Social workers face ethical dilemmas on a daily basis, Banks illustrates this in her quotation ‘ethical dilemmas occur when the social worker sees herself as facing a choice between two equally unwelcoming alternatives, which may involve a conflict of moral values, and it is not clear which choice will be the right one’ (Banks 2006:13). Banks implies that social workers are often involved in personal and even painful issues and ethical judgements in social work that are about ‘human welfare’ (Banks 2006:155). This poses many challenges as decisions made are likely to be life changing for service users. It is therefore important for a social worker to be able to justify action (or inaction) accordingly. The facts of a case alone cannot determine what action must be taken, ‘it would be impossible to make choices without values’ (Beckett and Maynard 2005:7). It is essential for a social worker to have a strong value base from which they work. In some instances problems may arise as social workers come into the profession with their own set of personal values and these may conflict with their professional values. Hence what Banks refers to as ‘conflict of moral values’ (Banks 2006:13). Personal values cannot simply be eradicated because they conflict with professional values, but we must ‘keep our values and assumptions under review, and be open to other arguments and other ideas’ (Beckett and Maynard 2005:17). In the case scenario of the Bertrams the ‘alternatives are unwelcoming’ and in order to navigate the ‘value “maze” in social work’ (Wilson, Ruch, Lymbery and Cooper 2008:92) social workers use various theories to inform practice.
Kantism also referred to as deontology was derived from the ideas of philosopher Immanuel Kant (1724-1804). Kant believed people should be treated as an ‘end’ and not a means to an end. By this Kant meant people should be valued and respected as an individual and not used for the benefit of others. Hence, Kant believed that everyone should be treated equally. Kant’s ideology was to set aside people’s view of religion and spiritual beliefs and move to the idea of being rational. ‘Rationality enables people to understand what their duties are and how their duties enlighten what they do in the world’ (Parrott 2010: 500). Kant also believed that by using reason this would develop a ‘consistent moral system’. In the case of the Bertram’s if the social worker were to use the deontological perspective to guide her decision-making it would be important to value Mrs Bertram as a person because the core of this perspective is ‘respect for persons’ (Beckett & Maynard 2005:35). This goes hand in hand with the British Association of Social Workers (BASW) Code of Ethics key principles: Respect for human dignity; Value for every human being, their beliefs, goals, preferences and needs; and Respect for human rights and self determination (BASW 2010).
Jeremy Bentham (1748-1832) developed the philosophical theory of Utilitarianism. ‘Utilitarianism looks at the consequences of actions balancing the relative advantages and disadvantages of a particular course of action,’ (Parrott 2010: 54)
Therefore one persons’ suffering is acceptable as the greatest number of people is happy. There are two principles of utilitarianism, the principles of justice and utility. The principle of justice is about being equal and fair as the value of everyone’s happiness should be the same. The principle of utility signifies the greatest good for everyone. In many cases these two principles clash as the minority of people are unhappy. In the case scenario of the Bertrams her happiness should be valued and it would be important to consider the repercussions of going against her wishes if it were considered in her best interests. A social worker would be expected to balance Mrs Bertram’s right to self-determination, her safety and the concerns of her family for her welfare as ‘it is often the social worker’s job to assess the whole situation and work for a solution in the best interests of all concerned’ (Banks 2006:167).
Virtue ethics is a theory that looks into an individual’s character. Ones ‘virtue ethics’ are developed by their personal belief system and this determines their character. Virtue ethics is an approach ‘according to which the basic judgments in ethics are judgments about character’ (Statman, 1997:7). Ethical issues are embedded in relationships and responsibilities. An individual may lie to be seen as virtuous because they want to be seen as an honest person.
Radical social work is seen as belonging to an area of social work which can also be known as “critical” or “activist” social work. The radical position takes a transformational view of social work, and as such is concerned with transforming society to benefit the most oppressed rather than focusing on the individual (Hill, 2010). Payne (1997) suggests some typical views are that; problems are defined as social and structural rather than individual. McIntyre (1982) cited in Payne (1997) summarises the radical approaches criticisms of traditional social work as; traditional social work reduces complex social problems into individual psychological ones, it cuts service users off from others who may share the same problem and it reinforces the capitalist social order that is oppressive. The radical position sees the professionalisation of social work as alienating workers from service users.
Praxis is the process of thinking and acting. It is like a spiral of thought and action, or a praxis spiral. Praxis is integral to social work practice and comes in the form of reflection. In social work theory, praxis is the reflexive relationship between theories and action. It describes a cyclical process of social work interactions developing new theories and refining old ones. In order to work anti-oppressively social workers need to reflect on factors that influence their practice; they then need to incorporate the results of this reflection into their practice (Lee, 2001).
Downie and Telfer (1969, 1980) state that ‘respect can be regarded as an active sympathy’ towards another human being’ (Banks S, 2006: 29). Darwell (1995) outlines two types of respect, recognition respect and appraisal respect. Recognition respect is in essence when a human being is worthy of respect whether it is for something they have communicated verbally or through their actions. Appraisal respect is acknowledging ones qualities. The level of respect would reflect on the qualities shown. Kantism has had an influence on the moral principle of respect in a relationship between a social worker and the service user. (Banks S, 2006: 31) In order for a social worker to show full respect there are four key elements that have to be met, these are, acknowledgement, preservation, non-destruction and engagement (Banks and Gallagher, 2009).
Relativism suggests that all points of view are equally valid and the individual determines what is true and relative for individuals. Relativism theorises that truth is different for different people, not simply that different people believe different things to be true. Subjective relativism allows us to be rulers of our own principles and how we chose to live our lives. Cultural relativism is the view that moral beliefs and practises vary with and depend on the human needs and social conditions of particular cultures so that no moral belief can be universally true.’ (A E Holmes 1984). – is this a direct quote? Descriptive Ethical relativism believes that different cultures have different moral values and normative ethical relativism suggests that each culture is right unto itself.
The Collins English Dictionary (2009) defines values as the moral principles and beliefs of a person or group and ethics as a social, religious or civil code of behaviour considered correct, especially that of a particular group, profession, or individual. Therefore values can be seen as the fundamental beliefs that an individual or group holds to be true and ethics the more formalised rules or guidelines of an organization or society. Banks (2010) states that values are ‘…regarded as particular types of belief that people hold about what is regarded as worthy or valuable’. (direct quote ?need pg number) Although values are personal to us as individuals, they may also be shared by the society or culture in which we live. Our values are formed through personal development and socialisation and will be influenced by both past and present experiences. (Parrott, 2010) Dubois and Miley (1996) state ethics are concerned with what people consider “right” while values are concerned with what people consider good. Most moral philosophers would define ethics as a singular term, which is used to describe a branch of philosophy concerned with the study of ‘Morality, moral problems and moral judgements’ (Frankena, 1963 cited in Banks, 2006: page number). According to Parrott (2010), ethics can be seen to guide an action and are there to inform and influence any judgements made according to the professional value base of social work. Reamer (2006) provides an insight into the historical origins of values and ethics in social care and states that they have been at the foundation of social care’s mission since its inception. He suggests that social work values and ethics come from four distinct stages: the morality period; the values period; the ethical theory and decision-making period and the ethical standards and risk management period (Reamer, 2006). These have culminated in the General Social Care Council’s (GSCC) code of conduct that is in place today (Barnard, 2008).
Social workers are duty bound to adhere to the GSCC codes of practice which acts as an ethical framework. A written code of ethics enables social workers to judge their practice against an ethical standard and enables service – users to understand what conduct they should expect from their social worker. If social workers are considered to be in breach of the GSCC codes they can be removed from the social care register and no longer practice. Professional social workers must take responsibility for their actions as they hold a position of trust and power that is legitimised by the state making ethics an important factor in accountability. The impact of all practice on service – users can be said to be powerful and therefore the ethics and value base emphasises the importance that the moral standing of service – users is equal to that of the professional (Hugman, 2008). The National Occupation Standards (NOS) for Social Workers state clearly that values and ethics are central to being a competent practitioner. Parrott (2010) suggests that values are important to social work as they ‘provide a common set of principles, which social workers can use and develop as a means of working in an ethical way with service users’.(direct quote ? pg number) He goes on to say that they guide professional behaviour, help maintain a professional identity and protect service – users from malpractice. It is important to clarify one’s personal values in order to increase one’s awareness of the potential conflicts and the impact these may have on ethical decision making. A person’s cultural experiences and background will affect the decisions they make and may bias their behaviour. ‘Social workers must first clarify their own value stance in relation to value-laden issues they meet in practice situations if they want to be true to themselves and to their profession’ (Dolgoff, 2009:54).
When linking moral philosophy and ethical dilemmas to social work practice it is important to acknowledge that no one theory provides an answer. Traditionally social work has taken the Kantian approach and focused on the social worker / service user relationship. The need for social work to challenge inequality and oppression on an individual and structural level means radical social work is also still relevant. An overall Kantian – Utilitarian – Radical approach may be better. (Banks, 2006) The right of a service – user to self determination may conflict with a social workers statutory duty if they are potentially endangering their own life or that of others (Clifford and Burke, 2009). Neil Thompson (2006, p40) defines oppression as ‘inhuman or degrading treatment of individuals or groups; hardship or injustice brought about by the dominance of one group over another; the negative and demeaning use of power. It often involves disregarding the rights of an individual or group and is thus a denial of citizenship’. Service – user’s will predominately come from oppressed and marginalised groups and it is crucial that social workers acknowledge institutional discrimination and avoid inadvertently stereotyping service – users, compounding existing oppressions. (Thompson, 2008) Social workers need to be aware of the unequal distribution of power within organisations and decide how best to advocate and negotiate within these organisations for the best interest of the service – user, even if it involves challenging the structure and values of an organisation from within (Dominelli, 2002). Paternalism focuses on the right for social workers with knowledge, authority, and skills to go into the lives of those who need their help, either by self referral or referrals from other professions. Mrs Bertram has been referred by another professional because of her Alzheimer’s. Ethical awareness is an important part of social work as it gives the social worker the ability and commitment to work alongside other professionals and service users. The Utilitarian view is consequential with the results given as much consideration as possible. Therefore when thinking about practice this approach would say to think of the persons outcome (future) when dealing with the present situation. This would mean weighing the good with the bad. The radical approach would empower the service user into change enabling them to overcome problems and equip them with techniques to deal with these independently in the future. Social workers should involve the service user in the decision making process, working in partnership and keeping them fully informed about their case.
The starting point of dealing with this case would be an assessment of the Bertram’s situation. The assessment task ‘when undertaken in a professional and informed manner is rewarding and sets the foundation for further interventions’ (Wilson, Ruch, Lymbery and Cooper 2008:269). The Bertrams’ financial situation is unclear as it appears that Mr Bertram doesn’t have much inheritance money left which has led to rent arrears. This situation would need to be resolved soon as their landlord is threatening to evict them for rent arrears and the state of the flat, which could render them both homeless. Mrs Bertrams’ insight appears to be severely impaired by her end stage Alzheimers and an assessment of the health risks may require securing detailed information from the GP about Mrs Bertram’s Alzheimer’s and other health issues, and the likely prognosis. Mr Bertram is believed to be an alcoholic and this could have implications for his health. The likelihood of a positive outcome would perhaps be increased if Mr Bertram could be offered help for alcoholism as well as a carers assessment to ascertain what his needs are. He spends considerable time at his club, leaving his wife alone in the house vulnerable and at risk. Mrs Bertram’s daughters distrust Mr Bertram and believe it’s in her best interest to be moved into residential care. Before her illness advanced Mrs Bertram stated she wanted to stay with her husband. Possible options to consider after the assessment would be providing support for Mr and Mrs Bertram at home, moving them into sheltered accommodation together or moving Mrs Bertram into residential care. All these alternatives may be unwelcoming to the Bertrams therefore in order to bring about any change it would be important to first build a relationship with both Mr Bertram and Mrs Bertram and her daughters applying the Kantist view that the truth is told. This could mean trying to communicate with Mrs Bertram at select times when she is more lucid and can participate as much as possible. It is important to ‘develop/construct a shared understanding of the problem(s) being faced’ (Wilson, Ruch, Lymbery and Cooper, 2008:282). Judgements should be informed directly by what Mr and Mrs Bertram say about their circumstances. Mr and Mrs Bertram must have a key part in the assessment of their situation, and any issues should be shared allowing them to continue to have as much choice as possible.
The strengths of this plan are that Mr and Mrs Bertram will be involved in the care plan and will be able to express their views, as well as Mrs Bertram’s daughters being able to contribute towards the care plan. This may build a strong relationship with the family and build on trust so they do co- operate and consider all the options as they will understand that the strategy would be for the health and well being of both Mr and Mrs Bertram. As social workers we need to have a basic understanding of what the Bertram’s values are as it would be difficult to empathise and get the necessary understanding of their wishes if we do not. As social workers we could then possibly struggle to make progress when trying to help the Bertram’s. This professional development is important as we will use this type of growth everyday in the workplace. In this case the main value/wish seems to be that the Bertram’s stayed together in their home.
A social worker’s personal values may inform their understanding of practice. However, a social worker needs to follow the broader framework provided by anti-oppressive social work ethics. The framework provided allows a place for personal values but challenges social workers to place them within the wider framework where they are accountable to others and they must desist from imposing their values and in fact question them. (Clifford and Burke, 2009) Different contributions are made by various ethical perspectives in any given situation and these must be considered. Ethical perspectives must be considered in light of an anti-oppressive approach to practice and in relation to each other as there are occasions when the different perspectives conflict. Social workers have an ‘obligation to work in a way that demonstrates not only knowledge of relevant ethical concepts and local laws but also a broader awareness of how ethical values are related to social inequalities and diversities’ (Clifford and Burke, 2009:203)