaking this makes no sense to me.
Outside of the therapist’s office, in the world of human beings, this is still WRONG. Nowhere in humanity is it accepted as fair or just to allow an innocent person to serve the sentence of the guilty. One guy did this very thing and the Christians haven’t shut up about it since! (That’s a joke, people). As a Christian, doing my best to live by the Golden Rule, how can I possibly sit back and accept this? Do unto others as you would have them do unto you. If I were that woman sitting in prison, I would darn sure want someone on the outside fighting for me. How about the Ten Commandments? Thou shalt not bear false witness. Could I, as a Christian, maintain my client’s confidentiality knowing it violated my religious beliefs to do so?
What about the viewpoint from a law-abiding citizen? My client has violated the justice system by withholding information regarding a crime in which someone was injured. I now have similar information regarding the case. Would I also not be breaking the law by withholding that information? The very order that we depend on in society is founded on the belief in a justice system that I, at that point, would be helping to undermine.
Aside from all these different viewpoints, I think this one thing burnt me up the most…this one particular line from my professor – “I would add as long as we keep our personal values and morals separate from ethical decisions and base decisions on knowledge of NASW Code of Ethics and Dolgoff’s Principles we are being ethical, responsible and professional social workers.”
In terms of this statement, I would like to point out Miriam-Webster’s definition of ‘ethics’: a branch of philosophy dealing with what is morally right or wrong.
One cannot have ethics without first having morals. And what good are those morals when we’re told that we can not let them guide or sway our sense of ethics?
I’ve learned a lot in my time with my current university, but I think today I learned the most important lesson of all. I learned what type of social worker I don’t want to be.
And a note of warning to anyone who may potentially be a future client of mine…..if you tell me that you hurt someone and you’re letting another person sit in prison serving the time for it, you can bet your sweet ass I’m turning you in.
Realizations, Ruminations, and Life 