Ethical Dilemmas in Social Work: What You Need to Know

Ethical dilemmas pose challenging questions in which two potentially justifiable solutions are in conflict. For example, an elderly person wants to live independently, but is having increasing trouble doing so. Which principle should guide your actions—the client’s right to self-determination, or the client’s need for assisted living? The answer is not clear-cut. The solution likely will not satisfy all ethical concerns.

Social work dilemmas often involve complicated, high-stakes problems with profound, irreversible consequences. Happily, a professional code of ethics exists to provide a decision-making model (even though social workers still need to use their own judgment) that can help you determine the best course of action. If you’re thinking about becoming a social worker, or already are pursuing your social work education to earn your Master in Social Work (MSW), this code of ethics—discussed below—can guide you through the many difficult situations you will likely encounter as a social worker and ensure that you adhere to your core values and follow ethical practices.

In this article on ethical dilemmas in social work we will cover:

• Defining an ethical dilemma
• What areas of social work have the most ethical dilemmas?
• Understanding the National Association of Social Workers (NASW) Code of Ethics
• Resolving ethical dilemmas

Defining an ethical dilemma

Ethical dilemmas are problems with no clear standard or rule determining process for a specific situation.

To constitute a dilemma, three conditions should be met:

Intersection of Issues

The complex web of values, morals, and behaviors—which social workers must manage within the context of legal and regulatory obligations—become tangled.

Multiple solutions

The problem can be solved in several ways, each of which falls within the regulatory obligations.

Conflict

No options are the clear best choice based on the initial legal and moral guidelines.

Some examples of ethical dilemmas are:

Personal bias

A social worker’s personal or professional values conflict with serving their client.

Conflict with ethics guide

A social worker’s values or conduct deviate from the professional code of ethics that governs social work.

Confidentiality safety

A social worker must decide whether to break confidentiality for the good of their client.

Professional dilemmas

An organization or colleague violates a standard of ethical conduct.

Although helping people is an inexact science, social work is an evidence-based discipline with standards and regulations for ethical dilemmas. The National Association of Social Workers (NASW) provides the Code of Ethics as a decision-making model that all social workers use. Professionals are held accountable to these standards and can be disciplined for violating them.

The primary purpose of the code is to anticipate and resolve dilemmas within the context of a professional relationship following professional ethics. Another function of the code is to ensure the conditions under which social workers practice. These include:

Maintaining appropriate professional boundaries

Social workers swear to avoid multiple forms of relationships with clients—such as personal connections outside of their work—to avoid the potential for exploitation.

Following privacy and confidentiality rules

Professionals may only disclose the personal information of their clients when legally released to do so—unless there is imminent harm to themselves or others.

Obtaining proper legal consent from clients

Clients work with social workers to understand their rights and services through the program. Social workers should provide clear and understandable legal consent forms before proceeding.

Finally, the code reminds social workers of their professional values and mission, and ethical responsibilities. These standards benefit both social worker and client—and, ideally, create an environment that is conducive to progress.

What areas of social work have the most ethical dilemmas?

It sounds simple: “Just follow the ethical guidelines, and everything will fall into place,” you might tell yourself. But people are more complicated than that. Here are some common areas where ethical dilemmas arise.

The obligation to minors

Social workers must balance complex confidentiality restrictions between a minor and their parents, for example.

Therapeutic boundaries

Challenges include issues that can push a social worker beyond their traditional responsibilities, as well as physical and emotional boundaries that can threaten trust and confidence in the program.

Moral and religious beliefs

When ingrained personal beliefs aim to sway or prevent a client from making specific decisions, social workers must advise the code of ethics to avoid bias.

The right to self-determination

This includes a client’s right to share beliefs and feelings, and to influence therapeutic direction.

Privacy and confidentiality

Especially in the age of social media, social workers must take great care not to divulge any information about a client and must decide when to break confidentiality for their protection.

Common ethical dilemmas related to colleagues and organizations

Some of the most ulcer-causing dilemmas come from dealing with colleagues at the intersection of friendship and professionalism. Some common situations include:

Misallocation of resources

This occurs when a social worker favors specific clients over others to provide more time, money, or advice.

Fraudulent use of resources

Social workers may intentionally lie about the allocation of specific resources to some clients over others.

Inappropirate Relationships

This covers unethical behavior among colleagues or between a colleague and their client.

Conflicts of interest

Social workers unintentionally or purposely give preference to clients, such as by steering clients to services run by personal friends.

Bribery

In extreme cases, social workers may accept payments of gifts as enticements for work, time, or additional privileges.

Research without oversight

Professionals should not engage in or quote research that did not go through the proper oversight channels within the field.

The importance of case studies

It’s easy to memorize rules and regulations, but it can be tough to apply them. Fortunately, the Association of Social Work Boards (ASWB) offers continuing education trainings in ethics. Completing these courses is a great way to sharpen your social work ethical judgment.

Case studies provide clear examples of ethical conflicts and, as such, can be very useful in the classroom or even in conversation with your peers. Some schools, such as the University of Minnesota – Twin Cities even provide online exercises, such as this one:

“Two deaf children have been removed from the home of their deaf parents because of neglect and have been placed in the home of hearing foster parents who do not know American Sign Language.”

Students must solve the problem by comparing the ethical principles at stake and using them to write a decision. Of course, it is impossible to truly capture the emotion and gravity of an actual ethical dilemma. Still, case studies are an excellent way to gain an understanding of the types of problems you’ll need to solve.

Understanding the National Association of Social Workers (NASW) Code of Ethics

Anyone entering the social work profession must adhere to the NASW Code of Ethics, which is divided into two areas.

Ethical principles

The six core ethical principles of social work, such as integrity and the importance of promoting social justice.

Ethical standards

The 17 ethical standards, which include guidelines on privacy, informed consent, and other mandates in social work that form the basis for ethical decision-making.

The six values and ethical principles of social work

The ethical values principles presented below are reproduced from the NASW website. This is the kind of list that one might want to embroider and hang on their wall. In the face of an ethical dilemma, one cannot lose sight of the overall guiding principles of social work, which are:

Service

Social workers’ primary goal is to help people in need and to address social problems.

Social Justice

Social workers should challenge social injustice and inequality.

Dignity and Worth of the Person

Social workers respect the inherent dignity and worth of the person, particularly when facing social challenges.

Importance of Human Relationships

Social workers recognize the central importance of human relationships, their boundaries, and the roles they play in personal wellbeing.

Integrity

Social workers behave in a trustworthy manner by following a consistent, professional, and fully understood code of ethics.

Competence

Social workers practice within their areas of competence, and develop and enhance their professional expertise.

The 17 standards of ethical social work

This portion of the code of ethics identifies 17 specific standards and rules for social work practice. These are the types of principles that might come in conflict with each other, depending on the situation.

Commitment to clients

Social workers have a professional and legal obligation to act in the best interest of their clients. This must supersede their self-interest, and sometimes the wishes of the client. As mandated reporters, social workers must advise clients that they are required to inform law enforcement of cases of abuse or harm to themselves or others.

Self-determination

Social workers should recognize the right of their clients to help form their own treatment and goals, but may limit the freedom of self-determination when it represents a threat or potential harm to oneself or others.

Informed consent

Social workers must work with clients to obtain valid informed consent for providing services, including:

Determining which language to communicate in

They should confirm that their client fully understands both spoken and written consent throughout the process.

Explaining the use of any technology

If the social worker utilizes software or technology to assist the client, they must ensure the process is not a boundary to meeting requirements.

Deciding to allow a third-party observer

A third party could negatively sway the success of the social worker’s support.

Mandated services

A social worker must discuss what rights a client has in the case of mandated services, such as in the event of legal complications.

Competence

Social workers must present themselves as competent within the context of their:

Education and Training

A client should understand the educational background of their assigned social worker to ensure proper expectations and expertise.

Licensing

Social workers must indicate their licensure—whether they hold an LMSW or an LCSW, and if their work requires professional supervision.

Professional activities and certifications

Organizations offer specialized training and certifications in areas such as veteran affairs, hospice care, or child services.

Cultural awareness and social diversity

Social workers must achieve a sufficient understanding of their client’s cultural group to perform services properly. This might include gaining knowledge of:

Race, ethnicity, and national origin

When working with clients, social workers must work to understand, respect, and celebrate their backgrounds.

Sex, sexual orientation, gender identity, or expression

Respecting a client’s pronouns, for example, builds a sense of trust with a social worker.

Age

Biases about younger, aging, or specific generations of clients cannot sway a social worker’s methods of communication and support.

Marital status

A social worker must avoid making assumptions or projecting biases on the client’s relationship status.

Political belief

Political context can help a social worker speak with a client and their current challenges without revealing their own preferences.

Religion

Religion may strongly inform a client’s actions, moral obligations, and responses to support methods or past events.

Immigration status

Social workers have a responsibility to understand the full range of immigration statuses and scenarios of their clients.

Mental or physical ability

Clients with specific diagnoses or undiagnosed mental and physical challenges should never feel they receive biased or unequal care due to their differences.

Conflicts of interest

Social workers must remain professional and impartial at all times. In some cases, terminating a relationship may be in the client’s best interest.

Privacy and confidentiality

Social workers must protect and safeguard the client’s right to privacy and confidentiality, except when doing so would pose serious, foreseeable, and imminent harm to the client or others. Social workers should advise clients about the limitations of their rights to confidentiality under such conditions.

Access to records

Social workers must grant clients access to their own records, and help to interpret them unless doing so would cause the client severe damage. In that case, social workers must record and justify their decision-making process.

Sexual relationships

Social workers must maintain a professional relationship with clients. This means no sexual relations with the client, their relatives/family members and friends, or anybody else that might have a personal connection to the situation. This rule includes former clients, as well. Don’t work with someone with whom you’ve had a sexual relationship in the past; refer them instead to someone more capable of impartiality.

Physical contact

These situations should be easy to determine. A handshake is OK; taking the client onto your lap and kissing their cheek is not.

Sexual harassment

If consensual sexual relations are not allowed, why would nonconsensual ones be? Under no circumstances can a social worker ask for sexual favors in return for services or sexually harass anyone.

Payment for services

Social workers must charge a reasonable amount for their services, and no, gifts are not allowed (ok, maybe a holiday card, but nothing of substantive value). Bartering is generally not allowed unless it can be demonstrated as culturally acceptable.

Clients who lack capacity for decision-making

Steps must be taken to protect clients who cannot make informed decisions.

Interruption of services

If a social worker is unable to provide services for some time, they should try to set up a way for the client to continue receiving attention from another source.

Referral for services

A social worker who cannot treat a particular client must refer them to the most qualified person. No payment can be accepted for a referral if no services have been provided.

Termination of services

When their services are no longer needed or useful, social workers should discontinue their relationship with the client.

Resolving ethical dilemmas

Understanding the Code of Ethics will help you make decisions in social work, but how does it help when you are confronted with a situation in which at least one principle will be compromised?

Massachusetts’ chapter of the NASW has a web page dedicated to supporting social workers in resolving ethical dilemmas. They suggest the following questions be considered in the process of defining the ethical dilemma, and determining solutions:

Who?

“Who are the key players? Who is involved? Who is/will be affected?”

What happened?

“What is the proposed action to be taken which needs to be evaluated as ethical or unethical? Are there relevant legal issues to be considered? Are there other standards that apply?”

Context

“What is the context of the proposed act?”

Goals

“What are the alternative actions that could be taken? What are the consequences of each alternative?”

Dilemma

“What are the social work values which are in conflict? Is there any way to “rank” order the values (i.e., the prevention of harm takes precedence over enhancing self-esteem)?”

Conflict with Affected Parties

“What other values and/or moral philosophy pertains to the dilemma being considered? (Be sure to include the personal values of the client and the professional values of other involved parties.)”

Resolution Responsibility

“Who has the responsibility to make the decision? Who has the right to make the decision? Who should participate in the decision? Why?”

Resolution Options

“What are the possible resolutions (must include at least two)?”

All decisions should be explained and examined through the lens of moral reasoning.

Individual NASW chapters may have more resources for handling specific dilemmas. State laws may alter your approach to particular challenges. In all cases, however, the NASW Code of Ethics is a useful starting point.

Other ways to handle dilemmas include:

Confer with a colleague

Reach out to a respected and trustworthy MSW clinician or colleague for discussion, counsel, and support. Social workers also can consult with their supervisor or the legal department at work.

Consult legal requirements

Refer to the federal laws governing accountability and privacy, such as the Health Insurance Accountability Act (HIPAA) and its Privacy Rules Laws.

Understand specific regulations

If you are a specialized social worker, further specific requirements may apply to you. Social workers who are employed by the government (essentially public school, military, and federal substance abuse programs), for example, have specific standards to uphold.

Managing ethical issues and dilemmas in social work

Many ethical dilemmas in social work don’t have an easy answer, even when there is a legal imperative to act. Making the call to take children away from their parents, for example, is pretty much always a difficult decision.

Although social work may present complex scenarios, utilizing the Code of Ethics to guide their moral reasoning and judgment can help professionals choose the best possible resolution in a situation with no perfect outcomes.

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