ETH3338 - SECTION 2: BEST PRACTICE MODELS OF ETHICAL DECISION MAKING
This course will now present a number of ethical decision making models, covering current and best practices strategies from the social work and counseling arenas, as well as from the private business sector. Each of these models will be presented in an easily printable form, allowing the trainee to print and store the models for easy later reference. Models are arranged in order of increasing complexity, from the simplest model to the most detailed model.
The clinician who wishes to operate from the most defensible and responsible ethical position would do well to have a comprehensive knowledge of all of these models, operate using the combined principles and understandings of these best practices models - applying them with integrity and skill - while carefully documenting the work and noting which model or models were utilized to arrive at the ethical decision.
Model I: Elaine Congress ETHIC Model of Decision Making
In her article, What Social Workers Should Know About Ethics: Understanding and Resolving Practice Dilemmas, (Advances in Social Work Practice, Vol. 1 No 1 Spring 2000, pgs 1 – 25), Congress discusses the major tenets of the newly revised NASW Code of Ethics.
In addition to her review, Congress also presents the ETHIC model of decision making: “This easy to use five step process includes examining personal, agency, client, and professional values, thinking about ethical standards and relevant laws, hypothesizing about consequences, identifying the most vulnerable, and consulting with supervisors.” This model, described in more detail below, is meant to be a quick and as effective as possible approach to resolving ethical dilemmas.
E – Evaluate relevant personal, societal, agency, client and professional values
T – Think about what ethical standard of the NASW Code of Ethics applies, as well as relevant laws and case decisions
H – Hypothesize about possible consequences of different decisions
I - Identify who will benefit and who will be harmed in view of social work’s commitment to the most vulnerable
C – Consult with supervisor and colleagues about the most ethical choice
Congress, Elaine P., What Social Workers Should Know About Ethics: Understanding and Resolving Practice Dilemmas, Advances in Social Work Practice, Vol. 1 No 1 Spring 2000, pgs 1 – 25
Model II: American Counseling Association Approach to Ethical Decision Making
In its statement of purpose, the ACA Code of Ethics states that counselors are expected to use a credible decision making approach to resolving dilemmas:
“When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a carefully considered ethical decision-making process. Reasonable differences of opinion can and do exist among counselors with respect to the ways in which values, ethical principles, and ethical standards would be applied when they conflict. While there is no specific ethical decision making model that is most effective, counselors are expected to be familiar with a credible model of decision making that can bear public scrutiny and its application.”
A Practitioner’s Guide to Ethical Decision Making (2006) developed by Holly Forester-Miller and Thomas Davis for the American Counseling Association presents an ethical decision making model for ACA members. This model is summarized below.
ACA Ethical Decision Making Model
1. Identify the problem.
2. Apply the ACA Code of Ethics.
3. Determine the nature of the dimensions of the dilemma.
4. Generate potential courses of action.
5. Consider the potential consequences of all options, choose a course of action.
6. Evaluate the selected course of action.
7. Implement the course of action.
Forester-Miller and Davis conclude that: “It is important to realize that different professionals may implement different courses of action in the same situation. There is rarely one right answer to a complex ethical dilemma. However, if you follow a systematic model, you can be assured that you will be able to give a professional explanation for the course of action you chose.”
Citing Van Hoose and Paradise (1979) they go on to say: “a counselor ‘is probably acting in an ethically responsible way concerning a client if: (1) he or she has maintained personal and professional honesty, coupled with (2) the best interests of the client, (3) without malice or personal gain, and (4) can justify his or her actions as the best judgment of what should be done based upon the current state of the profession.’”
Forrester-Miller, H. and Davis, T. (1996). A practitioner’s guide to ethical decision making. Alexandria, VA. American Counseling Association.
Van Hoose, W. H. and Paradise, L.V. (1979). Ethics in counseling and psychology: Perspectives in issues and decision-making. Cranston, RI: Carroll Press.
Model III: Essential Steps for Ethical Problem-Solving – Frederic Reamer and Sr. Ann Patrick Conrad
The following approach, discussed by Reamer and Conrad, was included in a video developed by the NASW Office of Ethics and Adjudication and produced by NASW Press and the NASW Insurance Trust as a tool for use by practitioners, faculty members and students, agency administrators, and licensing boards.
1. DETERMINE whether there is an ethical issue or/and dilemma. Is there a conflict of values, or rights, or professional responsibilities? (For example, there may be an issue of self-determination of an adolescent versus the well-being of the family.)
2. IDENTIFY the key values and principles involved. What meanings and limitations are typically attached to these competing values? (For example, rarely is confidential information held in absolute secrecy; however, typically decisions about access by third parties to sensitive content should be contracted with clients.)
3. RANK the values or ethical principles which - in your professional judgment - are most relevant to the issue or dilemma. What reasons can you provide for prioritizing one competing value/principle over another? (For example, your client's right to choose a beneficial course of action could bring hardship or harm to others who would be affected.)
4. DEVELOP an action plan that is consistent with the ethical priorities that have been determined as central to the dilemma. Have you conferred with clients and colleagues, as appropriate, about the potential risks and consequences of alternative courses of action? Can you support or justify your action plan with the values/principles on which the plan is based? (For example, have you conferred with all the necessary persons regarding the ethical dimensions of planning for a battered wife's quest to secure secret shelter and the implications for her teen-aged children?)
5. IMPLEMENT your plan, utilizing the most appropriate practice skills and competencies. How will you make use of core social work skills such as sensitive communication, skillful negotiation, and cultural competence? (For example, skillful colleague or supervisory communication and negotiation may enable an impaired colleague to see her/his impact on clients and to take appropriate action.)
6. REFLECT on the outcome of this ethical decision making process. How would you evaluate the consequences of this process for those involved: Client(s), professional(s), and agency (ies)? (Increasingly, professionals have begun to seek support, further professional training, and consultation through the development of Ethics Review Committees or Ethics Consultation processes.)
From discussion by Frederick Reamer & Sr. Ann Patrick Conrad in Professional Choices: Ethics at Work (1995), video available from NASW Press, Retrieved 1/21/08 from: http://www.socialworkers.org/pubs/code/oepr/steps.asp
Model IV: Steinman, Richardson and McEnroe Ethical Decision-Making Process
The Ethical Decision-Making Manual for Helping Professionals, by Steinman et al. states that before you can begin a decision making process you need to identify the problem. Once the problem is identified, their model includes the following steps:
Step 1: Identify the Ethical Standard Involved
- What are the codes or laws that apply? If there are none, then why is it a problem?
Step 2: Determine the Ethical Trap Possibilities
- Possible Ethical Traps to avoid include:
a. a belief that there is an easy “commonsense, objective” solution
b. conflicting values, such as between personal or religious values and professional values
c. the circumstances are so unique they must be taken into consideration, and
d. confusion about who will benefit from a decision
Step 3: Frame a Preliminary Response
– What do the code and the law say you should do; what circumstances, if any, should influence the response; and what is your preliminary response?
Step 4: Consider the Consequences
– What will happen if you take that action? What are the short and long term consequences? Could there be any unintended consequences? Are the consequences ethically defensible?
Step 5: Prepare Ethical Resolution
a. What is the situation, including possible relevant circumstances?
b. What ethical codes or laws are involved?
c. What do these codes or laws suggest I or others do?
d. If I have consulted with colleagues, supervisors, or professional ethics boards, at this point, what do they suggest I or others do?
e. What are the consequences of taking this action on the client, on me, on my employer, and on others in the community?
f. In light of these considerations, here is what I propose…….
Step 6: Get feedback
– Discuss with your supervisor, respected peer, and/or attorney if legal issues involved
Step 7: Take Action
– Use feedback to amend the resolution as needed and then take action.
Steinman, Sarah, Richardson, Nan Franks and McEnroe, Tim, The Ethical Decision-Making Manual for Helping Professionals, Brooks/Cole Publishing Company, New York, 1998
Model V: Dolgoff, Loewenberg and Harrington – A General Decision Making Model
In presenting his model for making ethical decisions, Dolgoff states that “Ethical decision making is far too complex to permit the development of a simple “how-to” problem-solving model…… A model is a permissible didactic devise as long as it is understood that in real life every decision is preceded and followed by other decisions, many of which have a direct bearing on the matter under consideration.” (pgs. 57 – 58)
A General Decision-Making Model
Step 1. Identify the problem and the factors that contribute to its maintenance
Step 2. Identify all of the persons and institutions involved in this problem, such as clients, victims, support systems, other professionals and others
Step 3. Determine who should be involved in the decision making
Step 4. Identify the values relevant to this problem held by the several participants identified in Step 2, including the client’s and worker’s
Step 5. Identify the goals and objectives whose attainment you believe may resolve (or reduce) the problem
Step 6. Identify alternate intervention strategies and targets
Step 7. Assess the effectiveness and efficiency of each alternative in terms of the identified goals
Step 8. Select the most appropriate strategy
Step 9. Implement the strategy selected
Step 10. Monitor the implementation, paying particular attention to unanticipated consequences
Step 11. Evaluate the results and identify additional problems
To assist social workers using Dolgoff’s Decision Making Model, he offers the Ethical Assessment Screen to “help social workers further clarify and integrate the ethical aspects of decision making in social work practice.” (pg 58)
Ethical Assessment Screen
1. Identify your own relevant personal values in relation to this ethical dilemma
2. Identify any societal values relevant to the ethical decision to be made
3. Identify the relevant professional values and ethics
What can you do to minimize conflicts between personnel, societal, and professional values?
4. Identify alternative ethical options that you may take
5. Which of the alternative ethical actions will protect to the greatest extent your client’s and others’ rights and welfare?
6. Which alternative action will protect to the greatest extent possible society’s rights and interests?
What can you do to minimize conflicts between your client’s, others’ and society’s rights and interests?
7. Which alternative action will result in your doing the “least harm” possible?
8. To what extent will alternative actions be efficient, effective and ethical?
9. Have you considered and weighed both the short and long term ethical consequences?
Ethical Rules Screen
With the Ethical Rules Screen, Dolgoff provides a step to help social workers understand that the Code takes precedent over their own personal values. This concept is relevant to counselors and marriage and family therapists, as well.
A social worker who has done an ethical self- assessment, such as the one provided above, will have a better appreciation of the values they hold that are personal versus those that they hold as a professional. The Ethical Rules Screen suggests that if one or more provisions of the Code apply, the Code should be followed.
If the Code does not cover the specific issue or if conflicting provisions of the Code apply, Dolgoff offers the social worker a way to rank the provisions of the Code as they apply to that particular situation in the Ethical Principles Screen provided below. Since the NASW Code of Ethics does not place any one particular value, principle or standard above another and recognizes that there will be reasonable differences of opinion, it is important that social workers attempting to apply any decision making model have a justifiable approach for how they have ranked the principles.
Ethical Rules Screen
Examine the Code of Ethics to determine if any of the Code rules are applicable. These rules take precedence over the worker’s personal value system.
If one or more of the Code rules apply, follow the Code rules.
If the Code does not address the specific problem, or several Code rules provide conflicting guidance, use the Ethical Principles Screen.
Ethical Principles Screen (EPS)
1. Protection of life
2. Equality and inequality
3. Autonomy and freedom
4. Least harm
5. Quality of life
6. Privacy and confidentiality
7. Truthfulness and full disclosure
Dolgoff, Ralph, Loewenberg, Frank, and Harrington, Donna, Ethical Decisions for Social Work Practice, Brooks/Cole – Thompson Learning, Belmont, CA, 2005